Contributions of bone density and structure to fracture risk assessment in men and women

Although bone mineral density (BMD) is a strong predictor of fractures, it is only a surrogate for bone strength. Bone structural parameters can now be measured on BMD scans, but it is unclear whether they would be more useful for risk assessment. We measured structural parameters using the Hip Structural Analysis Program and evaluated their association, compared with standard hip BMD, with fracture risk in a population-based sample of 213 postmenopausal women and 200 men 50 years of age. Altogether, 38% of the women and 27% of the men had experienced a fracture due to moderate trauma (half involved hip, spine or distal forearm), while 23% and 36%, respectively, had a previous fracture due to severe trauma. In logistic regression analyses adjusted for age, the hip BMD and structural parameters were all associated with moderate trauma fractures generally, and osteoporotic fractures specifically, in women, but the best predictor in a multivariate model was femoral neck BMD (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.9–4.0). BMD and the structural parameters were strongly correlated, however, and could be interchanged with little reduction in predictive power. These variables were less predictive of moderate trauma fractures in men. The best model included age (OR per 10 years, 1.5; 95% CI, 1.1–2.1), femoral neck section modulus (OR, 1.6; 95% CI, 1.1–2.5) and intertrochanteric buckling ratio (OR, 1.6; 95% CI, 1.3–2.0). Correction for body size did not alter these relationships. Fractures due to severe trauma were best predicted by structural parameters: in women, femoral neck buckling ratio (OR, 1.2; 95% CI, 1.04–1.5) and, in men, intertrochanteric buckling ratio (OR, 1.4; 95% CI, 1.2–1.6). These data suggest that selected structural variables as assessed by dual-energy X-ray absorptiometry would be as good as standard BMD measurements for predicting fracture risk. Because of the strong correlations, however, some judgment can be used in selecting the variables easiest to measure.     

上海市区居民3051例跟骨骨密度的测量

对上海市区居民３０５１人进行了跟骨骨密度测定。其中男１４４４人，女１６０７人，年龄１１～９５岁，按５岁为一年龄组将其分为１７组。结果：跟骨骨峰值出现在２０～２４岁组，女性骨峰值显著小于男性，中年开始出现跟骨骨量丢失，女性的骨丢失速度显著快于男性。女性骨累积丢失量也显著大于男性。女性的跟骨累积丢失量仅次于Ｗａｒｄ三角。跟骨骨密度除了随年龄变化外，也受身高、体重及体重指数的影响。６０岁以上老年女性骨质疏松症的患病率显著高于男性，男、女分别为１３．９％、５８．０％。结论：跟骨骨密度的测量能较好地反映人体骨矿含量的变化规律     

Assessment of Clinical Risk Factors to Validate the Probability of Osteoporosis and Subsequent Fractures in Korean Women

This cross-sectional, observational study was designed to identify clinical risk factors of osteoporosis and fractures in Korean women to validate the probability of osteoporosis and subsequent fractures. A total of 1541 Korean women were recruited nationally. Fracture history of any site, risk factors of osteoporosis, and fall-related risk factors were surveyed and physical performance tests were conducted. Peripheral dual-energy X-ray absorptiometry was used to measure calcaneus bone mineral density (BMD). The number of positive responses on the modified 1-min osteoporosis risk test was related to the risk of osteoporosis. The frequency of osteoporosis was higher in those with a height reduction of >4 cm and a reduced body mass index (BMI). Multivariate analysis showed that older age and lower BMI were related to higher relative risk of osteoporosis. Time required to stand up from a chair and questions related to fall injury were significantly related to clinical fracture history of any site. Multivariate analysis showed that the relative risk of fractures at any site was higher in older subjects with a lower T-score and parental hip fracture history. This study shows that age and BMI are the most significant clinical risk factors for osteoporosis and that age, BMD, and parental history of hip fracture are highly applicable risk factors for validating the probability of osteoporotic fractures in Korean women.     

