་ ඹ ᵝ ᘧ 㸯
Ꮫ ㄳ ồ ㄽ ᩥ ࡢ ෆ ᐜ ࡢ せ ᪨
ㄽ ᩥ ᥦ ฟ ⪅ Ặ ྡ ᶵ ⬟ ᘓ ⏕ ⛉ Ꮫ 㡿 ᇦ ⬨ ᳝ ⬨ 㧊 ែ ಟ Ꮫ ᩍ ⫱ ◊ ✲ ศ 㔝 Ặ ྡ ୍ ᡞ 㞞 அ
㸦 ㄽ ᩥ 㢟 ┠ 㸧
Prevalence and Associated Factors of Radiographic Vertebral Fractures in Men:
Rural Population Cross-sectional Observation Study in Japan
㸦 ⏨ ᛶ ᳝ య 㦵 ᢡ ࡢ ᭷ ⋡ 㛵 㐃 ࡍ ࡿ ᅉ Ꮚ ࡢ ᳨ ウ 㸸 ୍ ⯡ ఫ Ẹ ࠾ ࡅ ࡿ ᶓ ᩿ ⓗ ◊ ✲ 㸧
㸦 ෆ ᐜ ࡢ せ ᪨ 㸸1817 Ꮠ 㸧
࠙ ⫼ ᬒ ࠚ
㉸ 㧗 㱋 ♫ క ࠸, 㦵 ⢒ 㧼 ᛶ 㦵 ᢡ ࡣ ዪ ᛶ ࡔ ࡅ ࡛ ࡣ ࡞ ࡃ, ⏨ ᛶ ࠾ ࠸ ࡚ ࡶ 㔜 せ ࡞ ᗣ ၥ 㢟 ࡞ ࡗ ࡚ ࠸ ࡿ. ᳝ య 㦵 ᢡ ࡣ せ ࡞ 㦵 ⢒ 㧼 ᛶ 㦵 ᢡ ࡢ ୍ ࡘ ࡛ ࠶ ࡾ, ៏ ᛶ ⓗ ࡞ ⑊ ③ ࡸ QOL ࡢ ప ୗ, Ṛ ஸ ⋡ ࡢ ቑ ຍ ࢆ ࡁ ࡓ ࡍ ࡓ ࡵ, ண 㜵 ࡀ 㔜 せ ࡛ ࠶ ࡿ. ዪ ᛶ 㛵 ࡋ ࡚ ࡣ ప 㦵 ᐦ ᗘ
࡞ ከ ࡃ ࡢ ධ ࡍ ࡁ ᅉ Ꮚ ࡀ ሗ ࿌ ࡉ ࢀ ࡚ ࠸ ࡿ ࡀ, ⏨ ᛶ 㛵 ࡍ ࡿ ሗ ࿌ ࡣ ᑡ ࡞ ࡃ, ᫂ ࡞ Ⅼ ࡀ ከ ࠸.
ࡲ ࡓ, ᳝ య 㦵 ᢡ ࡣ ≧ ࢆ క ࢃ ࡎ, ་ ⒪ ᶵ 㛵 ࡛ ⮫ ᗋ ⓗ デ ᩿ ࡉ ࢀ ࡞ ࠸ ᙧ ែ 㦵 ᢡ ࡶ ከ ࠸ ሗ ࿌ ࡉ ࢀ ࡚ ࠸ ࡿ. ᳝ య 㦵 ᢡ ᝈ ⪅ ࡢ QOL 㛵 ࡍ ࡿ 㐣 ཤ ࡢ ሗ ࿌ ࡢ ከ ࡃ ࡣ ⮫ ᗋ ⓗ デ ᩿ ࡉ ࢀ ࡓ ⮫ ᗋ 㦵 ᢡ ࡢ ᝈ ⪅ ࡀ ᑐ ㇟ ࡛ ࠶ ࡾ, ᙧ ែ 㦵 ᢡ ࢆ ྵ ࡵ ࡓ ᳝ య 㦵 ᢡ ࡢ QOL ࡣ ᫂ ࡛ ࠶ ࡿ.
