共查询到20条相似文献,搜索用时 15 毫秒
1.
The Effect of Exercise Training Programs on Bone Mass: A Meta-analysis of Published Controlled Trials in Pre- and Postmenopausal Women 总被引:11,自引:0,他引:11
I. Wolff J. J. van Croonenborg H. C. G. Kemper P. J. Kostense J. W. R. Twisk 《Osteoporosis international》1999,9(1):1-12
With the aging of the population, the medical and social costs of skeletal fragility leading to fractures will cause an immense
burden on society unless effective prophylactic and therapeutic regimens can be developed. Exercise is suggested as a possible
regimen against involutional bone loss. The purpose of the present meta-analysis is to address a quantitative review of the
randomized controlled trials (RCTs) and nonrandomized controlled trials (CTs) on the effects of exercise training programs
on bone mass, measured as bone mineral density (BMD) or bone mineral content (BMC), of the lumbar spine (LS) and the femoral
neck (FN) in pre- and postmenopausal women. The literature from 1966 through December 1996 was searched for published RCTs
and CTs. Study treatment effect is defined as the difference between percentage change in bone mass per year in the training
group and the control group. Overall treatment effects (OTs) with the 95% confidence intervals of these study treatment effects
were calculated using inverse-variance weighting. Of the 62 articles identified, 25 met the inclusion criteria and were maintained
for further analyses. The weighted OTs for the RCTs showed very consistently that the exercise training programs prevented
or reversed almost 1% of bone loss per year in both LS and FN for both pre- and postmenopausal women. The two OTs that could
be calculated for strength training programs did not reach significance. The OTs for the CTs were almost twice as high as
those for the RCTs, which gives an indication of the confounding introduced by the nonrandom allocation of the subjects to
groups.
Received: 15 September 1997 / Accepted: 27 April 1998 相似文献
2.
Bone Mineral in Pre- and Postmenopausal Women with Insulin-Dependent and Non-insulin-Dependent Diabetes Mellitus 总被引:4,自引:0,他引:4
We have recently shown that bone radiogrammetric dimensions are associated with vitamin D receptor gene polymorphism. Since
parathyroid hormone (PTH) plays a central role in maintaining calcium homeostasis and in bone remodeling, we investigated
whether bone radiogrammetric dimensions are associated with a PTH gene polymorphism in 91 healthy Caucasian women, who were
premenopausal at entry into the study. These women had assessments of bone by radiogrammetry every five years for a median
period of 20 years (range 4–27). DNA was extracted from white blood cells. A segment of the PTH gene with a polymorphism at
a BstBI restriction site was amplified by polymerase chain reaction. Diameter, cortical thickness and cross-sectional area at standard
sites of the metacarpals, radius and femur were measured with radiogrammetry. Higher metacarpal diameter and cross-sectional
cortical area, and a slower decrease in radial cortical area with age, were associated with the absence of the BstBI restriction site of the PTH gene. PTH gene polymorphism accounts for about 7–9% of the total variances of bone dimensional
variables. These findings suggest that the dimensions of long bones are influenced by allelic variations in the PTH gene or
in genes nearby.
Received: 29 January 1998 / Accepted: 3 August 1998 相似文献
3.
S. Vedi D. W. Purdie P. Ballard S. Bord A. C. Cooper J. E. Compston 《Osteoporosis international》1999,10(1):52-58
Conventional hormone replacement therapy preserves bone mass predominantly by reducing bone turnover but does not exert significant
anabolic skeletal effects. In contrast, high doses of estrogen have been shown to increase bone formation in animals and we
have recently reported high bone mineral density values in women treated long-term with estradiol implant therapy. The aim
of this study was to investigate the mechanisms by which high doses of estrogen may increase bone mass in postmenopausal women.
Iliac crest biopsies were obtained from 12 women who had received long-term treatment with estradiol implants (at least 14
years), on demand, following hysterectomy and bilateral salpingo-oophorectomy. Indices of bone turnover, remodeling balance
and cancellous bone structure were assessed by image analysis and compared with those of premenopausal women. Mean wall width
was significantly higher in women treated with estradiol therapy than in premenopausal women (44.8 ± 4.8 vs 38.8 ± 2.8 mm;
mean ± SD; p = 0.001) and eroded cavity area was significantly lower in the implant-treated women (3612 ± 956 vs 5418 ± 1404 mm2; p = 0.001). Bone formation rate at tissue level and activation frequency were lower in the women treated with implants, although
the differences were not statistically significant. Indices of cancellous bone structure were generally similar between the
two groups. These results provide the first direct evidence that high-dose estrogen therapy produces anabolic skeletal effects
in postmenopausal women and indicate that these are achieved by stimulation of osteoblastic activity.
Received: 18 August 1998 / Accepted: 9 December 1998 相似文献
4.
