绝经后女性骨密度降低与听力损伤之间的关联

文献信息

中文摘要

目的： 评估绝经后女性骨密度（BMD）与听觉功能之间的关联，并评估正常骨密度、骨量减少和骨质疏松症之间的听力损伤程度。
方法： 在这项分析性横断面研究中，纳入了220名年龄50-75岁的绝经后女性。所有参与者均接受了腰椎和髋部的双能X线吸收测定法（DXA）检查，随后进行纯音测听和鼓室压测量评估。使用骨修饰药物的女性、带有金属植入物或影响DXA的肌肉骨骼疾病者，以及无法保持所需体位者被排除。额外的听力学排除标准涵盖耳科、神经科、肿瘤科、炎症性和遗传性原因导致的继发性听力损失。听力损失严重程度根据较好耳气导纯音平均值进行分级。使用非参数检验比较各BMD组之间的阈值和鼓室压测量参数，使用精确分类方法比较严重程度分布，并使用多变量逻辑回归调整年龄、体重指数（BMI）和绝经持续时间来分析BMD-听力关联。
结果： BMD降低与听觉功能逐步恶化相关。与骨量减少和正常BMD的女性相比，骨质疏松症女性的纯音平均值和骨导阈值显著更高，鼓室压峰值压力更负，静态声顺更低，共振频率更高（所有p < 0.001）。中度或更严重听力损失在骨质疏松症组中最普遍（72.2%），而骨量减少组为41.2%，正常BMD组为22.4%。所有两两差异均具有统计学意义。在调整年龄、BMI和绝经持续时间后，与正常BMD相比，骨质疏松症中度或更严重听力损失的比值比约高九倍（调整OR = 8.97，95%CI 3.81-21.1），骨量减少约高2.6倍（调整OR = 2.55，95%CI 1.31-4.98）。这些协变量均与结局无独立关联。
结论： 在绝经后女性中，骨密度降低与听觉功能受损显著相关，听力阈值从正常BMD到骨量减少逐步恶化，并在骨质疏松症中达到最严重程度，且独立于年龄、BMI和绝经持续时间。尽管无法从这项横断面研究中得出因果推断，但这些发现与骨质疏松症的系统性性质以及可能涉及耳囊和内耳结构相一致。有必要进行前瞻性纵向研究以进一步阐明这种关联。

英文摘要

OBJECTIVES: To assess the association between bone mineral density (BMD) and auditory function in postmenopausal women and to assess the degree of hearing impairment across normal BMD, osteopenia, and osteoporosis.
METHODS: In this analytical cross-sectional study, 220 postmenopausal women aged 50-75 years were enrolled. All participants underwent dual-energy X-ray absorptiometry (DXA) of the lumbar spine and hip, followed by pure-tone audiometry and tympanometric assessment. Women using bone-modifying medications, those with metal implants or musculoskeletal conditions interfering with DXA, and those unable to maintain required positioning were excluded. Additional audiological exclusions covered otologic, neurologic, oncologic, inflammatory, and hereditary causes of secondary hearing loss. Hearing loss severity was graded from the better-ear air conduction pure-tone average. Thresholds and tympanometric parameters were compared across BMD groups with non-parametric tests, the severity distribution with exact categorical methods, and the BMD-hearing associations with multivariate logistic regression adjusted for age, body mass index (BMI) and duration of menopause.
RESULTS: Decreasing BMD was associated with a stepwise worsening of auditory function. Women with osteoporosis demonstrated significantly higher pure-tone average and bone conduction thresholds, more negative tympanometric peak pressures, lower static admittance, and higher resonance frequencies compared with those with osteopenia and normal BMD (all p < 0.001). Moderate-or-worse hearing loss was most prevalent in the osteoporosis group (72.2%), compared with 41.2% in osteopenia and 22.4% in normal BMD. All pairwise differences were statistically significant. After adjustment for age, BMI and duration of menopause, the odds of moderate-or-worse hearing loss were about nine-fold higher in osteoporosis (adjusted OR = 8.97, 95%CI 3.81-21.1) and about 2.6 -fold higher in osteopenia (adjusted OR = 2.55, 95%CI 1.31-4.98) compared with normal BMD. None of these covariates was independently associated with the outcome.
CONCLUSION: Reduced bone mineral density is significantly associated with impaired auditory function in postmenopausal women, with hearing thresholds worsening progressively from normal BMD to osteopenia and reaching its greatest severity in osteoporosis, independently of age, BMI and duration of menopause. Although causal inference cannot be drawn from this cross-sectional study, these findings are consistent with the systemic nature of osteoporosis and a possible involvement of the otic capsule and inner ear structures. Prospective, longitudinal studies are warranted to further clarify this association.