老年女性生育人数与骨密度的关联性研究

朱仲鑫; 沈丽芳; 姚晓聪

doi:10.16766/j.cnki.issn.1674-4152.002549

老年女性生育人数与骨密度的关联性研究

doi: 10.16766/j.cnki.issn.1674-4152.002549

朱仲鑫^{1, 2, ,},
沈丽芳³,
姚晓聪¹

1.
温州医科大学附属萧山医院骨质疏松症诊疗中心，浙江杭州 311200
2.
温州医科大学附属萧山医院临床研究中心，浙江杭州 311200
3.
温州医科大学附属萧山医院产科，浙江杭州 311200

基金项目:

浙江省医药卫生科技计划项目 2021RC119

详细信息

通讯作者:
朱仲鑫, E-mail：orthozzx@163.com

中图分类号: R681 R714.14
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出版历程
- 收稿日期: 2021-09-07
- 网络出版日期: 2022-09-23

Association between number of pregnancies and bone mineral density in older females

1.
Department of Osteoporosis Care and Control, Xiaoshan First Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 311200, China

摘要

摘要: 目的妊娠晚期胎儿骨骼的迅速矿化以及哺乳期钙从乳汁中持续的流失等因素容易导致孕产妇出现骨量的丢失以及骨密度的下降。然而，二胎乃至多胎是否会增加其患骨质疏松症风险的报道仍非常有限且结论并不一致。因此，本研究基于大样本数据探讨老年女性生育人数与骨密度的关联性。方法本项研究从2007—2010年、2013—2014年、2017—2018年美国健康与营养调查(NHANES)数据库筛选资料完整的60~80岁老年女性作为研究对象。暴露因素为老年女性生育人数，结局指标为骨密度。通过多元回归模型分析生育人数与骨密度在老年女性中的关系。结果共纳入2 096名研究对象，其中一胎264人[年龄为(67.5±6.1)岁]、二胎593人[年龄为(67.9±6.5)岁]、三胎506人[年龄为(69.5±6.6)岁]、四胎及以上733人[年龄为(71.7±6.5)岁]。在调整年龄、种族、婚姻状况、末次月经时间、教育水平、适度的锻炼、家庭收入贫穷比、身体质量指数、血尿素氮、血尿酸、血磷和血钙后，不同生育人数与股骨颈骨密度、股骨总骨密度和Wards三角骨密度均无相关性(均P＞0.05)。结论生育二胎或多胎并不是女性老年时骨质疏松症的危险因素。
- 二胎 /
- 多胎 /
- 骨健康 /
- 骨质疏松症 /
- 健康与营养调查
Abstract: Objective The rapid mineralisation of foetal bones in the third trimester and the continuous loss of calcium from breast milk during lactation may lead to the loss of bone mass and the decline of bone mineral density (BMD) in pregnant women. However, evidence regarding the association between number of pregnancies and risk of osteoporosis in older females remains limited and inconsistent. Thus, we aimed to explore the association between number of pregnancies and BMD using a population-based sample database. Methods We conducted a study on older females aged 60-80 years with complete data who participated in the National Health and Nutrition Examination Survey (NHANES) in 2007-2010, 2013-2014 and 2017-2018. The independent variable was number of pregnancies. The dependent variable was BMD. We performed multivariable regression models to evaluate the associations between number of pregnancies and BMD. Results There were 2 096 subjects in the final analysis, including 264 subjects with one child [age=(67.5±6.1) years], 593 subjects with two children [age=(67.9±6.5) years], 506 subjects with three children [age=(69.5±6.6) years] and 733 subjects with four children or more [age=(71.7±6.5) years]. In the fully adjusted model, there were no significant associations in number of pregnancies with femoral neck BMD, total femur BMD, or Ward's triangle BMD after adjusting for age, race, marital status, time of last menstrual period, education level, moderate exercise, family income to poverty ratio, body mass index, blood urea nitrogen, serum uric acid, serum phosphorus and serum calcium (all P > 0.05). Conclusion Having two or multiple births is not a risk factor for osteoporosis for women at old age.
- Second child /
- Multiple births /
- Bone health /
- Osteoporosis /
- Health and nutrition examination survey

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表 1 不同生育人数老年女性一般资料比较[例(%)]

Table 1. Comparison of general data of elderly women with different fertility numbers

