PDF(Pubmed)
Abstract：
The sole determination of volumetric bone mineral density (vBMD) is insufficient to evaluate overall bone integrity. The accumulation of advanced glycation endproducts (AGEs) stiffens and embrittles collagen fibers. Despite the important role of AGEs in bone aging, the relationship between AGEs and vBMD is poorly understood. We hypothesized that an accumulation of AGEs, a marker of impaired bone quality, is related to decreased vBMD.
Prospectively collected data of 127 patients undergoing lumbar fusion were analyzed. Quantitative computed tomography (QCT) measurements were performed at the lumbar spine. Intraoperative bone biopsies were obtained and analyzed with confocal fluorescence microscopy for fluorescent AGEs, both trabecular and cortical. Spearman\'s correlation coefficients were calculated to examine relationships between vBMD and fAGEs, stratified by sex. Multivariable linear regression analysis with adjustments for age, sex, body mass index (BMI), race, diabetes mellitus and HbA1c was used to investigate associations between vBMD and fAGEs.
One-hundred and twenty-seven patients (51.2% female, 61.2 years, BMI of 28.7 kg/m2) with 107 bone biopsies were included in the final analysis, excluding patients on anti-osteoporotic drug therapy. In the univariate analysis, cortical fAGEs increased with decreasing vBMD at (r = -0.301; p = 0.030), but only in men. In the multivariable analysis, trabecular fAGEs increased with decreasing vBMD after adjusting for age, sex, BMI, race, diabetes mellitus and HbA1c (β = 0.99;95%CI=(0.994,1.000); p = 0.04).
QCT-derived vBMD measurements were found to be inversely associated with trabecular fAGEs. Our results enhance the understanding of bone integrity by suggesting that spine surgery patients with decreased bone quantity may also have poorer bone quality.
Prospectively collected data of 127 patients undergoing lumbar fusion were analyzed. Quantitative computed tomography (QCT) measurements were performed at the lumbar spine. Intraoperative bone biopsies were obtained and analyzed with confocal fluorescence microscopy for fluorescent AGEs, both trabecular and cortical. Spearman\'s correlation coefficients were calculated to examine relationships between vBMD and fAGEs, stratified by sex. Multivariable linear regression analysis with adjustments for age, sex, body mass index (BMI), race, diabetes mellitus and HbA1c was used to investigate associations between vBMD and fAGEs.
One-hundred and twenty-seven patients (51.2% female, 61.2 years, BMI of 28.7 kg/m2) with 107 bone biopsies were included in the final analysis, excluding patients on anti-osteoporotic drug therapy. In the univariate analysis, cortical fAGEs increased with decreasing vBMD at (r = -0.301; p = 0.030), but only in men. In the multivariable analysis, trabecular fAGEs increased with decreasing vBMD after adjusting for age, sex, BMI, race, diabetes mellitus and HbA1c (β = 0.99;95%CI=(0.994,1.000); p = 0.04).
QCT-derived vBMD measurements were found to be inversely associated with trabecular fAGEs. Our results enhance the understanding of bone integrity by suggesting that spine surgery patients with decreased bone quantity may also have poorer bone quality.
摘要：
目的：仅测定体积骨矿物质密度（vBMD）不足以评估整体骨完整性。晚期糖基化终产物（AGEs）的积累使胶原纤维变硬并脆化。尽管AGEs在骨老化中的重要作用，AGEs和vBMD之间的关系知之甚少。我们假设AGEs的积累，骨骼质量受损的标志，与vBMD降低有关。
方法：前瞻性收集的127例腰椎融合术患者资料进行分析。在腰椎进行定量计算机断层扫描（QCT）测量。术中获得骨活检并用共聚焦荧光显微镜分析荧光AGEs，小梁和皮质.计算Spearman相关系数以检查vBMD和fAGEs之间的关系，按性别分层。调整了年龄的多变量线性回归分析，性别,体重指数（BMI），种族,糖尿病和HbA1c用于研究vBMD和fAGEs之间的关联.
结果：一百二十七例患者（51.2％为女性，61.2年，BMI为28.7kg/m2），107例骨活检包括在最终分析中，排除接受抗骨质疏松药物治疗的患者。在单变量分析中，皮质fAGEs随着vBMD的降低而增加（r=-0.301；p=0.030），但只有男人。在多变量分析中，调整年龄后，小梁fAGEs随着vBMD的降低而增加，性别,BMI,种族,糖尿病和HbA1c(β=0.99;95CI=(0.994,1.000);p=0.04)。
结论：发现QCT衍生的vBMD测量值与小梁fAGEs呈负相关。我们的结果通过提示骨量减少的脊柱手术患者的骨质量也可能较差，从而增强了对骨完整性的理解。
方法：前瞻性收集的127例腰椎融合术患者资料进行分析。在腰椎进行定量计算机断层扫描（QCT）测量。术中获得骨活检并用共聚焦荧光显微镜分析荧光AGEs，小梁和皮质.计算Spearman相关系数以检查vBMD和fAGEs之间的关系，按性别分层。调整了年龄的多变量线性回归分析，性别,体重指数（BMI），种族,糖尿病和HbA1c用于研究vBMD和fAGEs之间的关联.
结果：一百二十七例患者（51.2％为女性，61.2年，BMI为28.7kg/m2），107例骨活检包括在最终分析中，排除接受抗骨质疏松药物治疗的患者。在单变量分析中，皮质fAGEs随着vBMD的降低而增加（r=-0.301；p=0.030），但只有男人。在多变量分析中，调整年龄后，小梁fAGEs随着vBMD的降低而增加，性别,BMI,种族,糖尿病和HbA1c(β=0.99;95CI=(0.994,1.000);p=0.04)。
结论：发现QCT衍生的vBMD测量值与小梁fAGEs呈负相关。我们的结果通过提示骨量减少的脊柱手术患者的骨质量也可能较差，从而增强了对骨完整性的理解。
