妇女绝经、老龄对骨质疏松的影响

骨质疏松严重危害妇女绝经后的生活质量.本文介绍了骨质疏松的生理原因和带有力学调控系统的各向异性骨再造模型,应用该模型用有限元方法对妇女绝经骨质疏松进行数值模拟.结果表明:单纯绝经因素骨量降低7%～12%,绝经后载荷下降20%,两种因素共同引起的结果,使骨量下降25%～29%,如载荷下降40%,骨量丢失35%左右.可见,力学因素是导致妇女绝经后骨质疏松的主要因素,生物学因素则加速了骨质疏松的过程.此结果证明了力学因素对于骨量的维持起着重要作用,为骨质疏松的研究开辟了一个新的思路.     

载荷下降形式对妇女绝经后骨质疏松模拟结果的影响

目的 数值模拟妇女绝经后的骨质疏松，研究载荷下降形式对妇女绝经后骨质疏松模拟结果的影响。方法 根据骨重建的力学调控和各向异性理论，结合有限元方法，构建绝经后骨质疏松症的数学模型。结果 妇女绝经后，由于肌肉力量的降低和活动量的减少而导致外载荷下降20％时，骨量相对于妇女绝经前丢失25％以上，产生骨质疏松。结论 生物学因素和力学因素共同作用的效果导致妇女绝经后的骨质疏松，载荷下降形式对模拟结果基本没有影响。     

白细胞介素—1,2,6在骨质疏松患者中的表达

绝经后骨质疏松(postmenopuusal osteporosisPMO)是危及老年妇女健康的一种常见病和多发病,它的特点是以绝经早期高骨转换为特征,表现为骨吸收大于骨形成,骨小梁大量丢失,结果导致骨密度减低,骨脆性增加,易发生骨折。近年来的研究证明,在骨质疏松发生的机理中,细胞因子的水平高低起着很重要的调控作用。本文检测了非骨质疏松妇女及绝经后骨质疏松妇女血清白细胞介素—1,2,6水平及骨密度(BMD)情况,现将结果报道如下。 资料和方法 一、对象:选取正常青年妇女30例,年龄25～35岁,月经周期正常,骨密度正常者作为非骨质疏松组;选取绝经后妇女30例,年龄48～60岁,绝经2～6年,骨密度<峰值二个标准差者,作为骨质疏松     

雌激素类治疗骨质疏松研究进展

雌激素在骨质疏松发生中的作用已获共识 ,雌激素可通过甲状旁腺素、降钙素和维生素D发挥间接作用 ,从而保持正常骨代谢过程。当内源性雌激素缺乏时 ,骨量丢失 (绝经后的妇女每年丢失骨量约 4.2 % ) ,女性一生中有 1 / 3的时间在绝经后度过 ,因此这一问题更为突出。并发骨质疏松的可能性也随之增加 ,在西方国家女性骨质疏松发病率明显高于东方妇女 ,雌激素替代(ERT)是本症的重要治疗措施。但是 ,用雌激素替代疗法有促发子宫内膜癌、乳腺癌和阴道出血的危险 ,历时 50余年的雌激素替代疗法被广泛接纳与应用 ,但由于不良反应较多而受到限制[1 …     