Spinal and Femoral DXA for the Assessment of Spinal Osteoporosis

The objective was to determine the diagnostic sensitivity of spinal and femoral dual x-ray absorptiometry (DXA) and to study whether a combination of both sites may enhance discriminatory capability in regard to the presence of vertebral fractures. Spinal and femoral DXA were obtained in 324 postmenopausal women, of whom 90 had at least one vertebral fracture. Age-adjusted logistic regression analyses, ROC analyses, and sensitivity-specificity statistics were used to assess the discriminatory ability of spinal and femoral bone density (BMD) alone and in combination. The age-adjusted odds ratios per standard deviation decrease in BMD (OR) for spinal and femoral measurements were comparable (Ward's triangle: OR = 1.62; femoral neck: OR = 1.51; total hip: OR = 1.47; spine: OR = 1.34). Combining spinal and femoral bone density measurements did not improve diagnostic sensitivity of DXA considerably as compared to using BMD of a single site and adjusting the ``fracture threshold.' The conclusion drawn is that spinal and femoral BMD measurements using DXA have a comparable diagnostic sensitivity for vertebral fracture discrimination. Different individuals at risk for osteoporosis may be identified using both methods. The clinical usefulness of a combination of two bone density measurements needs further study in a prospective setting. Received: 7 January 1997 / Accepted: 5 June 1997     

广州地区1 530例骨密度分析及骨质疏松发病率研究

目的为了解广州地区正常人群骨密度(BMD)的变化规律和骨质疏松(OP)的患病率.方法采用美国Lunar公司的双能X线骨密度仪对广州地区1 530名20～89岁居民进行腰椎2-4和髋部骨密度测量.结果男性腰椎骨密度峰值在20～29岁,女性腰椎骨密度峰值在30～39岁,男性与女性髋部骨密度峰值均在30～39岁,峰值后随年龄增加而骨密度下降,女性在50～59岁出现明显加速,男性没有加速下降现象.广州地区男性50～89岁骨质疏松患病率26.53%,女性50～89岁骨质疏松患病率42.64%,两者之间差异有非常显著性(P＜0.01).结论广州地区女性骨质疏松患病率高于男性,预防骨质疏松的重点在女性,但对男性骨质疏松患者也不容忽视.     

ISCD和IOF关于骨质疏松骨折风险评估（FRAX）临床应用的共识

国际临床骨密度学会（ International Society for Clinical Densitometry , ISCD ）和国际骨质疏松基金会（ International Osteoporosis Foundation ,IOF）于2010年11月14日在罗马尼亚的Bucharest召开FRAX共识会议（ PDC）,随后召开了为时两天的主题为“FRAX在临床应用的共识”的ISCD和IOF共同会议。在来自ISCD和IOF的国际专家组和FRAX专项专家的带领下,这3天关键性的探讨和辩论阐明了很多关于FRAX在临床应用中的重要内容。 PDC形成的官方共识目的在于在全世界范围内提高FRAX的临床应用质量和效能。由于骨骼评估是一个全新的并且发展迅速的领域,在PDC上发表的一些临床上十分重要的内容尚无确凿的医学证据。因此,一些官方共识很大程度上基于专家的意见。尽管任何发展进程中都会像这样存在一定局限,但ISCD和IOF相信,为临床医师和技术人员提供目前骨密度测量学科知识的精华,以及为科学团队提供指引是否需要进行更深入的研究来解释未知的和／或正存在争议的领域是十分重要的。     

Spine and femur BMD by DXA in patients with varying severity spinal osteoporosis

Summary Bone mineral density (BMD) at the lumbar spine, femoral neck, trochanteric region, and Ward's triangle was measured using dual-energy X-ray absorptiometry (DXA) in 118 women with osteoporotic vertebral collapse (average age 65 years), divided into four groups according to numbers and SD of vertebral deformation below norms: group 1:-3SD deformations only; group 2: one-4SD deformation; group 3: two-four-4SD deformations; and group 4: 5 or more-4SD deformations. There were no significant differences between the groups. Results were compared with those from 80 premenopausal (average age 32 years, range 20–40 years) and 109 postmenopausal normal women (average age 64, range 60–70 years). Mean BMD in osteoporotic group 1 was lower than premenopausal normal women by 32% at the lumbar spine, 31% femoral neck, 30% trochanteric region, and 44% at Ward's triangle, and postmenopausal controls by 17% lumbar spine, 16% femoral neck, 17% trochanter, and 14% Ward's triangle. There was a clear trend to reduction in mean BMD between osteoporotic groups 1 and 4 at all four measured sites with significant differences at the spine of 0.102 g/cm² (P<0.01) and Ward's triangle 0.059 g/cm² (P<0.01). When compared with premenopausal controls, there was a reduction in mean BMD between osteoporotic groups 1 and 4 of 10% at the lumbar spine, 7% femoral neck, 8% trochanteric region, and 13% Ward's triangle. Receiver operating characteristic analysis showed no significant differences in diagnostic sensitivities among the four measured sites for vertebral fractures. We conclude from this crosssectional data that the majority of bone loss in spinal osteoporosis occurs before the onset of fractures.     

