摘要
背景随着人口老龄化,骨质疏松症对健康的威胁也越发突出,绝经后的女性由于卵巢雌激素分泌减少,骨质疏松症患病率将进一步增加,为男性的3倍。骨质疏松症在绝经后女性中的患病率及危险因素已有较多报道并进行过系统总结,但汇总全球范围的相关研究的系统综述较少。目的系统评价绝经后女性骨质疏松症的患病率和影响因素。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库,检索关于绝经后女性骨质疏松症的患病率及影响因素的文献,另外根据已纳入文献中的参考文献进行文献追踪。检索时间为2002-11-01—2022-11-01。两名评价人员独立进行文献筛选以及信息提取工作,采用美国卫生保健质量和研究机构推荐的偏倚风险评价标准进行质量评价。采用Stata 16.0软件对绝经后女性骨质疏松症的患病率和影响因素进行Meta分析。结果共纳入68篇文献,总样本量112097例。Meta分析结果显示,绝经后女性骨质疏松症和骨量减少的患病率分别为34.73%(95%CI=31.02%~38.44%)和41.83%(95%CI=38.19%~45.47%)。亚组分析结果显示,年龄≥80岁组患病率最高(68.72%,95%CI=59.81%~77.62%),随后依次为70~79岁组(57.20%,95%CI=50.53%~63.87%)、60~69岁组(37.46%,95%CI=28.95%~45.98%)、50~59岁组(24.94%,95%CI=15.50%~34.39%)、40~49岁组(14.01%,95%CI=6.64%~21.38%);生育次数<2次的患病率(34.24%,95%CI=24.08%~44.41%)低于生育次数≥2次(39.27%,95%CI=30.10%~48.44%);绝经年限≥10年的患病率(47.15%,95%CI=42.27%~52.04%)高于绝经年限<10年(34.18%,95%CI=33.30%~35.06%);发展中国家患病率(35.87%,95%CI=31.39%~40.34%)高于发达国家(30.10%,95%CI=23.97%~36.23%)。绝经后女性骨质疏松症的影响因素包括糖尿病(OR=2.79,95%CI=1.75~4.46,P<0.05)、高BMI(OR=0.53,95%CI=0.43~0.64,P<0.05)、运动(OR=0.43,95%CI=0.28~0.65,P<0.05)、生育次数(OR=2.52,95%CI=1.72~3.67,P<0.05)、绝经年限(OR=1.88,95%CI=1.43~2.46,P<0.05)、家族病史(OR=1.92,95%CI=1.38~2.67,P<0.05)、饮酒(OR=1.95,95%CI=1.54~2.47,P<0.05)、使用激素治疗(OR=0.34,95%CI=0.25~0.44,P<0.05)、非暴力骨折史(OR=3.83,95%CI=1.88~7.98,P<0.05)、年龄(OR=1.43,95%CI:1.29~1.59,P<0.05)。结论骨质疏松症和骨量减少在绝经后女性中的患病率较高,约1/3的绝经后女性患有骨质疏松症,约1/2的绝经后女性患有骨量减少。高BMI、常运动、使用激素治疗为绝经后女性骨质疏松症的保护因素,糖尿病、生育次数多、绝经年限长、家族病史、饮酒、非暴力骨折史、高龄为危险因素。临床工作中应加强对骨质疏松症的评估和干预,同时有必要向绝经后女性宣传健康的生活方式,提高绝经后女性的生活质量。
Background With the aging of the population,the health threat of osteoporosis(OP)has become more prominent.The prevalence of OP in postmenopausal women will further increase to three times of that in men due to the reduction of ovarian estrogen secretion.The prevalence and risk factors of OP in postmenopausal women have been widely reported and systematically summarized,however,there are few systematic reviews of relevant studies worldwide.Objective To systematically review the prevalence and influencing factors of OP in postmenopausal women.Methods PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang Data,VIP and CBM were searched for studies on the prevalence and influencing factors of OP in postmenopausal women from 2002-11-01 to 2022-11-01;in addition to literature tracking based on the references in the included studies.Two reviewers independently conducted literature screening and information extraction,the quality was evaluated using the risk of bias assessment criteria recommended by the Agency for Healthcare Research and Quality.A Meta-analysis on the prevalence and influencing factors of OP in postmenopausal women was performed using Stata 16.0 software.Results A total of 68 articles were included,with a total sample size of 112097 cases.Meta-analysis showed that the prevalence of OP and osteopenia in postmenopausal women was 34.73%(95%CI=31.02%-38.44%)and 41.83%(95%CI=38.19%-45.47%),respectively.Subgroup analysis showed that the highest prevalence was found in the age≥80 years group(68.72%,95%CI=59.81%-77.62%),followed by the age of 70-79 years group(57.20%,95%CI=50.53%-63.87%)and the age of 60-69 years group(37.46%,95%CI=28.95%-45.98%),the age of 50-59 years group(24.94%,95%CI=15.50%-34.39%),the age of 40-49 years group(14.01%,95%CI=6.64%-21.38%);the prevalence rate of<2 births(34.24%,95%CI=24.08%-44.41%)was lower than that of≥2 births(39.27%,95%CI=30.10%-48.44%);the prevalence of age≥10 years menopause(47.15%,95%CI=42.27%-52.04%)was higher than that of<10 years menopause(34.18%,95%CI=33.30%-35.06%);the prevalence in developing countries(35.87%,95%CI=31.39%-40.34%)was higher than that in developed countries(30.10%,95%CI=23.97%-36.23%).The influencing factors of OP in postmenopausal women included diabetes(OR=2.79,95%CI=1.75-4.46,P<0.05);high BMI(OR=0.53,95%CI=0.43-0.64,P<0.05);exercise(OR=0.43,95%CI=0.28-0.65,P<0.05);number of births(OR=2.52,95%CI=1.72-3.67,P<0.05);duration of menopause(OR=1.88,95%CI=1.43-2.46,P<0.05);family history(OR=1.92,95%CI=1.38-2.67,P<0.05);alcohol consumption(OR=1.95,95%CI=1.54-2.47,P<0.05),menopausal hormone therapy(OR=0.34,95%CI=0.25-0.44,P<0.05);non-violent fracture history(OR=3.83,95%CI=1.88-7.98,P<0.05);and age(OR=1.43,95%CI=1.29-1.59,P<0.05).Conclusion The prevalence of OP and osteopenia in postmenopausal women is high,with about one third of postmenopausal women suffering from osteoporosis,and about half of postmenopausal women suffering from osteopenia.High BMI,regular exercise,and use of menopausal hormone therapy are protective factors for OP in postmenopausal women,while diabetes,high number of births,long years of menopause,family history of disease,alcohol consumption,non-violent fracture history,and advanced age are risk factors.The evaluation and intervention of OP should be strengthened in clinical practice,and it is also necessary to promote healthy lifestyle to postmenopausal women to improve their quality of life.
作者
何海洋
杨嘉玲
雷迅
HE Haiyang;YANG Jialing;LEI Xun(School of Public Health,Chongqing Medical University,Chongqing 400016,China)
出处
《中国全科医学》
北大核心
2024年第11期1370-1379,共10页
Chinese General Practice
基金
国家自然科学基金资助项目(72174033)
重庆医科大学未来医学青年创新团队发展支持计划(W0013)。
