入住疗养院者骨质疏松患病及防治状况研究

目的：探讨美国圣路易斯州入住疗养院者骨质疏松的患者及防治状况。方法：用定量超声骨密度测定仪测定217例入住疗养院者（年龄42－102岁，平均83．3岁）右侧跟骨的骨密度，结合病史及病历记录情况，对入住疗养院者骨质疏松防治状况进行。结果：入住疗养院者的骨密度低于同年龄段的社会居民，骨质疏松的患病率较高（58．5％），只有18．4％的疗养院入住者跟骨骨密度在青年成人骨密度均值1个标准差内，未诊断的骨质疏松占83．5％，未治疗骨质疏松占63．0％，只有37．0％的骨质疏松患者服用钙剂及／或维生素D治疗，用雌激素替代或用阿伦二膦酸盐积极治疗的仅有3．1％，结论：疗养院入住者骨密度低，骨质疏松患病率高，但防治状况差。     

成都地区普通人群骨密度与骨质疏松流行现状分析

目的了解成都地区普通人群的超声骨密度水平和骨质疏松的流行现状,为本地区人群骨质疏松的防治提供依据。方法采用定量超声骨密度仪对9111名健康体检者的跟骨超声声速值(SOS)进行测定,同时测量记录受检者的年龄、身高、体重,并进行统计分析。结果①男、女性的跟骨超声声速值(SOS)随年龄的增长而降低,50岁以上各年龄组男性的跟骨SOS值均明显高于女性(P<0.05);②男性骨质疏松患病率为3.5%,女性骨质疏松患病率为14.7%。除20～29岁组外,女性各年龄段的骨质疏松患病率均高于男性;③骨质疏松组的BMI值明显低于非骨质疏松组,BMI<18.5的男性的骨质疏松患病率明显高于BMI≥18.5的男性(P<0.05);④绝经是女性骨质疏松的重要危险因素,绝经女性发生骨质疏松的危险是非绝经女性的2.8倍。结论成都地区普通人群男性和女性的骨密度变化规律和骨质疏松流行水平存在差异,低体重指数的男性和围绝经期女性是骨质疏松的重点防治对象,应定期监测骨密度,早期预防。     

中老年人腰椎骨密度变化的临床观察

目的了解中老年人随着年龄增长骨密度变化规律及骨量减少和骨质疏松患病率。方法用双能X线骨密度测定仪测量40岁以上人群正位腰椎骨密度2 325例,按年龄、性别分组统计。结果男女骨密度值均随年龄增加而逐渐降低。中老年男性骨量减少患病率为42.2%,骨质疏松为37.3%;中老年女性骨量减少为19.8%,骨质疏松为66.5%;50岁以后女性骨质疏松患病率显著高于男性(P<0.05),男性骨量减少患病率显著高于女性(P<0.05)。老年男性骨质疏松患病率为42.3%,女性为79.7%,老年女性骨质疏松患病率显著高于老年男性(P<0.05)。结论随着年龄增长,骨质疏松患病率逐年增加,女性比男性更易患骨质疏松,低骨量是导致骨质疏松骨折的一个重要危险因素。     

维生素D受体基因型多态性与绝经前后妇女的骨密度

【目的】观察维生素D受体 (VDR)基因型与女性峰值骨密度以及绝经后骨质疏松的关系。【方法】收集 184例妇女 ,其中绝经后无骨折妇女 78例、绝经后有脆性骨折的病人 34例、围绝经期妇女 2 0例和年轻健康妇女 5 2例 ,用双能X线吸收骨密度仪 (DEXA)测量其骨密度 ,聚合酶链反应 限制性片段长度多态 (PCR RFLP)的方法来分析维生素D受体基因型。【结果】 184例妇女中 ,基因型BB、Bb和bb所占比例分别为 7 6 % (14/184)、45 1% (83/184)和 47 2 % (87/184) ;年轻健康妇女各基因型的峰值骨密度无明显差别 ;绝经后妇女各基因型的骨密度和骨质疏松的百分比也无明显差异。【结论】维生素D受体基因型与女性峰值骨密度和绝经后骨质疏松无明显联系。     

定量超声测定法筛查广州市萝岗区健康人群骨质疏松患病率

目的 通过定量超声测定法,筛查出萝岗区健康人群骨量减少、骨质疏松的患病率,并进行分析,为骨质疏松的治疗提供依据.方法 采用美国进口的跟骨定量超声测定仪,对萝岗区1 717例健康人进行跟骨骨密度测定,对测定结果分性别、年龄进行分析,分别计算女性和男性骨质疏松、骨量减少的患病率.结果 男性、女性骨量减少、骨质疏松的患病率分别为36.23%、29.34%和10.91%、7.06%.结论 定量超声测定法可作为健康人群普查骨质疏松的一种方法,有助于提高其早期诊断,为早期治疗提供依据.     

