| Objective:To investigate the application of bone mineral density analysis in elderly patients with limb fragility fractures and to discuss its application value.Material and methods:Based upon the inclusion and exclusion criteria,we retrospectively enrolled elderly patients(age 60 and above)with limb fragility fractures diagnosed in The Sixth People's Hospital of Chengdu between January 2018 and October 2019 in a cross-sectional way.We collected and analyzed their basic information,including age,gender,height(cm),weight(kg),fracture site,the first department in which the patients were diagnosed,the number of limb fragility fracture patients receiving dual-energy X-ray absorptiometry(DXA)examinations(experimental group),the department which issued DXA examination,and the number of limb fragility fracture patients receiving anti-osteoporosis treatment.We also enrolled 200 elderly healthy physical examinees who underwent DXA examinations during the same period(control group).A part of included patients with limb fragility fractures underwent L-spine(anteroposterior and lateral view)and magnetic resonance imaging(MRI)of the lumbar spine,and 40 patients with osteoporosis in the control group also underwent MRI of the lumbar spine.We then divided the population into normal weight group(body mass index,BMI 18.5-23.9),overweight group(BMI 24.0-27.9)and obese group(BMI ?28.0)in terms of the Chinese standard,and analyzed the differences of bone mineral density among the three groups in the fracture group and control group.Results:1.According to the inclusion and exclusion criteria,we enrolled a total of 328 elderly patients with limb fragility fractures,with an average age of 71.9±8.5.There were 110(33.5%)males and 218(66.5%)females.The most common fracture site is the hip(160/328,48.8%),followed by distal forearm(98/32,29.9%),distal lower limb(45/328,13.7%),proximal upper limb(12/328,3.7%)and others(13/328,4.0%).The first department in which the patients were diagnosed were mainly the emergency department(265/328,80.8%).During the hospitalization,52 patients(15.9%)received DXA examination.The department which issued DXA examination was mainly the Department of Rehabilitation(26/52,50.0%),followed by the Department of Orthopaedics(12/52,23.1%),Department of Hematology and Rheumatism(8/52,15.4%)and Department of Endocrinology(6/52,11.5%).Only 51.8%(170/328)received anti-osteoporosis treatment.2.Comparing to the control group,the detection rate of osteoporosis was significantly higher in the fracture group(48.1% vs 20.0%,P < 0.001),and the majority of osteoporosis cases were female.The bone mineral density and T value of the fracture group were lower than those of the control group(P < 0.05).3.At the same time in the part of the acceptance of X-ray and MRI are the lumbar limb brittle fracture patients,there were no obvious X-ray lumbar check fracture line,and 18 cases of patients with lumbar MRI examination to see fresh bone marrow edema,part of a display medullary cavity,cortical bone or cartilage T1 W show linear or flake low signal,and patch T2 W visible,fat suppression sequence was significantly high signal,prompt occult fracture,osteoporosis patients accounted for 83.3%(15/18).Among the 65 patients diagnosed with osteoporosis(25 in the experimental group and 40 in the control group),there was no significant change in T1 W signal in 13 patients,and significantly increased T1 W signal in 52 patients.4.In the fracture group and the control group,bone mineral density and T value of the male population were higher than those of the female population(P < 0.05),and bone mineral density increased with the increase of BMI(P < 0.05).5.After the fracture group and the control group were grouped according to BMI and gender,there was no difference in bone mineral density among the obese(1.21±0.26),overweight(0.99±0.11)and normal weight(0.99±0.22)men in the fracture group(P > 0.05).There was no difference in bone mineral density between overweight(0.87±0.08)and normal weight(0.82±0.13)women in the fracture group(P > 0.05).In the control group,the bone mineral density of obese(1.32±0.33)men was significantly higher than that of overweight(1.02±0.15)and normal weight(0.99±0.17)men(P < 0.05),but there was no difference between overweight and normal weight men(P > 0.05).In the control group,the bone mineral density of the obese(1.24±0.05)women was significantly higher than that of the overweight(1.05±0.17)and normal weight women(0.94±0.16)(P < 0.05),and the bone mineral density of the overweight women was also higher than that of the normal weight women(P < 0.05).Conclusion:DXA examination is of great value in the warning of occurrent fracture,and MRI is of certain value in the diagnosis of lumbar osteoporosis.We found that limb fragility fractures were most common in the hip in the elderly.Besides,the disconnection between first department in which the patients were diagnosed and the department which issued DXA examination,low detection rate of DXA,low treatment rate of osteoporosis,more women with osteoporosis than men,women's bone mineral density and T value lower than men,and the largest bone mineral density in overweight patients prompted to strengthen the importance and necessity of assessment and intervention for osteoporosis in elderly patients with limb fragility fractures(especially aged women with low BMI)by clinicians. |
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