绝经后骨质疏松症患者血清Hcy、ERα水平对骨折发生的预测价值OA

Objective To explore serum levels of homocysteine(Hcy)and estrogen receptor α(ERα)of patients with postmenopausal osteoporosis(PMOP),and to analyze correlation between Hcy,ERα and bone metabolism markers,dose-response relationship,and predictive values of them for occurrence of fracture.Methods A total of 308 PMOP patients who admitted to our hospital from July 2019 to December 2024 were enrolled.The PMOP patients were divided into fracture group(n=93)and non-fracture group(n=215)according to whether the patient had fracture.Serum levels of Hcy,ERα and bone metabolism markers of the patients were compared between the two groups.Linear regression was used to analyze associations of Hcy and ERα with bone metabolism markers.Multivariate Logistic regression was used to analyze independent risk factors for fracture in PMOP patients.Restricted cubic spline(RCS)was used to evaluate dose-response relationship between Hcy,ERα and fracture risk.Receiver operating characteristic(ROC)curve was used to evaluate predictive values of these indexes for fracture.Results The serum levels of Hcy,typeⅠcollagen amino terminal extender propeptide(PINP),type Ⅰ collagen carboxy terminal peptide β special sequence(β-CTX),osteocalcin N-terminus molecule(N-MID)and bone alkaline phosphatase(BALP)of the patients in the fracture group were significantly higher than those in the non-fracture group(t=11.094,14.614,14.196,9.925 and 11.498 respectively,all P<0.05),while the serum levels of ERα,lumbar bone mineral density(BMD),femoral neck BMD,total hip BMD and 25-Hydroxy vitamin D[25-(OH)D]of the patients in the fracture group were significantly lower than those in the non-fracture group(t=14.743,5.485,10.581,5.631 and 10.490 respectively,all P<0.05).Linear regression analysis showed that Hcy was negatively correlated with BMD and 25-(OH)D(all β<0,except for lumbar BMD),but positively correlated with bone turnover markers(all β>0),whereas ERα presented the opposite correlations with BMD,25-(OH)D and bone turnover markers(all P<0.05).After adjusting for confounding factors,elevated serum level of Hcy(OR=2.254,95%CI:1.755-2.899)and decreased serum level of ERα(OR=0.013,95%CI:0.003-0.046)remained independent influencing factors for fracture risk in PMOP patients(both P<0.05).RCS analysis revealed a linear association between Hcy and fracture risk(Plinearity<0.001,Pnon-linearity=0.844)and a non-linear association between ERα and fracture risk(Pnon-linearity=0.004).Combination of Hcy and ERα showed higher predictive value as compared with single indexes,with area under the curve(AUC)of 0.924(95%CI:0.895-0.952).Conclusion Serum Hcy level significantly elevates and ERα level down-regulates in PMOP patients with fracture,both of which were independent risk factors for fracture.Combined detection of serum Hcy and ERα levels has high early warning and predictive value for fracture risk in PMOP patients.