赤峰地区4633例成年人骨质疏松患病率调查

目的:调查赤峰地区成年人骨质疏松症(OP)患病率变化规律,为OP的预防和治疗提供科学依据。方法:对赤峰市4 633例成年人采取美国Lunar公司生产的Dpx Bravo型骨密度仪,检测腰椎、股骨颈及大粗隆处骨密度(BMD),对测定结果分性别、年龄段进行分析,比较各年龄段女性和男性骨量减少及骨质疏松的患病率。结果:赤峰地区骨量减少总患病率为39.30%,其中男性为39.46%,女性为39.21%,两者相比差异无统计学意义,在36~50岁以及75岁以上年龄组男性骨量减少的发生率高于女性(P<0.05)。骨质疏松总患病率为15.43%,其中男性为5.31%,女性为21.58%,两者相比差异有统计学意义(P<0.05)。50岁以后骨质疏松的患病率呈逐年增加趋势,其中女性50岁以后骨质疏松的患病率以大于5%的速度增长,且女性50岁以后骨质疏松的患病率明显高于同年龄组的男性(P<0.05)。结论:①中老年女性骨质疏松的患病率远高于男性,绝经后及老年女性是骨质疏松的高发人群,早期进行骨密度筛查防治骨质疏松与骨折的发生是我们必须关注的公共健康问题。②男性骨质疏松往往被忽视,男性骨量减少及骨质疏松的患病率均不低,如何重视老年男性骨质疏松的预防也是值得我们关注的问题。     

SARS患者预后骨密度和骨结构变化的现况研究

【目的】探讨SARS患者预后骨密度和骨结构变化的影响因素。【方法】利用病历资料调查患者治疗期间的糖皮质激素用法 ,在患者出院 3m后应用间接免疫荧光法 (IFA)测定血清特异抗体IgG ,应用定量超声(QUS)测定患者的骨密度和骨结构变化情况 ,统计分析采用协方差分析。【结果】 4 0例SARS患者中出现骨质疏松 2例 ,骨密度减低 30例 ,正常 8例。骨密度的影响因素有年龄、冲击疗法和糖皮质激素总量 ;骨结构和骨弹性的影响因素有冲击疗法、冲击疗法持续的天数 ;血清特异抗体IgG与患者预后出现的骨质疏松在统计学上无联系。【结论】SARS患者骨质破坏的发病率很高 ,骨密度的减低、骨结构的变化主要与年龄、激素剂量有关 ,和SARS病毒可能没有关系。     

老年人群骨质疏松症患病率及相关危险因素调查研究

目的调查老年人群骨质疏松症（OP）患病率及相关危险因素,为本地区OP的防治提供参考。方法采用x线骨密度仪（DEXA）,对患者腰椎及左侧股骨近端的骨密度（BMD）进行测定;同时用超声测量跟骨骨密度。并对骨质疏松高危因素进行问卷调查,采用偏相关分析,对各个因素与骨密度之间的相关性进行分析。结果男、女性骨质疏松症患病率均随年龄的增加而逐渐升高,且在66岁-70岁、71岁-75岁、76岁-81岁3个年龄段,男女患病率差异有统计学意义（均P〈0．05）;Spearman相关分析结果提示,年龄、性别、体重指数（BMI）、合并病史、是否服用钙剂、是否服用维生素D、生活行为方式与跟骨骨密度呈一定相关性,其中年龄为负相关。结论影响老年OP患病率的因素较多,患者应合理适当饮食,加强室外运动,保持正常体重,提高预后质量。     

亚高原地区正常人群骨密度检测结果分析

目的 探讨高原地区正常人群骨密度异常情况.方法 使用美国产的Achilles Insight 型超声跟骨骨密度检测仪对2397名健康体检者进行测定.结果 正常健康体检者中骨密度结果异常者占半数,且高于内地有关报道.结论 40岁以上人群骨质减少、骨质疏松发生率较高,是预防治疗的主要人群.     

