腹膜透析患者骨密度测定与骨折风险评价

目的观察腹膜透析患者骨密度改变及分析相关因素,为骨质疏松早期诊断和预防骨折发生提供临床依据。方法选择上海交通大学医学院附属瑞金医院肾内科84例慢性肾衰竭腹膜透析患者,以双能X线吸收(dual energy X-ray absorptiometry,DEXA)骨密度仪测定腰椎和股骨近端骨密度,同时采集其临床、生化指标及X线平片。结果 11.9%腹膜透析患者骨质疏松,36.9%骨量减少。骨质疏松多元回归分析入选变量为性别、年龄、体质量指数、尿素清除指数(Kt/V)和尿量。这些患者自腹膜透析始骨折总发生率为9.5%。进入骨折Cox回归模型是腰椎Z值和股骨颈Z值及体质量指数。结论透析不充分、低体质量指数、老年、女性、残余尿量少可能是腹膜透析患者骨质疏松重要危险因素。腰椎和股骨颈Z值可预测腹膜透析患者骨折发生,低体质量指数是腹膜透析患者骨折独立高危因素。     

骨质疏松性椎体压缩性骨折椎体成形术后再骨折的影响因素分析

目的分析骨质疏松性椎体压缩骨折椎体成形术后再骨折的影响因素和防治措施。方法对我院2013年8月至2015年1月行经皮椎体成形术治疗的106例骨质疏松性椎体压缩骨折患者进行回顾性分析,平均随访12.3个月。根据有无继发骨折分为再骨折和无骨折两组,比较各组性别、年龄、体质量指数、骨密度T值、损伤节段数量、骨水泥注射方式、骨水泥注射量、术后有无椎间盘骨水泥渗漏、椎体前柱高度恢复率、术后后凸畸形角度以及术前椎体内是否合并裂隙样变等情况。结果 106例患者共170个椎体行PVP术,术后继发骨折共22例40个椎体,单因素分析显示体质量指数、骨密度T值及术后后凸畸形角度与椎体再骨折具有相关性(P<0.05)。Logistic回归分析显示体质量指数(OR=0.644)及骨密度T值(OR=0.048)是术后椎体再骨折的高危因素(P<0.05)。结论体质量指数与低骨密度是引起椎体压缩性骨折PVP术后椎体再骨折的高风险因素,抗骨质疏松治疗及改善体质可能会降低椎体再骨折的发生。     

老年妇女骨质疏松性髋部骨折的危险性预测

目的:通过建立判别方程探讨老年妇女骨质疏松性髋部骨折的危险性因素。方法:以髋部骨折老年女性患者及保健体检的老年妇女各30例为对象进行病例对照观察。分为骨折组和对照组。其中骨折组来自2002-02/2004-02深圳市人民医院骨科收治老年女性骨质疏松髋部骨折患者,对照组来自同期在该院进行社区保健体检的健康老年妇女。两组受试者均知情同意。①两组受试者髋部骨密度测定:应用DEXA骨密度测定仪及握力器,骨折组测量健侧,对照组测量左侧,颈干角和左手握拳力。②体质量指数,根据身高和体质量算出。③确定个人及家族女性骨折史。④老年女性骨质疏松性髋部骨折判别方程建立:将单因素分析有意义的因素作为预测变量,家族史(X1)、股骨颈骨密度(X2)、Ward区骨密度(X3)、颈干角(X4)、人体质量指数(X5)和左手握拳力(X6)6个因素判别因子,建立判别方程。结果:①两组患者家庭及个人骨折史差异性统计分析结果:骨折组有骨折史者显著高于对照组(18,8,χ2=6.491,P=0.011)。②老年妇女骨质疏松性髋部骨折的危险因素:为Ward区骨密度、颈干角、体质量指数和左手握拳力。③老年女性骨质疏松性髋部骨折判别方程建立:Y1=-8.802X1+88.803X2+9.936X3+8.119X4+2.634X5+22.439X6-691.647;Y0=-9.901X1+93.959X2+15.872X3+8.045X4+3.037X5+23.533X6-696.287;将判别方程进行组内回代检验,特异度为76.7%,灵敏度为86.7%,预测正确率为81.7%。④老年骨质疏松性髋部骨折的危险因素比较:用标准化回归系数作比较,颈干角为0.487,Ward区骨密度为0.472,体质量指数为0.533,左手握拳力为0.458,可见体质量指数对骨折发生的影响最大。结论:老年女性骨质疏松性髋部骨折的发生是由诸多因素造成的,髋部骨密度、髋部几何结构、体质量指数、肌肉力量与健康状况、活动量的大小、跌倒、家族女性及个人骨折史等均与髋部骨折有关。因此,只有综合考虑各因素的作用,才能准确预测骨质疏松性髋部骨折。判别方程能更全面反映骨折的危险性程度,预测意义较大。     