To determine the effects of menopause on bone loss in different parts of the skeleton, bone mineral density (BMD) values
were measured longitudinally in 85 healthy women. BMD values included the lumbar spine measured by dual-energy X-ray absorptiometry
(DXA) and quantitative CT (QCT) and the distal and midradius measured by DXA obtained over 5 years. BMD at the calcaneus was
measured using DXA for 3 years, and the BMD values of the distal metaphyses and diaphyses of radius and tibia were measured
using peripheral QCT (pQCT) for 4 years. The subjects were 19 premenopausal, 17 perimenopausal, 12 early postmenopausal and
38 late postmenopausal women with the respective average ages of 39.1 ± 7.1 (SD), 51.9 ± 2.9, 55.8 ± 1.8 and 61.9 ± 3.9 years
at the start of measurement. Average years since menopause were 1.4 ± 1.8, 3.3 ± 1.3 and 12.7 ± 5.3 years, respectively. In
the perimenopausal group, the annual rate of bone loss for lumbar trabecular bone measured by QCT, and for the calcaneus,
and metaphyseal trabecular bone at the radius and tibia by pQCT were higher than the respective values in the premenopausal
group. These values in the late postmenopausal group became significantly lower compared with those in the perimenopausal
group, coming down to the level of the premenopausal group. While the annual rates of bone loss at the tibial diaphysis in
the perimenopausal group were also higher than those in the premenopausal group, the values at the radial diaphysis by DXA
or pQCT did not differ significantly. The reductions in the annual rates of bone loss with the passage of time after menopause
were not marked in these cortical bone dominated sites. These data indicated that the annual rates of bone loss at trabecular
bone dominated sites were accelerated in both axial and appendicular skeletons. Diaphyseal cortical bone, however, seemed
to be less sensitive to estrogen withdrawal. Other factors, such as genetics and calcium/vitamin D metabolism, would also
affect the age-dependent bone loss at the cortical bone dominated sites after menopause.
Received: 30 October 1998 / Accepted: 6 April 1999 相似文献
5.
Non-association of Estrogen Receptor Genotypes with Bone Mineral Density and Bone Turnover in Korean Pre-, Peri-, and Postmenopausal Women 总被引:19,自引:0,他引:19
K. Han J. Choi I. Moon H. Yoon I. Han H. Min Y. Kim Y. Choi 《Osteoporosis international》1999,9(4):290-295
Estrogen is known to play a critical role in both skeletal maturity and the rate of bone loss. This suggests the possibility
that the estrogen receptor (ER) gene is one of the candidate genes that determines peak bone density and/or bone turnover
rate. We investigated two established restriction fragment length polymorphisms (RFLPs) in intron 1 at the ER gene, represented
as PvuII and XbaI. In 598 healthy Korean women aged 20–74 years, we examined the association of these ER genotypes with bone mineral density
(BMD) and bone turnover status. The distribution of the PvuII and XbaI RFLPs was as follows: pp 205 (34.3%), Pp 308 (51.5%), PP 85 (14.2%) and xx 384 (64.2%), Xx 180 (30.1%), XX 34 (5.7%), respectively (where capital letters signify the absence of, and lower-case letters signify the presence of, the
restriction site of each RFLP). No significant genotypic differences were found in BMD and bone markers. We grouped the subjects
into three categories according to their menstrual status: 104 premenopausal women with regular menstruation, 182 perimenopausal
women who had amenorrhea of not less than 3 months and not more than 12 months’ duration, and 312 postmenopausal women whose
last menstruation was at least 12 months previously. No significant genotypic difference in either BMD or bone markers was
found in any of these three groups. Furthermore we categorized women in peri- and postmenopause into a high loser group and
a normal loser group according to the level of bone resorption markers. There was no difference in genotypic proportions between
the high and normal loser groups. Our data suggest that these ER polymorphisms are not associated with BMD or bone turnover
in Korean women.
Received: 16 March 1998 / Accepted: 17 August 1998 相似文献
6.
Birth Weight as a Predictor of Adult Bone Mass in Postmenopausal Women: The Rancho Bernardo Study 总被引:3,自引:0,他引:3
D. E. Yarbrough Elizabeth Barrett-Connor D. J. Morton 《Osteoporosis international》2000,11(7):626-630
Understanding the determinants of adult bone mass may help to identify women for prevention of osteoporosis. We postulated
that birth weight would predict low adult bone mass in old age. Subjects were 305 postmenopausal Caucasian women (mean age
70 years). Bone mineral content (BMC) and bone mineral density (BMD) were measured at the wrist, forearm, hip and lumbar spine.
