2~10岁性早熟女童骨密度检测分析

目的探讨性早熟对2~10岁女童骨密度的影响。 方法选择2003 01—2006 01在湖南省儿童医院内分泌专科就诊的2~10岁性早熟(明确诊断、并排除影响骨代谢性疾病)女童237例，根据真、假性性早熟(CPP、PPP)分为2组，各组再按年龄组分层，采用单光子骨矿物质密度测定仪测量左手桡骨中远1/3处桡、尺骨密度(BMD)，并与同龄健康女童进行对比和分析。 结果CPP、PPP和健康组BMD均随年龄增长而增加，3组各年龄桡骨BMD均高于尺骨；CPP桡、尺骨BMD均相对较高，8~10岁组中CPP较对照组约高6.4%~8.6%；3组桡、尺骨BMD均在8~10岁增长加速，特别是尺骨(P<0.05)，分别较6~7岁组增长20.4%、17.8%和14.3%；以CPP组增幅最大，明显高于健康组，与健康组(6~7岁)增长比较差异有显著性(桡骨P<0.05、尺骨P<0.001)。PPP组则与健康女童差异不显著。 结论健康女童骨矿化自9岁起开始青春期加速，CPP女童青春期尺骨生长加速的年龄提早，BMD相应增加，而PPP不像CPP那样明显影响女童的正常骨骼发育。     

北京地区汉族绝经后妇女雌激素受体基因多态性与尺桡骨骨密度相关性研究

目的　研究雌激素受体（ER）基因多态性在北京地区汉族绝经后妇女中的分布及其与骨密度的相关性。方法　对绝经1～4年、年龄49～55岁未行激素替代治疗且无对骨密度有影响疾病的健康绝经后北京市区汉族妇女99例,采用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）方法测定ER基因的XbaⅠ和PvuⅡ酶切多态性,用双能X线吸收测量法检测桡骨骨密度（以骨密度T-score值表示）,方差法分析ER基因多态性与骨密度的关系。结果　ER基因PvuⅡ酶切多态性与尺桡骨松质骨（尺桡骨远端）、密质骨（尺桡骨近端）的骨密度无相关性(P>0.05),而ER基因XbaⅠ酶切多态性与尺、桡骨松质骨、密质骨的骨密度有相关性(P<0.05);XX基因型骨密度值最低密质骨为-1.55±0.37、松质骨为-2.54±0.38,xx基因型骨密度值最高密质骨为-0.95±0.24、松质骨为-1.74±0.16。结论　ER基因XbaⅠ酶切多态性与尺、桡骨松质骨、密质骨的骨密度间显著相关,不同个体的基因差异可能影响骨质疏松症的发生、发展。     

北京地区青年峰值骨密度与遗传因素的相关性分析

目的　探讨北京地区女性峰值骨密度 (PBMD)与遗传因素的关系。方法　于 2 0 0 0年 3月至 2 0 0 1年 7月 ,选择居住在北京、汉族女性、年龄 2 5～ 37岁的健康志愿者 1 59名 ,(1 )使用双能X线吸收仪 (DXEA)测量腰椎和髋部BMD ;(2 )抽取静脉血 5～ 1 0ml,提取DNA ,应用多聚酶链反应 限制性片段长度多态性法 (PCR RFLP)对维生素D受体 (VDR)和雌激素受体 (ER)进行多态性分析 ;(3)分析PBMD与身高、体重、体重指数 (BMI)、VDR及ER基因多态性的相关关系。结果　 (1 )腰椎BMD和身高、体重及BMI呈正相关 ,髋部股骨颈BMD和体重呈正相关 ,而髋部其余部位BMD和BMI呈正相关 ;(2 )VDR基因经BsmⅠ酶切 ,bb基因型者的腰椎、髋部 (除Ward三角 )BMD高于Bb基因型者 ,但两者间差异无显著性 (P >0 0 5) ;(3)ER基因经PvuⅡ酶切 ,髋部Ward三角PP基因型者的BMD[(0 73±0 1 4 )g/cm2 ]明显低于Pp及pp基因型者 [(0 78± 0 1 6)与 (0 79± 0 1 6)g/cm2 ] (P <0 0 5) ;(4)VDR和ER基因联合分析 ,腰椎bbPP基因型者BMD[(1 0 5± 0 0 9)g/cm2 ]最高 ,BbPP基因型者BMD[(0 94±0 0 8)g/cm2 ]最低 ,两者差异有显著性 (P <0 0 5) ;髋部各部位BbPP基因型者BMD均最低 ,但校正体重后 ,各基因型者之间差异无显著性 (P >0 0 5)。结     