老年妇女骨质疏松性髋部骨折的危险性预测

目的：通过建立判别方程探讨老年妇女骨质疏松性髋部骨折的危险性因素。方法：以髋部骨折老年女性患者及保健体检的老年妇女各30例为对象进行病例对照观察。分为骨折组和对照组。其中骨折组来自2002—02／2004—02深圳市人民医院骨科收治老年女性骨质疏松髋部骨折患者，对照组来自同期在该院进行社区保健体检的健康老年妇女。两组受试者均知情同意。①两组受试者髋部骨密度测定：应用DEXA骨密度测定仪及握力器。骨折组测量健侧，对照组测量左侧，颈干角和左手握拳力。②体质量指数，根据身高和体质量算出。③确定个人及家族女性骨折史。④老年女性骨质疏松性髋部骨折判别方程建立：将单因素分析有意义的因素作为预测变量，家族史（X1）、股骨颈骨密度（X2）、Ward区骨密度（X3）、颈干角（X4）、人体质量指数（X5）和左手握拳力（X6）6个因素判别因子，建立判别方程。结果：①两组患者家庭及个人骨折史差异性统计分析结果：骨折组有骨折史者显著高于对照组（18，8，r=6．491，P=0．011）。②老年妇女骨质疏松性髋部骨折的危险因素：为Ward区骨密度、颈干角、体质量指数和左手握拳力。③老年女性骨质疏松性髋部骨折判别方程建立：Y2=-8．802X1＋88．803X2＋9．936X3＋8．119X4＋2．634X5＋22．439X6-691．647；Y0=-9．901X1＋93．959X2＋15．872X3＋8．045X4＋3．037X5＋23．533X6-696．287；将判别方程进行组内回代检验，特异度为76．7％，灵敏度为86．7％，预测正确率为81．7％。④老年骨质疏松性髋部骨折的危险因素比较：用标准化回归系数作比较，颈干角为0．487，Ward区骨密度为0．472，体质量指数为0．533，左手握拳力为0．458，可见体质量指数对骨折发生的影响最大。结论：老年女性骨质疏松性髋部骨折的发生是由诸多因素造成的，髋部骨密度、髋部几何结构、体质量指数、肌肉力量与健康状况、活动量的大小、跌倒、家族女性及个人骨折史等均与髋部骨折有关。因此，只有综合考虑各因素的作用，才能准确预测骨质疏松性髋部骨折。判别方程能更全面反映骨折的危险性程度，预测意义较大。     

CKD5D患者骨折风险的相关因素分析

目的探讨CKD5D骨折患者临床特点及风险相关因素。方法 124例CKD5D患者按既往或现在有无骨折的发生,分为骨折组和非骨折组。记录临床资料如年龄、性别、身高、体质量、透析时间、透析方式、体质量指数、高血压、糖尿病病史、服用药物史;实验室检查指标如血红蛋白、红细胞比积、血肌酐、尿素氮血糖、白蛋白、甘油三酯、胆固醇、高密度脂蛋白、低密度脂蛋白、血钠、血钙、血磷、甲状旁腺激素、碱性磷酸酶、25(OH)Vit D;骨密度检查。结果与非骨折组比较,骨折组血液透析比例更高、透析时间更长,血钙、血磷、PTH、AKP更高,骨密度T值、Z值均明显下降。骨折风险的单因素回归分析提示,透析龄长、高钙、高磷、高PTH、高AKP、高25(OH)Vit D与骨折的发生正相关,腹膜透析、使用钙剂与骨折的发生负相关。多因素逐步回归分析提示,高PTH、高AKP与骨折的发生正相关,腰椎骨密度和使用钙剂与骨折的发生负相关。结论低骨密度是骨折发生的重要危险因素,钙剂的使用能减少骨折风险,CKD5D患者高PTH、高AKP应积极干预。     

