Prevalence of low bone mass in healthy Indian population

Osteoporosis is a major problem of health care delivery services, both in the developed and developing countries. The first normative reference database of bone mineral density in the Indian women and men was established using digital x-ray radiogrammetry. Further analysis of this database revealed that 29.9% of women and 24.3% of men between the age of 20 and 79 years had low bone mass. About 50% women and 36% of men over 50 years of age were noted to have low bone mass. The observations of this study suggest that there is higher prevalence of low bone man in the Indian population compared to the western population.     

Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men

Context  Osteoporotic fractures are common among elderly men. Objective  To evaluate among older men the cost-effectiveness of bone densitometry followed by 5 years of oral bisphosphonate therapy to prevent fractures for those found to have osteoporosis (femoral neck T score –2.5), compared with no intervention. Design, Setting, and Population  Computer Markov microsimulation model using a societal perspective and a lifetime horizon. Simulations were performed for hypothetical cohorts of white men aged 65, 70, 75, 80, or 85 years, with or without prior clinical fracture. Data sources for model parameters included the Rochester Epidemiology Project for fracture costs and population-based age-specific fracture rates; the Osteoporotic Fractures in Men (MrOS) study and published meta-analyses for the associations among prior fractures, bone density, and incident fractures; and published studies of fracture disutility. Main Outcome Measures  Costs per quality-adjusted life-year (QALY) gained for the densitometry and follow-up treatment strategy compared with no intervention, calculated from lifetime costs and accumulated QALYs for each strategy. Results  Lifetime costs per QALY gained for the densitometry and follow-up treatment strategy were less than $50 000 for men aged 65 years or older with a prior clinical fracture and for men aged 80 years or older without a prior fracture. These results were most sensitive to oral bisphosphonate cost and fracture reduction efficacy, the strength of association between bone mineral density and fractures, fracture rates and disutility, and medication adherence. Conclusions  Bone densitometry followed by bisphosphonate therapy for those with osteoporosis may be cost-effective for men aged 65 years or older with a self-reported prior clinical fracture and for men aged 80 to 85 years with no prior fracture. This strategy may also be cost-effective for men as young as 70 years without a prior clinical fracture if oral bisphosphonate costs are less than $500 per year or if the societal willingness to pay per QALY gained is $100 000.      

男性吸烟与骨密度及骨生化指标关系的调查与分析

目的探讨男性吸烟与骨密度及骨生化指标关系。方法用DXA仪测定腰椎及髋部BMD，用ELISA测定389例20~80岁健康男性血清骨特异性碱性磷酸酶（sBAP）、血清骨钙素（sOC）和I型胶原氨基末端肽（sNTX）。结果腰椎正住总体、腰椎侧住、髋部总体、股骨颈及Ward＇s区BMD均与年龄呈显著负相关（均P〈0．05）。各部位BMD均在20～29岁年龄组最高，29岁之后随增龄而缓慢下降；40~0岁各年龄组之间的BMD差异无显著性。除腰椎侧住BMD外，吸烟组其他各部住BMD显著低于非吸烟组；吸烟组的sOC和BAP显著高于非吸烟组，两组之间的sNTX差异无显著性。校正年龄与BMI后，烟龄与腰椎正位，髋部总体，股骨颈及Ward＇s区BMD均呈显著负相关（P〈0．05）。每日吸烟量与腰椎正住及Ward’s区BMD呈显著负相关（P〈0．05）。结论男性随年龄增长骨量丢失。男性吸烟者骨生化指标与骨转换水平增高，骨量丢失加速。吸烟等生活方式增高骨转换水平，影响骨转换的增龄性变化并加速骨量的丢失。吸烟是骨质疏松的一个危险因素。预防骨质疏松症（OP）应提倡戒烟。     

Basal muscle amino acid kinetics and protein synthesis in healthy young and older men