两种激素补充治疗方案联合钙剂对绝经后妇女骨密度的影响

目的　研究利维爱 1 2 5mg d和结合雌激素 (CEE) 0 6 2 5mg +安宫黄体酮 (MPA) 2mg联合钙剂对绝经后骨质疏松和低骨量妇女骨密度的影响。方法　绝经后妇女 30人 ,分为利维爱组和CEE组。利维爱组8例为骨质疏松 ,中位年龄 6 4岁 ,中位绝经年限 1 4年 ;9例为低骨量 ,中位年龄 5 2岁 ,中位绝经年限 3年 ,均给予利维爱 1 2 5mg d、Ca -D 6 0 0mg d口服。CEE组中位年龄为 5 1岁 ,中位绝经年限为 2 5年。治疗前及治疗 1年时用DEXA方法检查前臂远端骨密度各 1次 ,做为自身对照 ,对比骨密度变化情况同时每年通过阴道B超监测子宫内膜的厚度。结果　利维爱组骨质疏松患者 ,松质骨骨密度增长中位数为 +4 0 % ,密质骨为 +2 6 % ;低骨量者 ,用利维爱者分别为 0和 - 1 0 % ,用CEE者为 +0 3%和 - 0 7%。所有患者依从性好 ,无明显副作用发生。结论　利维爱 1 2 5mg d联合钙剂能够提高绝经后骨质疏松妇女的前臂骨密度     

雷洛昔芬对绝经后妇女骨密度、骨代谢生化指标和血脂影响的随机对照研究

目的　确定盐酸雷洛昔芬 (RLX)对中国绝经后妇女骨密度、骨代谢生化指标及血脂的影响。方法　将来自 3所医院的 2 0 4例绝经后妇女 [平均年龄 (6 0± 5 )岁 ,平均体重 (6 3± 9)kg]随机分组 ,进行双盲安慰剂对照的临床研究 ,受试者每天接受RLX 6 0mg(n =10 2 ,RLX组 )或安慰剂 (n =10 2 ,安慰剂组 )治疗 12个月 ,并于服药前及服药 12个月后各进行一次骨密度、骨代谢生化指标及血脂的测定。结果　与安慰剂相比 ,RLX使腰椎和髋部骨密度显著升高 ,RLX组腰椎的骨密度增加2 30 % ,而安慰剂组降低 0 0 8% ,两组比较 ,差异有极显著性 (P <0 0 0 1) ;RLX组髋部骨密度增加2 4 6 % ,安慰剂组增加 1 0 7% ,两组比较 ,差异有显著性 (P <0 0 5 )。RLX组骨代谢生化指标血清骨钙素和血清C端交联肽分别降低 2 7 6 %和 2 4 0 % ,而安慰剂组则分别降低 10 6 %和升高 15 8% ,两组比较 ,差异有极显著性 (P <0 0 0 1)。RLX组总胆固醇和低密度脂蛋白胆固醇分别降低 6 4 %和34 6 % ,而安慰剂组则分别升高 1 4 %和降低 19 1% ,两组比较 ,差异有极显著性 (P <0 0 0 1)。两组间高密度脂蛋白胆固醇和甘油三酯水平未见差异。仅有 5例因不良事件而提前退出研究 (RLX组 3例 ,安慰剂组 2例 )。结论　RLX能增加绝经后中国妇女     

围绝经期和绝经后女性雌二醇和卵泡刺激素水平与骨密度的关系

目的研究围绝经期女性血清雌二醇(E2)及卵泡刺激素(FSH)变化规律及其与腰椎、髋部、股骨颈骨密度(bone mineral density,BMD)之间的关系。方法采用化学发光法测定402例就诊于北京友谊医院妇产科更年期门诊的40～65岁健康中国汉族女性早卵泡期或绝经后任意时期空腹血清E2和FSH水平,并采用双光能X线DXA测定其腰椎、总髋部、股骨近端BMD,分析血清E2和FSH与BMD的关系。结果低骨量组血清FSH水平显著高于正常组(P<0.05),E2水平显著低于正常组(P<0.05)。E2与BMD变化呈正相关(r=0.017～0.42,P<0.05);FSH与BMD变化呈负相关(r=-0.012～-0.94,P<0.05)。绝经后低骨量组FSH高于正常组,而E2无明显变化。结论血清E2和FSH水平与绝经前后妇女的BMD有关,绝经后FSH与BMD进一步丢失有关,而低水平雌激素可能不再是继续影响骨量的主要因素。     