中老年髋部骨折患病危险因素分析

目的调查中老年髋部骨折患病危险因素,寻找可能的防治方法。方法2001-01/2004-10在沈阳市第四人民医院骨科住院的髋部骨折患者76例,男29例,女47例。入院后1周内接受了患病危险因素调查和相关检查,并与83例(男45例,女38例)同期、同龄的健康体检者比较。结果76例髋部骨折患者与对照组比较,性别、平均绝经时间、平均哺乳时间、平均身高、平均体质量指数、平均骨密度、平均吸烟指数、居住房间朝阳率、长期服用钙剂、有糖尿病史、经常参加体育锻炼、骨折阳性家族史差异均有显著性意义(P均<0.01或0.05)。结论中老年髋部骨折患病主要原因为性别、平均绝经时间、平均哺乳时间、平均身高、平均体质量指数、平均骨密度、平均吸烟指数、居住房间朝阳率、长期服用钙剂、有糖尿病史、经常参加体育锻炼及有骨折阳性家族史。     

老年髋部骨折患者D-二聚体变化趋势及诊断临界点

目的分析老年髋部骨折患者骨折后D-二聚体变化规律及ROC曲线确定D-二聚体诊断老年髋部骨折患者深静脉血栓形成的诊断临界点。方法入院记录459例年龄≥50岁的髋部骨折患者血浆D-二聚体浓度,并应用SPSS 19.0软件进行统计学分析。结果老年髋部骨折患者,其D-二聚体有一个先降低后升高的趋势,转折点位于骨折后第3天;骨折后3天以内,其诊断临界点为12.13 mg/L;而3天后,其诊断临界点为2.79 mg/L。结论对于老年髋部骨折患者,骨折3天内、3天后应使用不同诊断临界点,以增加D-二聚体诊断深静脉血栓形成的准确性。     

不同部位创伤骨折患者的D-二聚体水平及其临床意义

目的研究不同部位创伤骨折患者D-二聚体水平及其临床意义。方法将1 142例骨折患者作为观察对象,根据患者是否为急性创伤以及患者的骨折部位进行分组。于入院次日取空腹静脉血10 ml采用免疫比浊法对患者的D-二聚体和血清纤维蛋白降解产物水平进行测定。观察急性创伤与非急性创伤患者以及不同部位患者D-二聚体水平及其与患者血凝和血栓之间的关联。结果急性创伤组714例患者中,D-二聚体水平为469.24±61.53μg/L,阳性人数214例,占比29.99%;非急性创伤组428例患者中D-二聚体水平为124.36±14.35μg/L,阳性人数17例,占比3.97%。急性创伤患者的D二聚体水平以及阳性率显著高于非急性创伤患者(P0.05);D-二聚体在上肢骨折、脊柱骨折、股骨骨折、胫腓骨骨折、足骨骨折、多骨折患者中阳性率分别为10.60%、20.91%、39.52%、87.73%、83.67%和59.77%。不同骨折部位患者D-二聚体水平与阳性率存在显著差异(P0.0.5),以胫腓骨骨折患者和足骨骨折患者D-二聚体阳性率最高。结论急性和非急性创伤患者间,不同部位骨折患者间D-二聚体水平存在显著差异,其可以作为临床诊疗的重要参考指标。     

中老年髋部骨折患病危险因素分析

目的调查中老年髋部骨折患病危险因素,寻找可能的防治方法.方法 2001-01/2004-10在沈阳市第四人民医院骨科住院的髋部骨折患者76例,男29例,女47例.入院后1周内接受了患病危险因素调查和相关检查,并与83例(男45例,女38例)同期、同龄的健康体检者比较.结果 76例髋部骨折患者与对照组比较,性别、平均绝经时间、平均哺乳时间、平均身高、平均体质量指数、平均骨密度、平均吸烟指数、居住房间朝阳率、长期服用钙剂、有糖尿病史、经常参加体育锻炼、骨折阳性家族史差异均有显著性意义(P均＜0.01或0.05).结论 中老年髋部骨折患病主要原因为性别、平均绝经时间、平均哺乳时间、平均身高、平均体质量指数、平均骨密度、平均吸烟指数、居住房间朝阳率、长期服用钙剂、有糖尿病史、经常参加体育锻炼及有骨折阳性家族史.     

