类风湿关节炎患者骨密度及骨矿物质含量的变化及意义

目的探讨类风湿关节炎(RA)患者骨密度(BMD)及骨矿物质(BMC)含量的变化及意义。方法选择71例RA患者(RA组)及20例正常人(对照组),采用双能X线骨密度仪检测各组前臂BMD、BMC含量,魏氏法检测血沉(ESR),免疫比浊法检测血清C反应蛋白(CRP),速率散射比浊法检测类风湿因子(RF),ELISA法检测抗环瓜氨酸肽抗体(ACCP);同时进行X线分期,计算患者疾病活动分数(DAS28)。结果 RA组前臂BMD、BMC均低于对照组(P均<0.01),ESR、CRP、RF、ACCP均高于对照组(P均<0.01)。Pearson’s相关分析显示,前臂BMD与DAS28、ESR、RF呈负相关(r分别为-0.357、-0.390、-0.255,P<0.05或<0.01),前臂BMC与DAS28、ESR呈负相关(r分别为-0.344、-0.401,P均<0.01)。多元线性回归分析显示,前臂BMD与RF、年龄呈负相关(T分别为-7.544、-3.254,P均<0.01);前臂BMC与DAS28呈负相关(T=-4.44,P<0.01)。RA组中X线分期为Ⅰ期的有15例,其中BMD示骨质疏松6例、骨量减少2例。结论 RA患者BMD、BMC含量明显减少,其含量减少与RA活动密切相关;RF可能是导致RA骨量丢失的危险因素;BMD检测能更早反映RA患者的骨量丢失情况。     

贵阳市部分成人代谢综合征对骨密度的影响

目的：了解代谢综合征及其组分对骨密度的影响。方法2009年11月至2010年2月贵阳市居民健康横断面调查的1512名20～79岁调查对象（男性636名,女性876名）纳入本研究,受试者平均年龄（45.3±14.4）岁。对所有受试者进行问卷调查及体格检查,用OLYMPUSAU5400全自动生化分析仪检测空腹静脉血糖及餐后2h血糖、三酰甘油、高密度脂蛋白胆固醇、血钙、血磷、血肌酐及血尿酸,用ROCHE化学发光法测定血清胰岛素;用双能X线检测股骨颈、全髋、Wards三角、粗隆及腰椎正位（L1-4）骨密度。结果完成血脂、尿酸、血糖、血钙、血磷、血肌酐、血胰岛素及骨密度检测者1216名,发现代谢综合征患者356例,患病率为29.3％,其中男性125例（35.1％）,女性231例（64.9％）;代谢综合征组骨折患病率为5.1％,非代谢综合征组为3.3％;代谢综合征患者全髋及粗隆骨密度较非代谢综合征者高[（0.95±0.15）g/cm2比（0.93±0.14）g/cm2;（0.76±0.13）g/cm2比（0.73±0.12）g/cm2;均P＜0.01];校正性别及年龄后,股骨颈、全髋、Wards三角、粗隆及L1-4骨密度值均随代谢综合征患者组份增加而增高（均P＜0.01）。结论代谢综合征患者有较高的全髋及粗隆骨密度,但其骨折率亦较高。     

骨密度测量在职业性氟中毒诊断中的应用

目的　观察骨密度测量在职业性氟中毒诊断中的应用价值。方法　运用 SD- 10 0 0型单光子吸收法定量测定某铝厂接触氟工人 113人 ,并与该厂非接触氟职工 80人的骨密度及 X线平片的资料进行比较。结果　氟作业者骨密度增高、骨皮质增厚及骨髓腔增大的异常率都显著高于正常人群 (P <0 .0 1) ;曾经 X线平片诊断为氟骨症者 ,骨密度检查的异常率基本上是符合的 ,而 X线平片没有诊断骨密度异常者 ,用骨密度测定能发现其中大部分骨密度异常。结论　骨密度测量对早期氟中毒检查的灵敏度高 ,在氟中毒的诊断中有一定的应用价值。     

