人体脂肪组织对骨密度的影响

目的探讨人体脂肪对骨密度的影响。方法将160例采用双能X线骨密度吸收仪(dual-energy X-ray absorptiometry,DXA)进行骨密度和身体成分分析的患者作为研究对象,根据脂肪指数将女性和男性患者平分为高脂肪指数组和低脂肪指数组,比较两组的股骨颈、全髋和腰椎骨密度。结果 54例高脂肪指数组女性的脂肪指数为(10.0198±1.6811)kg/m~2,身体脂肪百分比为(36.71±3.06)%;54例低脂肪指数组女性的脂肪指数为(6.7167±1.0130)kg/m~2,身体脂肪百分比为(30.05±3.76)%。26例高脂肪指数组男性的脂肪指数为(6.9240±0.9090)kg/m~2,身体脂肪百分比为(25.72±3.17)%;26例低脂肪指数组男性的脂肪指数为(4.8085±0.7368)kg/m~2;身体脂肪百分比为(21.55±2.39)%。女性高脂肪指数组的股骨颈、全髋和腰椎骨密度均显著高于低脂肪指数组(P0.05);男性高脂肪指数组与低脂肪指数组的各部位骨密度差异无统计学意义(P0.05)。结论女性脂肪量对股骨颈、全髋和腰椎骨密度有正面影响。     

健康中年男性人体成分对骨密度的影响

目的探讨健康中年男性人体成分对骨密度影响,为男性骨质疏松早期防治提供理论依据。方法以上海市奉贤区128名年龄为40~60岁(平均49.10±6.40岁)的健康中年男性为研究对象,测定其身高、体重、腰围、臀围,并计算体重指数(BMI);利用问卷调查调查其文化程度、饮酒吸烟、豆制品及奶制品摄入情况、静坐时间、睡眠时间等一般情况;利用全自动生化分析仪测定血钙(Ca)、血磷(P)、肝肾功能(ALT、AST、BUN、Cr、UA)、血脂(TC、TG、HDL、LDL)、血糖(FPG、2h-PG),高压液相法测定糖化血红蛋白(HbA1c)等生化指标;采用双能X线骨密度仪测定腰椎、股骨颈、股骨干、股骨大粗隆和全身骨密度(BMD),并根据T值或Z值评分结果将所有研究对象分为骨量正常组和骨量低下组;采用人体成分分析仪测定体脂肪含量、蛋白质含量、无机盐含量、骨骼肌含量和各部位肌肉含量。结果 128名年龄为40~60岁健康中年男性中,骨质疏松患者3人,骨量减少患者44人。骨量正常组体重、BMI、腰围、臀围、睡眠时间、蛋白质含量、无机质含量、骨骼肌含量、各部位肌肉含量皆高于骨量低下组,血清尿素及吸烟人数比率低于骨量低下组,且差异具有统计学意义;两组年龄、身高、饮酒情况、文化程度、工作性质、豆制品摄入情况及奶制品摄入情况、Ca、P、Cr、UA、ALT、AST、TC、TG、HDL、LDL、FPG、2h-PG、HbA1c、体脂肪及体脂百分比皆无统计学差异。结论适当延长每天睡眠时间有利于预防骨质疏松的发生;体重、BMI、腰围、臀围是骨质疏松的保护因素,但需通过加强体育锻炼及合理饮食,增加骨骼肌、无机质及蛋白质等非脂肪含量来增加骨密度预防骨质疏松。     

痩组织和脂肪的影响因素及其对骨密度和骨强度的影响

瘦组织和脂肪是两个重要的体成分,受饮食、运动、增龄、性别、种族、激素、疾病以及药物等多种因素的影响.瘦组织和脂肪对骨密度和骨强度的影响不同.研究结果存在不一致性,但多数研究表明瘦组织量可能是BMD和骨强度的重要决定因素,脂肪量过多将对骨骼产生不利影响.目前,瘦组织和脂肪对骨密度和骨强度的影响及机制并未被完全阐明.     