Birth weight was assessed by self-report. Birth weight was positively correlated with BMC at the forearm (r= 0.15), hip (r= 0.12) and lumbar spine (r= 0.18), and the age-adjusted mean BMC increased significantly from the lowest to the highest birth weight tertile. Adjusting
for adult weight diminished this association at the forearm and hip, but not at the spine. Adjustment for multiple other covariates,
including height, did not materially change these associations. Adult weight and height were significantly correlated with
birth weight (r= 0.19 and r= 0.24, respectively). Birth weight was not independently correlated with BMD. Birth weight was thus positively correlated
with adult weight and BMC 70 years later. These findings suggest that low birth weight may be a marker for future low bone
mass and that different mechanisms exist for establishing the adult bone envelope (estimated by BMC) versus its density (estimated
by BMD).
Received: 18 August 1999 / Accepted: 21 January 2000 相似文献
7.
Vitamin D Receptor Gene Polymorphisms, Bone Mass, Bone Loss and Prevalence of Vertebral Fracture: Differences in Postmenopausal Women and Men 总被引:7,自引:0,他引:7
C. Gómez M. L. Naves Y. Barrios J. B. Díaz J. L. Fernández E. Salido A. Torres J. B. Cannata 《Osteoporosis international》1999,10(3):175-182
Bone mineral density (BMD), the major determinant of fracture risk, is under strong genetic control. Although polymorphisms
of the vitamin D receptor (VDR) gene have been suggested to account for some of the genetic variation in bone mass, the influence
of VDR genotypes on osteoporosis remains controversial. Previous published studies have focused mainly on women, but the pattern
of response in men has not been determined. Using the BsmI restriction enzyme, we studied the influence of the different VDR genotypes on bone mass, bone loss and the prevalence of
vertebral fractures in a population-based sample of both sexes (n = 326). BMD was measured at the lumbar spine and femoral neck, with a 4-year interval, using dual-energy X-ray absorptiometry.
Vertebral fractures were assessed by two lateral radiographs at the beginning and end of the study. The prevalence of the
three possible VDR genotypes was similar to those in other Caucasian populations and no differences were found between men
and women. Women with the favorable bb genotype showed significantly higher BMD values at the lumbar spine and femoral neck,
and a positive rate of BMD change at the femoral neck compared with women with the BB and Bb genotypes. Moreover, women with
the bb genotype showed a trend toward a lower prevalence and incidence of vertebral fractures (p= 0.07). We have not found any differences between VDR genotypes in men. In conclusion, VDR gene polymorphisms are related
to bone mass and bone loss in women; also a trend in the prevalence of vertebral fractures was observed in postmenopausal
women but not in men.
Received: 8 June 1998 / Accepted: 7 December 1998 相似文献
8.
Association Between Colles’ Fracture and Low Bone Mass: Age-Based Differences in Postmenopausal Women 总被引:3,自引:0,他引:3
E. Kanterewicz E. Kanterewicz A. Yañez A. Pérez-Pons I. Codony L. Del Rio A. Díez-Pérez 《Osteoporosis international》2002,13(10):824-828
Colles’ fracture (CF) in postmenopausal women has been linked to low bone mass at the lumbar spine and hip. However, the
diverse methodological approaches of previous studies make the results difficult to compare and thus the implications of CF
in osteoporosis daily clinical practice are not clear. We explored the association between CF and low bone mineral density
(BMD) in an incident case-control study in 58 postmenopausal Spanish women aged 45–80 years with recent CF and in 83 population-based
controls of the same age range. The BMD of ultradistal distal forearm, lumbar spine and hip was measured by dual-energy X-ray
absorptiometry (DXA) and WHO criteria were used to define osteoporosis and osteopenia. BMD was significantly lower in cases
for all three areas (p<0.001). Osteoporosis was more prevalent in cases than controls in the wrist (60% vs. 35%, p<0.001), lumbar spine (47% vs. 20%, p<0.005) and hip (19% vs. 6%, p<0.005). After adjusting for age, menopausal status and body mass index, osteoporosis and osteopenia remained significantly
associated with CF only in women aged 65 years or less (ultradistal forearm OR 5.7 (95% CI 1.2–27.2), lumbar spine OR 3.9
(95% CI 1.1–14.3)). We conclude that CF in postmenopausal women aged 65 or less may be used as a sentinel finding to identify
patients with generalized osteoporosis. Additionally, 70% of all CF patients regardless of their age had low bone mass (T-score<−1SD) in any studied site.
Received: 3 December 2001 / Accepted: 22 May 2002 相似文献
9.
