Wrist fracture as a predictor of future fractures in younger versus older postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA)

Summary The short-term association between wrist-fracture history and future fracture has not been simultaneously compared between younger and older postmenopausal women. This 3-year follow-up study of 158,940 women showed a similar future fracture risk in younger and older women with wrist-fracture history. Introduction We examined the association between prior wrist fracture and future osteoporosis-related fractures within 3 years in younger and older postmenopausal women. Methods In the National Osteoporosis Risk Assessment (NORA) study, 158,940 postmenopausal women, aged 50-98 (median 63) years, provided information on fracture history since age 45, and responded to follow-up surveys 1 or 3 years later when new fractures were queried. Cox regression models were used to obtain relative risk (RR) and 95% confidence interval (CI) estimates. Results Of the 158,940 participants, 8,665 reported a history of wrist fracture at baseline; 4,316 women reported at least one new fracture within three years. The RR for any subsequent clinical fracture, adjusted for covariates and baseline BMD T-score, was 2.4 (2.0, 2.9) for younger and 2.1 (1.9, 2.3) for older women. A prior wrist fracture increased the risk of a future wrist fracture about 3-fold and doubled the risk of any osteoporotic fracture. Conclusions Prior wrist fracture strongly predicts three-year risk of any future osteoporotic fracture for older and younger postmenopausal women, independent of baseline BMD and common osteoporosis risk factors. More consideration should be given to evaluating and managing osteoporosis in younger and older women with a history of wrist fracture, independent of their BMD.     

Protective effect of green tea polyphenols on bone loss in middle-aged female rats

SUMMARY: Recent studies have suggested that green tea polyphenols (GTP) are promising agents for preventing bone loss in women. Findings that GTP supplementation resulted in increased urinary GTP concentrations and bone mass via an increase of antioxidant capacity and/or a decrease of oxidative stress damage suggest a significant role of GTP in bone health of women. INTRODUCTION: Recent studies suggested that green tea polyphenols (GTP) are promising agents for preventing bone loss in women. However, the mechanism related to the possible protective role of GTP in bone loss is not well understood. METHODS: This study evaluated bioavailability, mechanisms, bone mass, and safety of GTP in preventing bone loss in middle-aged rats without (sham, SH) and with ovariectomy (OVX). A 16-week study of 2 (SH vs. OVX) x 3 (no GTP, 0.1% GTP, and 0.5% GTP in drinking water) factorial design using 14-month-old female rats (n = 10/group) was performed. An additional 10 rats in baseline group were euthanized at the beginning of study to provide baseline parameters. RESULTS: There was no difference in femur bone mineral density between baseline and the SH+0.5% GTP group. Ovariectomy resulted in lower values for liver glutathione peroxidase activity, serum estradiol, and bone mineral density. GTP supplementation resulted in increased urinary epigallocatechin and epicatechin concentrations, liver glutathione peroxidase activity and femur bone mineral density, decreased urinary 8-hydroxy-2'-deoxyguanosine and urinary calcium levels, but no effect on serum estradiol and blood chemistry levels. CONCLUSION: We conclude that a bone-protective role of GTP may contribute to an increase of antioxidant capacity and/or a decrease of oxidative stress damage.     

丙泊酚联合尼尔雌醇在绝经妇女取环中的应用

目的探讨丙泊酚联合尼尔雌醇在绝经妇女取环(IUD)中的应用。方法设观察组和对照组。观察组予尼尔雌醇4mg顿服,1周后来院,术前禁饮禁食4小时,由麻醉师按丙泊酚2～3mg/kg静脉推药,待患者睫毛反射消失后施术,术中置心电监护。对照组常规宫颈注射利多卡因2ml。观察两组宫颈软化、镇痛效果、手术时间及手术效果。结果观察组宫颈软化率87.33%,完全无痛率100%,手术时间<5min者占81.33%,一次性取环成功率100%。对照组宫颈软化率36.00%,完全无痛率13.33%,手术时间<5min者占23.33%,一次性取环成功率77.33%,两组比较差异有显著性意义(P<0.01)。结论丙泊酚联合尼尔雌醇应用于绝经妇女取环,可促进宫颈软化,减少患者痛苦,提高取环成功率,值得在临床上广泛应用。     