补肾中药治疗绝经后骨质疏松症疗效分析

目的：客观评价补肾中药治疗绝经后骨质疏松症治疗作用。方法：绝经后骨质疏松症患者７７例随机分成两组，分别应用补肾中药、密钙息治疗半年。结果：补肾中药、密钙息治疗半年后，骨质疏松症腰背症状明显缓解（Ｐ＜０．５），腰椎骨质密度平均值升高（Ｐ＜０．０５）；尺、桡骨矿物质含量较治疗前明显增加（Ｐ＜０．０５）；两组间无明显差异（Ｐ＞０．０５）。两组治疗后Ｕ－Ｃａ／Ｃｒ、Ｕ－ＨｏＰ／Ｃｒ的测定值均明显下降（Ｐ＜０．０５），但补肾组ＡＫＰ测定值明显上升（Ｐ＜０．０５），密钙息组ＡＫＰ测定值明显下降（Ｐ＜０．０５），ＡＫＰ测定值两组间有明显差异（Ｐ＜０．０５）。结论；补肾中药与密钙息均能较好地治疗绝经后骨质疏松症。提示：补肾中药有促进骨形成的作用，还有成本低、副作用少等优点。     

DXA、QCT和SPA方法测量47例绝经后妇女骨质疏松症的比较

以骨密度测量应用最广的３种方法（ＤＸＡ─双能ｘ线吸收法，ＱＣＴ─定量ＣＴ法和ＳＰＡ─单光子吸收法）测量绝经后妇女的骨矿密度，比较其测量值、诊断结果和相关关系。首先用ＳＰＡ法测量绝经后妇女１８１例，诊断骨质疏松（ＯＰ）４７例。三种方法测量骨矿密度的均值分别低于峰值骨量的Ｍ─２ｓ的９％、２１．４％和２１％，且ＤＸＡ和ＱＣＴ两种方法测量的均值都在骨折阈值范围内。ＤＸＡ和ＱＣＴ诊断４７例ＯＰ之间无显著性差异，当排除椎骨骨质增生后的ｘ２＝０．２３７，且ＤＸＡ和ＱＣＴ测量值之间为正相关，ｒ＝０．７９９，而ＤＸＡ、ＱＣＴ和ＳＰＡ之间的相关系数，ｒ＝０．１８５和０．２８５，ＤＸＡ诊断ＯＰ的敏感性为８６．６％，特异性为７０％。     

浙北地区6330例跟骨骨密度测定及骨质疏松患病率分析

目的 分析浙北地区人群骨密度(BMD)变化规律及骨质疏松(OP)患病率。方法 使用美国进口的Dove3000骨密度仪对浙北地区20～93岁的居民6330人进行跟骨BMD测定，然后进行比较和统计分析。结果 男女性骨峰值在30—39岁年龄段，峰值后随年龄增长BMD逐渐下降，女性在50岁后可见明显的骨质丢失加速，而男性丢失是逐渐和缓慢的。浙北地区50～79岁人群骨质疏松症发病率男性为35．8％，女性为67．3％。结论 骨质疏松研究的重点在中老年妇女，但对于男性也不能忽视；骨质疏松的预防应从青少年开始。     

Osteoporosis and sex steroids

With increasing longevity, the maintenance of good health is pivotal for independent living in the elderly. Osteoporotic fractures are a crippling occurrence in their lives and are an obvious impediment for most of the activities of daily living. Osteoporotic fractures have long been regarded as a female ailment, but with the increasing longevity of men, it appears that the incidence and prevalence of osteoporotic fractures in men is not very different from the rate in women, although it occurs approximately 10 years later in the lives of men when their general health is deteriorating. A multitude of factors determine bone strength: genetic, nutritional (calcium), vitamin D (both nutritional or exposure to sunlight), physical activity, and hormonal factors. Hormonal factors are significant throughout life, from puberty onwards. In adolescence they are indispensable for the formation of peak bone mass. Throughout life, sex steroids maintain bone formation. Surprisingly, in men estrogens appear to be more significant for the development of peak bone mass and the maintenance of bone mineral density than androgens. In men estrogens are derived from androgens and levels of estrogens and androgens are strongly interrelated and adequate androgen levels imply adequate estrogen levels.     

