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1.
J. M. Thompson G. W. Modin C. D. Arnaud N. E. Lane 《Calcified tissue international》1997,61(5):377-381
Chronic steroid use results in osteoporosis, and postmenopausal women are believed to be at a high risk for steroid-induced
bone loss. The purpose of this study was to determine predictors of bone mineral density (BMD) in postmenopausal women on
both chronic steroid and hormone replacement therapy. Seventy-six postmenopausal women (≥3 years postmenopausal, ≥2 years
of steroid treatment of ≥5 mg/day of prednisone, and ≥1 year of hormone replacement therapy) were recruited into this study.
Measurements of BMD of the lumbar spine and femoral neck were obtained in all subjects. Risk factors for osteoporosis were
obtained by questionnaire. Discriminant analysis was performed to determine predictors of BMD. Osteoporosis, defined by a
T score of <−2.5, was present in the lumbar spine or femoral neck in 34 of the 76 subjects. Based on these criteria, women
with osteoporosis were significantly older, were more years postmenopausal, and had a lower body mass index (BMI) than women
who did not have osteoporosis. Predictors of osteoporosis for both the femoral neck and spine included a low BMI (P < 0.05),
more years postmenopausal (P < 0.01), and more years on steroids (P < 0.01). Low BMI was the only significant predictor of osteoporosis in the lumbar spine (P < 0.05), whereas for the femoral neck both years on steroids (P < 0.05) and BMI (P < 0.05) were significant predictors of low BMD. In summary, not all postmenopausal women on chronic steroid and hormone replacement
therapy are osteoporotic but a low BMI, more years on steroids, and more years postmenopausal were significant predictors
of osteoporosis in these subjects.
Received: 8 November 1997 / Accepted: 21 May 1997 相似文献
2.
Y. Taguchi I. Gorai M. G. Zhang O. Chaki M. Nakayama H. Minaguchi 《Calcified tissue international》1998,62(5):395-399
The objective of this study was to examine the value of NTx, a urinary cross-linked N-telopeptides of type I collagen, as
a marker of bone resorption. We assessed changes in pre- and postmenopausal bone resorption by evaluating the correlation
of NTx with L2–4 bone mineral density (BMD) in a total of 1100 Japanese women, aged 19–80 years [272 premenopausal (45.2 ±
6.2 years) and 828 postmenopausal (59.5 ± 6.2 years)]. Postmenopausal women were divided into three groups based on the range
of BMD (normal, osteopenic, and osteoporotic). Within each group, subjects were further segregated according to years since
menopause (YSM). NTx values were then evaluated for each group. Our results showed that BMD was significantly decreased (P < 0.05) and NTx was significantly increased (P < 0.01) after menopause in age-matched analysis. Consistent with a previous report, NTx was inversely correlated with BMD
for the entire cohort of study subjects (r =−0.299), although NTx correlated better with premenopausal than postmenopausal
BMD (r =−0.240 versus r =−0.086). This may have been due to the fact that elevated values of NTx were exhibited over the entire
range of BMD present in the postmenopausal women, suggesting that NTx might respond faster to the estrogen withdrawal than
BMD. In all postmenopausal women, regardless of the range of BMD, the increase in NTx reached a peak within 5 YSM. After 11
YSM, however, NTx remained elevated in the osteoporotic group but it decreased in the osteopenic group, and showed no significant
change in the group of postmenopausal women with normal BMD. These findings suggest that bone resorption is dramatically increased
within 5 years after menopause but remains increased only in osteoporotic women.
Received: 29 April 1997 / Accepted: 12 August 1997 相似文献
3.
Influence of Grip Strength on Metacarpal Bone Mineral Density in Postmenopausal Japanese Women: A Cross-Sectional Study 总被引:5,自引:0,他引:5
Osei-Hyiaman D Ueji M Toyokawa S Takahashi H Kano K 《Calcified tissue international》1999,64(3):263-266
Most published studies on the role of muscle strength in the maintenance of bone mineral density (BMD) focused on the relationship
between specific muscle groups and adjacent bones, mostly in young and premenopausal women. This study examined the influence
of grip strength on BMD of the metacarpal index in postmenopausal Japanese women. Subjects included 1168 postmenopausal women
aged 40–70 years. BMD measurement was done with computed X-ray densitometry (CXD) by analyzing X-ray films of the right second
metacarpal index. Grip strength was measured in both the dominant and nondominant hands using a squeeze dynamometer. Grip
strength (r = 0.2474; P= 0.0001) and age (r =−0.5443; P= 0.0001) significantly correlated positively and negatively, respectively, with BMD. Physical activity (r = 0.1318; P= 0.0001) also correlated positively with BMD. Breastfeeding (r =−0.1658; P= 0.0001), however, correlated negatively with BMD. Subjects with a history of regular physical activity had higher grip strengths
and BMD, than those with no physical activity. Adjustment for age, physical activity, calcium intake, BMI, breastfeeding,
testing site, and menopausal type indicated a significant (P for trend = 0.0013) positive association of grip strength with BMD. Subjects with stronger grip strengths had a decreased
risk for low BMD.