东乡族成年女性绝经前后骨强度和体成分特征及其相关性

目的 分析东乡族成年女性绝经前后骨强度和体成分变化并探讨体成分变化对骨强度的影响。 方法 2016年9月~2018年7月采用随机整群抽样选取甘肃省东乡族41～50岁成年女性203例（绝经前102例,绝经后101例）,采用超声骨密度仪、生物电阻抗分析仪分别测量跟骨骨强度和体成分指标。 结果 东乡族绝经后女性的骨强度、肌肉组织体成分低于绝经前（P<0.05）;脂肪组织体成分高于绝经前（P<0.01）。东乡族绝经后女性骨质疏松的患病率高于绝经前（P<0.01）。Pearson 相关分析显示,绝经前后女性的骨强度均与肌肉组织体成分正相关（P<0.01）,与脂肪组织体成分负相关（P<0.01）。多元线性逐步回归分析显示,四肢肌肉量是东乡族女性骨强度的保护性因素,皮下脂肪含量是骨强度下降的危险因素。 结论 肌肉以及脂肪组织共同决定着东乡族女性的骨强度且与体成分分布部位有关,但两者的关系不受绝经状态的影响。绝经是东乡族女性骨质疏松发生的重要影响因素,应加强绝经后女性骨质疏松的防控。加强肢体锻炼,增加四肢肌肉量,减少皮下脂肪,有助于提高东乡族绝经前、后女性骨强度,预防骨质疏松。     

绝经后妇女骨质疏松患者外周血NLR、PLR水平与骨密度的相关性分析

目的:探讨绝经后妇女骨质疏松患者外周血中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)水平与骨密度(BMD)的相关性.方法:选取2018年4月至2020年9月在本院采用双能X线吸收法(DXA)进行BMD检查的166例绝经后妇女为研究对象,依据BMD检查结果将研究对象分为三组:对照组(60例)、骨量减少组(55例)、骨质疏松组(51例).BMD采用双能X线骨密度测定仪进行测定;采用日本Sysmex XE-2100型全自动血细胞分析仪进行血常规检查,计算两组外周血NLR、PLR水平并进行比较;采用Pearson分析外周血NLR、PLR水平与BMD的相关性;采用多因素Logistic回归模型分析绝经后妇女发生骨质疏松的影响因素.结果:对照组、骨量减少组、骨质疏松组腰椎、髋部BMD均依次降低(P<0.05),中性粒细胞、血小板、NLR、PLR均依次升高(P<0.05);Pearson相关分析结果显示,骨质疏松组外周血NLR、PLR水平与腰椎、髋部BMD均呈负相关(P<0.05);多因素Logistic回归分析结果显示,年龄、NLR、PLR均是绝经后妇女发生骨质疏松的危险因素(P<0.05),BMI是保护因素(P<0.05).结论:与绝经后妇女骨量正常者相比,绝经后妇女骨质疏松患者外周血NLR、PLR水平较高,与骨质疏松的发生、发展密切相关,年龄、NLR、PLR均是绝经后妇女发生骨质疏松的危险因素,BMI是保护因素,可能为预防、诊断及治疗绝经后妇女骨质疏松提供参考.     

健康绝经妇女体成分差异对跟骨骨密度的影响

目的探讨锦州市健康绝经妇女身体质量指数(BMI)、左下肢肌肉含量及脂肪含量等身体组成成分与左侧跟骨骨密度(BMD)的关系。方法使用体成分仪及骨密度仪测量421例健康绝经妇女的体成分和左侧跟骨骨密度。结论左侧跟骨BMD与年龄呈负相关,与左下肢肌肉量、BMI呈正相关关系,而与左下肢脂肪量没有相关性。结论 BMI是影响绝经妇女BMD的重要因素,加强运动、增加身体肌肉含量对预防骨质疏松有重要作用。     