氨基酸螯合钙治疗老年女性原发性骨质疏松症疗效分析

随着我国社会已逐步进入老龄化阶段 ,老年原发性骨质疏松症 (OP)发生率已高达 2 6 .6 % [1] ,尤其是老年女性OP的发生率更高 ,占 16 .3%。 2 0 0 0年 1月至 2 0 0 3年 7月间我们以氨基酸螯合钙胶囊 (乐力 )治疗老年女性OP引起的腰腿痛并以普通钙剂为对照进行临床疗效观察 ,现总结报道如下。1　资料与方法1.1　病例选择　选自 2 0 0 0年 1月至 2 0 0 3年 7月仙居县人民医院就诊的年龄在 6 5岁以上 ,骨密度 (BMD)比正常低 2 .5个标准差 ,骨关节疼痛在II级以上 (疼痛分级标准 :O级 :无疼痛 ;Ⅰ级 :有时感疼痛或注意力集中时疼痛 ;Ⅱ级 :正…     

绝经后骨质疏松症的防治

低骨量及快速的骨质丢失是发生骨质疏松症的决定性因素。女性的峰值骨量明显低于男性,4 0岁后骨质还会伴随年龄的增长出现缓慢的丢失。绝经后由于卵巢功能减退,骨失去了雌激素的保护作用致使骨转换率明显增高,骨吸收增多,骨丢失加速,年丢失骨量约占全部骨量的2 .5 % ,甚者可高达5 % ,此过程持续约5～10年,尤以绝经后的前3年骨丢失速度最快。当绝经后妇女的骨量减少,骨密度(bonemineraldensity,BMD)达到峰值BMD的- 2 .5S或以下即为绝经后骨质疏松症(postmenopausalosteoporosis,PMO)。　　PMO是原发性骨质疏松症中最常见的一种,其患病…     

小剂量结合型雌激素或合用醋酸甲羟孕酮对绝经早期妇女骨骼的影响

为探讨小剂量结合型雌激素 (CEEs)与合用醋酸甲羟孕酮 (MPA ) (CEEs- MPA )对绝经后妇女脊柱、髋骨骨密度(BMD)、总骨矿含量 (BMC)和骨转化指标的影响 ,美国于1995年 8月～ 2 0 0 0年 10月间进行了一项为期 2年的多中心随机、双盲、安慰剂对照试验。病例纳入标准 :14 0～ 6 5岁健康绝经妇女。 2绝经 1～ 4年。3血 FSH≥ 30 IU / L。4血 E2 ≤ 185 pmol/ L ,5子宫完整。6体重不超出正常范围 2 0 %。排除标准 :1合并影响骨代谢的疾病或可能影响 BMD测定的腰椎退行性变等。 2腰椎 BMD基线水平低于健康青年妇女均值的 3个标准差。 …     

汉族女性峰值骨密度和维生素D受体基因多态性及环境因素的相关性研究

目的　研究汉族女性峰值骨密度 (peakbonemineraldensity ,PBMD)与某些环境及遗传因素的关系。方法　选择健康的志愿者 1 5 9人 ,①通过饮食回顾法计算每日钙及蛋白入量 ;②通过 7d运动评估法计算运动强度 ;③使用DEXA骨密度仪 (HologicQDR 4 5 0 0 )测量志愿者腰椎和髋部骨密度 (BMD) ;④应用PCR -限制性片段长度多态性对维生素D受体 (VDR)基因进行多态性分析。结果　①腰椎BMD结果参照日本人标准 ,低骨量或骨质疏松共有 35人 (2 2 % ) ,正常骨量者为 1 2 4人 (78% )。两组间体重及体重指数 (BMI)间有显著差异 ;②腰椎及髋部股骨颈BMD与体重呈正相关 ,髋部其余位点BMD值和BMI呈正相关 ;③VDR基因BsmI酶切多态性组间BMD无显著性差异。结论　本研究显示 :体重及或BMI是汉族女性PBMD重要保护因素之一。汉族女性PBMD和当前营养状态、运动强度、VDRBsmI酶切位点基因多态性未见有相关性     