Received: 24 February 1998 / Accepted: 7 August 1998 相似文献
4.
The objective of this study was to evaluate whether the pharmacological activity of cyclical etidronate therapy is sustained
beyond the dosing period. A group of 121 postmenopausal women who had completed a 2-year, double-blind, placebo-controlled
parallel study with etidronate or placebo (400 mg/day for 14 days every 3 months) and calcium agreed to participate in a 1-year
open-label follow-up study to evaluate the effect of discontinuing etidronate treatment. Fifty-nine subjects in the former
etidronate group and 62 in the placebo group received 500 mg/day of elemental calcium; 54/59 and 58/62 subjects, respectively,
completed the study. Outcomes of the study were bone mineral density (BMD), measured by dual energy X-ray absorptiometry (DXA),
and biochemical markers of bone turnover (urinary deoxypyridinoline/creatinine and serum osteocalcin). To determine whether
there was a residual effect of previous therapy we compared mean percentage changes from baseline (year 0) to year 3 for both
spinal and femoral neck BMD and markers of bone turnover in the former cyclical etidronate and placebo groups. To evaluate
the carryover effect of treatment we compared the percent change from year 2 to year 3 for the same variables. Mean percentage
change (SEM) from year 2 to year 3 for spinal BMD in the former cyclical etidronate group was −2.87% (0.48%) versus −0.99%
(0.36%) in the placebo group (P= 0.0022). In the femoral neck, the BMD changes were −0.86% (0.42%) versus −1.01% (0.41%) (NS). Biochemical markers increased
within 6 months toward baseline levels. Mean percentage changes from baseline (year 0) in both spinal and femoral neck BMD
were significantly different between groups 1 year after treatment discontinuation. No differences between groups were maintained
in deoxypyridinoline and osteocalcin. It is concluded that following withdrawal of cyclical etidronate therapy bone loss resumes
at a normal and moderately accelerated rate in the proximal femur and lumbar spine, respectively. A positive effect on BMD
at both cortical and trabecular sites is maintained for 1 year after treatment withdrawal.
Received: 8 May 1999 / Accepted: 10 December 1999 相似文献
5.
M. Miyao T. Hosoi S. Inoue S. Hoshino M. Shiraki H. Orimo Y. Ouchi 《Calcified tissue international》1998,63(4):306-311
6.
C. L. Benitez D. L. Schneider E. Barrett-Connor D. J. Sartoris 《Osteoporosis international》2000,11(3):203-210
There is a need for low-cost screening methods to detect low bone mass (osteopenia or osteoporosis) in postmenopausal women.
The utility of quantitative ultrasonography (QUS) of the hand was assessed for osteoporosis screening using the WHO criteria.
Bone mineral density (BMD) was measured in 206 postmenopausal Mexican-American women at the total hip and lumbar spine by
dual-energy X-ray absorptiometry (DXA). The amplitude-dependent speed of sound (AD-SoS) was measured in the phalanges by QUS.
Subjects identified by DXA as having osteopenia or osteoporosis had significantly lower AD-SoS values in comparison with normals.
Estrogen users had significantly higher spine and hip BMD and AD-SoS values compared with non-estrogen users. The areas under
the receiver operating characteristic (ROC) curves (AUC) for AD-SoS to screen for osteoporosis (T-score ≤−2.5) at the spine or hip were 0.73 for all subjects, 0.74 for estrogen users and 0.68 for non-estrogen users. The
AUC for non-estrogen users to screen for osteopenia (T-score −1 to −2.5) was 0.77. Performance comparisons of AD-SoS with SCORE (a risk factor questionnaire) and body weight showed
AUC values of 0.73, 0.69 and 0.65, respectively. QUS was the superior screening test when considering both the AUC and the
shape of the ROC curves. For non-estrogen users, the group at higher risk for osteoporosis, QUS correctly identified 31% as
normal, and 62% as having low bone mass and needing DXA referral; and the remaining 7% were false negatives. These data suggest
phalangeal QUS can be effectively used for screening osteoporosis in postmenopausal women.
Received: 2 April 1998 / Accepted: 27 July 1999 相似文献
7.
Risk Factors for the Development of Vertebral and Total Skeleton Osteoporosis in Patients with Primary Biliary Cirrhosis 总被引:4,自引:0,他引:4
A. Bagur C. Mautalen J. Findor J. Sorda J. Somoza 《Calcified tissue international》1998,63(5):385-390
The objectives of this work was to (1) study the bone mineral density (BMD) of the lumbar spine, total skeleton, and body
composition in patients with primary biliary cirrhosis (PBC) and (2) evaluate the risk factors (premature menopause, stages
of the disease, hyperbilirubinemia) and bone and liver biochemical parameters for the development of osteoporosis. We studied
23 women with a compatible diagnosis of PBC. The BMD and body composition were evaluated by X-ray absorptiometry (Lunar DPX-L).