PMO患者血清E2、IL-6及IGF-Ⅰ水平的临床观察

目的：通过观察绝经后骨质疏松症（PMO）患者血清E2、IL-6及IGF-Ⅰ含量的变化，探讨E2、IL-6及IGF-Ⅰ在绝经后骨质疏松症发病机理中的作用。方法：根据腰椎骨密度（BMD）扫描结果，将受试者分为三组，即绝经后骨质疏松组32例、绝经后非骨质疏松组30例、绝经前健康组30例。采用放免法测定血清IL-6、BGP、IGF-Ⅰ水平，用化学发光免疫分析法测定血清E2水平，同时测定血清P、Ca、AKP水平。结果：绝经后妇女血清IL-6水平高于绝经前妇女，骨质疏松组又高于非骨质疏松组。IL-6与BMD、E2呈负相关关系（r分别为-0．587、-0．438，P〈0．05），与BGP呈正相关关系（r=0．545，P〈0．05）。绝经后妇女IGF-Ⅰ含量降低，骨质疏松组IGF-Ⅰ含量最低。IGF-Ⅰ与BMD、E2呈显著正相关关系（相关系数r分别为0．569、0．433，P〈0．01），与年龄呈显著负相关关系（r=-0．538，P〈0．01）。结论：绝经后骨质疏松为高转换率骨质疏松，IL-6高表达与骨质疏松症发病以及雌激素减少有关，雌激素水平下降可导致IL-6分泌的增多。体内雌激素还有助于维持IGF-Ⅰ的水平，绝经后骨质疏松患者体内IGF-Ⅰ水平明显下降。IL-6分泌增多、IGF-Ⅰ水平下降均可以导致骨吸收超过骨形成，引起骨丢失和骨质疏松症的发生。因此，IL-6、IGF-Ⅰ可作为一种预测骨质疏松症发病的检测手段。合理应用雌激素、IGF-Ⅰ可预防绝经后骨质疏松症的发生。     

细胞整合素与骨质疏松性骨丢失

老年人尤其是绝经后妇女骨量的快速丢失所造成的低骨量，是骨质疏松及骨质疏松性骨折发生的最重要因素。本文综述了近年来破骨细胞粘附及其整合素在破骨细胞功能调控中的作用方面的研究进展，并对临床应用前景进行了展望。     

运动疗法治疗绝经后妇女骨质疏松症的荟萃分析

背景：运动疗法对预防绝经后妇女骨丢失的价值尚存在争议。 目的：评价运动疗法治疗绝经后妇女骨质疏松症的疗效。 方法：计算机检索PubMed,Embase,Cochrane Library,CBM,CNKI,VIP数据库关于运动疗法治疗绝经后妇女骨质疏松症的随机对照试验。纳入健康的绝经后妇女,种族、国籍、地域不限,年龄在50~70岁之间。排除合并有基础疾病的患者。采用Cochrane协作组提供的Revman 5.0软件进行统计分析。临床评价指标包括骨矿物质密度和骨折发生率。 结果与结论：共纳入9篇随机对照试验,Meta分析结果显示：与常规治疗比较,运动疗法联合常规治疗可明显提高绝经后妇女骨矿物质密度[WMD=0.96,95%CI (0.47,1.44),P < 0.05],但对其骨折发生率影响不明显(P > 0.05)。提示运动疗法可以增加绝经后妇女骨质疏松症的骨矿物质密度,但并不能减低骨折的发生率。     

The prevalence of osteoporosis in the Hong Kong Chinese female population

Objectives: This paper aims to present population-based age-related bone mass values in the Hong Kong Chinese female population, and to assess the number and proportion of Chinese women considered osteoporotic according to the WHO diagnostic guidelines. Methods: A total of 769 community-based female subjects were recruited. Social demographic characteristics of these subjects were similar to the Hong Kong general population. All bone mass measurements were performed by means of a dual energy X-ray densitometry (Norland XR 26) at two sites: lumbar vertebrae L2–L4 and left hip. These values were expressed as T-scores, with reference to the mean bone mineral density (BMD) values of the group aged 21–40 years. Results: The study revealed that, in women aged 60 years and above, their mean BMD values are 30% lower than the young normal mean. The prevalence of osteoporosis at the spine increased dramatically from about 10% in the age group 50–59 to 45% in the group aged 60–69. In women aged 70 onwards, over half have osteoporosis at the hip. The prevalence of osteoporosis at the spine is relatively stable in the age groups above 60, while that for osteoporosis at the hip increased exponentially with age. Conclusions: The prevalence of osteoporosis in Hong Kong women is comparable to that found in Caucasian populations. Prevention of osteoporosis, involving both immediate and long-term measures, and targeting at different age groups, are required to combat this serious public health problem in Hong Kong.     