Normative bone mineral density values in Filipino women

Objective: To obtain reference values of bone mineral density (BMD) for Filipino women in order to make a population‐specific diagnosis of osteoporosis. Method: Sudy design: Cross‐sectional. Setting: Osteoporosis Unit, Joint and Bone Center, Section of Rheumatology and Clinical Immunology, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines. Participants: 442 healthy Filipino women volunteers recruited from the outpatient department, Rheumatology and Clinical Immunology Clinic of the University of Santo Tomas Hospital and from within the University of Santo Tomas campus. Subjects with known underlying illness or conditions or intake of drugs that predispose to osteoporosis were excluded from the study. Intervention: Bone mineral density (BMD) measurements, expressed in grams per square centimenter of the lumbar spine, non‐dominant femur and non‐dominant forearm were done in 442 consecutive healthy Filipino women using the LUNAR DPX‐IQ machine. Results: Means and standard deviations of BMD measurements at each site were calculated using Kwikstat software Version 3.6, Release 7. Results were grouped in decades to serve as reference per decade. Conclusion: Bone mineral density measurements of these 442 healthy Filipino women may serve as an initial reference guide for the diagnosis of osteoporosis in Filipino women.     

Prevalence and predictors of osteoporosis and the impact of life style factors on bone mineral density

Aim: The aim of this study was to determine the prevalence and predictors of osteoporosis and the impact of life style factors on bone mineral density (BMD) in premenopausal and postmenopausal Qatari women. Methods: This is a cross‐sectional study. A total of 821 healthy Qatari women aged 20–70 years had given consent and participated and the study was conducted from June 2005 to December 2006 at the Rumaillah Hospital, Hamad Medical Corporation (HMC), Doha, State of Qatar. All subjects completed a questionnaire on reproductive and life style factors. Height and weight were measured. All subjects underwent dual‐energy X‐ray absorptiometry (DXA) to determine factors influencing BMD of the spine and femur. The main outcome measures were menopausal status, socio‐demographic and lifestyle factors and BMD measurements. Results: The prevalence of osteoporosis in postmenopausal women was 12.3%. BMI was significantly higher among postmenopausal women (P < 0.001) when compared to premenopausal women. The subjects who regularly consumed dairy products had better BMD at spine, neck and ward sites (P < 0.05). Those doing regular household work for 3–4 h a week had higher BMD at all sites compared to those who did not do their own household work. Multiple regression analysis showed that education level and body mass index were strong positive predictors showing high significance. Conclusion: The relation between lifestyle and BMD were explored in Qatari women. The prevalence of osteoporosis in Qatari women is comparable to other countries. BMD values were higher in women who were taking diary products regularly, and were involved with household work.     

Effectiveness of bisphosphonates on bone mineral density in osteopenic postmenopausal women: A systematic review and network meta-analysis of randomized controlled trials

Background:Various bisphosphonate agents have been proven to be effective in preventing bone loss and fracture in osteopenic postmenopausal women. This study was designed to compare the effectiveness of various BPs on preventing the loss of bone mineral density (BMD) for postmenopausal women with osteopenia.Methods:PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were screened up to identify randomized controlled trails comparing effectiveness of BPs or placebo on the BMD of postmenopausal women with osteopenia. Network meta-analysis and standard pair-wise meta-analyses were performed. The main outcomes include the percentage changes of 6-, 12-, 24-, and 36-month BMD at lumbar, total hip and femoral neck, and frequencies of new fractures and severe adverse events.Results:Fourteen randomized controlled trials were eligible, involving 11,540 participants. No significant difference was presented among the available interventions for the 6-month BMD at 3 different sites, but the magnitudes of differences among the treatment regimens became gradually increased along with the extending of follow-up periods. Daily aledronate of more than 5 mg provided the maximal percentage increase on BMD of femoral neck and lumbar spine, while zoledronate provided maximal change on BMD of total hip, at different follow-up periods. This network meta-analysis also demonstrated similar frequencies of new clinical fractures and severe adverse events among different interventions.Conclusions:A ranking spectrum depicting the effectiveness on BMD percentage change following interventions with different bisphosphonate regimens was provided. Generally, regimens with zoledronate and aledronate were found to be the most effective interventions in the 3 sites at different end points.     