Longitudinal Study of Bone Loss in Pre- and Perimenopausal Women: Evidence for Bone Loss in Perimenopausal Women 总被引:3,自引:0,他引:3
R. D. Chapurlat P. Garnero E. Sornay-Rendu M. E. Arlot B. Claustrat P. D. Delmas 《Osteoporosis international》2000,11(6):493-498
Bone loss before and around the time of menopause is not well characterized by longitudinal studies. We measured bone mineral
density at various skeletal sites – total body, femoral neck, trochanter, anteroposterior (AP) and lateral spine, and forearm
– with dual-energy X-ray absorptiometry in a large prospective cohort of 272 untreated pre- and perimenopausal women aged
31–59 years, at 1 year intervals for 3 years. Sex steroids and the following markers of bone remodeling were measured: serum
osteocalcin (OC), procollagen I carboxyterminal extension peptide, bone alkaline phosphatase (BAP) and urinary crosslinks
(CTX and NTX). Seventy-six women were classified as perimenopausal and 196 as premenopausal. Over the 3 years, premenopausal
women had no significant bone loss at any site and a small but significant increase in bone mineral density at the trochanter,
total hip, AP spine and radius. Perimenopausal women significantly lost bone from cancellous and cortical sites, i.e., the
femoral neck, trochanter and lumbar spine. In perimenopausal women with increased follicle stimulating hormone, the rate of
bone loss at the femoral neck correlated negatively with OC and BAP. In perimenopausal women, serum estradiol levels decreased
during the 3 years of follow-up and bone loss from the trochanter and the AP spine was correlated with serum estradiol after
3 years. In conclusion, among premenopausal women there is no bone loss. In contrast, there is a rapid and diffuse bone loss
in perimenopausal women, related to decreased estrogen secretion. Bone markers may be useful to identify these women losing
bone.
Received: 13 October 1997 / Accepted: 19 October 1998 相似文献
10.
N. B. Watts D. K. Jenkins J. M. Visor D. C. Casal P. Geusens 《Osteoporosis international》2001,12(4):279-288
Alendronate therapy in osteoporotic women decreases bone turnover and increases bone mineral density (BMD). Optimal patient
management should include verification that each patient is responding to therapy. Markers of bone turnover and BMD have both
been proposed for this purpose. We have investigated changes resulting from alendronate therapy with an enzyme immunoassay
for bone alkaline phosphatase (BAP) and compared it with total alkaline phosphatase (TAP) and BMD of the lumbar spine, hip,
and total body. Subjects were drawn from a multicenter randomized, placebo-controlled trial of alendronate in postmenopausal
women with osteoporosis. BAP and TAP levels were measured at baseline and following 3, 6 and 12 months of therapy with either
placebo (n= 180) or alendronate 10 mg/day (n= 134). All subjects also received 500 mg/day supplemental calcium. BMD was measured at baseline and following 3, 6, 12, 18,
24 and 36 months of therapy. To compare BAP, TAP and BMD at each site for identifying women that experienced a skeletal effect
of alendronate, we calculated least significant change (LSC) values from the long-term intraindividual variability in each
placebo-treated woman. Median levels of BAP decreased by 34%, 44% and 43% at 3, 6 and 12 months, respectively, in alendronate-treated
women (p<0.0001 compared with baseline and with placebo). These changes were significantly greater (p<0.0001) than changes observed for TAP. Following 6 months of alendronate therapy, 90% of the women had experienced a decrease
in BAP exceeding the LSC compared with only 71% for TAP. The greatest number of women similarly identified with BMD at any
site (i.e. a gain in BMD exceeding the LSC) was 81% for spinal BMD at 36 months. All other sites were less than 70% at 36
months. Short-term changes in BAP and TAP were modestly associated with subsequent changes in BMD at all sites (Spearman’s
rho −0.22 to −0.52, p<0.05). Compared with TAP and BMD, BAP testing rapidly and sensitively identified skeletal effects of alendronate thus enabling
appropriate drug monitoring of osteoporotic women. Though BAP and TAP changes were modestly predictive of BMD changes, the
value of the bone marker tests is their ability to detect rapidly a skeletal effect of therapy.
Received: 19 May 2000 / Accepted: 31 October 2000 相似文献
11.
Withdrawal of Hormone Replacement Therapy is Associated with Significant Vertebral Bone Loss in Postmenopausal Women 总被引:2,自引:0,他引:2
This study aimed to assess the changes in vertebral bone mineral density (BMD) after cessation of hormone replacement therapy
(HRT) in postmenopausal women who had been treated on a long-term basis. Fifty healthy postmenopausal women who had been followed
both during the course of HRT and after cessation of treatment in our menopause clinic were included in this study. All women
had started HRT within the first 3 years after the postmenopause and had received HRT (either 1.5 mg/day of 17β-estradiol
given percutaneously or 50 μg/day of 17β-estradiol given as a transdermal patch, combined in all women with natural progesterone
or a 19-norprogesterone derivative) for a mean 5 ± 2.4 years. In all women, vertebral BMD was assessed during the course of
HRT up to the last 6 months before estrogen withdrawal, then at least once within the first 18 months after cessation of treatment.