ᮏ ◊ ✲ ࡢ ┠ ⓗ ࡣ, ୍ ⯡ ఫ Ẹ ࠾ ࡅ ࡿ ⏨ ᛶ ࡢ ᙧ ែ 㦵 ᢡ ࢆ ྵ ࡵ ࡓ ᳝ య 㦵 ᢡ 㛵 㐃 ࡍ ࡿ ᅉ Ꮚ
, ᳝ య 㦵 ᢡ ࡀ QOL ཬ ࡰ ࡍ ᙳ 㡪 ࢆ ᫂ ࡽ ࡍ ࡿ ࡇ ࡛ ࠶ ࡿ.
࠙ ᑐ ㇟ ᪉ ἲ ࠚ
2015 ᖺ ࡲ ࡓ ࡣ 2016 ᖺ ࡢ ᒾ ᮌ ᗣ ቑ 㐍 ࣉ ࣟ ࢪ ࢙ ࢡ ࢺ ཧ ຍ ࡋ ࡓ 40 ṓ ௨ ୖ ࡢ ⏨ ᛶ 401
ྡ 㸦 ᖹ ᆒ 60.5±11.8 ṓ 㸧 ࢆ ᑐ ㇟ ࡋ ࡓ.
ホ ౯ 㡯 ┠ ࡣ ᖺ 㱋, ⭜ ᳝ X⥺ ഃ 㠃 ീ ࡼ ࡿ ᳝ య 㦵 ᢡ㸦vertebral fracture, VFx㸧ࡢ ᭷ ↓, ᶨ 㦵 DXA ἲ ࡼ ࡿ 㦵 ᐦ ᗘ㸦bone mineral density, BMD㸧, య ⤌ ᡂ, ᥱ ຊ, Ṍ ⾜ ㏿ ᗘ, 㦵 ௦ ㅰ ࣐ ࣮ ࢝ ࣮ ࢆ ྵ ࡴ ⏕ Ꮫ ᳨ ᰝ, QOLࢫ ࢥ 㸦Short Form 36, SF-36; ᪥ ᮏ ᩚ ᙧ እ ⛉ Ꮫ
⭜ ③ ホ ౯ ㉁ ၥ ⚊, JOA-BPEQ㸧 ࡛ ࠶ ࡿ 㸬
᳝ య 㦵 ᢡ ⩌ 㸦VFx⩌ 㸧 㠀 ᳝ య 㦵 ᢡ ⩌㸦non-VFx ⩌ 㸧ࡢ 2 ⩌ 㛫 ศ ࡅ, ྛ ࣃ ࣛ ࣓ ࣮ ࢱ
ࢆ Mann-Whitneyࡢ U᳨ ᐃ ࢆ ⏝ ࠸ ࡚ ⩌ 㛫 ẚ ㍑ ࢆ ⾜ ࡗ ࡓ. ࡲ ࡓ, ⩌ 㛫 ẚ ㍑ ࡛ ᭷ ព ᕪ ࢆ ㄆ ࡵ ࡓ 㡯 ┠ ࢆ ࣟ ࢪ ࢫ ࢸ ࢵ ࢡ ᅇ ᖐ ศ ᯒ ࡛ ᖺ 㱋 ⿵ ṇ ࢆ ⾜ ࠸ ᳨ ウ ࡋ ࡓ. QOLࢫ ࢥ ࡣ ୧ ⩌ 㛫 ࡛ ᭷ ព ᕪ ࢆ ㄆ ࡵ ࡓ ࢻ ࣓ ࣥ Ⅼ ᩘ ࢆ ⊂ ❧ ኚ ᩘ ࡋ ࡚ ከ 㔜 ⥺ ᙧ ᅇ ᖐ ศ ᯒ ࢆ ⾜ ࡗ ࡓ. ᭷ ព Ỉ ‽ ࢆ 0.05 ࡋ ࡓ.
