尿钙等骨代谢指标在骨质疏松性骨折中的研究进展

Research Progress on Urinary Calcium and Other Bone Turnover Markers in Osteoporotic Fractures

摘要: 随着社会发展，人口老龄化的问题越来越严峻，骨质疏松已经成为了我国乃至世界严重的公共卫生问题。骨质疏松症(Osteoprosis, 0P)是一种全身性骨骼疾病，其特征是骨量降低和骨组织微结构破坏，导致骨脆性增加，从而增加髋部脊柱和其他部位骨折的风险。骨质疏松性骨折是骨质疏松最严重的并发症，其中髋部骨折被称为人生中最后一次骨折，具有极高的致残率、致死率。骨质疏松的发生不仅与骨密度下降相关，更与骨转换失衡存在密切关系。目前用双能X线(DXA)测定骨密度(BMD)是诊断骨质疏松的金标准，但具有滞后性等缺陷，不能体现骨转换这一动态过程，而尿钙等骨代谢生化指标能动态反映骨吸收与骨形成的平衡状态，能够弥补骨密度(BMD)的缺陷，可以作为对骨质疏松诊断的补充，对骨折风险的预测和评估也具有独特价值。本研究就尿钙及其他骨代谢指标与骨质疏松及骨质疏松性骨折发生风险严重程度的现有证据，探讨其临床应用潜力与局限性，为后续研究和临床应用提供参考。

Abstract: With societal development, the issue of population aging is becoming increasingly severe. Osteoporosis (OP) has emerged as a critical public health problem both in China and globally. Osteoporosis is a systemic skeletal disease characterized by reduced bone mass and deterioration of bone tissue microarchitecture, leading to increased bone fragility and a consequent elevated risk of fractures at the hip, spine, and other sites. Osteoporotic fractures represent the most severe complication of OP. Among these, hip fractures, often termed the “last fracture” in one’s lifetime, are associated with exceptionally high rates of disability and mortality. The pathogenesis of osteoporosis is not only related to the decline in bone mineral density (BMD) but is also closely associated with an imbalance in bone turnover. Currently, the measurement of BMD using dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis. However, it has inherent limitations, such as being a lagging indicator, and fails to reflect the dynamic process of bone turnover. In contrast, biochemical markers of bone metabolism, such as urinary calcium, can dynamically reflect the balance between bone resorption and formation. These markers can compensate for the shortcomings of BMD measurements, serve as a complementary tool for osteoporosis diagnosis, and hold unique value in predicting and assessing fracture risk. This review synthesizes existing evidence on the relationship between urinary calcium, other bone metabolic markers, and the risk and severity of osteoporosis and osteoporotic fractures. It explores their clinical application potential and limitations, aiming to provide a reference for subsequent research and clinical practice.