Of the initial population, 30 women were additionally reviewed later on and up to 8 years after cessation of treatment (mean
duration of follow-up for the whole population: 3.9 ± 1.7 years). Rates of changes in vertebral BMD were compared with those
determined in a group of healthy untreated women who had been followed within the first years of postmenopause during the
same time period as the study population. In the study group, bone loss was found to accelerate within the first 2 years after
HRT withdrawal and the annual rate of loss was identical to that which occurs within the first 2 years of postmenopause in
untreated women (−1.64%± 1.3% vs −1.52 ± 0.9%, NS). Beyond this first 2-year time period, the annual rate of bone loss decreased
as a function of time following cessation of treatment, as was observed following the menopause in untreated women (between
3 and 5 years: −0.83%+ 1.35% in the study group vs −0.70%± 0.8% in the control group, NS). On average, 3 years after cessation
of HRT mean vertebral BMD when expressed as a Z-score was significantly higher (−0.13 vs −0.89, p<0.01) than at baseline, before HRT was started, which suggested a lasting beneficial effect on bone mass. However, even though
our findings do not support the hypothesis that bone loss might continue to be accelerated several years after cessation of
treatment we cannot fully address the question as to whether any residual benefit on bone mass over a longer period of time
may be observed. In conclusion, the pattern of bone loss observed after cessation of estrogen therapy was found to be comparable
to that which occurs in younger women within the first years after the menopause. Such a pattern needs to be kept in mind
when the decision to stop HRT is taken, especially in women who were given HRT to prevent osteoporosis. The issue of assessing
their risk of fracture several years after cessation of treatment thus needs to be addressed.
Received: 25 July 2000 / Accepted: 5 December 2000 相似文献
12.
Systematic Review of Randomized Trials of the Effect of Exercise on Bone Mass in Pre- and Postmenopausal Women 总被引:15,自引:0,他引:15
Studies of the effect of exercise programs on bone mass appear inconsistent. Our objective was to systematically review and
meta-analyze randomized trials of the effect of exercise on bone mass in pre- and postmenopausal women. A computerized MEDLINE
search was conducted for the years 1966–1997. Thirty-five randomized trials were identified. Meta-analytic methods were used
to statistically pool results of studies of the effect of impact (e.g., aerobics) and non-impact (e.g., weight training) exercise
on the lumbar spine and femoral neck. The most studied bone site was the lumbar spine in postmenopausal women (15 studies),
where both impact [1.6% bone loss prevented, 95% confidence intervals (CI): 1.0%–2.2%] and non-impact (1.0%, 95% CI: 0.4%–1.6%)
exercise programs had a positive effect. Results for the lumbar spine in premenopausal women (eight studies) were similar:
1.5% (95% CI: 0.6%–2.4%) less bone loss (or net gain) after impact exercise and 1.2% (95% CI: 0.7%–1.7%) after non-impact
exercise. Impact exercise programs appeared to have a positive effect at the femoral neck in postmenopausal women (five studies),
1.0% (95% CI: 0.4%–1.6%) bone loss prevented, and possibly in premenopausal women, 0.9% (95% CI: −0.2%–2.0%) bone loss prevented.
There were too few trials to draw conclusions from meta-analyses of the effect of nonimpact exercise on the neck of femur.
This systematic review of randomized trials shows that both impact and non-impact exercise have a positive effect at the lumbar
spine in pre- and postmenopausal women. Impact exercise probably has a positive effect at the femoral neck. More studies are
required to determine the optimal intensity and type of exercise.
Received: 11 May 1999 / Accepted: 18 January 2000 相似文献
13.
Hong-Wen Deng Jian Li Jin-Long Li M. Johnson G. Gong R. R. Recker 《Osteoporosis international》1999,9(6):499-507
Much work has been done on the association between vitamin D receptor (VDR) genotypes and bone mineral density (BMD). Despite
considerable effort, the results are inconsistent. While the VDR association remains unresolved, studies have expanded to
other candidate genes (i.e., estrogen receptor (ER) genotypes), also yielding inconsistent results. A few studies have suggested
that interaction effects between VDR and ER genotypes significantly affect BMD. We assessed associations of BMD with VDR BsmI genotypes, and ER XbaI and PvuII polymorphisms (denoted as ERX and ERP respectively) with spine, femoral neck, distal radius BMD, and with total body bone
mineral content (tbBMC) in 108 US Mid-western postmenopausal Caucasian women. We statistically controlled for confounding
factors such as height, weight, etc., in the analysis. No significant association was detected for ER genotypes with spine
and radius BMD, or for VDR genotypes with femoral neck and radius BMD and tbBMC. No significant interaction between VDR and
ER genotypes was detected in our sample. However, the VDR genotypes are significantly (p = 0.004) associated with *5.8% spine BMD variation. Both ERX and ERP genotypes are significantly (p = 0.02) associated with *3.5% femoral neck BMD variation. ERX genotypes are significantly (p = 0.03) associated with *2.4% tbBMC variation. However, if the data were analyzed by simple ANOVA as in some previous studies,
without adjusting statistically for confounding factors, all the significant results we found here would have gone undetected.