中青年甲状腺功能亢进患者骨密度特点

目的分析中青年甲状腺功能亢进(甲亢)患者骨密度特点及其与病程、病情严重程度的关系。方法使用双能X线骨密度仪分别测定340例中青年甲亢患者及160名年龄匹配的正常对照者的前臂、腰椎及股骨颈骨密度,用化学发光法测定甲亢患者游离三碘甲腺原氨酸(FT3)、游离甲状腺激素(FT4)及促甲状腺激素(TSH),用自动生化仪检测血清钙(Ca)、血清磷(P)、碱性磷酸酶(ALP),比较2组间骨密度及Ca、P、ALP的差异。根据国际临床骨密度学会(ISCD)和国际骨质疏松基金会(IOF)对中青年骨质疏松诊断的不同定义分别将甲亢患者分为骨量正常组(ON1)和骨质疏松组(OP1)、骨量正常组(ON2)、骨量减少组(OD2)、骨质疏松组(OP2),比较使用2种诊断方法得出的骨质疏松检出率,比较各组甲状腺激素(TH)及TSH的差异。结果与正常对照组相比,甲亢患者桡骨全部、腰椎L2-4及股骨颈骨密度均明显降低(均P0.05)。根据ISCD定义得出的骨质疏松检出率为46.8%,根据IOF定义得出的骨质疏松检出率为27.1%,前臂较腰椎、股骨颈骨密度降低更明显。甲亢患者骨质疏松组较骨量正常组的FT3、FT4明显升高(P0.05),TSH明显降低(P0.05)。多元线性回归分析显示桡骨骨密度与FT4、Ca呈负相关,与TSH呈正相关。结论中青年甲亢患者骨质疏松患病率高,骨量丢失较明显的部位为桡骨,过量甲状腺激素及低TSH均可导致骨代谢紊乱。     

定量CT测量髋关节骨密度的重复性与DXA测量的一致性

目的 探讨定量CT（QCT）髋关节骨密度（BMD）测量重复性及与双能X线骨密度测定仪（DXA）测量的一致性.方法 随机抽取28名（男10例,女18例）老年受试者（男性＞60岁,女性＞50岁）,并分别采用QCT与DXA测量髋关节骨密度.收集左侧髋关节QCT扫描CT原始数据,分别由3名操作者各测量1次,其中1名操作者在不同时间重复测量3次,用于评价QCT髋关节骨密度结果的重复性.比较QCT和DXA测量左侧髋关节骨密度结果.结果 3名不同操作者或同一操作者不同时间采用QCT测量28名受试者左侧髋关节的骨密度值之间具有很好的相关性（ICC：0.93～0.98,P＜0.01）,全髋骨密度值之间差异无统计学意义.DXA与QCT测量的股骨颈和全髋骨密度结果之间具有显著相关性（r=0.88,0.89,P＜0.01）,DXA测量的骨密度值较QCT相对应骨密度值大10.5%和9.7%（t=7.53,9.68,P＜0.01）.上述骨密度值系统误差可被校正.结论采用QCT测量髋关节BMD具有较好的重复性,其BMD值与DXA所测BMD结果具有相关性.QCT髋关节（CTXA）骨密度测量可用于骨质疏松症的诊断和疗效随访,具有临床应用前景.     

Low bone mineral density is associated with increased arterial stiffness in participants of a health records based study

Aims

Many epidemiological studies have shown that low bone mineral density (BMD) and atherosclerosis appear to be related. However, their precise correlation is not completely understood after full adjustment the shared confounders of atherosclerosis and bone metabolism. The aim of this cross-sectional study was to investigate the relationship between BMD and subclinical atherosclerosis in a healthy Chinese population and the difference in gender.

Methods

The study population consisted of 2,487 subjects (1,467 men, 1,020 women) who participated in health check-up programs and were selected to be free of major diseases which might affect atherosclerosis and bone metabolism. Bone status was assessed by BMD in lumbar spine. The brachial-ankle PWV (baPWV) was assessed as a functional marker of atherosclerosis. The ankle-brachial index (ABI), carotid artery intima-media thickness (CIMT), estimated glomerular filtration rate (eGRF) and microalbuminuria were evaluated as indexes of structural markers of atherosclerosis.

Results

After adjustment for risk factors, significant association was shown between baPWV and BMD in both genders (male: r=−0.084, P=0.035; female: r=−0.088, P=0.014). The correlation was stronger in females than in males, and in females, the correlation was stronger after menopause. Similarly, mean baPWV differed significantly according to the decreased BMD (normal BMD, Osteopenia, Osteoporosis). In contrast, no significant differences were observed for ABI, CIMT, eGFR or microalbuminuria with BMD.