࠙ ⤖ ᯝ ࠚ
VFx ࡢ ᭷ ⋡ ࡣ 8.7%㸦35 㸧 ࡛ ࠶ ࡗ ࡓ. VFx ⩌ ࡢ ᖺ 㱋 ࡣ ᭷ ព 㧗 㱋 ࡛ ࠶ ࡗ ࡓ 㸦VFx
⩌: 69.6 ṓ, non-VFx⩌: 59.6 ṓ, p<0.001㸧. BMD ࡣ 2⩌ 㛫 ࡛ ᭷ ព ᕪ ࢆ ㄆ ࡵ ࡞ ࡗ ࡓ 㸦p=0.35㸧. ⩌ 㛫 ẚ ㍑ ࡛ ࡣ ᥎ ᐃ 㦵 㔞, ➽ 㔞, Ṍ ⾜ ㏿ ᗘ, ⾑ ୰ ࢝ ࣝ ࢩ ࢘ ࣒, ࢹ ࣏ ࢿ ࢡ ࢳ
ࣥ, IGF-1࡛ ᭷ ព ᕪ ࢆ ㄆ ࡵ ࡓ ࡀ, ከ ኚ 㔞 ゎ ᯒ ࡼ ࡿ ᖺ 㱋 ⿵ ṇ ᚋ ࡣ, పIGF-1ࡢ ࡳ ࡀ ᳝ య 㦵 ᢡ ᭷ ព ࡞ 㛵 㐃 ᅉ Ꮚ ࡛ ࠶ ࡗ ࡓ 㸦Odds ẚ 0.985, p=0.02㸧.
QOL 㛵 ࡋ ࡚ ࡣ, VFx ⩌ ࠾ ࡅ ࡿ SF-36 ࡢ physical component summary (PCS) scores JOA-BPEQ ࡢ Ṍ ⾜ ⬟ ຊ ࡀ non-VFx⩌ ࡼ ࡾ ᭷ ព ప ࡗ ࡓ ࡀ, ከ ኚ 㔞 ゎ ᯒ ᚋ ࡛ ࡣ ࠸ ࡎ ࢀ ࡶ ᭷ ព ᕪ ࢆ ㄆ ࡵ ࡞ ࡗ ࡓ.
࠙ ⪃ ᐹ ࠚ
ඛ ⾜ ◊ ✲ ࡛ ࡣ ⏨ ᛶ ࡢ VFxࡢ ᭷ ⋡ ࡣ 5-20% ࡢ ሗ ࿌ ࡀ ࠶ ࡾ, ༙ ᐃ 㔞 ⓗ ホ ౯ ἲ㸦SQ ἲ 㸧
ࢆ ⏝ ࠸ ࡓ ࣓ ࣜ ࢝ ࡢ ሗ ࿌ ࡛ ࡣ 6.2%࡛ ࠶ ࡗ ࡓ. ᮏ ◊ ✲ ࡛ ࡶ SQ ἲ ࢆ ⏝ ࠸ ࡚ デ ᩿ ࡋ ࡚ ࠾ ࡾ,
᭷ ⋡ ࡣ 8.7% ࡰ ྠ ᵝ ࡢ ⤖ ᯝ ࡛ ࠶ ࡗ ࡓ.
ᮏ ◊ ✲ ࡛ ࡣ BMDࡣ VFx ᭷ ព ࡞ 㛵 㐃 ࢆ ㄆ ࡵ ࡞ ࡗ ࡓ. ዪ ᛶ ࡛ ࡣ ప BMDࡀ VFxࡢ ண ᅉ Ꮚ ࡋ ࡚ ᗈ ࡃ ▱ ࡽ ࢀ ࡚ ࠸ ࡿ ࡀ, ⏨ ᛶ ࠾ ࡅ ࡿ ప BMD ࡣ 㦵 ⢒ 㧼 ᛶ 㦵 ᢡ ࡢ ண ⬟ ࡀ ᙅ ࠸ ඛ ⾜ ◊ ✲ ࡛ ሗ ࿌ ࡉ ࢀ ࡚ ࠸ ࡿ. 㦵 ᙉ ᗘ ࡣ BMD 㦵 ㉁ ࡢ ࡘ ࡢ せ ⣲ ࡛ Ỵ ᐃ ࡉ ࢀ ࡿ ࡓ
ࡵ, ⏨ ᛶ ࡢ 㦵 ⢒ 㧼 ᛶ 㦵 ᢡ ࡛ ࡣ ዪ ᛶ ࡼ ࡾ ࡶ 㦵 ㉁ ࡢ ᙳ 㡪 ࡀ ࡁ ࠸ ྍ ⬟ ᛶ ࡀ ࠶ ࡿ.
