폐경 여성에 있어서 비만과 골교체 표지자(Osteocalcin, Total Alkaline Phosphatase, Cross-linked Telopeptide of Type I Collagen)와의 관련성
The Relationship of Obesity and Bone Turnover Markers in Postmenopausal Women
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목적: 폐경 여성에서, 비만을 평가하는 신체질량지수(BMI), 체지방률(Percent body fat), 비만도(Obesity degree), 허리둘레(Waist circumference)를 사용하여 비만과 골교체 표지자인 osteocalcin, total alkaline phosphatase(ALP), C-terminal cross linking telopeptide of type I collagen(CTX)와의 연관성을 알아보고자 하였다. 그리고 이러한 연관성이 실제로 요추 골밀도(Bone mineral density)와는 어떠한 관련이 있는지 확인하고자 하였다. 방법: 폐경 후 여성 165명을 대상으로 신체질량지수, 체지방률, 비만도, 허리둘레를 측정하고, 혈청에서 osteocalcin, ALP와 CTX를 검사하였다. 또, 요추 골밀도를 측정하였다. 얻어진 결과를 토대로 통계학적 방법을 사용하여 연관성을 검정하였다. 결과: CTX와 신체질량지수, 체지방률, 비만도, 허리둘레(r=-0.190, P=0.015; r=-0.199, P=0.010; r=-0.191, P=0.014; r=-0.155, P=0.046)는 유의한 음의 상관관계를 보였다(P<0.05). 나이를 보정하였을 경우에는, CTX와 신체질량지수, 체지방률, 비만도에서만 유의한 음의 상관관계가 있었다(P<0.05). 신체질량지수가 25kg/㎠ 이상인 군과 이하인 군, 허리둘레가 85cm이상인 군과 이하인 군으로 각각 나누어, CTX의 평균을 비교하였을 때 두 군 간에 유의한 차이를 보였다(P<0.05). 또한, 이러한 결과들이 요추 골밀도에서도 같은 결과를 보였다(P<0.05). 결론: 신체질량지수, 체지방률, 비만도, 허리둘레의 기준에 의해서 비만으로 분류된 환자들은, 비만하지 않은 환자들에 비해 골흡수 표지자(Bone resorption marker)인 CTX가 낮아져 있는 경향을 보였고, 요추 골밀도도 증가되어 있는 경향을 보였다. 폐경 후 여성에서 비만의 골밀도 감소 예방 효과는 골교체율의 감소와 연관성이 있을 것이라고 생각된다.
Abstract
Objectives: The relationship between obesity and osteoporosis has been widely studied, and the evidence shows that obesity is associated with increased bone mass. Methods: One hundred and sixty five postmenopausal Korean women were enrolled to determine the effects of obesity on bone turnover markers(osteocalcin, total alkaline phosphatase, C-terminal cross linking telopeptide of type I collagen(CTX)) and the bone mineral density of the lumbar spine. Body mass index (BMI), percent body fat (PBF), obesity degree and waist circumference of the subjects were also estimated. We evaluated the relationship between obesity and bone turnover makers. Subjects were classified into two groups: the obese group (BMI≥25kg/㎠ or PBF≥30% or obesity degree ≥120% or waist circumference ≥85cm) and the normal group(BMI<25kg/㎠ or PBF<30% or obesity degree <120% or waist circumference <85cm). We compared the bone turnover markers and bone mineral density of the lumbar spine of the two groups by the independent sample T-test. Results: CTX was negatively correlated with the BMI(kg/㎠), PBF (%), obesity degree (%) and waist circumference(cm)(r=-0.190, P=0.015; r=-0.199, P=0.010; r=-0.191, P=0.014; r=-0.155, P=0.046). When postmenopausal women were grouped according to their BMI and waist circumference, the obese group had lower levels of CTX compared to the normal group(0.47±0.25 vs. 0.55±0.23, P=0.037; 0.46±0.26 vs. 0.55±0.23, P=0.019). In addition, the obese group has higher bone mineral density of the lumbar spine compared to the normal group(0.9088±0.1485 vs. 0.8355±0.1175, P=0.001; 0.8934±0.1498 vs. 0.8495± 0.1238, P=0.047). Conclusion: The results of this study suggest that obesity might have an effect on the bone turnover rate; however, further well-designed studies are needed to confirm this finding.
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