维持性血液透析患者发生骨折与骨矿物质代谢紊乱的关系

目的 观察维持性血液透析（MHD）患者发生骨折与患者预后的关系以及骨代谢指标监测对临床的指导意义。方法 采用前瞻队列研究,从2010～2012年对中国中医科学院广安门医院血液净化中心行MＨD的158例患者进行随访,记录患者干体质量变化,陈旧及新发生骨折例数,新发骨折对患者生存以及心血管事件发生情况的影响,定期监测患者血钙、磷、碱性磷酸酶、全段甲状旁腺素（iPTH）、总维生素D（总VitD）、Ⅰ型胶原交联Ｃ末端肽,骨钙素,降钙素,比较新发生骨折者与未发生骨折者上述指标以及预后的差异。结果 研究开始时已存在陈旧骨折者27例,随访期内新发骨折21例,平均骨折发生率为：4．43／100个患者年,均为脆性骨折。与未发现骨折者比较,新发生骨折患者年龄更大,ALP水平较高,女性所占比例较高,体质指数较低,干体质量呈下降者更多（P〈０．05）,规律使用骨化三醇或阿发骨化醇者比例较低（42．86％比72．26％,P〈０．05）,随访期内死亡及心血管事件发生率较高,分别为：66．67％比18．98％和52．38％比10．95％（P〈0．05）,2组患者其余矿物质及骨代谢相关指标均未见明显差异。发生骨折后未接受骨科固定治疗者1年内死亡率明显高于接受治疗者（70．59％比25．00％）,寿命表生存分析显示新发骨折使MHD患者累计生存率较未骨折组明显降低（中位生存月15．75比36．00）。Logistic回归表明干体质量下降、女性是MHD患者发生骨折的独立危险因素,OR值分别为42．94（95％CI：9．31,196．34）和3．47（95％CI：1．11,10．84）。结论 老龄、女性、干体重下降、血ALP水平增高、未规律补充维生素D治疗可能与MHD者骨折风险增高有关;除ALP外,其余骨代谢指标对预测骨折风险意义有限。骨折与MHD患者死亡及心血管事件风险明显增高有?     

OSTEOPOROSIS AND THE EFFECTS OF AGEING ON BONE MASS IN ELDERLY MEN AND WOMEN1

A longitudinal study of the effects of ageing on bone mass,height, and body weight was made in random samples of a definedpopulation of elderly men and women. The observations were madetwice with an interval of 11 years between them. At initialsurvey ages ranged from 55 to 64 years. Bone mass was assessedfrom measurements of the second metacarpal cortex made directlyfrom radiographs. Loss of bone occurred in both sexes but thiswas not a universal phenomenon; some men and women lost littleor no bone over the period of study. In those persons in whombone loss did take place this happened at different rates; andthe women tended to lose more bone than the men.Change in bonemass in the metacarpal was not related to loss of heigh, changein body weight, the occurence of fracture, or the presence ofback pains. A separate population of persons with the clinicalsyndrome of senile osteoporosis was not identified.     

Age and bone mass as predictors of fracture in a prospective study

To study the effect of bone mass on the risk of fracture, we followed 521 Caucasian women over an average of 6.5 yr and took repeated bone mass measurements at the radius. We observed 138 nonspinal fractures in 3,388 person-yr. The person-years of follow-up and the incident fractures were cross-classified by age and bone mass. The incidence of fracture was then fitted to a log-linear model in age and bone mass. It was found that incidence of fracture increased with both increasing age and decreasing radius bone mass. When subsets of fractures were examined it was found that age was a stronger predictor of hip fractures, whereas midshaft radius bone mass was a stronger predictor of fractures at the distal forearm. We concluded that bone mass is a useful predictor of fractures but that other age-related factors associated with fractures need to be identified.     

Pain, osteopenia and body composition of 22 patients with Duchenne muscular dystrophy: a descriptive study]

OBJECTIVES: To study the link between pain, osteopenia and body composition in patients with Duchenne muscular dystrophy and to present a detailed questionnaire to evaluate their pain. MATERIALS AND METHODS: Twenty-two boys with Duchenne muscular dystrophy, mean age 11.4+/-4.0 years, were examined between February and March 2003. They were asked to complete a detailed questionnaire and undergo a global assessment of pain on a visual analog scale and muscular testing. They were also asked about a history of fractures. Their bone mineral content at the lumbar spine and femoral neck levels, as well as their body composition in fat and lean mass, were assessed by dual energy absorptiometry. RESULTS: The mean age for walking incapacity was 8.8+/-1.7 years. The youngest patients, who were still able to walk, had a higher level of pain than patients who depended on wheelchairs. No significant correlation was established between pain and osteopenia. One in 2 patients had spontaneous pain, and mobilization was painful for 21. The score obtained by detailed questioning about pain correlates with the average pain scores on visual analog scales. The bone mineral content was lower, especially in the lower limbs, had decreased before the inability to walk and was correlated with muscular weakness. Fractures were more frequent in mobile patients and usually occurred after a fall. CONCLUSION: Although pain in Duchenne muscular dystrophy has not been extensively studied, it is frequent and significant. Twenty-one patients had moderate to severe pain. The youngest patients had intense pain, especially during mobilisation. To evaluate this pain, we propose to use the mean results of 2 visual analog scales associated with a detailed questionnaire. However, in this study, Duchenne muscular dystrophy, pain and osteopenia were not correlated. Dual X-ray absorptiometry provides interesting information about bone mineral content, fat body mass and lean body mass. The fat body mass was higher than normal in our patients. The bone mineral content and lean body mass were lower than that for normal children, because the dystrophic process advances with age. The fracture prevalence was high, especially in young patients. Falling was the most common mechanism of fracture.     