吸烟对男性骨密度的影响

为探讨吸烟对男性骨密度的影响，我们用单光子骨矿分析仪测量了１４５例３０～５０岁吸烟男性的骨密度和１１２例同年龄不吸烟男性的骨密度，报告如下。资料和方法１．病例选择：本组２５７例３０～５０岁男性患者。均无糖尿病、甲状旁腺机能亢进、肿瘤、肾病等病史。其中有吸烟嗜好１４５例。吸烟标准为个人史中有吸烟嗜好，每天吸烟１包以上。另设对照组１１２例，为无吸烟嗜好的同年龄男性患者。２．方法：骨密度测量用中国原子能科学研究所和北京广播技术研究所联合研制的ＢＭＤ—４型骨矿分析仪，测量部位为前臂，右力者测左臂，左力者…     

身体成分对绝经后女性骨密度和骨骼肌量的影响

目的 基于双能X线骨密度仪测量的身体成分分析,探讨影响绝经后女性骨密度和骨骼肌量的共同因素,为绝经后骨质疏松和肌少症的协同防治提供思路。方法 纳入2015年1月至2020年10月在中山大学附属第一医院进行身体成分分析的171例绝经后女性,根据全身骨密度和相对骨骼肌肉指数(relative skeletal muscle index,RSMI)分为正常组(T值≥-1且RSMI＞5.45 kg/m2)、肌少组(T值≥-1且RSMI≤5.45 kg/m2)、骨量异常组(T值＜-1且RSMI＞5.45 kg/m2)和肌少/骨量异常组(T值＜-1且RSMI≤5.45 kg/m2)。采用单因素方差分析比较4组一般资料和身体成分差异,Pearson相关分析研究身体成分与骨密度和RSMI的相关性,多元线性回归分析探索影响骨密度和RSMI的共同因素。结果 4组在体脂率(percent body fat,PBF)、脂肪量(fat mass,FM)、脂肪指数(fat mass index,FMI)、瘦组织(lean mass,LM)、瘦组织指数(lean mass index,LMI)、骨矿盐含量(bone mineral content,BMC)、Android/Gynoid区域脂肪比率和休止代谢率(resting metabolic rate,RMR)的整体比较中差异均有统计学意义(P＜0.05)。调整混杂因素后,PBF、FM、FMI与骨密度和RSMI呈不同程度负相关,LM、LMI、BMC、RMR与骨密度和RSMI呈正相关。多元线性回归显示高PBF、低LM和低BMC是骨密度和RSMI的共同危险因素。结论 绝经后女性骨密度与骨骼肌量变化密切相关,针对影响二者的共同危险因素采取干预措施可能有利于绝经后骨质疏松和肌少症的协同防治。     

脂联素与女性身体成分和骨密度的研究进展

脂联素是参与调节糖脂代谢、能量消耗、炎症反应、免疫应答、心血管功能和生殖的内分泌因子。除此之外,脂联素还可以促进成骨细胞的增殖和分化,同时抑制破骨细胞的形成,对骨骼的发育以及维持具有积极作用。该文系统描述了从出生到更年期女性的血清脂联素波动情况及其分泌模式,讨论了脂联素在女性身体成分和骨密度方面发挥的调节作用。胎儿时期,脂联素通过母胎界面,以自分泌/旁分泌的方式在胎盘和脂肪组织中发挥作用,并促进葡萄糖代谢和胎儿发育。新生儿时期,脐带血清脂联素水平是成人的2～3倍,体重与血清脂联素水平呈正相关。幼儿时期,血清脂联素水平与体脂率呈负相关;骨量和骨密度也随体重增加而增加,与脂联素呈负相关。青年时期,血清脂联素水平似乎与雌激素分泌调节无必然关系;内脏脂肪是肥胖女性骨密度的负预测因子,与血清脂联素水平呈负相关。中年期,血清脂联素水平与体重呈负相关,肥胖的个体表现出血清脂联素水平下降,血清脂联素水平与骨密度亦呈负相关。绝经后,随着雌激素水平的降低,女性血清脂联素水平升高。总之,一生中不断增加的体脂肪总量似乎影响了女性脂联素的分泌,与雌激素水平的下降协同,导致女性老年时期发生骨质疏松的风险增加。     