项目	类别	一胎(n=264)	二胎(n=593)	三胎(n=506)	四胎及以上(n=733)	统计量	P值
年龄(x±s, 岁)		68.0±6.7	68.4±6.8	69.1±6.7	70.6±6.7	16.263^a	＜0.001
婚姻状况[例(%)]	已婚/有伴侣	109 (41.3)	305 (51.4)	270 (53.4)	311 (42.4)	7.496^b	＜0.001
	丧偶/离婚/分居	155 (58.7)	288 (48.6)	236 (46.6)	422 (57.6)
末次月经[例(%)]	≤40岁	58 (22.0)	152 (25.6)	117 (23.1)	161 (22.0)	0.850^b	0.466
	41~50岁	113 (42.8)	227 (38.3)	218 (43.1)	319 (43.5)
	≥51岁	75 (28.4)	186 (31.4)	150 (29.6)	189 (25.8)
	未记录	18 (6.8)	28 (4.7)	21 (4.2)	64 (8.7)
种族[例(%)]	白人	128 (48.5)	314 (53.0)	244 (48.2)	277 (37.8)	5.721^b	＜0.001
	黑人	61 (23.1)	121 (20.4)	86 (17.0)	158 (21.6)
	墨西哥裔	19 (7.2)	44 (7.4)	67 (13.2)	180 (24.6)
	其他种族	56 (21.2)	114 (19.2)	109 (21.5)	118 (16.1)
教育水平[例(%)]	高中以下	47 (17.8)	103 (17.4)	144 (28.5)	366 (49.9)	75.301^b	＜0.001
	高中	58 (22.0)	171 (28.8)	155 (30.6)	168 (22.9)
	高中以上	159 (60.2)	319 (53.8)	207 (40.9)	199 (27.1)
适度的锻炼[例(%)]	是	104 (39.4)	253 (42.7)	177 (35.0)	178 (24.3)	18.559^b	＜0.001
	否	160 (60.6)	340 (57.3)	329 (65.0)	555 (75.7)
家庭收入贫穷比(x±s)		2.6±1.5	2.8±1.5	2.5±1.4	2.0±1.3	43.421^a	＜0.001
BMI(x±s)		27.5±5.8	29.0±6.0	29.2±5.9	29.3±5.9	6.503^a	＜0.001
血尿素氮(x±s, mmol/L)		5.6±2.4	5.6±2.0	5.8±2.8	5.8±2.5	1.168^a	0.320
血尿酸(x±s, μmol/L)		307.1±80.7	312.3±83.6	319.7±85.9	316.4±79.6	1.635^a	0.179
血磷(x±s, mmol/L)		1.23±0.16	1.24±0.16	1.24±0.16	1.23±0.17	1.318^a	0.266
血钙(x±s, mmol/L)		2.37±0.09	2.38±0.10	2.37±0.10	2.36±0.10	2.077^a	0.101
股骨颈骨密度(x±s, g/cm²)		0.69±0.12	0.71±0.12	0.70±0.13	0.70±0.14	1.078^a	0.356
股骨总骨密度(x±s, g/cm²)		0.82±0.14	0.84±0.14	0.83±0.14	0.83±0.15	1.655^a	0.174
Wards三角骨密度(x±s, g/cm²)		0.51±0.14	0.52±0.15	0.51±0.15	0.51±0.16	1.003^a	0.390
注：^a为F值，^b为χ²值。

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表 2 分类变量的赋值方法

Table 2. Categorical variable assignment method

变量	赋值方法
婚姻状况	已婚/有伴侣=1，丧偶/离婚/分居=2
末次月经	≤40岁=(0，0，0)，41~50岁=(1, 0, 0)，≥51岁=(0, 1, 0)，未记录=(0, 0, 1)
种族	白人=(0，0，0)，黑人=(1, 0, 0)，墨西哥裔=(0, 1, 0)，其他种族=(0, 0, 1)
教育水平	高中以下=1，高中=2，高中以上=3
适度的锻炼	是=1，否=0

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表 3 不同胎数老年女性股骨颈骨密度的多元回归分析

Table 3. Multiple regression analysis of femoral neck bone mineral density in elderly women with different parity

胎数	B	SE	β	95% CI	t值	P值
二胎	0.025	0.009	0.014	-0.002~0.029	2.833	0.085
三胎	0.021	0.009	0.014	-0.003~0.031	2.283	0.102
四胎及以上	0.008	0.009	0.010	-0.007~0.027	0.854	0.252
注：以一胎为参照。调整了年龄、种族、婚姻状况、末次月经时间、教育水平、适度的锻炼、家庭收入贫穷比、BMI、血尿素氮、血尿酸、血磷和血钙。

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表 4 不同胎数老年女性股骨总骨密度的多元回归分析

Table 4. Multiple regression analysis of total bone mineral density of femur in elderly women with different parity

胎数	B	SE	β	95% CI	t值	P值
二胎	0.018	0.010	0.003	-0.013~0.019	1.934	0.698
三胎	0.015	0.010	0.004	-0.013~0.021	1.462	0.656
四胎及以上	-0.008	0.010	-0.004	-0.022~0.013	-0.804	0.617
注：以一胎为参照。调整了年龄、种族、婚姻状况、末次月经时间、教育水平、适度的锻炼、家庭收入贫穷比、BMI、血尿素氮、血尿酸、血磷和血钙。

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表 5 不同胎数老年女性Wards三角骨密度的多元回归分析

Table 5. Multiple regression analysis of Wards triangle bone mineral density in elderly women with different parities

胎数	B	SE	β	95% CI	t值	P值
二胎	0.018	0.010	0.006	-0.013~0.024	1.747	0.534
三胎	0.020	0.011	0.015	-0.005~0.035	1.891	0.131
四胎及以上	-0.006	0.011	0.005	-0.015~0.025	-0.592	0.624
注：以一胎为参照。调整了年龄、种族、婚姻状况、末次月经时间、教育水平、适度的锻炼、家庭收入贫穷比、BMI、血尿素氮、血尿酸、血磷和血钙。

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