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| 骨密度性别差异双重路径：身高与BMI并行及交互效应 |
| Dual pathways of gender differences in bone density: Parallel and interactive effects of height and BMI |
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| DOI：10.3969/j.issn.1006-7108.2026.08.012 |
| 中文关键词: 骨密度 性别差异 身高 体质量指数 中介分析 |
| 英文关键词:bone mineral density sex differences height body mass index mediation analysis |
| 基金项目:山东省医药卫生科技重点项目（202409011332） |
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| 中文摘要: |
| 目的 量化评估身高与体质量指数（body mess index, BMI）在骨密度（bone mineral density, BMD）性别差异中的并行中介作用及身高的交互效应。方法 回顾性纳入青岛地区2 339例健康体检者（男1 394例，女945例）。采用双能X线吸收法（DXA）测量腰椎骨密度T值。采用多元线性回归评估校正体格因素后的性别差异。使用Hayes PROCESS宏（版本 4.1）Model4模型，在控制年龄、碱性磷酸酶（ALP）、系统性免疫炎症指数（SII）和尿酸（UA）后，检验身高与BMI在“性别-骨密度”关联中的并行中介效应（Bootstrap = 5 000次），并引入性别×身高交互项以检验交互作用。结果 未校正时，男性骨密度高于女性（女性–男性均值差= – 0.205，P<0.001）。校正身高和BMI后，男性骨密度显著低于女性（B= – 0.270，P<0.001）。中介分析显示，总间接效应为0.361（95% CI: 0.307~0.413），其中身高路径贡献81.6%（效应量=0.295，95% CI: 0.245~0.344），BMI路径贡献18.4%（效应量=0.066，95% CI: 0.040~0.094）。身高与性别的交互作用显著（B= – 0.021，P<0.001），女性身高每增加1 cm对骨密度的提升效应（B=0.085 SD）是男性（B=0.043 SD）的1.98倍。结论 身高是解释骨密度性别差异的主要体格因素，其效应在女性中更强。校正身高与BMI后，男性骨密度反而更低。临床骨密度评估应校正身高并考虑性别特异性。 |
| 英文摘要: |
| Objective To quantify the parallel mediating effects of height and body mass index (BMI) on sex differences in bone mineral density (BMD), alongside the interaction effect between sex and height. Methods This retrospective study included 2 339 healthy participants (1 394 men and 945 women) from Qingdao, China. Lumbar spine BMD T-scores were measured using dual-energy X-ray absorptiometry (DXA). Multivariable linear regression was employed to evaluate sex differences in BMD after adjusting for anthropometric factors. Using the Hayes PROCESS macro (Version 4.1, Model 4), we examined the parallel mediating effects of height and BMI in the association between sex and BMD, while controlling for age, alkaline phosphatase (ALP), systemic immune-inflammation index (SII), and uric acid (UA) with bias-corrected bootstrapping (5 000 resamples). A sex × height interaction term was introduced to test for moderation. Results Before adjustment, BMD was higher in men than in women(mean difference [women?men] = ?0.205, P<0.001). After adjusting for height and BMI, men showed significantly lower BMD than women (B=?0.270, P<0.001). Mediation analysis revealed a total indirect effect of 0.361 (95% CI: 0.307–0.413). The height path accounted for 81.6% of this effect (effect size=0.295, 95% CI: 0.245–0.344), while the BMI path accounted for 18.4% (effect size=0.066, 95% CI: 0.040–0.094). The interaction between sex and height was significant (B= ?0.021, P<0.001). For each 1cm increase in height, BMD increased by 0.085 SD in women, an effect 1.98 times stronger than that in men (0.043 SD per cm). Conclusion Height is the primary anthropometric factor mediating sex differences in BMD, with a stronger effect in women. After adjusting for height and BMI, men exhibit lower BMD than women. Clinical BMD assessment should account for height and adopt sex-specific interpretations. |
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