Discriminative Capacity of Calcaneal Quantitative Ultrasound and of Osteoporosis and Fracture Risk Factors in Postmenopausal Women with Osteoporotic Fractures

Bone fragility fractures constitute the principal complication of osteoporosis. The identification of individuals at high risk of sustaining osteoporotic fractures is important for implementing preventive measures. The purpose of this study is to analyze the discriminative capacity of a series of osteoporosis and fracture risk factors, and of calcaneal quantitative ultrasound (QUS), in a population of postmenopausal women with a history of osteoporotic fracture. A cross-sectional analysis was made of a cohort of 5195 women aged 65 or older (mean±SD: 72.3±5.4 years) seen in 58 primary care centers in Spain. A total of 1042 women (20.1%) presented with a history of osteoporotic fracture. Most fractures (93%) were non-vertebral. Age-adjusted odds ratios corresponding to each decrease in one standard deviation of the different QUS parameters ranged from 1.47 to 1.55 (P < 0.001) for fractures. The age-adjusted multivariate analysis yielded the following risk factors independently associated with a history of osteoporotic fracture: number of fertile years, a family history of fracture, falls in the previous year, a history of chronic obstructive airway disease, the use of antiarrhythmic drugs, and a low value for any of the QUS parameters. The area under the receiver operating characteristic curve of the best model was 0.656. In summary, a series of easily assessable osteoporotic fracture risk factors has been identified. QUS was shown to discriminate between women with and without a history of fracture, and constitutes a useful tool for assessing fracture risk. Various of the vertebral and hip fracture risk factors frequently cited in North American and British populations showed no discriminative capacity in our series—thus suggesting that such factors may not be fully applicable to our population and/or to the predominant type of fractures included in the present study. For a complete list of ECOSAP investigators, see Appendix ECOSAP, Ecografia Ósea in Atención Primaria     

Perception of Osteoporosis by Belgian Women Who Work in a University Hospital

Campaigns to increase ‘awareness’ of osteoporosis have been organized. The aim of this study was to assess how Belgian women who benefit from superior conditions favoring ‘awareness’ perceive osteoporosis as being an important disease. A survey sent to the private home of all the women working in a university hospital in Brussels (n= 1154). From a list of 13 diseases the women were asked to rank, by order of importance, the five which they found to be the most important for a woman of their age. They were also asked about visits to physicians, and screening procedures. The response rate was 55.4%. A high uptake of medical visits and screening procedures was reported: 89% of the women had seen a general practitioner or a gynecologist and 81.6% had undergone at least one gynecologic examination during the previous year. Three times more women had ever undergone mammography than a bone mineral density (BMD) measurement. Overall, 18.1% reported having had a BMD measurement in the past. In women over 50 years, 61% reported having had a BMD measurement and 92.7% having had a mammogram. Osteoporosis was ranked among the five most important diseases by 19.4% of women before the age of 50 years and by 39.3% after that age, far behind breast cancer (respectively 86.3% and 77.7%) and uterine cancer (respectively 74.2% and 58.0%). Thus even among a population of women who benefit from superior conditions for information and screening, the perception of osteoporosis remains low, as does the uptake of osteoporosis screening. Received: 5 November 1998 / Accepted: 29 March 1999     

降钙素治疗骨质疏松症骨质量病变的研究

目的研究降钙素在骨质疏松症治疗中对骨密度bonemineraldensityBMD、骨强度及骨质疏松脆性骨折发生率的作用。方法为期1年的单中心、前瞻性、随机研究135例原发性骨质疏松症女性患者随机分成降钙素 钙剂组和钙剂组,进行开放、对比研究。降钙素 钙剂组66例鲑鱼降钙素50IU,肌内注射,第1周每天1次,第2周隔日1次,以后每周2次;同时口服元素钙600mg每天1次。钙剂组69例元素钙600mg每天1次。治疗前后分别进行血清钙、磷、碱性磷酸酶、骨钙素、尿羟脯氨酸、双能X线BMD和超声骨强度测量以及脊椎胸腰段正、侧位X线片比较。结果治疗1年后,降钙素 钙剂组53例获随访,与治疗前比较,腰椎BMD上升约1%P<0.05,髋部BMD无明显变化,桡骨和胫骨骨强度均明显改善;钙剂组59例获随访,腰椎、髋部BMD和桡骨、胫骨骨强度均较治疗前下降P<0.05。两组治疗前后各项生化检测指标无明显变化,骨质疏松脆性骨折的发生率钙剂组明显高于降钙素 钙剂组。结论降钙素治疗骨质疏松症有良好作用,不仅能有效地缓解骨痛,还能确实提高骨质量,降低骨质疏松脆性骨折的发生率。     