835例成年女性骨密度测量结果分析

目的：探讨成年女性骨密度变化的特点及其与骨质疏松的关系。方法：用UBIS5000型超声跟骨质量测定仪测量835例成年女性跟骨密度。结果：成年女性骨峰值在40～49岁，50岁以后骨密度明显下降；女性在50岁以后骨量减少、60岁以后骨质疏松的发生率明显增加，70岁以后骨质疏松的发生率增加得更为明显；50岁以前骨质疏松发生率虽然较低，但有12％—21％的成年女性处于骨量减少状态。结论：女性骨质疏松主要发生在绝经后并随绝经后时间延长发生率增加。女性骨质疏松的防治应从绝经过渡期开始。     

Low bone mineral density and risk of fracture in white female nursing home residents

CONTEXT: Low bone mineral density (BMD) is a strong risk factor for fracture in community-dwelling white women, but the relationship in white female nursing home residents, for whom fracture rates are highest, is less clear. OBJECTIVE: To assess the relative contribution of low BMD to fracture risk in nursing home residents. DESIGN: Prospective cohort study with baseline data collected April 1995 to June 1997, with 18 months of follow-up. SETTING: Forty-seven randomly selected nursing homes in Maryland. PATIENTS: A total of 1427 white female nursing home residents aged 65 years or older. MAIN OUTCOME MEASURE: Documented osteoporotic fracture occurring during follow-up as a function of baseline BMD measurements higher vs lower than the median, and after controlling for demographic, functional, cognitive, psychosocial, and medical factors. RESULTS: A total of 223 osteoporotic fractures occurred among 180 women. Low BMD and transfer independence were significant independent risk factors for fracture in this nursing home sample (P<.001) and the 2 factors acted synergistically (P =.06) to further increase fracture risk. Compared with women whose BMD was higher than the median (0. 296 g/cm(2)), those whose BMD was lower than the median had an unadjusted hazard ratio for risk of fracture of 2.1 (95% confidence interval [CI], 1.5-2.8); women who were independent in transfer had a hazard ratio of 1.6 (95% CI, 1.2-2.2) compared with women dependent in transfer. Among residents independent in transfer, those with BMD below the median had a more than 3-fold increase in fracture risk compared with those with higher BMD (unadjusted hazard ratio, 3.1; 95% CI, 2.2-4.4). Among residents dependent in transfer, those with BMD below the median had a 60% increase in fracture risk (unadjusted hazard ratio, 1.6; 95% CI, 1.1-2.3). Adjustment for covariates did not alter the BMD-fracture relationship. CONCLUSIONS: Our data indicate that low BMD and independence in transfer are significant predictors of osteoporotic fracture in white female nursing home residents. JAMA. 2000;284:972-977     

Cognitive and behavioural impairment among elderly people in institutions providing different levels of care.

OBJECTIVE: To compare the prevalence and degree of cognitive and behavioural impairment in elderly patients in institutions providing different levels of care. DESIGN: Prevalence study. SETTING: A nursing home, a home for the aged and psychogeriatric wards in a provincial psychiatric hospital. PATIENTS: Only subjects 65 years of age or older were eligible for inclusion. A random sample was selected comprising 25% of the residents in the nursing home and the home for the aged; of the 119 asked to participate 95 agreed (44 in the nursing home and 51 in the home for the aged). All 50 on the psychogeriatric wards agreed to participate. MAIN OUTCOME MEASURES: The Mini-Mental State Examination (MMSE) and the Kingston Dementia Rating Scale (KDRS). RESULTS: An MMSE score of less than 24 (cognitive impairment) was given to 37 (84%) of the residents in the nursing home, 43 (84%) of those in the home for the aged and 48 (96%) of the patients in the psychiatric hospital; the corresponding numbers for a KDRS score of more than 0 (cognitive impairment) were 41 (93%), 48 (94%) and 50 (100%). The seven patients receiving the highest level of care at the home for the aged (special care) had more behavioural problems than those in the psychiatric hospital did (p less than 0.001). CONCLUSIONS: Cognitive and behavioural impairment was widespread in the three institutions regardless of the level of care. When planning services and allocating resources government funding agencies should consider the degree and prevalence of such impairment among elderly people in institutions.     