绝经后女性的体成分与年龄和绝经的关系及其对不同部位骨密度的影响

目的 调查绝经后女性的体成分与年龄、绝经年龄、绝经年限和腰椎、髋部BMD之间的关系.方法 用双能X线骨密度仪测量919例绝经后女性的体成分、正位腰椎和髋部BMD.结果 下身脂肪量、全身脂肪量和全身瘦组织量与年龄、绝经年龄和绝经年限都相关(P＜0.05～0.01),但只有绝经年限进入体成分的多元逐步回归方程,采用复合或三次回归模型拟合优度最佳.体成分随绝经年限的延长有下降趋势.绝经10年以上女性的下身脂肪量和全身瘦组织量显著减少,分别较绝经年限5年以内女性下降8.6%和3.1%.所有部位的体成分与所测区域的BMD 均呈正相关(P＜0.05～0.01),控制体重变量后,仅有全身脂肪量与腰椎BMD 呈正相关(P＜0.05),而全身瘦组织量与髋部BMD 呈正相关(P＜0.05).多元逐步回归分析发现体成分是影响腰椎和髋部BMD的一个重要因素,但对腰椎BMD影响最大的是全身脂肪量,而对髋部BMD影响最大的是全身瘦组织量.BMD 越低者,全身脂肪量和全身瘦组织量也越低,组间比较有显著性差异.结论 绝经后女性的体成分与年龄、绝经年龄、绝经年限和腰椎、髋部BMD相关,其中,绝经年限对体成分的影响最大,体成分组分对BMD的影响存在部位差异.     

2型糖尿病患者骨密度与身体成分关系的研究

目的分析不同性别中老年2型糖尿病患者骨密度与身体成分的关系。方法纳入2017年1月至2018年7月在南京医科大学附属常州市第二人民医院内分泌科治疗的657例2型糖尿病患者,年龄50～80岁,其中男性351例,女性306例。记录受试者的糖尿病病程、身高、体重、体质量指数(body mass index,BMI),检测血脂(TC、TG、HDL、LDL)、糖化血红蛋白(Hb A1c)。采用双能X线骨密度仪测定受试者腰椎(L_(1～4))、股骨颈(Neck)、大转子(Troch)和Ward三角(Wards)的骨密度(bone mineral density,BMD)。采用生物电阻抗法测定体脂率(PBF)、去脂体重(FFM)、肌肉量(SLM)、骨骼肌含量(SMM)及骨骼肌质量指数(SMI),并进行统计学分析。结果男性2型糖尿病患者的FFM、SLM、SMM、SMI、腰椎L_(1～4)、股骨颈、大转子和Ward三角的BMD均显著高于女性2型糖尿病患者(P0. 001),而体脂率明显低于女性(P0. 001);按性别分组,男性、女性的BMI、FFM、SLM、SMM、SMI与各部位的BMD均呈显著正相关(P0. 01)。其中,反映骨骼肌肉含量的指标如FFM、SLM、SMM、SMI与BMD的相关性高于反映脂肪含量的指标PBF;多元线性回归显示,骨密度随着年龄增长呈下降趋势。身体成分中,SLM对各部位BMD无明显影响,PBF、FFM、SMM、SMI对各部位BMD的影响不同。结论骨骼肌肉含量及体脂率对2型糖尿病患者骨密度有重要影响,糖尿病患者需重视体成分对骨质疏松的影响,应加强锻炼,合理控制体脂率。     

河北地区不同年龄健康男性不同部位骨密度与体成分分析

目的探讨河北地区不同年龄健康男性不同部位骨密度（BMD）与体成分的关系。方法 225名受试对象年龄20～79岁,每10岁为1个年龄组,其中20～29岁28名,30～39岁35名,40～49岁40名,50～59岁42名,60～69岁39名,70～79岁41名,均检测正位腰椎（L2～4）、股骨（股骨颈、Ward三角、大转子、转子间）BMD,同时测定全身各部位肌肉和脂肪含量。结果各年龄组体质量指数（BMI）无明显差别,具有可比性。男性在40～49岁组骨质疏松发生率为5.00%,50～59岁组为13.04%,60～69岁组24.39%,70～79岁组41.86%。30～39岁组各部位BMD均为最高值,且在股骨颈、Ward三角明显高于其他年龄组（P〈0.05）,20～29岁、40～49岁、50～59岁间各部位BMD比较均无明显差异（P〉0.05）,60～69岁组L2～4、股骨颈、转子间BMD均明显高于70～79岁组（P〈0.05）;30～39岁组躯干、腿部、总肌肉含量均高于其他年龄组,但与40～49岁组比较均无明显差异（P〉0.05）,50～59岁与70～79岁组比较,躯干、总肌肉含量差异有统计学意义（P〈0.05）;各部位脂肪含量随增龄虽有增加趋势,但仅70～79岁组躯干、腿部、总脂肪含量较20～29岁、30～39岁组明显增加（P〈0.05）,其他年龄组各部位脂肪含量两两比较差异均无统计学意义（P〉0.05）;多元线性回归分析显示男性L2～4、股骨均值BMD均与BMI、所对应的肌肉含量、年龄关系密切,与所对应的脂肪含量无相关性。结论河北地区健康男性各部位骨密度均随增龄逐渐降低,无快速骨量丢失期,各部位骨峰值出现在30～39岁之间,各部位肌肉含量均与BMD有明显相关性,与脂肪含量无关。     