The average age of the population was 56.7 ± 10.2 years. The BMD of the lumbar spine and of the total skeleton was 1.3 SDs
below the normal population matched for sex and age. In the total skeleton, the legs were the most severely affected area
(Z score −1.5). The body composition showed no significant difference compared with the normal population. The BMD of 56%
of the patients was less than −2.5 SDs from the average normal young values. Patients with a history of vertebral fractures
had diminished mineral density of the lumbar spine, as did those who had had no fractures. Of the risk factors studied, patients
with premature menopause had a lower bone mass compared with patients with normal menopausal age (Z score of the total skeleton
was −2.1 ± 1.8 versus −1.1 ± 1.0) but the difference did not reach statistical significance. The bone mass was not affected
in patients with regular menstrual cycles. There were no statistically significant differences in high levels of bilirubin,
advanced stages of the disease, or the biochemical variables studied. It is concluded that patients with primary biliary cirrhosis
present diminished cortical and trabecular bone mass, whereas body composition was unaffected. Premature hormone deficit,
possibly triggered by the chronic hepatic pathology, is a contributing factor to the osteoporosis in this population.
Received: 21 October 1997 / Accepted: 5 March 1998 相似文献
8.
I. Gorai O. Chaki Y. Taguchi M. Nakayama H. Osada N. Suzuki N. Katagiri Y. Misu H. Minaguchi 《Calcified tissue international》1999,65(1):16-22
A total of 79 Japanese women who were within 5 years of menopause were randomly assigned 1α-hydroxyvitamin D3 [1α(OH)D3] 1.0 μg/day, conjugated estrogens 0.625 mg/day, a combination of both, or control (no treatment). Lumbar spine and proximal
femur bone mineral density (BMD) and biochemical indices were monitored over 2 years. In the 1α(OH)D3-treated group, there was a nonsignificant decrease in lumbar spine BMD compared with controls, and no significant loss in
the femoral neck compared with controls. In the estrogen-treated group, there was a nonsignificant increase in spine BMD (+2.17%
in the first year and +1.71% in the second year), and no loss in femoral neck BMD. The combination of conjugated estrogens
+1α(OH)D3 was more effective in increasing BMD in the spine (+3.68% in the first year and +3.63% in the second year) and femur (+2.56%
in the first year and +4.44% in the second year) BMD. There was a significant difference in lumbar spine BMD in both the first
and second years between the combination-treated group and the 1α(OH)D3-treated and control groups (P < 0.01). Serum osteocalcin (OC) significantly decreased in the combination-treated group (−23.8% in the first year) and the
estrogen-treated group (−37.6% and −41.2% at 6 and 18 months, respectively), and serum alkaline phosphatase (Alp) decreased
significantly in the first year in the combination-treated (−31.5%), estrogen-treated (−27.3%), and 1α(OH)D3-treated (−7.9%) groups, whereas serum OC increased (+45.4% in the first year) in women without treatment. The results of
this study indicate that early postmenopausal bone loss in the femoral neck is prevented by conjugated estrogens, 1α(OH)D3, or both, whereas bone loss in the spine is not prevented by 1α(OH)D3. Estrogen proves effective in preventing early postmenopausal bone loss by markedly inhibiting bone turnover. Moreover, a
synergistic bone-sparing effect can be expected when estrogen is administered concomitantly with 1α(OH)D3 rather than when used alone.
Received: 28 April 1998 / Accepted: 23 December 1998 相似文献
9.
Lateral Spine Densitometry in Obese Women 总被引:3,自引:0,他引:3
E. R. Brooks D. Heltz P. Wozniak C. Partington J. C. Lovejoy 《Calcified tissue international》1998,63(2):173-176
The lateral (LAT) spine scan has been suggested as a more sensitive measure than posterior-anterior (PA) scanning for assessing
age-related bone loss in normal-weight postmenopausal women. The measurement error of PA and LAT bone mineral density (BMD)
using dual energy X-ray absorptiometry (DXA) has also been shown to rise with incremental increases in fat and from large
variance in fat thickness, respectively. The purpose of this cross-sectional study was to determine specific affects of obesity
on paired PA and LAT lumbar (L2–L4) BMD and Z score (BMD of patient versus age-matched reference database) correlation in 30 obese postmenopausal women (mean
BMI ± SD = 33.3 ± 4.06). The mean PA and LAT BMD ± SD were 0.946 ± 0.123 and 0.749 ± 0.134, respectively. The mean PA and
LAT Z scores were −0.17 ± 1.15 and 0.80 ± 1.7. The correlation between PA and LAT BMD was significantly lower (r = 0.55; P < 0.05) than previously reported, and PA and LAT Z score correlation was (r = 0.57; P= 0.0016). After adjusting for body mass index (BMI), percent body fat, fat mass, and truncal fat by DXA, waist:hip ratio
(WHR) and visceral and subcutaneous abdominal fat by computerized axial tomography (CT), PA and LAT Z score correlation increased
to r = 0.62; P= 0.0065. In our subjects, the mean LAT Z score was 4.6 times higher than the mean AP Z, contrary to previous observations
in normal-weight postmenopausal women. Our findings may be due to increased soft tissue composition and fat inhomogeneity
in the LAT scanning field resulting in increased X-ray attenuation in obesity.