IGF-1 ࡣ ᡂ 㛗 ࣍ ࣝ ࣔ ࣥ ࡢ ⤌ ⧊ ᡂ 㛗 ಁ 㐍 స ⏝ ࡢ ࣓ ࢹ ࢚ ࣮ ࢱ ࣮ ࡛ ࠶ ࡾ, 㦵 ࠾ ࠸ ࡚ ࡣ 㦵 ⱆ ⣽ ⬊ ࡢ ࣏ ࢺ ࣮ ࢩ ࢫ ࢆ ῶ ᑡ ࡉ ࡏ, ⣽ ⬊ ቑ Ṫ ࢆ ಁ ࡍ ࡇ ࡛ 㦵 ᙧ ᡂ ࢆ ಁ 㐍 ࡍ ࡿ ࡶ , RANK-L స ⏝ ࡋ ◚ 㦵 ⣽ ⬊ ࡢ ᙧ ᡂ ࢆ ㄏ ᑟ ࡍ ࡿ ࡇ ࡛ 㦵 ྾ ࢆ ಁ 㐍 ࡉ ࡏ ࡿ. ప IGF-1ࡀ 㦵 ᢡ 㛵 㐃 ࡍ ࡿ ࡢ ඛ ⾜ ◊ ✲ ࡀ ࠶ ࡿ ࡀ, VFx ࡢ 㛵 㐃 ࡣ ᫂ ࡽ ࡛ ࡣ ࡞ ࡗ ࡓ. ᮏ ᶓ ᩿ ◊ ✲
࡛ ࡣ, పIGF-1ࡀ ⏨ ᛶ ࡢ VFx ᭷ ព 㛵 㐃 ࡋ ࡚ ࠾ ࡾ, IGF-1ࡀ ⏨ ᛶ 㦵 ⢒ 㧼 ᛶ VFxࡢ ᭷
⏝ ࡞ ࣂ ࢜ ࣐ ࣮ ࢝ ࣮ ࡞ ࡿ 㸪 ᚋ ⦪ ᩿ ⓗ ࡞ ㄪ ᰝ ࡀ ᚲ せ ࡛ ࠶ ࡿ.
QOL ࡘ ࠸ ࡚ ࡣ, ⮫ ᗋ ⓗ デ ᩿ ࡉ ࢀ ࡓ VFxᝈ ⪅ ࡣ QOLࢫ ࢥ ࡀ ప ࠸ ሗ ࿌ ࡉ ࢀ ࡚ ࠸
ࡿ. ᮏ ◊ ✲ ࡛ ࡣ ⮫ ᗋ ⓗ デ ᩿ ࡉ ࢀ ࡚ ࠸ ࡞ ࠸ ᙧ ែ 㦵 ᢡ ↔ Ⅼ ࢆ ᙜ ࡚ ࡓ. ༢ ኚ 㔞 ゎ ᯒ ࡛ ࡣ SF-36ࡢ PCS scores JOA-BPEQ ࡢ Ṍ ⾜ ⬟ ຊ ࡀ ᭷ ព ప ୗ ࡋ ࡚ ࠸ ࡓ ࡀ, ᖺ 㱋 ㄪ ᩚ ᚋ ࡣ
᭷ ព ᕪ ࢆ ㄆ ࡵ ࡞ ࡗ ࡓ. ࡑ ࡢ ⌮ ⏤ ࡢ ୍ ࡘ ࡋ ࡚, ᙧ ែ 㦵 ᢡ ࡣ ⮫ ᗋ ≧ ஈ ࡋ ࡃ, ᮏ ㄪ ᰝ
࡛ ࡶ VFx ⩌ non-VFx ⩌ 㛫 ࡢ ⑊ ③ ࡸ ᖺ 㱋 ⿵ ṇ ᚋ ࡢ 㐠 ື ᶵ ⬟ ᭷ ព ᕪ ࢆ ㄆ ࡵ ࡞ ࠸ ࡇ