绝经后生殖系统恶性肿瘤患者骨代谢的变化

目的探讨绝经后生殖系统恶性肿瘤患者骨代谢的变化.方法分别采用放射免疫法、Behr's法及ACP酶学测定法检测了32例自然绝经患者(绝经组)和32例自然绝经后发生女性生殖系统恶性肿瘤患者(肿瘤组)血清雌二醇(E2)、骨性碱性磷酸酶(bonealkalinephosphatase,BALP)和抗酒石酸酸性磷酸酶(tartrateresistentacidphosphatase,TRAP)浓度.结果绝经组与肿瘤组血清E2浓度无显著差异(P＞0.05).肿瘤组血清BALP显著低于绝经组(P＜0.05).绝经组与肿瘤组血清TRAP无显著差异(P＞0.05).结论自然绝经后患者骨代谢紊乱程度较未发生肿瘤者更为严重.     

绝经前全子宫切除保留卵巢对妇女骨代谢及骨密度的影响

目的 :追踪观察绝经前妇女全子宫切除保留卵巢对远期骨代谢及骨密度的影响。方法 :对比观察绝经前行全子宫切除保留单侧卵巢 4 8例、全子宫切除保留双侧卵巢 15例和正常妇女 30例的血清钙 (Ca)、血清磷 (P)、血清碱性磷酸酶 (AKP)、血清骨钙素(BGP)、空腹尿Ca Cr及尿HYP Cr值、骨密度值的变化和差异。结果 :全子宫切除保留单侧卵巢组血AKP值、BGP值、空腹尿Ca Cr和尿HYP Cr均显著高于对照组 (P <0 0 5 ) ,而骨密度值则显著低于对照组 (P <0 0 5 )。保留双侧卵巢组尿HYP Cr显著高于对照组 (P <0 0 5 )。结论 :子宫全切除保留单侧卵巢者远期骨转换加快 ,导致骨丢失及骨密度下降 ,双侧卵巢保留者骨吸收亦加快 ,但骨密度无下降     

依替膦酸二钠对卵巢切除妇女骨密度降低的预防作用

目的 探讨双膦酸盐对切除双侧卵巢的妇女骨密度减低的预防作用。方法 18例早期恶性肿瘤行双侧卵巢切除的患者使用骨吸收抑制剂依替膦酸二钠,400 mg/d×14d,每3个月间断用药一次,持续1年,并以20例因其它病因而实施去势手术的妇女作为对照,研究骨吸收抑制剂依替膦酸二钠对早期恶性肿瘤去势术后妇女骨量的保护作用。结果使用依替膦酸二钠1年时,患者的骨量虽然未能保持在术前水平,但可以显著减少骨量的丢失,与对照组相比差异有显著性(P<0.05),并且骨密度的变化与BALP呈负相关性(P<0.05)。投药1年时肿瘤患者无1例复发。结论依替膦酸二钠可以减少去势手术妇女的骨量丢失,对预防去势手术妇女的骨质疏松有积极的作用。     

The effects of progestins on bone density and bone metabolism in postmenopausal women: a randomized controlled trial

OBJECTIVE: The purpose of this study was to evaluate the action of progestins on bone metabolism in early menopausal women. STUDY DESIGN: One hundred thirty-two menopausal women were randomized into a 2-year double-blinded, placebo-controlled clinical trial. There were 6 treatment groups: micronized progesterone (P 4 ) 300 mg/day; medroxyprogesterone acetate (MPA) 10 mg/day; norethindrone (NET) 1 mg/day; micronized estradiol (E 2 ) 1 mg/day; E 2 1 mg/day + MPA 10 mg/day; and placebo. All subjects received 1000 mg of calcium and 400 IU of vitamin D/day. Primary outcome variables were bone mineral density (BMD) changes at the spine and hip. Secondary variables were bone turnover markers. RESULTS: With E 2 or E 2 +MPA treatment, BMD at L2-L4 increased by 2% to 4% over 2 years. Bone mineral density (BMD) at the spine followed a decreasing trend with MPA, P 4 , and placebo treatments. With NET treatment, BMD did not change from baseline. At the femoral neck site, BMD did not change significantly for any treatment group. Bone resorption and bone formation markers decreased with E 2 or E 2 +MPA treatment, and did not change appreciably with all 3 progestin-alone treatments. There were no vertebral or hip fractures observed during the trial. CONCLUSION: Estrogen remains the primary bone active agent in hormone therapy, while progestins have significantly less activity. The selection of the appropriate progestin in hormone therapy should be based on criteria other than bone activity.     