Our findings suggest that: (1) VDR and ER genotypes may have different effects on BMD at different sites and on tbBMC; and
(2) if significant factors influencing bone are not appropriately controlled, true significant associations can easily be
missed. These findings may offer a partial explanation for some of the earlier inconsistent results of association studies
on BMD with VDR and ER genotypes.
Received: 4 August 1998 / Accepted: 2 November 1998 相似文献
14.
Treatment of Postmenopausal Women with Osteoporosis or Low Bone Density with Raloxifene 总被引:3,自引:0,他引:3
P. J. Meunier E. Vignot P. Garnero E. Confavreux E. Paris S. Liu-Leage S. Sarkar T. Liu M. Wong M. W. Draper 《Osteoporosis international》1999,10(4):330-336
Raloxifene, a selective estrogen receptor modulator (SERM), has been shown to improved bone mineral density (BMD) and serum
lipid profiles in healthy postmenopausal women. The objective of this study was to examine the effects of raloxifene on BMD,
biochemical markers of bone metabolism and serum lipids in postmenopausal women with low bone density or osteoporosis. This
Phase II, multicenter, 24-month, double-masked study assessed the efficacy and safety of raloxifene in 129 postmenopausal
women (mean age ± SD: 60.2 ± 6.7 years) with osteoporosis or low bone density (baseline mean lumbar spine BMD T-score: −2.8). Women were randomly assigned to one of three treatment groups: placebo, 60 mg/day raloxifene-HCl (RLX 60) or
150 mg/day raloxifene-HCl (RLX 150) and concomitantly received 1000 mg/day calcium and 300 U/day vitamin D3. At 24 months, BMD was significantly increased in the lumbar spine (+3.2%), femoral neck (+2.1%), trochanter (+2.7%) and
total hip (+1.6%) in the RLX 60 group compared with the placebo group (p<0.05). The RLX 150 group had increases in BMD similar to those observed with RLX 60. A greater percentage of raloxifene-treated
patients, compared with those receiving placebo, had increased BMD (p<0.05). Serum bone-specific alkaline phosphatase activity, serum osteocalcin, and urinary type I collagen:creatinine ratio
were significantly decreased in the RLX-treated groups, compared with the placebo group (p<0.01). RLX 60 treatment significantly decreased serum levels of triglycerides, and total- and LDL-cholesterol levels (p<0.01). The rates of patient discontinuation and adverse events were not significantly different among groups. In this study,
raloxifene increased bone density, decreased bone turnover, and improved the serum lipid profile with minimal adverse events,
and may be a safe and effective treatment for postmenopausal women with osteoporosis or low bone density.
Received: 26 December 1998 / Accepted: 31 March 1999 相似文献
15.
Prevention of Bone Loss by Clodronate in Early Postmenopausal Women with Vertebral Osteopenia: A Dose-Finding Study 总被引:1,自引:0,他引:1
M. J. V?lim?ki K. Laitinen K. Laitinen A. Patronen H. Puolijoki H. Puolijoki J. Sepp?nen L. Pylkk?nenand the Probone Study Group 《Osteoporosis international》2002,13(12):937-947
This double-masked, placebo-controlled study was undertaken to determine the efficacy and safety of oral clodronate in the
prevention of bone loss in early postmenopausal women with vertebral osteopenia. Altogether 610 women with a mean age of 53
years were recruited for the study. They were 1–5 years postmenopausal and their lumbar spine bone mineral density (BMD) was
at least 1 standard deviation below the mean of premenopausal women (T-score ≤−1). The subjects were randomized into five study groups to receive either placebo, clodronate 65 mg, 400 mg or 800
mg daily, or intermittent clodronate in 3 month cycles with 400 mg daily for 15 days followed with no treatment for 75 days
for 3 years. One hundred and eighty-seven of 509 women who completed the primary study continued in the extension study of
2 years in which previous placebo users were switched to clodronate 800 mg daily, while previous users of 400 mg or 800 mg
of clodronate used either placebo or 800 mg of clodronate daily. In the primary study clodronate was administered in the evening,
and in the extension 1 h before breakfast on an empty stomach. In the primary study mean changes in lumbar spine BMD were
−3.4% in the placebo group and +0.4% in 800 mg clodronate group [difference between groups at 3 years 3.8% (95% CI 2.7% to
4.9%, p<0.0001)], and in the trochanter area BMD −1.1% in the placebo group, and + 0.4% in the 800 mg clodronate group [difference
between groups at 3 years 1.5% (95% CI 0.05% to 2.9%)]. During the extension study mean changes in lumbar spine BMD were +1.5%
in the clodronate group and −0.2 % in the placebo group [difference between groups 1.7% (CI 0.4% to 3.0%, p = 0.010)] and in trochanter BMD were +2.5% in the clodronate group and no change in the placebo group [difference between
groups 2.1% (CI 0.3% to 3.9%, p = 0.007)]. No statistically significant differences between the placebo and 800 mg clodronate groups were found in the femoral
neck BMD. In the primary study the urinary excretion of type I collagen aminoterminal telopeptide (NTX) decreased by 44% (p<0.0001 compared with placebo) and that of deoxypyridinoline by 18% (p<0.0001) in the clodronate 800 mg group. In the extension study urinary NTX decreased by 51% (p<0.0001) in those who were switched to 800 mg of clodronate and increased by 67% (p<0.0001) in those who stopped using that dose. There was no difference in the frequency of gastrointestinal complaints between
clodronate- and placebo-treated patients in the primary study, but they were more common among women who received clodronate
in the extension phase. Clodronate in daily doses of 400–800 mg caused a slight elevation of aminotransferase levels, usually
within the reference range. In bone biopsies no defect in mineralization was found. In conclusion, clodronate in a daily dose
of 800 mg prevents early postmenopausal bone loss at the sites of the skeleton in which cancellous bone predominates. It effectively
reduces bone resorption and bone turnover rate. Antifracture efficacy of clodronate remains to be established by prospective,
placebo-controlled trials.