降钙素受体基因多态性与原发性骨质疏松的相关性

目的：骨质疏松是多基因调控疾病，峰值骨量达到和骨量丢失均受遗传因素影响。观察山东半岛地区汉族人群降钙素受体Alu-Ⅰ基因多态性各基因型频率及其与骨质疏松的关系，探讨原发性骨质疏松症的遗传易感因素。 方法：试验于2005—06／2007—06在青岛大学医学院附属医院中心实验室完成。①试验对象：选取332名长期居住在山东半岛地区无亲缘关系的汉族人群，纳入标准：健康门诊查体人员、原发性骨质疏松症及原发性骨质疏松症所致骨折患者：患者对试验知情同意。排除标准：各种继发性骨质疏松症：影响骨代谢相关疾病史；服用影响骨代谢药物等。其中骨质疏松合并骨折75例作为骨质疏松性骨折组，余257例经过骨密度测定确定骨量，按骨质疏松诊断标准（骨密度测定值比同性别峰值骨密度均值降低2，5个标准差）分为骨量正常组（n=201）及骨质疏松组（n=56）。②试验方法：应用聚合酶链反应限制性片段长度多态性分析技术测定257名山东半岛汉族成年人和75名骨质疏松性骨折患者降钙素受体基因型，用双能X射线吸收法测定腰椎、股骨颈、粗隆间、Ward’s三角和大转子区等部位的骨密度值。结果：纳入受试者332人，均进入结果分析。①本试验人群降钙素受体基因型频率分布均符合Hardy-Weinberg定律（x^2=0．47，P=0．493）。基因型频率分布依次为CC型占89.5％，CT型占10，5％，TT型占0％。②年龄与不同部位骨密度值之间呈负相关（P〈0．01），体质量指数与骨密度值之间呈正相关（P〈0．01），在将年龄和体质量指数进行校正后发现女性CC基因型较CT基因型在ward’s三角区有较高的骨密度（P〈0．05），骨量正常组各基因型与骨质疏松性骨折组之间差异无显著性意义（P〉0．05）。 结论：山东半岛汉族女性降钙素受体基因型与骨密度之间存     

不同营养评价方法对高龄老年骨折患者营养状况与切口愈合的临床价值

目的探讨微型营养评价方法(MNA-SF)及营养风险筛查2002(NRS 2002)对评估87例高龄老年骨折患者营养状况和切口愈合的临床价值。方法选择我院2014年6月-2015年12月行手术治疗的87例高龄老年患者,根据两种营养评价方法分别进行营养状况评估,记录手术切口愈合情况。结合体格及实验室检查比较相关性,应用ROC曲线评价两种方法预测患者切口愈合疗效的价值。结果所有患者中切口甲级愈合率66.7%,MNA-SF及NRS 2002营养不良检出率分别为37.9%及27.6%。MNA-SF与BMI、ALB、HB表达呈正相关,NRS2000与BMI、ALB、HB表达呈负相关,两种评价方法中营养状况评价良好的患者切口乙级愈合的发生率明显低于营养状况不良的患者。结论 MNA-SF及NRS 2002在评价高龄老年骨折病人营养状况和切口愈合中均具有良好的临床价值,MNA-SF稍好于NRS 2002。     

Bone mass measured by photon absorptiometry: comparison of forearm, heel, and spine