Potential roles for quantitative ultrasound in the management of osteoporosis

OBJECTIVE: To assess the validity of four models for the role of quantitative ultrasound (QUS) in the management of osteoporosis. DESIGN: Cross-sectional survey and review of literature. SETTINGS: Nuclear medicine departments of three teaching hospitals in Sydney. SUBJECTS: 1000 women aged 22 to 88 years (mean, 59 years) referred for assessment of osteoporotic fracture risk. MAIN OUTCOME MEASURES: BMD categories as defined by dual-energy x-ray absorptiometry (DEXA) of the lumbar spine and proximal femur, and QUS category as defined by calcaneal ultrasound stiffness; prevalence of DEXA-defined osteoporosis in the different QUS categories. RESULTS: In women with QUS Achilles stiffness < or = 70 the prevalence of axial osteoporosis was 51%, whereas in the group with stiffness > 70 the prevalence of axial osteoporosis was 8%. In women 65 years and over the corresponding values were 59% and 17%. CONCLUSIONS: Of the four possible models for QUS, the use of QUS for the estimation of BMD, or in a "standalone" model, can not be recommended at the current time. The model of QUS as a "prescreening" modality may be acceptable assuming adequate education of clinicians and patients of its limitations, particularly the risk of false negatives. The model of QUS as one factor in a composite risk factor assessment of patients is promising but more data are required.     

Cross sectional study of osteoporosis among women

Osteoporosis is a major public health problem, associated with substantial morbidity and socio-economic burden. An early detection can help in reducing the fracture rates and overall socio-economic burden. The present study was carried out to screen the bone status (osteopenia and osteoporosis) above the age of 35 yrs in the women. A community based cross sectional study was carried out in 158 women by calculating WHO T-scores utilizing calcaneal QUS as diagnostic tool. The prevalence of osteoporosis and osteopenia was found to be 13.3% ± 5.29% and 48.1% ± 7.79% respectively. Statistical association of prevalence of osteopenia and osteoporosis was found to be significant with age group; gravida status; attainment of menopause; body weight and physically active status of the women. The statistical association was not significant in relation to the rank status of their husband, as well as dietary pattern of the women but still it has to be substantiated by conducting larger community based trials in future.The present study found that there was statistically significant relationship between age group and the prevalence of osteopenia and osteoporosis. There was a negative correlation between age of the women and BMD. Besides age, gravida status and menopausal status have negative correlation with BMD while positive correlation with physically active lifestyle. The results were found to be non-significant in relation to rank status of husband and dietary pattern.     

Spontaneous fractures in nursing home residents.

OBJECTIVES: To evaluate spontaneous long bone fractures occurring in nursing home residents and to identify what factors put them at risk for fractures. DESIGN: Retrospective study. SETTING: Department of Orthopaedics and Traumatology of a pubic hospital in Hong Kong. PATIENTS: A total of 30 nursing home residents who developed spontaneous long bone fractures between 1994 and 2005 were reviewed. MAIN OUTCOME MEASURES: Demographic data, mechanism of injury, pattern of fractures, associated risk factors, complications, outcomes, and post-treatment status. RESULTS: The mean age of patients was 84 years. Co-morbidities were as follows: 22 patients were bedridden, 21 required long-term feeding by Ryle's tube, 19 had a history of cerebrovascular accident and 18 of whom had a long bone fracture on the side of the hemiplegia, 15 had dementia, and 25 had lower limb contractures. Closed supracondylar fractures of the femur occurred in 23 patients, 17 of whom presented with limb deformity. In 21 patients, fractures were treated successfully with hinged braces. In one patient, the fracture changed from closed to open. In five patients, the fractures were complicated by sacrum or heel sores, and in one by infected nonunion. In 28 patients, the fractures eventually healed without further complications. Three formerly bedridden patients were able to sit after their fractures had been treated. CONCLUSIONS: Female nursing home residents who require long-term Ryle's tube feeding, have dementia, hemiplegia, lower limb contractures, osteoporosis, or are bedridden, are at high risk for spontaneous fractures.     

Performance of clinical referral criteria for bone densitometry in patients under 65 years of age assessed by spine bone mineral density

Background: A case finding strategy based on a number of established risk factors has been suggested by Royal College of Physicians'' (RCP) guidelines to optimise bone densitometry referrals for assessment of osteoporosis. Objective: The performance of clinical referral criteria was examined in women and men aged <65 years referred for bone mineral density (BMD) assessment. Study design: Cross sectional observational study over six months. Results: Though BMD tended to be lower in patients with multiple criteria for referral, differences from those referred with a single criterion were not statistically significant. The overall prevalence of osteoporosis was higher than expected in both sexes, 11.6% in women and 27.5% in men (expected prevalences were 8% and <1% respectively). BMD was significantly lower in patients referred with a single criterion compatible with the RCP guidelines than in age matched controls or in those patients referred with non-RCP criteria (mean (SD) Z score –0.47(1.38) v 0.35(1.41), p<0.001). Low body mass index was also significantly associated with a lower than expected BMD. In contrast, spine BMD was higher than expected in those with self reported back pain, loss of height, or spinal curvature (p = NS). Conclusion: Most of the criteria recommended by the RCP performed well in identifying relatively younger patients with low BMD and osteoporosis. However, prior fractures and corticosteroid use did not reach statistical significance probably due to inclusion of all energy fractures, and current or past steroid use of unspecified dose or duration. Criteria like loss of height and/or spine curvature perform relatively poorly, reflecting the need for further investigation to better identify those needing BMD assessment.     

