일개 대학병원 건강검진 수진자에서 혈청 호모시스테인 농도와 요추 및 대퇴골 골밀도의 상관관계
The Relationship of Serum Homocysteine Levels with Lumbar and Femoral Bone Mineral Density
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연구배경: 최근 혈청 호모시스테인 농도와 골절의 위험도 및 골밀도와의 상관관계가 여러 연구들을 통하여 알려지면서 혈청 호모시스테인 농도와 골대사와의 관계에 대한 관심이 증가되었다. 그러나 이에 대한 국내 연구는 미흡한 실정이다. 따라서 본 연구에서는 한국인 성인을 대상으로 혈청 호모시스테인 농도와 골밀도의 상관관계를 밝히고자 하였다. 방법: 2005년 1월부터 2006년 3월까지 일개 대학 병원 건강증진센터에서 건강검진을 시행한 성인 2,750명 중 제외기준이 없는 남성 1,142명, 여성 1,393명을 대상으로 하였다. 대상자들은 직접 문진표를 작성하였고 공복 상태에서 혈액 검사를 시행하였으며 요추 및 대퇴골의 골밀도를 측정하였다. 남성, 여성 각각에서 연령, 체질량 지수, 음주 여부, 흡연 여부를 보정한 혈청 호모시스테인 농도와 골밀도의 상관관계를 다중회귀 분석법을 이용하여 분석하였다. 또한 폐경에 의한 영향을 보정하기 위하여 연령에 따라 세 군으로 나누어(≤45세, 46∼55세, 56세≤) 같은 분석을 시행하였다. 결과: 다중회귀 분석의 결과 여성에서는 혈청 호모시스테인 농도와 요추 및 대퇴골 골밀도 사이에 음의 상관관계가 성립하였으나(요추: β=-0.006, P=0.015, 대퇴골: β=0.065, P=0.012), 남성에서는 유의한 상관관계가 없었다(요추: β=0.001, P=0.240, 대퇴골: β=0.001, P=0.242). 여성 중에서는 46~55세 군이 요추 및 대퇴골 모두에서 유의한 음의 상관관계를 보였다(요추: β=0.014, P=0.024, 대퇴골: β=0.007, P=0.019). 결론: 46∼55세의 한국인 여성에서 혈청 호모시스테인의 증가는 골밀도의 감소와 관계가 있다. 따라서 한국인 여성, 특히 폐경기 여성에서 증가된 혈청 호모시스테인은 골다공증의 위험요소 중의 하나로 볼 수 있다. 한국인 남성에서는 상관관계가 없는 것으로 나타났으며 앞으로 이러한 성별 차이 및 호모시스테인이 골밀도에 영향을 주는 기전에 대한 연구가 필요하다.
Abstract
Background: Recently, an elevated serum homocysteine level has been reported to be associated with increased fracture risk and reduced bone mineral density (BMD). So far, little research has been done to evaluate such association in Korean population. Therefore, we investigated the association between serum homocysteine levels and BMD in Korean adults. Methods: The subjects consisted of 2,750 adults who visited a health promotion center at a university hospital from January 2005 to March 2006. Self-administered questionnaires provided information about lifestyle and medical history. Fasting plasma samples were collected and BMD of the lumbar spine and femoral neck were obtained by dual energy X-ray absorptiometry. To adjust for menopausal state, the female subjects were divided into three groups according to age (≤45 yrs, 46∼55 yrs, 55 yrs ＜). Multiple linear regression analysis was used to evaluate the association between serum homocysteine levels and BMD in each gender and age group. Results: The results adjusted for alcohol and smoking history showed significant association between serum homocysteine levels and BMD in women (Lumbar spine: β=0.006, P=0.015, Femoral neck: β=0.065, P=0.012) but not in men (Lumbar spine: β=0.001, P=0.240, Femoral neck: β=0.001, P=0.242). With analyses by three age groups, plasma homocysteine level was associated with both lumbar and femoral BMD in age 46∼55 women (Lumbar spine: β=0.014, P=0.024, Femoral neck: β= 0.007, P=0.019). Conclusion: Our study suggests that increased serum homocysteine level is an independent risk factor for low BMD among women, especially perimenopausal women. Further studies about the sexual differences and the mechanisms linking serum homocysteine level to BMD are needed. (J Korean Acad Fam Med 2008;29:175-181) Background: Recently, an elevated serum homocysteine level has been reported to be associated with increased fracture risk and reduced bone mineral density (BMD). So far, little research has been done to evaluate such association in Korean population. Therefore, we investigated the association between serum homocysteine levels and BMD in Korean adults. Methods: The subjects consisted of 2,750 adults who visited a health promotion center at a university hospital from January 2005 to March 2006. Self-administered questionnaires provided information about lifestyle and medical history. Fasting plasma samples were collected and BMD of the lumbar spine and femoral neck were obtained by dual energy X-ray absorptiometry. To adjust for menopausal state, the female subjects were divided into three groups according to age (≤45 yrs, 46∼55 yrs, 55 yrs ＜). Multiple linear regression analysis was used to evaluate the association between serum homocysteine levels and BMD in each gender and age group. Results: The results adjusted for alcohol and smoking history showed significant association between serum homocysteine levels and BMD in women (Lumbar spine: β=0.006, P=0.015, Femoral neck: β=0.065, P=0.012) but not in men (Lumbar spine: β=0.001, P=0.240, Femoral neck: β=0.001, P=0.242). With analyses by three age groups, plasma homocysteine level was associated with both lumbar and femoral BMD in age 46∼55 women (Lumbar spine: β=0.014, P=0.024, Femoral neck: β= 0.007, P=0.019). Conclusion: Our study suggests that increased serum homocysteine level is an independent risk factor for low BMD among women, especially perimenopausal women. Further studies about the sexual differences and the mechanisms linking serum homocysteine level to BMD are needed. (J Korean Acad Fam Med 2008;29:175-181)
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