Evaluation of the Simple Calculated Osteoporosis Risk Estimation (SCORE) in Older Caucasian Women: The Rancho Bernardo Study

Osteoporosis is a major health problem in older women. A risk assessment tool, the Simple Calculated Osteoporosis Risk Estimation (SCORE), has been developed to identify postmenopausal women likely to have low bone mass who should be referred for bone densitometry. The objective of this study was to calculate the sensitivity, specificity and predictive values of SCORE in a community-dwelling sample of older women. A total of 1013 postmenopausal Caucasian women aged 44–98 years provided a standard medical history including history of osteoporotic fractures and medication use. Bone mineral density (BMD) was measured at the femoral neck using dual-energy X-ray absorptiometry. In accordance with the SCORE protocol, low BMD was defined as 2 or more standard deviations below the mean BMD in healthy young women. Among these older women (mean age = 72.5 years), 67% had low BMD. Using the recommended SCORE cutpoint of 6, the sensitivity of SCORE was 98% but the specificity was only 12.5%. The positive predictive value (PPV) and negative predictive value (NPV) were 69% and 75%, respectively, meaning that all but 5.5% of the women would be recommended for bone densitometry. Increasing the cutpoint of 11, based on ethnicity and the receiver operating characteristic (ROC) curve, reduced sensitivity to 80% but improved specificity to 46%. The PPV and NPV were 75% and 53%, respectively, meaning that bone scans would not be recommended for 28% of the women. However, 13% of the women with low BMD would be missed. Analyses restricted to women <74 years of age reduced the rate of recommended bone densitometry but increased the number of women with low BMD who would be missed. We conclude that SCORE has limited value as a method for appropriately referring older ambulatory women for bone densitometry. Received: 28 December 1998 / Accepted: 30 December 1998     

Effects of salmon calcitonin in postmenopausal osteoporosis: A controlled double-blind clinical study

Summary In this paper we present the results of a 12-month double-blind clinical multicenter study assessing the effects of synthetic salmon cacitonin (CT) administration in a group of white postmenopausal osteoporotic women. Treated patients were given 100 MRC units of synthetic salmon CT injected i.m. in the morning every other day. Control patients received a placebo injection. All patients received 500 mg of elementary calcium p.o., b.i.d. Bone mineral content (BMC) was measured at the extreme distal radius of the nondominant arm by a dual photon bone densitometer which utilizes two radionuclides,²⁴¹Am and¹²⁵I, with energies of about 60 keV and 30 keV respectively. Biochemical parameters of calcium-phosphorus metabolism were also measured. After 12 months of treatment a significant mean increment of BMC and nondialyzable OHPr/creatinine values and a significant decrease of total OHPr/creatinine values were observed in the treated group, while controls showed a significant decrease in BMC values. These results, together with the observation that in some patients the decrease in total OHPr/creatinine values was not accompanied by an increment of BMC, show that long-term salmon CT treatment may be of benefit in postmenopausal osteoporosis and that the effects of CT on bone mass may be due not only to the inhibition of bone resorption but also to the stimulation of bone formation. The results of this study were partially reported in an abstract presented at the International Symposium “Calcitonin '84”, held in Milan on 2–4 October 1984.     