吸烟对老年男性糖尿病患者骨密度的影响

目的探讨吸烟对老年男性糖尿病患者骨密度的影响。方法选取2009年4月一 2010年6 月来我院就诊的老年男性2型糖尿病患者，分为吸烟组（61例）和不吸烟组（65例），测量骨密度。结 果对于老年男性糖尿病患者，吸烟组与不吸烟组相比，骨密度明显减低，骨质疏松人数增多，差异有 显著性(P<0.01);在吸烟的老年糖尿病患者中，吸烟年限(rs =0.481，P<0. 01 )、每日吸烟量(rs = 0. 432，P <0.01)与骨密度减低呈显著正相关。结论吸烟致老年男性糖尿病患者骨质疏松发病率 高，且与吸烟年限和每日吸烟量呈显著正相关，及早戒烟是明智选择。     

Relationship between body composition and bone mineral density in healthy young and premenopausal Chinese women

This study investigated the relative contribution of fat mass and lean mass to bone mineral density (BMD) in young and premenopausal healthy Chinese women. The study was performed in 282 young and premenopausal healthy women with regular menstrual cycles. The BMD at lumbar spine (L2–L4), total hip and total body, together with fat mass and lean mass were assessed by dual-energy X-ray absorptiometry (DXA); body height, weight, waist and hip circumference were also measured, and body mass index (BMI) and waist-hip ratio were calculated. Fat mass was a major determinant for BMI, BMI and lean mass were positively related to L2–L4, total hip and total body bone density (P<0.001 for all), lean mass was the only independent factor contributing to BMD at L2–L4 (standardized coefficient =0.282, P<0.001), total hip (=0.336, P<0.001) and total body (=0.361, P<0.001) in multiple stepwise regression analysis. The correlation between BMI and BMD was improved after adjustment for fat mass, while decreased or even lost when lean mass was adjusted. These data suggested that in the Chinese population, lean mass is an important factor determining BMD in young and premenopausal women.     

Gender differences in relationships between body composition components, their distribution and bone mineral density: a cross-sectional opposite sex twin study

Numerous studies indicate that bone mineral density (BMD) is closely related to body mass and its components. Most studies have examined these relationships in women with little attention given to how these relationships differ by gender. The aims of the present study were to use the opposite sex twin model to determine if there were gender differences in the relationship between body composition and its relation to BMD and how any such differences were influenced by age. We measured body composition and bone mass by dual energy X-ray absorptiometry in 93 pairs of opposite sex twins. To examine the effect of age, they were divided into two age groups: under 50 years old (45 pairs) and over 50 years old (48 pairs). Lean mass (LM) had stronger positive relationships with the most bone variables than fat mass in both genders at all ages. Fat mass (FM) had positive relationships with total body and hip BMD in women under age 50, but not over 50. There was no significant relationship between FM and total or regional BMD in men under age 50, but men over 50 showed positive relationships between FM measures and total and some regional BMD measures. Central adiposity showed a positive relationship with BMD in men over 50 and women under 50. Fat mass (FM) and lean mass (LM) and their distribution in the body have different relationships with regional BMD in men and women that differ by age.     