Received: 4 March 2002 / Accepted: 9 July 2002 相似文献
16.
Bone Mass, Bone Metabolism, Gonadal Status and Body Mass Index 总被引:3,自引:0,他引:3
H. Rico I. Arribas F. J. Casanova A. M. Duce E. R. Herna´ndez J. Cortes-Prieto 《Osteoporosis international》2002,13(5):379-387
Weight and gonadal status are the main determinants of bone mass in women. Because of this it is important to study which
influences it more. The effect of weight (expressed as body mass index, BMI) and gonadal status of women on total-body bone
mineral content (TBBMC) and regional bone mineral content (BMC) was investigated. A total of 373 normal women (mean age 48.9
± 13.4 years) were studied: 171 postmenopausal women (mean age 59.3 ± 9.5 years; years since menopause 11.3 ± 6.7 years);
76 perimenopausal women (mean age 48.9 ± 2.2 years); and 126 premenopausal women (mean age 34.7 ± 7.4 years). In all the women,
TBBMC and regional BMC were determined by dual-energy X-ray absorptiometry. Also biochemical markers of bone metabolism (total
alkaline phosphatase and tartrate-resistant acid phosphatase) and serum estrone and estradiol were determined. When the women
were stratified by gonadal status and BMI, thin women (BMI <20 kg/m2) had significantly lower TBBMC and regional BMC, lower gonadal steroid concentration and higher levels of biochemical markers
than overweight (BMI 25–30 kg/m2) and obese (BMI >30 kg/m2) women, regardless of gonadal status. Overweight and obese women had findings suggestive of increased parathyroid activity,
but greater bone mass. Weight rather than gonadal steroid concentration is the main determinant of bone mass in women regardless
of gonadal status.
Received: 6 July 2001 / Accepted: 15 November 2001 相似文献
17.
Alendronate significantly increases bone mass and reduces hip and spine fractures in postmenopausal women. To determine whether
forearm densitometry could be used to monitor the efficacy of alendronate, we examined changes in bone mineral density (BMD)
at the forearm (one-third distal, mid-distal, ultradistal radius) versus changes at the hip (femoral neck, total hip) and
spine (posteroanterior and lateral) in a double-masked, randomized, placebo-controlled clinical trial of 120 elderly women
(mean age 70 ± 4 years) treated with alendronate for 2.5 years. We found that among women in the treatment group, BMD increased
by 4.0–12.2% at the hip and spine sites (all p<0.001), whereas BMD increased only nominally at the one-third distal radius (1.3%, p<0.001) and mid-radius (0.8%, p<0.05), and remained stable at the ultradistal radius. At baseline, forearm BMD correlated with that of the hip (r= 0.55–0.64, p<0.001), femoral neck (r= 0.54–0.61, p<0.001) and posteroanterior spine (r= 0.56–0.63, p<0.001). Changes in radial BMD after 1 year of therapy were not correlated with changes in hip and spine BMD after 2.5 years
of therapy. In contrast, short-term changes in total hip and spine BMD were generally positively associated with long-term
changes in total hip, femoral neck and spine BMD (r= 0.30–0.71, p<0.05). Furthermore, long-term BMD changes at the forearm did not correlate with long-term hip and spine BMD changes, in contrast
to the moderate correlations seen between spine and hip BMD at 2.5 years (r= 0.38–0.45, p<0.01). We conclude that neither short- nor long-term changes in forearm BMD predict long-term changes in overall BMD for
elderly women on alendronate therapy, suggesting that measurements of clinically relevant central sites (hip and spine) are
necessary to assess therapeutic efficacy.