CONTEXT: Sarcopenia is associated with loss of strength and function, eventually leading to loss of independence. Some studies suggest that basal muscle protein turnover is reduced with aging, but other studies do not confirm this finding. OBJECTIVE: To determine if aging per se affects basal muscle protein turnover in men. DESIGN AND SETTING: Cross-sectional study conducted from June 1997 to July 2000 in a general US community. PARTICIPANTS: Twenty-six young (mean [SE] age, 28 [2] years) and 22 older (mean [SE] age, 70 [1] years) men, who were healthy and independent based on activities of daily living, physical examinations, and screening tests. Subjects were excluded if they had cardiac, pulmonary, liver, or kidney disease; any impairment in activities of daily living; or steroid use. MAIN OUTCOME MEASURES: We measured basal muscle protein and amino acid kinetics, based on stable isotope techniques with femoral arteriovenous catheterization and muscle biopsies. Three models (arteriovenous balance, three-pool, and fractional synthesis rate) were used to estimate the metabolic parameters. RESULTS: Mean (SE) total leg volume was 9.60 (0.32) L in older men vs 10.83 (0.43) L in younger men, which suggests muscle loss in the older men. Net muscle protein balance was similar in both groups (older men, - 19 [2] nmol/min per 100 mL of leg volume vs younger men, - 21 [2] nmol/min per 100 mL of leg volume; P =.51). Small differences were found in mean (SE) muscle protein synthesis in comparisons of older vs younger men: arteriovenous balance, 48 (5) nmol/min per 100 mL of leg volume vs 32 (3) nmol/min per 100 mL of leg volume; P =.004; three-pool, 58 (5) nmol/min per 100 mL of leg volume vs 43 (4) nmol/min per 100 mL of leg volume; P =.04; and fractional synthesis rate, 0.0601 (0.0046) %/h vs 0.0578 (0.0047) %/h; P =.73. Small differences were also found in mean (SE) muscle protein breakdown: arteriovenous balance, 66 (5) nmol/min per 100 mL of leg volume in older vs 53 (4) nmol/min per 100 mL of leg volume in younger men, P =.045; and three-pool, 76 (6) nmol/min per 100 mL of leg volume vs 64 (5) nmol/min per 100 mL of leg volume, P =.14. CONCLUSION: Differences in basal muscle protein turnover between older and younger men do not appear to explain muscle loss that occurs with age.     

佛山地区女性峰值骨量影响因素研究

目的研究佛山地区健康女性峰值骨量的影响因素,为下一步骨质疏松症的预防和治疗提供科学依据。方法对本地区1317名健康体检女性行腰椎骨密度测定,以问卷形式进行可能影响骨量的有关因素调查,分析峰值骨量的影响因素。结果峰值骨量与体重指数、运动、营养呈显著正相关,而月经初潮、母系骨折史与峰值骨量呈负相关。结论月经初潮、母系骨折史、体重、运动、牛奶摄入等因素与本地区女性人群峰值骨量有密切关系。     

Group- vs home-based exercise training in healthy older men and women. A community-based clinical trial

OBJECTIVE.--To determine the effectiveness of group- vs home-based exercise training of higher and lower intensities among healthy, sedentary older adults. DESIGN.--Year-long randomized, controlled trial comparing (1) higher-intensity group-based exercise training; (2) higher-intensity home-based exercise training; (3) lower-intensity home-based exercise training; or (4) assessment-only control. SETTING.--General community located in northern California. PARTICIPANTS.--One hundred sixty women and 197 men 50 to 65 years of age who were sedentary and free of cardiovascular disease. One out of nine persons contacted through a community random-digit-dial telephone survey and citywide promotion were randomized. INTERVENTIONS.--For higher-intensity exercise training, three 40-minute endurance training sessions per week were prescribed at 73% to 88% of peak treadmill heart rate. For lower-intensity exercise training, five 30-minute endurance training sessions per week were prescribed at 60% to 73% of peak treadmill heart rate. MAIN OUTCOME MEASURES.--Treadmill exercise test performance, exercise participation rates, and heart disease risk factors. RESULTS.--Compared with controls, subjects in all three exercise training conditions showed significant improvements in treadmill exercise test performance at 6 and 12 months (P less than .03). Lower-intensity exercise training achieved changes comparable with those of higher-intensity exercise training. Twelve-month exercise adherence rates were better for the two home-based exercise training conditions relative to the group-based exercise training condition (P less than .0005). There were no significant training-induced changes in lipid levels, weight, or blood pressure. CONCLUSIONS.--We conclude that (1) this community-based exercise training program improved fitness but not heart disease risk factors among sedentary, healthy older adults; (2) home-based exercise was as effective as group exercise in producing these changes; (3) lower-intensity exercise training was as effective as higher-intensity exercise training in the home setting; and (4) the exercise programs were relatively safe.     

男性骨生化指标随年龄的变化及其与骨密度的关系

目的:探讨男性人群血清骨特异性碱性磷酸酶(BAP)和Ⅰ型胶原氨基末端肽(NTX)随年龄变化及其与骨密度(BMD)之间的关系.方法:用ELISA测定389例20～80岁健康男性BAP和NTX,用DXA仪测定腰椎及髋部BMD.结果:BAP和NTX与年龄呈负相关,随年龄的变化均以三次回归模型的拟合程度最佳,拟合曲线的决定系数(R2)为0.013～0.029(P＜0.05).2个生化指标的水平在20～29岁年龄段最高,随后随年龄的增长而降低;50～59岁段达最低值.60岁之后骨吸收指标轻度增加,而骨形成指标则保持相对稳定.校正年龄、身高、体质量、体质量指数及吸烟后的偏相关分析显示BAP与各部位BMD呈负相关,而NTX与腰椎及髋部总体BMD呈负相关.结论:BAP和NTX是反映中国男性随年龄变化的骨转换的敏感性、特异性较强的指标,监测这两个指标有助于早期防治骨质疏松症(OP).     