Received: 22 July 1997 / Accepted: 26 January 1998 相似文献
10.
Association Study of Parathyroid Hormone Gene Polymorphism and Bone Mineral Density in Japanese Postmenopausal Women 总被引:16,自引:1,他引:15
Hosoi T Miyao M Inoue S Hoshino S Shiraki M Orimo H Ouchi Y 《Calcified tissue international》1999,64(3):205-208
Association of BST B1 restriction fragment length polymorphism (RFLP) of the parathyroid hormone (PTH) gene with bone mineral density (BMD)
was examined in 383 healthy postmenopausal women in Japan who were unrelated. The RFLP was represented as B or b, the capital
letter signifying the presence of and the small letter the absence of restriction site for BST B1. The frequency of each genotype—BB, Bb, and bb—was 82.5%, 16.7%, and 0.8%, respectively. When we statistically compared
age, years after menopause, body height, and body weight between the BB genotype and the Bb genotype groups, there was no
significant difference between the groups. However, the lumbar BMD and the score of BMD adjusted for age and body weight (Z
score) were significantly lower in the group of genotype Bb than in the BB: 0.859 ± 0.019 g/cm2 versus 0.925 ± 0.011 (mean ± SE, P= 0.01) and −0.412 ± 0.138 versus 0.067 ± 0.082 (mean ± SE, P= 0.01). In addition, the Z score of total body BMD in the Bb genotype group was lower than that in the BB group. Comparison
of serum and urinary biochemical bone metabolic markers suggested that the subjects with Bb genotype might be in a relatively
higher state of bone turnover than those with BB genotype. These results suggest that the polymorphism in the PTH gene would
be a useful genetic marker for lower BMD and the susceptibility for osteoporosis.
Received: 19 March 1998 / Accepted: 24 June 1998 相似文献
11.
Haden ST Fuleihan GE Angell JE Cotran NM LeBoff MS 《Calcified tissue international》1999,64(4):275-279
We performed a retrospective study of 237 patients attending a specialty osteoporosis practice. Secondary causes for reduced
bone mineral density (BMD) were evaluated in 196 postmenopausal women and 41 premenopausal women; mean age was 56 ± 13.8 years
(mean ± SD). BMD was measured by dual-energy X-ray absorptiometry (DXA) (QDR 1000W/2000 Hologic). Levels of intact parathyroid
hormone (iPTH), calcidiol [25(OH)D], thyroid-stimulating hormone, and 24-hour urinary calcium were measured, and serum and
urine protein (SPEP and UPEP) electrophoresis were performed. Overall, 16% of our patients had 25(OH)D levels <15 ng/ml, the
lowest acceptable vitamin D level without a concomitant rise in iPTH levels. Among the osteoporotic patients (T score <−2.5
SD), 17% had 25(OH)D levels <15 ng/ml and 7% <10 ng/ml. Among the osteopenic patients (−2.5 < T < −1.0 SD), 11% had 25(OH)D
levels <15 ng/ml. Seventeen percent of patients with Z score ≤−1.0 SD (low range normal value) had 25(OH)D levels <15 ng/ml.
Low 25(OH)D levels were inversely related to high iPTH values (r = 0.30, P < 0.0001). Hypercalciuria was present in 15% of our patients, elevations of PTH levels (>65 pg/ml, upper normal limit of
assay) were present in 11.5%, and hyperthyroidism in 4%. A 25(OH)D level of <25 ng/ml in women (n = 86) with no known secondary causes of low BMD was associated with an iPTH level above 49 pg/ml. The measurement of 25(OH)D levels is recommended in the evaluation of secondary
causes for reduced BMD. Supplementation with vitamin D appears needed to keep 25(OH)D above 25 ng/ml, the level required to
prevent increments in iPTH levels.
Received: 9 February 1998 / Accepted: 1 October 1998 相似文献
12.