Does long-term swimming participation have a deleterious effect on the adult female skeleton?

Swimming is a popular activity for Australian women with proven cardiovascular benefits yet lacks the features thought necessary to stimulate positive adaptive changes in bone. Given that peak bone mass is attained close to the end of the second decade, we asked whether swimming was negatively associated with bone mineral density in premenopausal women beyond this age. Bone mass and retrospective physical activity data were gathered from 43 female swimmers and 44 controls (mean ages 40.4 and 43.8 years, respectively). Swimmers were recruited from the Australian Union of Senior Swimmers International while controls were healthy community dwellers with similar lean mass, fat mass, height, weight and body mass index. None of the participants had a history of medical complaints nor use of medications known to affect bone. Dual energy X-ray absorptiometry was used to determine areal bone mineral density at total body, lumbar spine, proximal femur, distal radius and tibia while self-administered questionnaires were used to approximate historical and recent physical activity and calcium intake. Swimmers had averaged over 2 hours of swimming per week for the past 5 years and 1.45 h/week over lifetime with no systematic swimming exposure for controls. Lifetime exposure to weight bearing and impact exercise were similar. There were no intergroup differences for bone mass at any site though controls had higher incidence of low bone mass/osteoporosis. No differences in bone mass were detected between swimmers in the upper and lower quartiles for swim participation for any period. Long-term swim participation did not compromise areal bone mineral density.     

Osteoporosis in women with anorexia nervosa

Because estrogen deficiency predisposes to osteoporosis, we assessed the skeletal mass of women with anorexia nervosa, using direct photon absorptiometry to measure radial bone density in 18 anorectic women and 28 normal controls. The patients with anorexia had significantly reduced mean bone density as compared with the controls (0.64 +/- 0.06 vs. 0.72 +/- 0.04 g per square centimeter, P less than 0.001). Vertebral compression fractures developed in two patients, and bone biopsy in one of them demonstrated osteoporosis. Bone density in the patients was not related to the estradiol level (r = 0.02). Levels of parathyroid hormone, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D were normal despite low calcium intakes. The patients with anorexia who reported a high physical activity level had a greater bone density than the patients who were less active (P less than 0.001); this difference could not be accounted for by differences in age, relative weight, duration of illness, or serum estradiol levels. The bone density of physically active patients did not differ from that of active or sedentary controls. We conclude that women with anorexia nervosa have a reduced bone mass due to osteoporosis, but that a high level of physical activity may protect their skeletons.     

中老年女性骨代谢指标与骨质疏松的相关性研究

目的 分析骨代谢指标与骨质疏松的关系,为骨质疏松的防治提供流行病学依据。方法 采取随机分层抽样方法,选取2018年1月~5月来我院健康体检的30~90岁的成年女性400名。采用双能X线吸收测量仪（DEXA）测量腰椎及左侧股骨骨密度,由调查人员对所有体检对象进行问卷调查,同时收集清晨空腹血检测血常规、肝肾功、骨吸收指标TRAP-5b、CTX、 N-MID及骨形成指标BAP、PⅠNP等资料,进行统计学分析。结果 ①我院30岁以上女性骨质疏松的检出率为55.28%;②骨质疏松人群平均年龄为（63.54±9.40）岁,大于骨量减少人群的（49.42±9.51）岁和骨量正常人群的（44.14±6.71）岁,差异有统计学意义（P＜0.05）;年龄与骨密度存在相关性;③骨质疏松人群TRAP-5b、CTX、BAP水平大于骨量减少和骨量正常人群,均与骨密度存在相关性;N-MID、PⅠNP在骨质疏松人群、骨量减少和骨量正常人群中比较,差异无统计学意义（P＞0.05）,与骨密度无相关性;④年龄升高是骨质疏松的危险因素,而超重和肥胖可能是骨质疏松的保护因素。⑤以年龄＞55岁来预测骨质疏松的敏感性和特异性分别为82.52%,81.48%;而以BAP＞17.7 μg/L来预测骨质疏松的敏感性和特异性分别为53.84%,73.65%。结论 中老年女性骨质疏松的检出率较高,年龄升高是骨质疏松的危险因素,骨密度与骨代谢指标TRAP-5b、CTX、BAP呈负相关。     