Short-term effects of an oral contraceptive containing oestradiol valerate and dienogest on bone metabolism and bone mineral density: An observational,preliminary study

Abstract

Objectives To evaluate the effects of a combined oral contraceptive (COC) containing dienogest/oestradiol valerate (DNG/E₂V) on bone mineral density (BMD) and on serum and urinary bone turnover markers in young, healthy, fertile women.

Methods At baseline and after three and six months of intake of the aforementioned COC, serum and urinary calcium, osteocalcin, urinary pyridinoline (PYD), and deoxypyridinoline (D-PYD) of 30 women aged 21 to 34 years were measured. At baseline and after six months, lumbar bone mineral density was determined by dual-energy X-ray absorptiometry (DEXA).

Results Urinary levels of PYD and D-PYD were significantly lower at three and six months in comparison with basal values (p < 0.05). Serum calcium levels showed an increasing trend, which reached statistical significance after six months in comparison with basal values while urinary levels of calcium did not vary significantly. Serum osteocalcin levels were somewhat, but not significantly, lower during pill use in comparison with basal values. After six months, spinal BMD values did not differ significantly from basal values.

Conclusions The DNG/E₂V COC has no short-term adverse effect on bone turnover markers. No significant change in BMD was observed after six months of use of that pill.     

Comparison of the acute alterations in serum bone turnover markers and bone mineral density among women with surgical menopause

Objective

To determine the effect of a sudden decrease in estrogen levels via bilateral oophorectomy on serum turnover markers and to examine their correlation with bone mineral density (BMD).

Study design

This study included 51 women who had regular menses preoperatively and underwent bilateral oophorectomy for benign reasons. These women did not have any systemic disease or drug use that would influence bone metabolism. For each woman, spine and femur BMD were measured preoperatively and sixth months after surgery. Serum C-terminal telopeptide (CTX) and bone alkaline phosphatase (BAP) were measured preoperatively and at the first and sixth months after surgery. Correlations between bone turnover markers and BMD were pre- and post-operatively analyzed.

Results

The mean serum CTX and BAP concentrations at the first and sixth postoperative months were significantly higher compared to the preoperative measurements (p = 0.001). Spine BMD values at the sixth postoperative month was significantly lower compared to preoperative period (p = 0.0001). There was a significant negative correlation between spine BMD values and BAP levels both in the preoperative period and at the sixth postoperative month (r = −0.407, p = 0.001), whereas a significant positive correlation between serum CTX and BAP was noted at this time periods (r = 0.615, p < 0.001).

Conclusions

The results of this study showed that serum BAP and CTX levels rapidly increase in women after bilateral oophorectomy. Therefore, these markers (especially BAP) could be useful in the evaluation of osteoporosis risk in the early period of surgical menopause.     

吗啡对雌性大鼠性腺轴和骨组织的影响

目的:研究吗啡对雌性大鼠性腺轴和骨组织的影响。方法:选取3月龄雌性大鼠45只,随机分为吗啡组30只和对照组15只。吗啡组采用剂量递增法皮下注射盐酸吗啡12周,对照组注射同等体积的生理盐水12周。放射免疫法测定血清FSH、LH、E2、P;免疫组织化学检测下丘脑、垂体、卵巢雌激素受体(ER)和β-内啡肽(β-EP)的表达;原位杂交方法测定下丘脑、垂体和卵巢的μ-阿片受体mRNA的表达;双能X线骨密度测量仪测量不同部位的骨密度值;测量骨代谢生化指标;对骨组织切片进行形态计量分析;并用RT-PCR方法检测骨组织中雌激素受体(ER)mRNA的变化。结果:(1)吗啡组FSH、LH、E2、P基础分泌较对照组降低(P<0·01,P<0·05,P<0·01,P<0·05);(2)吗啡组大鼠性腺轴各组织中ER平均光密度值均显著降低(P均<0·01);(3)吗啡组大鼠下丘脑、垂体β-内啡肽的含量下降,而μ-阿片受体mRNA表达增强;(4)吗啡组大鼠股骨远侧干骺端和胫骨近侧干骺端骨密度以及骨组织中ERmRNA表达均较对照组显著下降(P<0·05),组织切片观察显示,吗啡组大鼠骨小梁纤细、断裂、形态结构完整性差,骨髓腔大小不一,对照组大鼠骨小梁粗壮、饱满、形态结构完整,骨髓腔相对较小,计量分析显示,吗啡组骨小梁面积明显低于对照组(P<0·05);骨代谢生化指标结果显示,吗啡组大鼠血清钙和尿钙以及TRAP、HOP较对照组增加显著(P<0·05)。结论:长期使用吗啡对下丘脑-垂体-卵巢轴及骨组织会有不同程度的损伤。     