M. Ito T. F. Lang M. Jergas M. Ohki M. Takada T. Nakamura K. Hayashi H. K. Genant 《Calcified tissue international》1997,61(2):123-128
This study examined trabecular bone mineral density (BMD) in Japanese women with and without spinal fracture, and compared
the results to American women with and without fracture. The quantitative computed tomography (QCT) systems used at the University
of California, San Francisco (UCSF) and at Nagasaki University were cross-calibrated. Normative BMD was assessed with the
K2HPO4 liquid phantom in 538 Americans aged 20–85 years, and with the B-MAS200 phantom in 577 Japanese aged 20–83 years. These BMD
were adjusted for use with the Image Analysis solid phantom using the result of cross-calibration. The trabecular BMD in 111
postmenopausal American women (55 with fracture), and in 185 postmenopausal Japanese women (67 with fracture) were compared
for investigation of the difference in BMD values relative to fracture status. The absolute BMD values in Japanese were lower
than those in Americans, and the differences were greater with advancing age. The magnitude of the BMD difference was 8.6,
20.5, 38.1 mg/cm3 in women aged 20–24 years, 40–44 years, 60–64 years, respectively. In premenopausal women, BMD began to decrease at the age
of 20 in Japanese, whereas the peak bone mass was maintained until the age of 35 in the American women. In immediate postmenopausal
women, BMD significantly decreased in both populations. In later postmenopausal women, BMD significantly decreased with age
in the Japanese women but decreased less rapidly in the American women. The aging decrease of BMD was 1.4% and 2.2% per year
in the later postmenopausal American and Japanese women, respectively. The fracture threshold is considered to be lower in
Japanese women. However, the BMD difference between American and Japanese women with fracture was similar to that without
fracture. The Z-scores of fracture subjects versus controls were 2.9 in American and 1.8 in Japanese women. In conclusion,
Japanese women were found to have a lower BMD and lower fracture threshold than American women. The significant decrease of
spinal trabecular BMD in late postmenopause is potentially responsible for the higher prevalence of spinal fracture in Japanese
women.
Received: 18 December 1995 / Accepted: 23 September 1996 相似文献
13.
Peripheral Volumetric Bone Mineral Density in Pre- and Postmenopausal Chinese Women in Hong Kong 总被引:2,自引:0,他引:2
Qin L Au SK Chan KM Lau MC Woo J Dambacher MA Leung PC 《Calcified tissue international》2000,67(1):29-36
The aim of this cross-sectional study was to use a newly available precise and multislice pQCT (Densiscan 2000) for establishing
reference data of volumetric bone mineral density (vBMD) of the distal radius. vBMD of the nondominant wrist was measured
in 118 healthy Hong Kong Chinese women aged 41–60. Anthropometric parameters, menstrual status, and handgrip strength were
also measured. Results showed that there was a significant age-related decline in trabecular BMD (tBMD), integral BMD (iBMD),
and cortical BMD (cBMD), with correlation coefficients ranging from −0.401 to −0.547 (P < 0.001). The annual decline of vBMD was 2.22%, 1.79%, and 0.88% in tBMD, iBMD, and cBMD, respectively. When subjects were
divided into premenopausal and postmenopausal groups, we found an age-related decline in tBMD and iBMD, but not in cBMD in
both groups. The vBMD values interpreted in mg/cm3 in premenopausal women were 238.4 ± 57.2 in tBMD, 604.6 ± 82.9 in iBMD, 1415.5 ± 129.9 in cBMD, and declined significantly
(all P < 0.001) to 193.7 ± 54.7 in tBMD, 500.0 ± 90.3 in iBMD, and 1306.7 ± 153.5 in cBMD in the postmenopausal women. On average,
16.7% of the subjects showed their vBMDs to be below −1 SD and only 1.7% of them lower than −2 SD. Linear regression showed
that the annual decline of vBMD was faster in postmenopausal women with 2.42% in tBMD, 1.90% in iBMD, and 0.88% in cBMD compared
with 1.91% in tBMD, 0.98% in iBMD, and 0.55% in cBMD in the premenopausal women. After adjustment for age, only the iBMD with
dominant trabecular elements showed a significantly accelerated decrease after the onset of menopause (P= 0.008). Weak or no association was found among vBMDs with anthropometric parameters, years since menopause, or handgrip
strength. In conclusion, we found a significant age-related decline of vBMDs in Hong Kong Chinese women aged 41–60 years,
characterized by the early reduction of metabolically active trabecular bone after entering the fourth decade of life, with
an accelerated decline after the onset of menopause.
Received: 20 May 1999 / Accepted: 21 January 2000 相似文献
14.