Acceptability of pharmacy-based bone density measurement by women and primary healthcare providers

OBJECTIVES: To assess women's information sources regarding, and monetary value placed on, pharmacy-based bone density screening. In addition, we evaluated clinicians' response to peripheral bone mass measurements. DESIGN: We recruited 197 women 50 years of age or older in four rural Midwestern community pharmacies. Each woman completed a questionnaire and underwent calcaneal bone density testing. Results were sent to participants' primary care providers. These providers, and others practicing within a 50-mile radius, were surveyed anonymously to evaluate usefulness of bone density data provided by this program or pharmacy-based osteoporosis screening in general. In addition, clinicians were asked how they would manage a woman with a calcaneal T-score of -1.3. RESULTS: Fifty-six percent of participants [95% CI, 49%-63%] became interested in screening through the media, and only 6% (CI, 3%-9%) became interested through contact with their primary care provider. Women were willing to pay a median of $25 for screening. Of 18 responding clinicians with patients in this study, 72% (CI, 47%-90%) found the results useful. Of the 67 responding clinicians, 51% (CI, 39%-63%) supported pharmacy-based bone mass measurement. For a case scenario of a woman with a calcaneal T-score of -1.3, 57% (CI, 46%-68%) of clinicians indicated that they would have ordered central dual-energy x-ray absorptiometry, and 20% (CI, 11%-29%) would have prescribed antiresorptive therapy. CONCLUSIONS: This study suggests that (1) women are an important force in obtaining bone density testing outside the clinic setting, both by self-education and willingness to pay, and (2) primary care clinicians receiving such results find them useful and indicate willingness to use them in decision-making.     

西藏藏族成人体成分与骨量异常的相关性

目的探讨西藏藏族成人骨强度指数的变化特点,并分析骨量异常与体成分的相关性。方法抽取西藏藏族自治区日喀则市藏族成人560例,采用生物电阻抗分析仪及超声骨密度仪分别测量被研究者体成分各指标及右足跟骨骨强度指数、T值等,采用非条件Logistic回归法分析骨量异常与体成分间的关系。结果西藏藏族男女性成人骨强度指数均在18~30岁达到峰值,之后随年龄增长而下降;50岁以上男女性骨质疏松症检出率分别为7.6%及11.7%;Binary Logistic回归分析显示,年龄(B=0.046,OR=1.047,P0.01)、内脏脂肪量(B=0.452,OR=1.572,P0.05)是西藏藏族成人发生骨量异常的危险因素,而皮下脂肪含量(B=-0.181,OR=0.835,P0.01)及肌肉量(B=-0.055,OR=0.947,P0.05)是骨量异常的保护性因素,腰臀比与骨量异常无相关性。结论西藏藏族50岁以上人群骨质疏松症发病率相对国内其他报道的民族同龄人群较低;内脏脂肪量越高、皮下脂肪量及肌肉量越低者,发生骨量下降及骨质疏松症的危险性越高。     

Hormone replacement therapy and bone mineral density: a co-twin approach

OBJECTIVE: Our objective was to estimate the difference in bone mass at clinically relevant sites within female twin pairs who were discordant for use of hormone replacement therapy (HRT). METHODS: We studied 46 female twin pairs who were discordant for HRT use. Bone mineral content and density were measured at the lumbar spine, total hip, femoral neck, 13 total forearm, and the total body. HRT use, calcium intake, physical activity, alcohol intake, and lifetime smoking were determined by questionnaire. RESULTS: Within a pair, lumbar spine bone mineral density was significantly greater in past and current HRT users compared with nonusers (6.2% +/- 2.0%; P = 0.006). In those pairs who were currently using HRT, the within-pair difference in lumbar spine bone density was 7.8% +/- 2.1% (P = 0.002), and a significant within-pair difference in forearm bone density (5.1 +/- 2.1%; P = 0.02) was apparent. A significant difference (4.6%; P = 0.03) was observed in total body bone mineral content when an adjustment was made for age, lean mass, fat mass, and height. CONCLUSIONS: In keeping with randomized clinical trial findings, these results indicate that HRT in routine clinical use protects significantly against menopausal bone loss at the lumbar spine and the forearm. Our results also quantify the magnitude of the benefit of HRT on bone density that might be anticipated in clinical practice.     