卵巢早衰与自然绝经妇女骨密度的对比观察

目的　比较卵巢早衰 (POF)与自然绝经妇女的骨密度 (BMD)。方法　 6 3例经DEXA确诊为骨质疏松的病人分为两组 :2 9例POF为A组 ,年龄 4 8～ 76岁 (6 2 1± 7 0 ) ;34例自然绝经妇女为B组 ,年龄 5 2～ 77岁 (6 3 4± 6 0 )。应用美国Hologic公司QDR4 5 0 0 W型双能X线骨密度仪测定A组和B组腰椎及股骨颈BMD。结果　A、B两组腰椎 2 4、股骨颈BMD相比 ,有显著性差异 (P <0 0 5 )。结论　POF比自然绝经妇女骨量丢失的早并且丢失的多 ,应及早应用HRT。     

Bisphenol A exposure is associated with oxidative stress and inflammation in postmenopausal women

Bisphenol A (BPA) is widely used in the production of polycarbonate plastics and epoxy resins. There is increasing health concerns regarding low-level exposure to BPA among the general population. The aim of this study was to determine the association between BPA exposure with oxidative stress and inflammation in adult populations. A cross-sectional study was conducted. This study included 485 adults (259 men, 92 premenopausal women, and 134 postmenopausal women) living in general communities within large cities. Urinary concentrations of BPA, malondialdehyde (MDA), and 8-hydroxydeoxyguanosine (8-OHdG), white blood cell (WBC) count, and C-reactive protein (CRP) were measured. Multivariate analyses were applied to determine the associations of BPA exposure with oxidative stress and inflammation. The geometric means of urinary BPA for men, premenopausal women, and postmenopausal women were 0.53, 0.61, and 0.58 μg/g cr, respectively. The urinary BPA concentrations were positively associated with MDA, 8-OHdG, and CRP levels in the postmenopausal women; however, such associations did not exist in men and premenopausal women. The findings of this study suggest that BPA exposure would promote oxidative stress and inflammation, in which postmenopausal women are likely to be more susceptible to BPA-induced health effects.     

阴道超声监测绝经后子宫内膜的临床研究

本研究应用阴道超声(transvaginal ultrasonography,TVS)检测绝经后子宫内膜厚度及超声图像的改变,评估有无内膜病变,并将其与相应的诊断病理结果比较,以判断该方法鉴别内膜病变的可靠性.     

阴道B超及宫腔镜在诊断绝经后阴道出血的价值

目的 :评价阴道B超 (TVS)及宫腔镜在诊断绝经后出血的准确性。方法 :对 1 98例绝经后出血患者进行TVS检查 ,测量其子宫内膜厚度 ,随后进行宫腔镜检查并在宫腔镜下进行内膜活检 ,将TVS和宫腔镜检查结果与病理检查进行分析、比较。结果 :病理检查结果为 :1 7例未能刮出内膜组织或内膜组织过少不足以作出病理诊断 ,萎缩性子宫内膜 1 0 2例、内膜息肉 2 0例、内膜增殖症 1 7例、子宫内膜癌 1 6例、内膜炎 8例、正常内膜 1 8例。TV显示 1 0 8例内膜厚度≤ 5mm ,90例 >5mm ,所有子宫内膜癌的内膜厚度均 >5mm ,宫腔镜诊断1 4 1例内膜正常 ,57例异常。TVS的敏感性、特异性、阳性预测值及阴性预测值分别为 1 0 0 %、40 %、69.8%、1 0 0 % ,宫腔镜的敏感性、特异性、阳性预测值及阴性预测值分别为 1 0 0 %、89%、93 %、1 0 0 %。结论 :TVS及宫腔镜对诊断绝经后出血敏感性都很高 ,但宫腔镜的特异性高于TVS ,绝经后出血的患者应常规行TVS检查 ,如子宫内膜厚度超过 5mm ,应行宫腔镜检查     

中医药治疗绝经后骨质疏松症的研究进展

绝经后骨质疏松的产生多因卵巢功用下降导致体内雌激素含量显著降低引发,其发病率高,易形成脆性骨折,严重影响患者的生存质量,给社会和家庭带来繁重的担负。目前,临床上治疗绝经后骨质疏松症仍以西药治疗为主,但西药治疗PMOP有着诸多的不良影响和并发症。该文以中医药的方法治疗绝经后骨质疏松症为出发点,包括有中药方剂、针灸和运动等疗法,通过查找近期国内外的相关文献,对中医药治疗绝经后骨质疏松症的临床应用进行总结,并得出其具有疗效确切,副作用小的临床成效。