Received: 18 February 1999 / Accepted: 20 May 1999 相似文献
18.
C. A. C. Coupland M. J. Grainge S. J. Cliffe D. J. Hosking C. E. D. Chilvers 《Osteoporosis international》2000,11(4):310-315
Few studies have assessed the relationship between occupational activity and bone mineral density (BMD), although two case–control
studies have reported a protective effect of occupational activity on hip fracture. In the present study 580 postmenopausal
women aged 45–61 years completed a risk factor questionnaire including a detailed occupational history. For each job, hours
spent sitting, standing, walking, lifting and carrying were recorded; these measures, evaluated at ages 20, 30, 40 years,
in the current job and over the working lifetime, were used in the analysis. BMD was measured with dual-energy X-ray absorptiometry,
and measurements at five sites were used in a multiple regression analysis adjusting for potential confounding variables.
There was a significant negative association between sitting at age 20 years and BMD at the radius (p= 0.037), with negative relationships of borderline significance at the anteroposterior spine (p = 0.091) and whole body (p= 0.078). There were significant positive associations between standing at age 30 years and BMD at all five sites (p<0.05), but no significant linear associations for standing at ages 20 and 40 years. No significant associations were found
for lifetime or current occupational measures of sitting, standing, walking and lifting or carrying. The lack of consistency
of these significant findings suggests that they may have occurred by chance, and that occupational activity has little if
any effect on BMD in postmenopausal women.
Received: 12 March 1999 / Accepted: 17 September 1999 相似文献
19.
We conducted a cross-sectional study of the effects of soybean protein intake on bone mineral density and biochemical markers
in 85 postmenopausal Japanese women. Nutrients in the diet of postmenopausal Japanese women visiting the osteoporosis unit,
including subjects with normal lumbar spine bone mineral density (L2–4 BMD), were investigated by questionnaire, and the calculated
daily energy, protein, soy protein and calcium intake were obtained. L2–4 BMD was measured with dual-energy X-ray absorptiometry,
and assays done of serum alkaline phosphatase (ALP) and serum intact osteocalcin (IOC) as bone formation markers and urinary
pyridinoline (UPYR) and urinary deoxypyridinoline (UDPYR) as bone resorption markers. Soy protein intake was significantly
associated with the Z-score for L2–4 BMD (r= 0.23, p = 0.038) and UDPYR (r =−0.23, p = 0.034). Stepwise multiple regression analyses showed that soy protein intake is significantly associated with the Z-score for L2–4 BMD (β= 0.225, p = 0.04) and UDPYR (β=−0.08, p = 0.03) among four nutritional factors. These results suggest that high soy protein intake is associated with a higher bone
mineral density and a lower level of bone resorption, but further studies are needed to confirm the causal dynamic mechanisms.
Received: 17 September 1999 / Accepted: 29 February 2000 相似文献
20.
Short-Term Risedronate Treatment in Postmenopausal Women: Effects on Biochemical Markers of Bone Turnover 总被引:3,自引:0,他引:3
L. Raisz J.-A. Smith M. Trahiotis P. Fall K. Shoukri J. DiGennaro N. Sacco-Gibson 《Osteoporosis international》2000,11(7):615-620
The development of new biochemical markers has made it possible to assess the effects of therapeutic agents on bone turnover
more rapidly and precisely. In this early phase II study, we analyzed the effects of short-term, high-dose treatment with
risedronate, a potent pyridinyl bisphosphonate, on markers of bone resorption and formation. Resorption markers included urinary
free deoxypyridinoline (D-Pyr) crosslinks, N-terminal telopeptide (NTx) and C-terminal telopeptide (CTx) type I collagen crosslinks.
Bone formation markers included osteocalcin (OC), bone-specific alkaline phosphatase (BSAP) and the C-terminal peptide of
type I procollagen (PICP). All three resorption markers showed rapid, significant (p<0.05) decreases from baseline following daily administration of 30 mg risedronate for 2 weeks. The mean decreases at 2 weeks
were 28% for D-Pyr, 61% for NTx and 73% for CTx, respectively. Over the next 10 weeks after treatment, D-Pyr approached baseline
while NTx and CTx remained well below baseline values. The markers of bone formation showed little change during therapy but
decreased significantly at 4–10 weeks after therapy – an expected outcome of bisphosphonate therapy. Moreover, there was a
significant correlation between the early effects on bone resorption markers and the delayed effects on formation markers.
This study demonstrates that the approved dose of risedonate (30 mg/day) for Paget”s disease is effective at decreasing bone
turnover after 2 weeks of treatment, as observed by the sensitive response of bone turnover markers.
Received: 18 August 1999 / Accepted: 18 January 2000 相似文献