2111例上海健康女性骨密度值测定与年龄相关骨丢失的研究

目的　建立上海市健康女性骨密度 (BMD)参考值数据库 ,为骨质疏松症的诊断及防治效果评估提供依据。方法　选取健康女性 2 111例 ,为上海市区的居民 ,汉族 ,年龄 2 0～ 84岁 ,分为13组。研究对象均详细填写健康调查表格 ,排除因继发性骨病或服用影响骨代谢药物 ,以及一些特殊职业者。用双能X线吸收仪 (HologicQDR - 2 0 0 0型 )测定所有对象的腰椎 (L1 - 4)、股骨颈 (Neck)、大转子 (Troch)、粗隆间 (Inter)及Ward’s三角区部位的BMD值。结果　峰值骨量 (PBM)出现的年龄段如下 :腰椎为 30～ 34岁 ,股骨近端为 2 0～ 2 4岁。此后 ,随年龄增长而BMD值下降 ,但在 4 0～ 4 4岁时BMD值均有较明显回升 (但低于各部位峰值 ) ,呈“沟壑状”。绝经后妇女在绝经后头 10年及 2 6～30年时有两个骨量快速丢失期 ,前者见于腰椎和股骨上端 ,年丢失率为 1 4 %～ 3 2 % ,后者仅见于股骨上端 ,年丢失率为 1 1%～ 1 4 %。腰椎部位BMD值在 75～ 79岁组略有回升。各部位骨量累积丢失率随年龄增长而增加。到 80岁时 ,各部位的骨量累积丢失为 2 8%～ 5 8% (比PBM)。骨质疏松症检出率在腰椎和Ward’s两部位最高 ,在 6 0～ 6 4岁组分别达 4 8%和 4 3% (以WHO诊断标准 ,T score<2 5SD)。 75岁以后 ,Ward’s部位检出率达 83%。结论

Bone mineral density and age-related bone loss in 2111 healthy women in Shanghai

Objective\ To establish the data base of bone mineral density(BMD)in healthy women in Shanghai for reference and to provide evidence for diagnosing and evaluating the effects of prevention and treatment of osteoporosis. Methods\ The study population consisted of 2111 healthy women aged 20-84 years.They were divided into 13 groups by every 5 year interval.BMD of lumbar spines(L 1-4 ),femoral neck(Neck),trochanter(Troch),intertrochanteric(Inter)and Ward's triangle(Ward's)were measured by dual energy X ray absorptiometry.(DXA,Hologic QDR-2000). Results\ The peak bone mass (PBM) for each site appeared as follows:30-34 years old in L 1-4 ,and 20-24 years old in proximal femur.BMD decreased with increasing age after PBM appeared.BMD rose in the group aged 40-44,in the shape of ravine.There were two accelerated bone loss periods after menopause:10 and 26-30 years.In the first period,the bone loss rate was 1 4%-3 2% annually while in the second period,it was 1 1%-1 4% annually.The accumulative bone loss percentage(compared with PBM)gradually increased with aging.It reached 28%-58% at the age of 80.The higher rate of detecting osteoporosis was at L 1-4 and Ward's.The rates were 48% for L 1-4 and 43% for Ward's in the group aged 60-64(according to WHO criteria:T score<-2 5SD).After the age of 75,it reached 83% in Ward's. Conclusion\ PBM for each skeleton site appeared in different ages.The two accelerated bone loss periods menopause,should be actively intervened to prevent osteoporosis.Bone loss first occurs in the sites which mainly consist of trabecular bone,such as Ward's and L 1-4 .These two sites were the sensitive sites for detecting osteoporosis.