Osteoporosis screening is unjustifiably low in older African-American women

BACKGROUND: More than one million Americans suffer osteoporotic fractures yearly, resulting in a marked increase in morbidity and mortality. Despite a decrease in bone mineral density with increasing age in all ethnic groups and both genders, preventative and therapeutics efforts in osteoporosis have been focused on caucasian and Asian women. This study assesses the osteoporosis screening practices and the frequency of low bone density in a primarily African-American population of older women. METHODS: Medical records of 252 women at risk for osteoporosis were reviewed for the diagnosis of osteoporosis, prior osteoporosis screening, prior breast cancer screening, and the use of calcium, vitamin D or estrogen. Subsequently, 128 women were assessed for risk factors for osteoporosis, and their bone mineral density was measured using a peripheral bone densitometer. RESULTS: Osteoporosis screening had been performed in 11.5% of the subjects. Of the women evaluated by peripheral bone densitometry, 44.5% of all women, 40.4% of African-American women, and 53.3% of caucasian women had abnormally low bone density measurements. The frequency of abnormal bone density increased with both increasing age and decreasing body mass index. CONCLUSIONS: Although few women in this population were previously screened for osteoporosis, low bone density occurred in African-American women at substantial rates. Increasing age and low body mass are important risk factors for low bone density in African-American women. Ethnicity should not be used as an exclusion criterion for screening for osteoporosis.     

女性2型糖尿病患者的骨密度变化

目的：探讨女性2型糖尿病与骨质疏松的关系。方法：应用双能X线骨密度仪（DEXA）对56例女性2型糖尿病患者及52例女性健康对照者进行骨密度（BMD）测定,并测定糖尿病患者的空腹胰岛素及餐后2h胰岛素（2h Ins）水平,结合病程、年龄等相关因素进行分析。结果：52例健康对照组中低骨量8例,骨质疏松5例,骨密度减低的发生率为25%;56例2型糖尿病患者中,低骨量16例,骨质疏松23例,骨密度减低的发生率为69.7%,明显高于对照组,差异有显著性（P〈0.01,χ^2=21.524）,骨密度减低者胰岛素水平相对更低。结论：女性2型糖尿病患者的骨质疏松发生率高,且与年龄、病程、胰岛素水平相关。     

上海市高知女性跟骨骨密度测定：197个结果分析

背景：研究表明,女性骨峰值低于男性,而不同地区人群骨矿含量存在差异,因此有必要建立各地区不同人群的峰值骨密度。 目的：调查上海市高知女性骨密度随年龄、体质量指数等变化规律。 方法：纳入27~62岁高知女性受试者共197例,5岁为一个年龄段,共分为7组。准确记录各组受试者年龄,身高及体质量,并采用超声波骨密度仪测定各组受试者跟骨骨密度。用逐步回归分析各组骨峰值与年龄、体质量和握力的相关性。 结果与结论：研究结果显示上海市女性骨量峰值出现在38~39岁年龄段。骨密度值的下降率在31~35岁和41~45岁下降幅度最大。逐步回归分析结果显示,上海高知女性骨峰值与年龄、体质量、握力成正相关,年龄对骨峰值的影响最为明显,峰值骨量越低或出现越早,发生骨质疏松的危险越大。结果表明上海市高知女性群体发生骨质疏松的危险性较大。