摘要目的 探究肌肉衰减综合征对社区中老年人(≥50岁)骨质疏松症、 脆性骨折发生风险的影响.方法 检索自1987年1月至2018年7月OVID/Medline,PubMed,EMBASE,Cochrane,Web of Science(SCI),中国知网(CNKI)和万方数据库等数据库中探讨老年人肌肉衰减综合征与骨质疏松症、 脆性骨折相关性研究的文献.按纳入和排除标准筛选文献,并采用风险偏倚评估工具NOS评价量表及AHRQ清单评价文献质量.通过Meta回归分析研究间异质性来源,针对性别、 种族、 年龄、 肌肉衰减综合征诊断标准、 结局类型等重要特征变量,亚组分析评估其对骨质疏松症发生风险影响的差异.采用敏感性分析和剪补法检验Meta分析结果的稳定性.采用Stata 12.2软件进行数据汇总及Meta分析.结果 共纳入符合质量要求的文献23篇,包括56544例研究对象.Meta分析结果较稳健,肌肉衰减综合征中老年患者骨质疏松症发生风险是非患者的1.61倍(95％CI:1.42～1.82,P<0.00001).特别地,相比于绝经后女性RR=1.37(95％CI:1.23～1.53,P<0.0001)、 黄色人种RR=1.53(95％CI:1.34～1.75,P<0.0001),肌肉衰减综合征对老年男性RR=2.26(95％CI:1.71～2.98,P<0.0001)、 高加索人RR=2.03(95％CI:1.46～2.81,P<0.0001)发生骨质疏松症风险影响的趋势更大.结论 在中老年社区人群中(≥50岁),肌肉衰减综合征可显著增加61％骨质疏松症和59％～61％脆性骨折的发生风险.早期对社区中老年人进行肌肉衰减综合征的预防及筛查,有助于鉴别脆性骨折高危人群,降低不良结局的发生风险.

abstractsObjective To explore the relationship between sarcopenia and the risks of osteoporosis and fragility fractures among community-dwelling middle and old people (≥50 years) . Methods OVID/Medline, Pubmed, EMBASE, Cochrane Library, Web of Science ( SCI ) , China National Knowledge Infrastructure ( CNKI) , and Chinese WanFang Database were searched systematically for literatures related to the relationship between sarcopenia and osteoporosis and fragility fractures from January 1987 to July 2018. The searched litera-tures were screened based on the inclusion and exclusion criteria. The quality of the literatures were evaluated by using the risk assessment tool NOS ( Newcastle-Ottawa Scale) and AHRQ ( Agency for Healthcare Research and Quality) . Meta-regression analysis was used to explore the cause of heterogeneity between studies. The sub-group analysis was used to assess the differences in the risk of osteoporosis based on the important characteristic variables, such as gender, ethnicity, age, diagnostic criteria of sarcopenia, and outcome type. Sensitivity anal-ysis and trim and fill method were conducted to test the stability of the results of this Meta-analysis. Data col-lected and summarized by Stata 12. 2 software. Results A total of 23 studies in line with quality requirements were included eventually, including 56, 544 subjects. The results of this Meta-analysis were relatively robust. Compared with non-sarcopenia, the relative risk ( RR ) for osteoporosis among subjects with sarcopenia was 1. 61 (95％ CI: 1. 42～1. 82, P<0. 00001). Especially, compared with postmenopausal women RR=1. 37 (95％ CI: 1. 23-1. 53, P<0. 0001) and yellow race RR=1. 53 (95％ CI: 1. 34-1. 75, P<0. 0001), sar-copenia had a higher impact trend on the risk of osteoporosis in older men RR=2. 26 ( 95％ CI: 1. 71-2. 98, P<0. 0001 ) and Caucasian RR = 2. 03 ( 95％ CI: 1. 46-2. 81, P<0. 0001 ) . Conclusion Among community-dwelling middle and old aged people (≥50 year) , sarcopenia increases the risk of osteoporosis and fragility fracture by 61％ and 59％ -61％ significantly, respectively. Middle and old aged people should be pre-vented and screened early for sarcopenia, which attributes to identify high risk groups of fragile fractures and re-duce the risk of adverse outcomes.