Quantitative ultrasound (QUS) is emerging as a simple, inexpensive and noninvasive method for assessing bone quality and
assessing fracture risk. We assessed the usefulness of a contact calcaneal ultrasonometer by studying normal premenopausal
women (group I, n= 53), normal postmenopausal women (group II, n= 198), and osteoporotic women without (group III, n= 141) and with vertebral fractures (group IV, n= 53). The osteoporotic subjects had a T-score of the spine or hip neck bone mineral density (BMD) <−2.5 based on the local Chinese peak young mean values. When compared
with postmenopausal controls, mean broadband ultrasound attenuation (BUA), speed of sound (SOS), and quantitative ultrasound
index (QUI) were 26%, 2.1% and 25% lower in women with vertebral fractures (p all <0.005). The correlation coefficients between QUS parameters and BMD of the spine and hip ranged between 0.4 and 0.5.
The ability of the QUS to discriminate between patients groups was determined based on the mean value of normal premenopausal
women in group I. The mean T-score for women with fractures was −2.87 ± 1.02 for BUA, −2.54 ± 0.79 for SOS, −3.17 ± 0.70 for QUI, −2.65 ± 0.86 for L2–4
BMD and −2.53 ± 0.66 for hip neck BMD. After adjustment for age and body mass index, the odds ratio of vertebral fracture
was 1.71 (95% CI 1.2–2.6) for each 1 SD reduction in BUA, 2.72 (1.3–5.3) for SOS, 2.58 (1.4–4.6) for QUI, 2.33 (1.6–3.3) for
L2–4 BMD, 2.09 (1.37–3.20) for femoral neck BMD and 1.88 (1.34–2.92) for total hip BMD. The association between the QUS parameters
and vertebral fracture risk persisted even adjustment for BMD. The area under the receiver operating characteristic curve
for BUA for vertebral fracture was 0.92, for SOS, QUI, L2–4 BMD and femoral neck BMD was 0.95, and for total hip was 0.91.
Received: 7 January 1999 / Accepted: 18 May 1999 相似文献
15.
Bone Density of the Spine and Femur in Adult White Females 总被引:14,自引:0,他引:14
We measured bone mineral density (BMD in g/cm2) of the spine (L2-L4) and femur (four regions) in 1472 and 1487 cases, respectively, of ambulatory white women ages 20–79
years in the USA. A DPX densitometer was used in a mobile setting. The BMD values for women up to 69 years corresponded closely
with published values for the USA, the UK, and northern Europe; our values were somewhat lower than those from other studies
only in women over 70 years. The USA data were combined with data from Europe to give reference curves on about 12,000 subjects.
Decreases of BMD with age in women below 50 years were much smaller than in older women (0.2% versus 0.6–1.0% per year). Femoral
bone decreased from the neck region, but not the trochanter with age; the decrease of total femur BMD with age was due to
loss from the former region. Loss of bone mineral content (BMC in g) from the femur neck and total femur region did not accelerate
until after age 50 years, much like the spine. The apparent decrease of BMD in these regions that begins about age 40 actually
is due to an increase of bone area. About 20% of USA women aged 50–79 years had BMD levels for the lumbar spine, or for the
femur neck, more than −2.5 SD below the average values in young adult women 20–39 years old. Body weight had several times
more impact on BMD than height, and in fact, a change of 1 kg in postmenopausal women was commensurate with the effect of
a 1-year change in age. Subjects in the lowest quartile of body weight had T-scores that were 1 SD below those in the highest
quartile.
Received: 10 September 1998 / Accepted: 15 December 1998 相似文献
16.
P. Dargent-Molina M. N. Douchin C. Cormier P. J. Meunier G. Bréart for the EPIDOS study group 《Osteoporosis international》2002,13(7):593-599
Elderly women with very low bone mineral density (BMD) (T-score ≤−3.5) have a risk of hip fracture more than two times higher than the average risk of women of the same age. Using
data from the EPIDOS prospective study, we have shown that by measuring BMD on the 50% of women who have the lowest weight,
it is possible to identify the majority of these women at higher risk. In the present analysis, we assessed whether the use
of clinical risk factors, in the subset of women selected for osteodensitometry and with moderately low BMD (T-score between −3.5 and −2.5), allows the identification of another subgroup of women with a risk 2 times higher than average
and, thereby, increases the efficiency of selective BMD screening. We then assessed the discriminant value for hip fracture
of the overall screening strategy (i.e., use of weight to select women for osteodensitometry, then use of clinical risk factors
to enhance the predictive value of BMD), and compared it with the value of BMD used as a population screening tool. In total,
6933 EPIDOS participants, aged 75 years or above, were included in this analysis. Using Cox regression models, we first determined
which baseline factors were most predictive of hip fracture among the 1588 women with weight below median (selection criteria
for osteodensitometry in the proposed strategy) and T-score between −3.5 and −2.5. Based on the relative risk (RR) estimates from the final risk function, we calculated an individual
risk score for hip fracture. We assessed the incidence of hip fracture for each value of the score, and determined the cutoff
to identify women with a risk about 2 times higher than the average risk in this elderly cohort. The overall screening strategy
(i.e., selective BMD measurement based on weight, followed by clinical fracture risk assessment) identifies two subgroups
of higher risk women: a group with very low BMD (T-score ≤–3.5), and another group with moderately low BMD (T-score between –3.5 and –2.5) but a high fracture risk score. We calculated the total number of women classified as being
at high risk, and assessed the overall sensitivity and specificity of this strategy to identify elderly women who will suffer
a hip fracture. Among women with weight below median and T-score between −3.5 and −2.5, the factors most predictive of the risk of hip fracture were age, history of fall, ability to
do the tandem walk (test of dynamic balance), gait speed and visual acuity. A simple additive score based on these factors
(except visual acuity) allows a high-risk group (risk about 2 times higher than average) to be clearly distinguished from
a low-risk group (risk below average). Overall, the proposed strategy identifies approximately 15% of the women in the cohort
as being at high risk, i.e., 543 women with T-score ≤−3.5 and 503 women with −3.5 <T-score ≤−2.5 and a high fracture risk score. The sensitivity for hip fracture is equal to 37% and the specificity to 85%,
which is equivalent to the discriminant value of BMD as a population screening tool. In elderly women, the use of a simple
clinical risk score, in women with previous BMD values, allows the number of high-risk women identified to be increased. Overall,
the proposed screening strategy (use of weight to select women for osteodensitometry, and then use of clinical risk factors
to enhance the predictive value of BMD) has the same discriminant value for hip fracture as BMD used as a population screening
tool.