Oral contraception usage in relation to bone mineral density and bone turnover in adolescent girls

Objectives?To compare the effect of a low-dose oral contraceptive (OC) containing 30 μg ethinyloestradiol (EE) with that of an ultra-low-dose OC containing 15 μg EE on bone turnover and BMD in healthy adolescent women and, in addition, to ascertain the influence of body mass index (BMI) and exercise on these indices of bone metabolism.

Methods?We recruited to the study 92 healthy girls aged between 16 and 19. They were divided into three groups. Participants in the first two groups used an OC with either 15 or 30 μg ethinyloestradiol (EE), whereas those in the third group used no hormonal contraception. Bone mineral density (BMD) and bone turnover markers were measured before and after 12 months of treatment.

Results?The BMD values of the total hip in females using the OC containing 30 μg EE was 0.912 g/cm² at baseline and 0.918 g/cm² after one year; in females using the OC containing 15 μg EE the corresponding values were 0.888 g/cm² and 0.895 g/cm² whereas in females who used no contraception BMD values were 0.942 g/cm² and 0.949 g/cm², respectively. The changes were statistically insignificant. Levels of osteocalcin and CTX had decreased after one year in all groups, but not statistically significantly so.

Conclusion?Low dose and ultra-low dose oral contraceptives did not significantly differ in their effects on bone mineral density or bone turnover markers in adolescent girls aged 16–19.     

高龄妇女1637例骨健康状况分析

目的 探讨高龄妇女骨健康状况.方法 将2004年5月至2008年10月在复旦大学附属华东医院进行双能X线骨密度仪测定骨密度(BMD)的60岁以上的妇女1637例按每10岁1个年龄段进行分组,共分为4个组(印～69岁组、70～79岁组、80～89岁组和≥90岁组),分别比较各组妇女腰椎、髋部BMD,骨折发生率及骨转换标志物水平.结果 (1)BMD:腰椎BMD在≥90岁组为(0.96±0.18)g/cm2、80～89岁组为(0.90±0.20)g/cm2、70～79岁组为(0.81±0.16)g/cm2、60～69岁组为(0.83±0.14)g/cm2,其中≥90岁组、80～89岁组BMD明显高于60～69岁组,差异有统计学意义(P<0.05).股骨颈、全髋、大转子及华氏三角区各部位的BMD在≥90岁组分别为(0.60±0.11)、(0.65±0.11)、(0.47±0.09)、(0.37±0.09)g/cm2;80～89岁组分别为(0.57±0.10)、(0.68±0.13)、(0.48±0.11)、(0.35±0.10)g/cm2;70～79岁组分别为(0.57±0.10)、(0.69±0.12)、(0.49±0.10)、(0.36±0.11)g/cm2;60～69岁组分别为(0.63±0.10)、(0.76±0.12)、(0.54±0.10)、(0.45±0.12)g/cm2;其中髋部各部位BID 70～79岁组、80～89岁组、≥90岁组均明显低于60～69岁组,差异均有统计学意义(P<0.05);(2)骨折发生率:各组妇女≥1次骨折的发生率60～69岁组为34.8%(242/695)、70～79岁组为45.0%(296/658)、80～89岁组为51.3%(137/267)、≥90岁组为5/17;(3)骨转换标志物:血清骨钙素N端中分子片段(N-midBGP)水平、尿Ⅰ型胶原羧基端肽(CTX)与肌酐(Cr)的比值(CTX/Cr)在≥90岁组分别为(17±5)μg/L、(106±56)μg/mmol,80～89岁组分别为(17±7)μg/L、(128±99)μg/mmol,70～79岁组分别为(21±14)μg/L、(182±173)μg/mmol,60～69岁组分别为(25±13)μg/L、(190±168)μg/mmol,其中80～89岁组、70～79岁组N-midBGP水平明显低于60～69岁组,差异有统计学意义(P<0.05);80～89岁组CTX/Cr明显低于60～69岁组,差异也有统计学意义(P<0.05).结论 高龄妇女随年龄增加骨代谢逐渐降低,骨折风险增加;髋部BMD用于诊断高龄妇女骨质疏松症更可靠.