Total body bone mineral and lean body mass by dual-photon absorptiometry

Summary A method was developed for measuring total body bone mineral (TBBM) and lean body mass in vivo using dual-photon absorptiometry. The entire body was scanned in a rectilinear raster (transverse speed of 1 cm/s and longitudinal steps of 2.5 cm) with a modified nuclear medicine scanner and conventional nuclear counting electronics. The source was¹⁵³Gd (1 Ci) with principal photopeaks at 44 and 100 keV. The scan time was about 70 min with an absorbed dose of under 1 mrem. The low dose allows measurements to be repeated at frequent intervals or used on children. Short-term (months) precision of TBBM was about 1.5% for isolated skeletons and about 2% on normal human subjects. Long-term (years) precision on skeletons was under 3%. The precision of percent fat was 0.9%, which would lead to an error of less than 1% in the TBBM. Geometry of measurements also had minimal (and correctable) influence on the accuracy of results. The accuracy (1 standard error of estimate) of TBBM on isolated skeletons (N=5) was 36 g (equivalent to about 13 g of Ca) with a correlation coefficient of 0.99; this error amounts to about 1–1.5% in normal adults, 2% in older women, and 2.5% in osteoporotic females. The dual-photon absorptiometry method could be implemented in many nuclear medicine departments to follow skeletal changes during growth and aging or to follow the course of a disease or treatment.     

2型糖尿病患者体质成分与骨密度的关系

目的 分析2型糖尿病患者体质成分与骨密度的相互关系,以阐明躯体脂肪含量和肌肉含量在维持骨量中的作用。方法 采用双能X线分析仪（DEXA）测定76例2型糖尿病患者全身各部位的骨密度和肌肉、脂肪含量,并根据腰椎骨密度值将病人分为骨质疏松组19例与非骨质疏松组57例。结果 两组间体重指数、全身及局部脂肪含量无显著差异（P＞0．05）,骨质疏松组各部位的骨密度和肌肉含量明显较非骨质疏松组低（P＜0．05－0．01）。糖尿病患者骨密度与全身及局部脂肪含量无明显相关性,而与肌肉含量呈显著正相关（P＜0．01）。结论 2型糖尿病患者肌肉组织比脂肪组织对骨密度有更显著的影响作用。     

探讨体重指数对绝经后老年妇女不同部位骨密度的影响

目的分析不同体重指数患者的腰椎和股骨近端、股骨颈、Ward’s三角区的骨密度及T值评分,探讨体重指数对绝经老年妇女不同部位骨密度的影响。方法以我院225例年龄均为60以上的绝经老年妇女为研究对象,计算体重指数将患者分为体瘦组、正常组和肥胖组,检测患者腰椎和股骨近端、股骨颈、Ward’s三角区的骨密度,分析各部位骨密度变化与体重指数的关系。结果体瘦组的患者各部位骨密度明显低于正常和肥胖组的患者,体瘦组与正常组或肥胖组比较,腰椎(L1～L4)、股骨颈、股骨近端、Ward’s三角区的骨密度均有显著的差异(P<0.01);正常组与肥胖组比较,仅L3和L4的骨密度有显著的差异(P<0.05),其余部位的骨密度无显著的差异(P>0.05)。结论体重和体重指数是影响骨密度的一个重要因素,体重和体重指数与绝经老年妇女不同部位的骨密度存在一定的相关性,低体重指数的绝经老年妇女,骨丢失而引起的骨量减少明显,易发生骨质疏松。     

Contribution of lean tissue mass to the urban-rural difference in bone mineral density

While the urban-rural difference in bone mineral density (BMD) has been shown in some, but not all, Western populations, such a difference and the reason for the difference is largely unknown, particularly in developing countries. This cross-sectional, epidemiologic study was designed to examine the hypothesis that differences in measures of body composition such as lean mass (LM) and fat mass (FM) contribute to the urban-rural difference in BMD. Lean mass, fat mass, lumbar spine and femoral neck BMD were measured by DXA (GE Lunar Corp, Wis.) in 411 urban (Bangkok city) and 436 rural (Khon Kaen province) Thai subjects, aged 20–84 years. Rural men and women had significantly higher LM and lower FM than their urban counterparts. In multiple linear regression analysis, age, LM, menopausal status (in women) and residence were independent determinants of BMD. After adjusting for age, menopause and LM, rural subjects were found to have significantly higher femoral neck BMD, but not lumbar spine BMD, than urban subjects. Furthermore, to alleviate the potential effect of multicolinearity of LM and FM, each rural subject was matched with each urban subject for FM and age, which resulted in 46 pairs of men and 91 pairs of women. In this matched-pair analysis, the femoral necks in rural men and women were, respectively, 7.3±2.1% (mean±SE; P <0.01) and 6.3±2.8% ( P <0.02) higher than in urban men and women. The urban-rural difference in LM accounted for approximately 23 and 5% of the urban-rural difference in femoral neck BMD in men and women, respectively. These data are thus consistent with the hypothesis that the urban-rural difference in BMD at a weight-bearing site is in part associated with the urban-rural difference in lean mass.     