外伤性脊髓损伤患者的骨质疏松

为探讨脊髓损伤后骨质疏松的发生规律和特点,对83名外伤性脊髓损伤患者腰椎及髋部骨质疏松程度作放射学观察,井与正常对照者进行比较。结果:脊髓损伤患者的腰椎及髋部骨密度均较正常对照组有明显减低(P<0.01),但完全性瘫痪患者与不完全性瘫痪患者无显著统计学差异(P>0.05),骨密度参数与病程长短亦无显著统计学差异(P>0.05)。认为:脊髓损伤性骨质疏松与传统意义上的废用性骨质疏松有所不同,其发病机理及影响因素较为复杂,尚有待进一步研究。     

Osteoporosis in HFE2 juvenile hemochromatosis. A case report and review of the literature

Juvenile hemochromatosis (JH) is a severe form of hemochromatosis, which involves rapid iron overload and leads to organ damage, typically before the age of 30. We report a single case of a 25-year-old man suffering from juvenile hemochromatosis, with aggressive clinical manifestations, typically characterized by transaminasemia and progressive erectile dysfunction, due to hypogonadotropic hypogonadism. The clinical case appears interesting, as the patient also had secondary osteoporosis accompanied by increased bone resorption, which prevalently affected trabecular bone. Approximately 6 months after normalization of serum ferritin levels was achieved by frequent phlebotomies, he became eugonadal and bone mineral density of the lumbar spine increased. Our observations suggest that osteoporosis might occur in the state of JH even at a young age, mainly due to the deprivation of sex steroids and the direct tissue toxicity of iron.     

The Effects of Strontium Ranelate in Asian Women with Postmenopausal Osteoporosis

The aim of this study was to assess the efficacy and safety of strontium ranelate in the treatment of postmenopausal women with osteoporosis in Taiwan. In this 12-month multicenter, randomized, double-blind, placebo-controlled study, 125 women with osteoporosis were randomly given either strontium ranelate 2 g daily or placebo. Lumbar spine, femoral neck, and total-hip bone mineral density (BMD) and biochemical markers of bone turnover were measured; adverse events and tolerability were recorded and assessed. Subjects treated with strontium ranelate showed significant increases in BMD of 5.9% at the lumbar spine, 2.6% at the femoral neck, and 2.7% at the total hip, while the placebo group exhibited no significant change at 12 months. Serum level of a formation marker (bone-specific alkaline phosphatase) was also significantly increased at 6 and 12 months. Thus, although the sample size and the treatment duration of this study could not show its effect of reducing osteoprotic fractures, strontium ranelate showed bone protection effects by increasing BMD and concentrations of a bone formation marker. Safety assessment revealed adverse events were mild and not significantly different from placebo. An erratum to this article can be found at     

骨质疏松性骨折的危险因素及中医证候要素风险评估研究现状

骨质疏松性骨折是骨质疏松症最具破坏性的结局,多个相互作用的危险因素对其发生有一定的影响。人在40岁之后,随着年龄的增长,身体的机能开始逐渐衰退,开始出现如腰酸、背痛、下肢抽筋、乏力等症状,这些症状与肾虚、肝虚、脾虚、血瘀等中医证候要素之间存在一定的关联性,而这些症状的出现可能对骨折的发生有一定的早期提示作用。现有的骨质疏松性骨折风险评估工具多是基于现代医学危险因素开发而成,缺乏骨质疏松性骨折证候学方面的研究内容,在实际应用中存在一定的局限。如果在预测工具中融入中医证候的相关研究内容,建立符合我国人口学特征的骨质疏松性骨折风险评估模型,必将有助于提高风险评估工具对骨质疏松性骨折高危人群的风险评估准确性。     

Vertebral bone mineral density of the elderly in the urban community by mobile DXA

The present paper describes a population survey of bone mineral density (BMD) on the third lumbar vertebra (L3) using dual X-ray absorptiometry fixed in a van (mobile DXA) with lateral projection. Subjects were 387 persons aged 65 to 84 years living in Koganei City, a western suburb of Tokyo. This is the baseline survey of the 10-year project “Longitudinal Interdisciplinary Study on Aging” supported by Tokyo Metropolitan Institute of Gerontology (TMIG-LISA). As for the pattern of age-related BMD calculated in the range-of-interest (ROI) being set in the center of vertebral body to eliminate the posterior segment of vertebra and/or secondary hyperostotic changes with aging, the mean BMD of L3 declined in females from 0.514±0.121g/cm² (mean±standard deviation) in age-group 65–69 to 0.377±0.137 g/cm² in age-group 80–84. In males, it showed a decrease from 0.731±0.155 in 65–69 to 0.613±0.158 in 75–79 but a slight (insignificant) increase at age-group 80–84. There were significant differences of mean BMD between males and females in each age-group and in average. BMD was significantly associated with age (negatively) and body mass index (positively) in the multiple regression analysis.