跟骨定量超声筛查老年女性膝骨性关节炎患者骨质疏松的相关性研究

目的 分析老年女性膝骨关节炎患者跟骨定量超声与双能X线吸收(DXA)骨密度测定结果之间的相关性。 方法 以101例老年女性膝骨关节炎患者为研究对象，根据年龄分为3组:﹤65岁38例，65～75岁48例，>75岁15例。均行跟骨定量超声与DXA骨密度检查，分析两者相关性；并以DXA T值评估结果为标准，分析跟骨定量超声相关指标BUA、SOS、T-score和SI对骨质疏松和骨密度降低的诊断效能。 结果 >75岁患者的DXA平均T值明显低于﹤65岁患者和65～75岁患者，组间差异有统计学意义(P<0.05)；65～75岁患者的BUA、T-score、SI明显低于﹤65岁患者，>75岁患者的BUA、T-score、SI明显低于65～75岁患者，组间差异有统计学意义(P<0.05)。BUA值、T-score、SI与DXA T值具有良好的正相关性(R2=0.3154、0.3207，P<0.05)，三者对骨质疏松和骨密度下降均有良好的诊断效能。BUA值、T-score、SI诊断骨质疏松的最佳工作点分别为:BUA=55.205 dB/MHZ，T-score=-2.47，SI=65.635；诊断骨密度降低的最佳工作点分别为:BUA=60.725 dB/MHZ，T-score=-1.605，SI=79.196。 结论 跟骨定量超声结果BUA和T-score与老年女性膝骨关节炎患者骨密度密切相关，对骨质疏松具有预测作用，有望成为其临床筛查工具。      

Bone mineral density in premenopausal women receiving long-term physiological doses of levothyroxine

Total body and regional bone mineral density (BMD) levels were determined in 26 premenopausal women with Hashimoto's thyroiditis receiving long-term physiological doses of levothyroxine sodium replacement therapy. The BMD levels of each patient were compared with the mean of the BMD levels of age-matched normal controls. The mean levothyroxine sodium dose was 111 +/- 6 micrograms/d, and the mean duration of treatment was 7.5 +/- 5.3 years (range, 1 to 24 years). Dietary calcium intake was similar in both groups, as were serum thyroxine, triiodothyronine, free thyroxine index, and thyrotropin levels. Women receiving the levothyroxine treatment had normal total body BMD levels but had significantly lower BMD levels at the femoral neck (-5.7%), femoral trochanter (-7.0%), Ward's triangle (-10.6%), both arms (right, -7.8%; left, -8.9%), and pelvis (-4.9%). In contrast, lumbar spine BMD levels were similar in the two groups. There was no correlation between the total body or different regional BMD levels and the duration or dosage of levothyroxine treatment or thyroid function test results. However, the z score of the femoral neck of these patients showed a significant negative correlation with their serum free thyroxine index levels. We conclude that patients receiving physiological doses of levothyroxine may have decreased bone density. Thyroid functions in patients receiving long-term levothyroxine treatment should be closely monitored and bone densitometry should be performed in patients at risk for osteoporosis.     

温肾补脾法合推拿治疗老年性骨质疏松症

目的:观察温肾补脾汤配合轻手法推拿治疗老年性骨质疏松症的临床疗效.方法:对150例符合诊断标准的老年骨质疏松症分治疗组90例,用温肾健脾汤合轻手法推拿治疗;对照组60例,用钙尔奇D片和维生素AD丸治疗,观察6个月.检测治疗前后跟骨BMD值变化、腰背痛程度、腰背痛改善率.结果:治疗组跟骨BMD平均上升3.33%,与治疗前比较,差异有显著性意义,对照组差异无统计学意义;两组跟骨BMD改善率比较,治疗组87.77%,对照组41.67%,两组比较差异有显著性意义(P<0.01).腰背痛改善率,治疗组83.33%,对照组45.00%,两组比较差异有显著性意义(P<0.01).疗程中,对照组骨痛改善分值下降,治疗组提高.结论:老年性骨质疏松症证属阴阳俱虚,以阳虚为主.温肾健脾汤配合轻手法推拿治疗能有效缓解骨质疏松症的临床症状,提高骨密度值.