健康老年男性不同骨量、骨代谢生化指标及其他相关因素的初步研究

目的　观察健康老年男性不同骨量、骨代谢生化指标及其他相关因素的变化 ,以探讨原发性男性骨质疏松症 (OP)的发病机制。方法　 6 0例健康老年男性按照宽波段超声衰减 (BUA)值分成骨量正常组 (A组 )、骨量减少组 (B组 )和骨质疏松组 (C组 )。采用酶联免疫吸附法 (ELISA)测定各种骨形成及骨吸收的生化标志物 ,采用放射免疫分析法 (RIA)测定血清雌二醇 (E2 )、睾酮 (T)、卵泡刺激素 (FSH)、黄体生成素 (LH)。结果　B、C两组分别与A组比较 ,吡啶酚 (PYD)、脱氧吡啶酚 (DPD)明显升高 ,而骨钙素 (BGP)仅在C组明显升高。C组分别与A、B两组比较 ,体重、体重指数 (BMI)、E2 、T明显下降 ,而FSH、LH明显升高 ,且E2 在B组明显下降。直线相关分析显示 ,BUA与BMI、体重、E2 、T呈正相关 (r分别为 0 .387、0 .2 89、0 .4 5 5、0 .2 97,P <0 .0 5 ) ,多元逐步回归分析显示 ,BUA与BMI、E2 相关 (P分别为 0 .0 1、0 .0 16 ) ,回归方程为Y =3.14 9+0 .6 6 5X1+8.916×10 -2 X2 。结论　原发性男性OP的骨吸收生化标志物明显升高 ,骨形成指标轻度升高 ,属高转换型 ;雌、雄激素下降 ,尤其是前者的下降可能是其主要发病机制 ;低体重是原发性男性OP的危险因素之一。     

广西南宁市健康人群骨密度及骨质疏松患病率研究

目的：评估广西南宁市健康人群骨量和骨质疏松（OP）的发病情况。方法：455名健康人群采用双级X线骨密度仪检测腰椎正位、髋部、前臂的骨密度（BMD）值，按年龄、性别进行分组，以5岁作为一个年龄段。结果：骨峰值年龄分布：男性髋部骨峰值年龄在40－44岁，腰椎在35－39岁，前臂在30－34岁，女性髋部、腰椎、前臂骨峰值年龄在35－39岁。60岁后OP患病率男性43．75％，女性72．30％，女性峰值骨密度水平较上海等地区低（P＜0．05），男性较南京地区、广州地区低（P＜0．05）。结论：南宁市健康人群较低的峰值骨密度水平和老年人较高的骨质疏松检出率除与所使用的仪器型号有关外，可能与饮食结构、生活习惯、职业、运动等等环境因素有关系，提高峰值骨密度和对骨质疏松骨折的高危人群进行防治是今后的一项重要任务。     

维生素D受体基因ApaⅠ多态性与男性骨量的关系

目的了解维生素D受体(vitaminDreceptor,VDR)基因ApaⅠ多态性与男性骨量的关系。方法PCR-限制性片段长度多态性技术检测上海市388例健康汉族男性VDR基因ApaⅠ多态性,并用双能X线吸收仪检查上述人群腰椎1～4(L1～4)和股骨近端股骨颈(Neck)、大转子区(Troch)及Ward's三角部位骨密度(bonemineraldensity,BMD)和骨矿含量(bonemineralcontent,BMC)。结果ApaⅠ多态性等位基因频率分布符合Hardy-Weinberg定律,基因型频率分布依次为aa(48.1%)、Aa(44.2%)和AA(7.7%)。协方差分析显示,在所有388例受试者中和160例60岁及以下亚组中,ApaⅠ基因型与L1～4和股骨近端各部位BMD、BMC值均无相关性;在228例60岁以上亚组中,ApaⅠ基因型与L1～4、Neck和Ward's三角部位BMD、BMC值均相关(P<0.05,P<0.01),AA基因型平均BMD、BMC值高于Aa和aa基因型(P<0.05,P<0.01),但是ApaⅠ基因型与Troch部位BMD和BMC值无相关性。结论VDR基因ApaⅠ多态性与60岁以上男性骨量相关,AA基因型具有较高的骨量,提示ApaⅠ多态性可能影响老年男性的松质和皮质骨骨量的丢失。     

