結石病患與日後發生骨質酥鬆症的關係
錢祖明1、呂研嫚1、李經家1,2、阮雍順1,3、李威明1,4、柯宏龍1,4、葉信志1,2,4、黃琮懿1,4、溫聖辰1,4、李香瑩1,2、周以和1,4、吳文正1,2,4、黃俊農1,4
1高雄醫學大學 附設中和紀念醫院 泌尿科
2高雄市立大同醫院
3高雄市立小港醫院
4高雄醫學大學 醫學系
Urolithiasis increases the risk for osteoporosis: A nationwide 9-year follow-up study
Tsu-Ming Chien1、Yen-Man Lu1、Ching-Chia Li1,2、Yung-Shun Juan1,3、Wei-Ming Li1,4、Hung-Lung Ke1,4、Hsin-Chih Yeh1,2,4、Tsung-Yi Huang1,4、Sheng-Chen Wen1,4、Hsiang-Ying Lee1,2、Yii-Her Chou1,4、Wen-Jeng Wu1,2,4、Chun-Nung Huang1,4
1Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
2 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
3Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
4Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Purpose:
Previous studies have shown that a relationship exists between the loss of bone mineral density and calcium urolithiasis. We aimed to determine whether urolithiasis is a warning sign indicating long-term osteoporosis. Controls were matched for age, sex, and other comorbidities, including hypertension, diabetes mellitus, dyslipidemia, liver disease, and cardiovascular disease.
Materials and Methods:
Data were obtained from the Longitudinal Health Insurance Database (LHID2000) of Taiwan, Republic of China, compiled by the NHI from 1996 to 2013. We further evaluated potential risk factors stratified by different comorbidities.
Results:
After performing the propensity score matching (urolithiasis: control; ratio, 1:3), we included a total of 104,900 patients, including 26,225 patients with urolithiasis and 78,675 control patients. There was a significant difference between the incidence of osteoporosis between the urolithiasis and control groups (adjusted hazard ratio 1.20, 95% CI 1.15-1.27, p<0.001).
Interestingly, the impact of urolithiasis on osteoporosis was more prominent in the younger patient population (age <40 years, adjusted hazard ratio 1.4, 95% CI 1.12-1.75, p=0.003; 40-59 years, adjusted hazard ratio 1.3, 95% CI 1.20-1.40, p<0.001), than in the older patient population (age >60 years, adjusted hazard ratio 1.13, 95% CI 1.05-1.21, p=0.001; p=0.015 for interaction). We also observed that urolithiasis had an impact on hypertension-free patients (hypertension free, adjusted hazard ratio 1.28, 95% CI 1.20-1.36, p<0.001; hypertension, adjusted hazard ratio 1.12, 95% CI 1.03-1.22, p=0.006, p=0.020 for interaction).
Conclusion:
In conclusion, on the basis of our results, an association exists between urolithiasis patients and subsequent osteoporosis diagnosis. Though the clinical mechanisms are not fully understood, patients who had urolithiasis history may need regular follow up of bone marrow density.