We assessed bone mass quantification at different skeletal sites by single and dual photon absorptiometric (SPA and DPA) methods. Improved DPA measurement of spinal bone mineral density in young healthy subjects showed a short- and long-term precision of 1.2% and 1.6%. Compared to the conventional DPA method the imprecision was reduced by more than 50%. The appendicular measurements were more precise (0.5-1.2%). We present the intercorrelations and predictive errors between peripheral measurements and improved spinal and total body bone measurements in early postmenopausal women (n = 144) recruited in 1988. To compare the improved system with the conventional methods, we retrieved data on age-matched early postmenopausal women (n = 151) recruited in 1983. In the 1988 population all peripheral methods had similar predictive errors in estimation of spinal bone mineral density (SEE = 11-13%) and total body bone mineral density (SEE = 4-5%). Measurement of trabecular bone in the heel and distal forearm did not improve the validity of predicting spinal bone mass. In a cadaver study (n = 11) the predictive error in estimation of the spinal ash weight from forearm measurements was of the same magnitude (15%) as that in estimation of the spinal BMC from the forearm (16%). We conclude that the predictive error in estimation of spinal bone mass from peripheral bone measurements is more likely to be caused by intra-skeletal variation in bone mass than by precision errors. However, this does not reflect the inability of peripheral bone mass measurements to predict fracture risk.     

上肢创伤骨折并发深静脉血栓的危险因素分析

目的：探讨上肢创伤骨折并发深静脉血栓（DVT）的相关危险因素,为其预防提供参考。方法对2158例上肢创伤患者进行回顾性分析。对DVT发生的相关因素进行单因素及多因素回归分析。结果上肢创伤骨折患者中DVT发生率为0．83％（18/2158）。单因素分析发现年龄大于60岁、高血脂、体质量指数大于25kg/m2、糖尿病、粉碎性骨折、挤压伤、肩胛骨骨折、肱骨外科颈骨折、3处以上骨折9个危险因素与上肢DVT的发生有关。多因素分析发现肩胛骨骨折、3处以上骨折、肱骨外科颈骨折、高血脂4个因素为上肢创伤骨折并发DVT的独立危险因素。结论肩胛骨骨折、3处以上骨折、肱骨外科颈骨折、高血脂是上肢创伤骨折并发DVT的相关因素,正确认识这些危险因素对其防治具有指导意义。     

Risk assessment of vertebral compressive fracture using bone mass index and strength predicted by computed tomography image based finite element analysis

BackgroundA main purpose of osteoporosis diagnosis is to evaluate the bone fracture risk. Some bone mass indices evaluated using bone mineral density has been utilized clinically to assess the degree of osteoporosis. On the other hand, Computed tomography image based finite element analysis has been developed to evaluate bone strength of vertebral bodies. The strength of a vertebra is defined as the load at the onset of compressive fracture. The objective of this study was therefore to propose a new feasible method to combine the advantages of the two osteoporotic indices such as the bone mass index and the bone strength.MethodsThree-dimensional finite element models of 246 vertebral bodies from 88 patients were constructed using the computed tomography images. Finite element analysis was then conducted to evaluate their strength values. The Pearson's correlation analysis was also conducted between the vertebral strength and bone mass indices.FindingsIt was found that relatively weak positive correlations existed between the strength and the bone mass indices. A new assessment method was then proposed by combining the strength and the bone mass index. “high risk zone” corresponding to low strength with normal bone mass was found from the assessment method.InterpretationSinge bone mass index cannot predict the fracture risk with high standard. The results of fracture risk assessment conducted by the new method clearly indicated the necessity and effectiveness to take both the strength and the bone mass index into account.     

Determinants of the first decade of bone loss after menopause at spine, hip and radius

This study documented bone loss at three different sites in the early postmenopausal period, and examined potential predictors. Forty-three women underwent repeated measurements of bone density at the lumbar spine, proximal femur and distal radius for up to 14 years. Individual rates of bone loss were calculated for the spine and hip; for radial trabecular bone, rates were calculated separately for two time periods, earlier and later after menopause. In the spine and radius, initially high rates of loss diminished with time after menopause. No positive correlations for bone loss were found between the three sites, suggesting that faster than average bone loss was specific to individual bones. High body mass index (BMI) was significantly protective against fast bone loss at the spine and radius; in the spine, each unit increase in BMI was associated with a approximately 5% reduction in the rate of bone loss. Of the other variables measured (maximum oxygen consumption, lean body mass, fat mass, mean psoas muscle area at the L3 level, hand grip strength as well as anthropometry) only bone densitometry was sufficiently predictive to help guidance on hormone replacement or other prophylactic therapy. The data suggest that the known relationship between excessive leanness and risk of osteoporosis and vertebral fracture after menopause might in part be due to fast post-menopausal bone loss. Because bulk of psoas muscle was associated with low spine loss rates, the data also support a role for applied muscular loading in local maintenance of bone density.