Received: 20 November 2001 / Accepted: 11 February 2002 相似文献
17.
N. Yoshimura T. Hashimoto S. Morioka K. Sakata T. Kasamatsu C. Cooper 《Osteoporosis international》1998,8(6):604-610
The objective of this study was to assess the rate of bone loss and characterize its determinants, among the inhabitants
of Taiji, a rural Japanese community. A cohort of 2261 inhabitants aged 40–79 years was established using resident registration
in 1992. Fifty men and 50 women in each of four age strata between 40 and 79 years were randomly selected and completed a
self-administered risk factor questionnaire. Baseline bone density of lumbar spine and proximal femur was measured by dual-energy
X-ray absorptiometry in 1993. BMD was measured again on the same participants in 1996. The rates of change of lumbar spine
BMD in men in their 40s, 50s, 60s and 70s were 0.20%, 0.34%, 0.43% and 0.28% respectively. Rates in women were –0.35%, –1.02%,
–0.10% and –0.20% respectively. At the femoral neck, rates of change in BMD among men in their 40s, 50s, 60s and 70s were
0.09%, –0.07%, 0.34% and 0.31% respectively. Femoral neck rates of change among women were –0.55%, 0.02%, 0.49% and –0.25%
respectively. The rate of change of lumbar spine BMD was –0.24% in premenopausal women with regular periods, –1.99% in premenopausal
women with irregular periods and –0.33% in postmenopausal women. Anthropometric measurements at baseline were also related
significantly to change in bone density. Baseline weight and height were statistically significant predictors of bone loss
rate.These data provide estimates of the rate of bone loss among Japanese men and women aged 40– 79 years. They suggest that
body build and menstrual function in women are important determinants of bone loss.
Received: 20 November 1997 / Revised: 1 April 1998 相似文献
18.
M. Pedrazzoni F. S. Alfano G. Girasole N. Giuliani M. Fantuzzi C. Gatti C. Campanini M. Passeri 《Calcified tissue international》1996,59(5):334-338
The purpose of this study was to examine the serum levels of bone alkaline phosphatase (BALP) measured with a new assay in
normal and in osteoporotic women, and to evaluate prospectively its responsiveness to changes of bone metabolism. The following
groups of subjects were studied: (1) 95 healthy women (44–75 years) (22 pre- and 73 postmenopausal) and 35 osteoporotic women
[vertebral bone mineral density (BMD) more than 2.5 SD below the normal adult mean]; (2) 10 women (44–50 years) ovariectomized
(OVX) for benign uterine diseases, examined before and 12 months after surgery; (3) 16 OVX women (36–54 years), examined before
and after 12 months of transdermal estrogen replacement therapy (50 μg/day); (4) 12 previously untreated pagetic patients
(4 women and 8 men, 50–80 years), examined before and 3 months after the I.V. administration of clodronate (600 mg) or alendronate
(5 mg) for 2 consecutive days. The median BALP value was 11.6 U/liter (25–75th percentiles: 10.5–12.7; range 7.7–19.3) in
healthy premenopausal (PreMP) women and significantly higher (median: 16.8 U/liter; 25–75th percentile: 13.8–21.8; P < 0.01) in postmenopausal (PostMP) women. There was a clear age-related increase in normal subjects (r = 0.43; P < 0.001). In the osteoporotic group, BALP levels, as well as other biochemical parameters of bone turnover, were not significantly
different from those of normal women when adjusted for age. In OVX women, BALP levels showed a marked increase 12 months after
surgery (median: 113%; 25–75th percentile: 87–139%), significantly higher than the increase of total ALP (median: 43%; 25–75th
percentile: 25–66%; P < 0.001), and similar to the increases of serum osteocalcin and urinary hydroxyproline. Transdermal estrogen treatment prevented
the BALP increase, even if no reduction was observed; total ALP showed a similar behavior. The basal levels of BALP were significantly
elevated in pagetic patients (median: 91 U/liter; range 18–610 U/liter) and correlated to the scintigraphic extent of the
disease (r = 0.76; P < 0.01). Three months after the I.V. administration of bisphosphonates, the decrease of BALP was more marked than that of
total ALP (median: −54% versus −41%; P < 0.05). In conclusion, these results suggest that BALP measurement with this immunoassay may be clinically useful, and more
sensitive than total ALP, in the assessment of bone turnover during changes of the estrogen status as well as in monitoring
the effects of treatments that modify the metabolic activity of the skeleton.