体重体成分与骨密度的关系

为了研究体成分与骨密度（ＢＭＤ）之间的关系，因体重与ＢＭＤ显著相关，体成分各个组成相加等于体重，而体成分与ＢＭＤ的关系仍不清楚。方法随机选取２０６名１６～５２岁健康的男女性汉族人，用双能Ｘ射线吸收法（ＤＸＡ）测量ＢＭＤ与体成分，进行ＢＭＤ与体重，体成分的多元线性回归分析。结果体重，瘦组织（ＬＴＭ）与男女性的ＢＭＤ显著正相关，脂肪组织（ＦＴＭ）仅对女性全身，腰椎ＢＭＤ起显著性作用。结论影响男女性ＢＭＤ的体成分中，ＬＴＭ是主要因素，ＦＴＭ仅对女性ＢＭＤ有影响。本文较全面地研究了体成分与ＢＭＤ的关系。     

不同锻炼水平对大学生骨密度和体成分的影响及其相关性分析

目的探讨不同锻炼水平对大学生骨密度和体成分的影响,同时分析骨密度和体成分之间的相关性。方法选取中国矿业大学在校本科大学生120名,根据参与运动情况分为缺乏运动组、普通运动组和大运动量组,每组40名,男女各20名,采用超声法和生物电阻法分别检测其跟骨密度和体成分各项指标,测试所得数据采用Spss16.0软件进行统计分析。结果普通运动组大学生的骨密度明显高于缺乏运动组和大运动量组大学生的骨密度(P0.05),与缺乏运动组相比,普通运动组和大运动量组的体脂百分比均显著降低(P0.05),而去脂体重和肌肉量却明显升高(P0.05),与缺乏运动组和大运动量组相比,普通运动组矿物质含量明显升高(P0.05),各组去脂体重/体重、肌肉量/体重、矿物质含量与骨密度呈高度正相关(P0.01)。结论适量运动使大学生骨密度增加,大强度长时间的大量运动使骨密度下降,不利于骨骼的生长,运动锻炼可以有效改善大学生身体成分,降低脂肪含量,增加去脂体重,预防肥胖。     

High-dose glucocorticoid treatment induces rapid loss of trabecular bone mineral density and lean body mass

A recent large-scale study revealed that glucocorticoid treatment increased fracture risk, which occurred at a far smaller dose and by a shorter duration than previously thought. To study the underlying mechanism for the increased risk of fracture, we studied the early changes in bone mineral density (BMD) and body composition by dual energy X-ray absorptiometry (DXA) after initiating high-dose glucocorticoid treatment. High-dose glucocorticoid treatment was arbitrarily defined as daily doses of 40 mg of a predonisolone equivalent. The 33 patients enrolled in this study had not received glucocorticoid treatment before. Only 2 months of treatment resulted in substantial BMD loss, most markedly in the lumbar spine, followed by the femoral neck and total body, which suggests the preferential trabecular bone loss. Body composition was also greatly affected. Thus, 2-month treatment with glucocorticoid significantly reduced bone mineral content (BMC), lean body mass (LBM) and increased fat mass (FAT). Our results are likely to have some clinical relevance. First, BMD loss occurs quite rapidly after starting glucocorticoid treatment, and patients receiving glucocorticoid treatment should be more carefully monitored for their BMD. Second, LBM, which mainly represents muscle volume, decreases rapidly after initiating glucocorticoid treatment. Decreased LBM might be also responsible for the increased risk of fracture, since falling is a well-known risk factor for fracture, and patients receiving glucocorticoid treatment should also be evaluated for their body composition.