Conclusions

Independent of confounding factors, low BMD is associated with the functional marker of subclinical atherosclerosis (increased baPWV), but not with structural markers (ABI, CIMT, eGFR or microalbuminuria) among healthy females and males.     

去卵巢大鼠血清乳铁蛋白与骨密度的相关性研究

目的 探讨去卵巢大鼠血清乳铁蛋白(LF)水平与骨密度(BMD)的关系,为临床应用乳铁蛋白提供实验依据.方法 采用4月龄Wistar雌性大鼠,随机分为假手术组(sham,20只)与去卵巢模型组(ovariectomy,OVX,40只,分为OVX I组与OVX Ⅱ组,各20只),分别于术后14与18周处死OVX I组与OV...     

健康成年男性身体成分对骨密度的影响

目的探讨健康成年男性身体成份对骨密度（BMD）的影响程度。方法对257名健康男性采用双能X线检测腰椎（L1-4）、髋部和全身BMD及身体成份一全身脂肪量（FM）和全身瘦组织量（I．M）,并测量身高和体重。结果FM是决定体重指数（BMI）的主要因素（R^2=0．675,LM：标准偏回归系数B=0．252,P=0．000;FM：标准偏回归系数p=0．692,P=0．000）;年龄、BMI、FM、LM和FM占体重百分比（FM％）均与股骨颈、全髋、L1-4和全身BMD呈显著正相关（P〈0．01）。躯干部脂肪组织量占体重百分比（TKFM％）只与L1-4BMD有相关性（P=0．011）。多元逐步回归分析显示,LM是决定股骨颈（R^2=0．264,p=0．211,P=0．001）和全身BMD（R^2=0．227,B=0．160,P=0．016）的独立影响因素。在控制年龄的基础上,分别控制FM和LM后,BMI与股骨颈、全髋、L1-4和全身BMD的偏相关分析结果一致,但在BMI的回归模型中FM是BMI的主要决定因子,因FM的B是LM的2倍多,LM与所测部位BMD的相关性要强于FM。结论LM是与全身和股骨颈BMD独立相关的主要因素。     

强直性脊柱炎患者骨密度随年龄的变化

目的 采用双能X线吸收法测量强直性脊柱炎患者(AS)不同部位的骨密度(BMD),探讨其与年龄变化的关系,为临床防治AS患者BMD降低提供参考.方法 选取门诊50例符合纽约诊断标准的AS患者,按年龄≤40岁、年龄＞ 40岁分为两组,分别检测其侧位腰椎(L1-L4)、股骨颈、髋关节BMD,以T值≤-1.0定义为BMD降低,包括骨量减少(-2.5＜T＜-1.0)与骨质疏松(T≤-2.5).结果 两组AS患者出现BMD降低的比例均高于正常人,且年龄＞ 40岁组其腰椎BMD减少的比例高于年龄≤40岁组(P＜0.05),而其腰椎平均T值低于年龄≤40岁组(P＜0.05),在股骨颈测得的BMD、骨质疏松比例两组无明显差异(P＞0.05).结论 AS患者早期即可出现骨量减少甚至骨质疏松,随着年龄的增长其侧位腰椎BMD降低明显,骨折风险增大.临床上应当提高对AS合并骨质疏松的警惕,及时予补钙等治疗,提高患者的生活质量.     

肥胖男性体成分与骨密度的相关性

目的探讨成年肥胖男性体成分与骨密度（BMD）的关系。方法选取89名20～50岁男性为研究对象,根据体重指数分为体重正常组（25名）、超重组（31名）和肥胖组（33名）。应用双能X线骨密度仪进行BMD及体成分测定。结果肥胖组受试者总体脂肪质量、总体肌肉质量和BMD均高于对照绀（P〈0．05）。BMD与总体脂肪质量（r=0．296）、总体肌肉质量（r=0．392）、上肢脂肪质节（r=0．355）、人腿脂肪质量（r=0．334）和躯干脂肪质量（r=0．256）均呈正相关（P〈0．05）。BMD与躯干／总体脂肪（r=-0．197,P=0．068）呈负相关趋势。以BMD为因变量,行多元线性回归分析结果显爪,总体肌肉质量（B=0．005,P=0．000）和躯干／总体脂肪（β=-0．399,P=0．010）被引入办程。结论成年肥胖男性BMD高于非肥胖男性。肥胖者BMD增加与肌肉质量关系更为密切。建议成年肥胖男性加强体育锻炼,减少脂肪禽硅,增加肌肉含量,以预防骨质疏松症。     

Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral density

OBJECTIVES: To determine whether the use of more elaborate diagnostic tests can identify possible risk factors for secondary osteoporosis and to evaluate the impact of these possible risk factors on the severity of bone disease in the study population. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: We have investigated 377 subjects (285 females, 92 males) with osteoporosis (T-score less than -2.5 in dual energy X-ray absorption) or nontraumatic lumbar vertebral fractures; these patients were referred to our hospital, a secondary care centre, for evaluation and treatment of osteoporosis. RESULTS: Osteoporosis without attributable risk factor was diagnosed in 106 women (37%) and 30 men (33%). In 241 patients (179 women, 62 men) one or more possible risk factors for osteoporosis (in this paper also called subclinical disease) were revealed. The most common were lactose malabsorption, disturbed exocrine pancreatic function and renal tubular disturbances, including renal hypercalciuria, incomplete renal tubular acidosis and mild phosphate diabetes. The number of possible risk factors in the individual patient was significantly related to the severity of osteoporosis as assessed by Z-scores (Spearman correlation r = -0.43, P < 0.001, n = 172 for females; r = -0.28, P < 0.05, n = 65 for males). CONCLUSIONS: All the identified subclinical diseases would have remained undetected if the currently accepted guidelines for the investigation of patients with osteoporosis were applied. The statistically significant correlation between the number of identified possible risk factors and the severity of bone disease in the individual patient strongly suggests the pathogenetic significance of the identified subclinical diseases. It is yet to be shown, whether specific treatment of these subclinical diseases yields additional improvement of bone mass as compared with standard treatment of osteoporosis.     

Longitudinal study of bone mineral density in patients with Crohn's disease

Osteoporosis is frequent in Crohn's disease. The aim of the study was to assess the rate of bone loss over time retrospectively and the influence of disease-related factors on bone loss. Twenty-nine patients (8 male), admitted for repeated bone mineral density assessments (BMD) were enrolled. BMD measured by dual energy x-ray absoptiometry was expressed in grams per square centimeter, and as sex- and age-matched Z score. The mean interval between BMD assessments was 41 months, during which period 27 patients used corticosteroids (mean dose 8.6 g) and 21 patients some form of bone protective medication. Initial Z scores at a mean age of 41 years were significantly below zero (spine –1.6 ± 1.4; femur –1.4 ± 1.4). Over time, no change in absolute BMD was observed accompanied by an improvement in Z scores. At the same time, an increase in body weight and a decrease in erythrocyte sedimentation rate (ESR) was observed. Multilinear regression analysis demonstrated change in ESR as independent predictor for change in femoral Z score. In conclusion, low BMD is frequent in Crohn's disease, but decline of BMD over time was not found, despite ongoing use of corticosteroids.     

阿仑膦酸钠对全髋关节置换术后髋臼周围骨密度的影响

目的探讨阿仑膦酸钠对全髋关节置换术后髋臼周围骨密度的影响。方法将符合全髋置换纳入标准的患者随机分成阿仑膦酸钠组与对照组,阿仑膦酸钠组术后除常规治疗外尚服用阿仑膦酸钠,对照组仅常规治疗。2组患者均应用骨密度测量仪（DEXA）分别于术后第6天、3、6个月测定髋臼各个分区的骨密度。结果获得完整随访病例共58例,术后3、6个月各区骨密度均呈持续下降趋势,和对照组相比,术后3个月阿仑膦酸钠组髋臼假体周围骨量（Ⅲ区）的差异有统计学意义（P〈0．01）,其余各测量区骨密度2组相比差异无统计学意义（P〉0．05）。与对照组相比,术后6个月阿仑膦酸钠组髋臼假体周围骨量（Ⅲ区）的差异有统计学意义（P〈0．01）,其余各测量区2组相比差异无统计学意义（P〉0．05）。结论阿仑膦酸钠能有效防止髋臼假体周围骨量减少。