深圳市正常体质量指数成人骨密度和峰值骨密度的调查

目的:调查深圳市正常体质量指数人群骨密度和峰值骨密度(PBD),以期为深圳地区骨质疏松症防治工作提供理论依据.方法:近5 a体检的健康成年677名,年龄20以上,男女性均以5岁一个年龄段分为14组;双能X光骨密度仪测量骨密度.结果:男性各部位PBD值出现在25～岁,女性各腰椎PBD值出现在35～岁,髋部PBD值出现在40～岁.在80～岁年龄段,男性腰椎骨密度出现高于其PBD的另一个峰值,女性骨密度自45～岁年龄段后随年龄逐年下降.结论:女性PBD形成晚于男性而接近绝经期;其骨密度自45岁年龄段迅速减低,而男性则发生在65岁年龄段;骨质疏松的预防应从青少年时期提高PBD开始.     

男性骨生化指标随年龄的变化及其与骨密度的关系

目的探讨男性人群骨生化指标,血清骨特异性碱性磷酸酶(sBAP)、血清骨钙素(sOC)和Ⅰ型胶原氨基末端肽(sNTX)随年龄变化及其与骨密度(BMD)之间的关系。方法用ELISA测定389例20-80岁健康男性sBAP、sOC和sNTX;用DXA仪测定腰椎及髋部BMD。结果(1)sBAP、sOC和sNTX与年龄呈负相关,3个骨生化指标随年龄的变化均以三次回归模型的拟合程度最佳,拟合曲线的决定系数(R2)为0．013-0．029(P<0．05)。(2)按每10岁年龄段分组发现sBAP,sOC和sNTX的水平在20-29岁年龄段最高,分别为31 U／L±13 U／L、13μg／L±6μg／L、18μmol／L±7μmol／L;随年龄的增长而降低;50-59岁年龄段达最低值分别为27 U／L±9 U／L、9μg/L±5μg/L、16μmol／L±6μmol／L。60岁之后骨吸收指标sNTX轻度增加为16μmol／L±6μmol／L,而骨形成指标则保持相对稳定。(3)校正年龄、身高、体重、体重指数及吸烟后的偏相关分析显示:sBAP与各部位BMD呈负相关;除腰椎侧位外,sOC与其他各部位BMD均呈负相关;而sNTX与腰椎正位AP(L1-L4)及髋部整体BMD负相关。结论敏感性、特异性较强的骨转换指标如sBAP、sOC和sNTX随男性年龄而变化,且与BMD呈负相关。     

Effect of two randomised exercise programmes on bone mass of healthy postmenopausal women

The effect of two structured exercise programmes on the bone mass of 48 healthy postmenopausal white women aged 50-62 was studied after one year. Volunteers were randomised to group 1 (control), group 2 (aerobic exercise), or group 3 (aerobic and strengthening exercises). Before and after the training programme each subject had evaluations of bone mass (determined by neutron activation analysis and expressed as calcium bone index) and maximum oxygen uptake attained on a multistage exercise treadmill test. After one year both exercise groups had higher levels of fitness and greater bone mass than controls. Mean values (2 SEM) for changes in the calcium bone index were -0.011 (0.037), 0.039 (0.035), and 0.066 (0.036) for groups 1, 2, and 3, respectively. Analysis of variance on the observed data and analysis of covariance adjusting changes to the initial mean value for the whole group showed significant differences between each exercise group and the controls but no difference between the exercise groups themselves. Both exercise groups showed a significant improvement in maximum oxygen uptake. This study suggests that exercise may modify bone loss in healthy postmenopausal women.     

健康男性血液流变学的变化（附60例报告）

健康成年人随年龄增长 ,血液流变学的改变已有报道[1] 。本文的目的在于研究健康男性随增龄血液流变学的变化 ,以及抗脂质过氧化药物和血液稀释治疗后 ,老年前期和老年期健康人的血液流变学的改善。1　资料和方法受检者均为健康男性 ,符合 1982年中华医学会老年医学会建议的健康老年人的五条标准。年龄分组为 :青壮年组平均为 36 0± 5 9;老年前期组平均年龄为 5 2 2± 4 6 ;老年组平均年龄为 6 8 8± 6 6。用药组为老年前期和老年组中有胆固醇高于 5 70ｍｍｏｌ/Ｌ或甘油三脂高于 1 70ｍｍｏｌ/Ｌ ,伴有脑、基底动脉供血不足表现者 (…