Received: 25 January 1996 / Accepted: 3 May 1996 相似文献
19.
Versluis RG Petri H Vismans FJ van de Ven CM Springer MP Papapoulos SE 《Calcified tissue international》2000,66(1):1-4
Radiographic absorptiometry (RA) of the phalanges is a convenient and reliable technique for measuring bone mineral density
(BMD). It needs only a radiograph of the hand, which can be sent for evaluation to a central facility, whereas other techniques
require specialized equipment. We assessed the relationship between RA measurements and the presence of vertebral deformities
in a population-based cohort of postmenopausal women, and to compare the results with simultaneously obtained BMD of the hip
by dual-energy X-ray absorptiometry (DXA). A total of 389 women aged 55–84 (mean age 67.2 years, SD 8.7) were randomly selected
from a large general practice. RA, DXA of the hip, and vertebral deformities in the lateral spine X-rays by vertebral morphometry
were assessed. Thirty-eight women (9.8%) had severe (grade II) vertebral deformities, and their BMD at the phalanges and femoral
neck was significantly lower than that of women without severe vertebral deformities. Odds ratios for the presence of severe
vertebral deformities of 1.5 (95% CI: 1.1–2.1) for RA and 1.3 (95% CI: 0.9–1.9) for DXA, together with similar receiver operating
characteristics curves, were found using age-adjusted logistic regression. Phalangeal BMD is related to vertebral deformities
at least as closely as BMD of the femoral neck BMD. RA may therefore help to evaluate fracture risk, especially if no DXA
equipment is available.
Received: 21 July 1998 / Accepted: 1 July 1999 相似文献
20.
L. M. Salamone T. Whiteside D. Friberg R. S. Epstein L. H. Kuller J. A. Cauley 《Calcified tissue international》1998,63(6):466-470
Cytokines such as interleukin-1 (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor (TNF-α) can influence both bone resorption
and bone formation. The objective of this cross-sectional study was to examine the relationship between cytokine production
by peripheral blood mononuclear cells (PBMC) and bone mineral density (BMD); the annual rate of change in BMD was examined.
Subjects participating in a randomized clinical trial entitled the Women's Healthy Lifestyle Project in Allegheny County,
Pennsylvania were used. They included 50 healthy premenopausal women, aged 45–52 years, who had regular menses within the
past 3 months and were not on replacement estrogens. Dual-energy X-ray absorptiometry measurements at the AP lumbar spine
and femoral neck were made at baseline and at the first annual exam using a Hologic QDR 2000 densitometer. Cytokine production
of IL-1β, IL-6, and TNF-α by PBMC was measured at the annual exam. The median values for stimulated cytokine production by
PBMC were 3.92 ng/ml, 31.3 ng/ml, and 1.05 ng/ml, for IL-1β, IL-6, and TNF-α, respectively. There were modest correlations
between cytokine production and cross-sectional BMD, ranging from r =−0.30 to r =−0.13. Trends of greater spinal bone loss
were observed in women with ``high' (≥75th percentile) cytokine production of stimulated IL-1β and IL-6 (IL-1β: ``high'
=−1.56% ± 0.70 versus ``low' (<75th percentile) =−0.56% ± 0.35, P= 0.21). In contrast, greater annual gains in femoral neck BMD were observed in those with high cytokine production of IL-1β
and IL-6 (IL-1β: high = 3.39% ± 1.16 versus low =−0.85 ± 0.58, P= 0.002). There was no association between stimulated TNF production and annual change in BMD. In this population of healthy
premenopausal women, the relationship between cytokine production by PBMC and the rate of change in BMD was significantly
different for the lumbar spine and femoral neck, possibly reflecting differences in the proportion of trabecular and cortical
bone at these sites.
Received: 5 February 1997 / Accepted: 11 May 1998 相似文献