Abstract：

Objective To investigate bone health conditions in 1637 aged women. Methods From May 2004 to October 2008, Bone mineral density (BMD) of 1637 women at age of more than 60 years old were measured by Hologic DephiA dual energy X-ray absorptiometry (DXEA) in Huadong hospital affiliated to Fudan University. All data were compared and analyzed among each group which will be divided by every ten years. Those women were divided into groups on 10 years range. BMD of lumbar vertebral and hip bone,fracture incidence and bone turnover marker were compared and analyzed. Results (1) BMD: at age of 3=90, 80 - 89, 70 - 79, 60 - 69, BMD of the lumbar vertebral 2 - 4(L2-4) values were (0. 96 ± 0. 18),(0. 90 ± 0. 20) , (0. 81 ± 0. 16) , (0. 83 ± 0. 14) g/cm2 , respectively. There were significantly increased BMD of lumbar of women at the age of 80 - 89 and ≥90 year-old compared with those of 60 - 69 year-old (P<0. 05). At age of ≥90,80 -89,70-79,60 -69 BMD of femur neck, Total, Torch, Ward's trianger were(0. 60 ±0. 11) , (0. 65 ±0. 11) ,(0. 47 ±0. 09) ,(0. 37 ±0. 09) g/cm2; at age of 80 -89 BMD of FN,Total, Torch, Ward's trianger were(0. 57 ±0. 10) , (0. 68 ±0. 13) , (0. 48 ±0. 11) , (0. 35 ±0. 10) g/cm2;at age of 70-79 BMD of FN, Total, Torch, Ward's trianger were (0.57±0. 10) ,(0. 69 ±0. 12), (0.49± 0. 10) , (0. 36 ± 0. 11) g/cm2; at age of 60 - 69 BMD of FN, Total, Torch, Ward's trianger were (0. 63 ± 0. 10) , (0. 76 ±0. 12) , (0. 54 ±0. 10), (0. 45 ±0. 15) g/cm2; There were significantly decreased in BMD of hip at the age of 70 - 79, 80 - 89,≥90 year-old compared with those of 60 - 69 year-old (P < 0. 05).(2) Fracture incidence: one time fracture incidence at age of 60 - 69,70 - 79,80 - 89, ≥ 90 were 34. 8 % (242/695) ,45. 0% (296/658) ,51. 3% (137/267) ,5/17. There were increasing trend of fracture in aged women. (3) Bone turnover marker of bone Gla protein (BGP) N-mid(N-midBGP) in serum and C-terminal telopeptide of type Ⅰ collagen/Cr (CTX/Cr) in urine values were (17 ±5) μg/L, (106 ±56) μg/mmol at age of more than 90 years ,(17 ±7) (μg/L,(128 ±99)μg/mmol at age of 80-89 years,(21 ± 14) μg/L,(182 ± 173)μg/mmol at age of 70-79 years, (25±13)μg/L, (190 ± 168)μg/mmol at age of 60 - 69 years. There were significant decreased trends of N-midBGP at age of 70 -79,80 -89 compared with that of 60-year (P < 0. 05). There were significant decreased trends of CTX/Cr 80 - 89 compared with that of 60-year (P < 0. 05). Conclusions There were significant decreased bone metabolism in aged women. The risk of hip fracture is significantly increased in aged women. Diagnosis of osteoporosis based on BMD of hip in aged women is more reliable.     

孕激素对绝经后妇女骨质代谢的影响

选取１９８７年１月至１９９０年１２月，因子宫肌瘤行全子宫、双例附件除的手术后病人２６例及自然绝经无内科合并症女女４例，随机分为Ｉ组和Ⅱ组，每组１５。Ｉ组服宫黄体酮１０ｍｇ，每日２次，连续３个月；Ⅱ组口服安宫黄体酮１０ｍｇ，每日２次；口服尼尔雌醇５ｍｇ，每月１次，连续３个月。