ࡽ, ⏨ ᛶ ࡢ ᙧ ែ 㦵 ᢡ ࡣ QOL ప ୗ ᙳ 㡪 ࡋ ࡞ ࠸ ྍ ⬟ ᛶ ࡀ ᣲ ࡆ ࡽ ࢀ ࡿ. ࡲ ࡓ, ᮏ ◊ ✲ ࡢ ཧ ຍ
⪅ ࡣ ࢇ ࡀ ᗣ ࡞ ᡂ ே ࡛ QOL ࢫ ࢥ ࡶ Ⰻ ዲ ࡛ ࠶ ࡾ, VFx ⩌ non-VFx⩌ ࡢ ࢫ ࢥ ࡢ ᕪ ࡀ ࢃ ࡎ ࡛ ࠶ ࡗ ࡓ ࡓ ࡵ, ከ ኚ 㔞 ゎ ᯒ ࡢ 㝿 㐣 ㄪ ᩚ ࡉ ࢀ ࡓ ྍ ⬟ ᛶ ࡶ ⪃ ࠼ ࡽ ࢀ ࡿ. ᮏ ◊ ✲ ࡢ limitation ࡋ ࡚, ᶓ ᩿ ㄪ ᰝ ࡛ ࠶ ࡿ Ⅼ, ᑐ ㇟ ⪅ ᩘ ࡀ ᑡ ࡞ ࠸ Ⅼ ࡀ ᣲ ࡆ ࡽ ࢀ ࡿ ࡀ, ከ ኚ 㔞 ゎ ᯒ ࡼ ࡾ ⏨ ᛶ 㦵 ⢒ 㧼 ᛶ VFx ࡢ ᪂ ࡓ ࡞ ࣂ ࢜ ࣐ ࣮ ࢝ ࣮ ೃ ⿵ ࡋ ࡚ IGF-1 ࢆ ᢳ ฟ ࡍ ࡿ ࡇ ࡀ ࡛ ࡁ ࡓ.
࠙ ⤖ ㄒ ࠚ
⏨ ᛶ ࠾ ࡅ ࡿ VFx ࡢ ᭷ ⋡ ࡣ 8.7%࡛ ࠶ ࡗ ࡓ. ᖺ 㱋 ㄪ ᩚ ᚋ ࡶ VFx ⩌ ࡢ IGF-1 ࡣ non-VFx⩌ ẚ ࡚ ᭷ ព ప ್ ࡛ ࠶ ࡗ ࡓ. IGF-1ࡣ ⏨ ᛶ ࡢ VFxࡢ ࣂ ࢜ ࣐ ࣮ ࢝ ࣮ ࡞ ࡿ
ྍ ⬟ ᛶ ࡀ ࠶ ࡾ, ࡉ ࡽ ⦪ ᩿ ⓗ ࡞ ◊ ✲ ࡀ ᚲ せ ࡛ ࠶ ࡿ. VFx⩌ ࠾ ࡅ ࡿ SF-36ࡢ PCS scores
JOA-BPEQ ࡢ Ṍ ⾜ ⬟ ຊ ࡀ non-VFx⩌ ࡼ ࡾ ᭷ ព ప ࡗ ࡓ ࡀ, ᖺ 㱋 ㄪ ᩚ ᚋ ࡣ ᭷ ព ᕪ ࢆ ㄆ ࡵ ࡞ ࡗ ࡓ 㸬
ͤ1 எ ࡢ ሙ ྜ 㸪ۑ ۑ 㡿 ᇦ ۑ ۑ ᩍ ⫱ ◊ ✲ ศ 㔝 ࠼ ࡚ 㸪ᡤ ᒓ ࡢ ۑ ۑ ㅮ ᗙ ࢆ グ ධ ࡍ ࡿ ࡇ ࠋ
ͤ2 ㄽ ᩥ 㢟 ┠ ࡀ ⱥ ᩥ ࡢ ሙ ྜ ࡣ 㸦 㸧 ෆ ヂ ࢆ グ ࡍ ࡿ ࡇ ࠋ
