Effects of alendronate on metacarpal and lumbar bone mineral density,bone resorption,and chronic back pain in postmenopausal women with osteoporosis

The purpose of this study was to investigate the effect of alendronate on metacarpal and lumbar bone mineral density (BMD), bone resorption, and chronic back pain in postmenopausal women with osteoporosis. Eighty postmenopausal women with osteoporosis, 59–88 years of age, were divided into two groups of 40 each according to the site of BMD measurement: the metacarpus (M) and the lumbar spine (L). All of them were treated with alendronate (5 mg/day) for 12 months. Metacarpal or lumbar BMD was measured by computed X-ray densitometry or dual-energy X-ray absorptiometry in the M or the L group, respectively, at baseline and every 6 months. Urinary cross-linked N-terminal telopeptides of type I collagen (NTX) were measured by enzyme-linked immunosorbent assay, and chronic back pain was evaluated by face scale score at baseline and every 6 months in both groups. There were no significant differences in baseline characteristics, including age, body mass index, years since menopause, urinary NTX level, face scale score, or number of prevalent vertebral fractures per patient between the two groups. Urinary NTX level was reduced and chronic back pain was improved similarly in both groups. Whereas metacarpal BMD did not significantly change in the M group (0.20% increase), lumbar BMD increased by 8.15% in the L group. These results suggest that although alendronate increases BMD of the lumbar spine, which is rich in cancellous bone, and improves chronic back pain, with suppression of bone resorption in postmenopausal women with osteoporosis, it may fail to increase cortical BMD of the metacarpus, a distal site of the upper extremity.Abbreviations ALP Alkaline phosphatase - BMD Bone mineral density - DXA Dual-energy X-ray absorptiometry - NTX Cross-linked N-terminal telopeptides of type I collagen     

Comparison of the effect of alendronate on lumbar bone mineral density and bone turnover in men and postmenopausal women with osteoporosis

The purpose of the present study was to compare the effect of alendronate treatment on lumbar bone mineral density (BMD) and bone turnover in men and postmenopausal women with osteoporosis. Sixty men with primary or secondary osteoporosis and 318 women with postmenopausal osteoporosis were treated with alendronate. The primary end points were lumbar BMD and urinary cross-linked N-terminal telopeptides of type I collagen (NTX) and serum alkaline phosphatase (ALP) levels. The secondary end point was the incidence of vertebral and nonvertebral fractures. Forty-seven (78.3%) men and 254 (79.9%) women who could complete the 12-month trial were analyzed. The mean ages of men and postmenopausal women were 69.1 and 70.4 years, respectively. Both men and postmenopausal women showed higher levels of urinary NTX as compared with normal range of premenopausal women. Alendronate treatment decreased urinary NTX level by 39.2% in men and 45.4% in postmenopausal women at 3 months and serum ALP level by 17.8 and 21.0%, respectively, at 12 months. Following reduction in bone turnover markers, lumbar BMD increased 5.8 and 7.6% in men and postmenopausal women, respectively, at 12 months. Reduction in urinary NTX level and increase in lumbar BMD were smaller in men than in postmenopausal women. The incidence of vertebral and nonvertebral fractures was 10.6 and 8.5%, respectively, in men and 8.3 and 7.5%, respectively, in postmenopausal women, with no significant difference in these incidences between them. These results suggested that alendronate treatment effectively increased lumbar BMD from baseline in men with primary or secondary osteoporosis following reduction in bone turnover, although its efficacy did not appear to be greater than in postmenopausal women with osteoporosis. We have no funding sources; we have no conflict of interest.     

Low normal TSH levels are associated with low bone mineral density in healthy postmenopausal women

OBJECTIVE: Hyperthyroidism is accompanied by low bone mass. Because the reference range of TSH levels is defined statistically, some individuals with low normal TSH levels may have mild hyperthyroidism and reduced bone mass. We therefore determined whether serum TSH levels correlate with bone mineral density (BMD). DESIGN: A cross-sectional hospital-based survey. Participants Nine hundred and fifty-nine healthy postmenopausal women. MEASUREMENTS: We measured BMD at the lumbar spine and femoral neck using dual energy X-ray absorptiometry, and serum TSH concentrations using immunoluminometry. RESULTS: BMD at the lumbar spine and femoral neck increased with TSH level (P for trend < 0.001 at both sites). Even after adjustment for age, years since menopause and body mass index, subjects with low normal TSH levels (0.5-1.1 mU/l) had significantly lower BMDs at the lumbar spine (0.863 +/- 0.009 g/cm2 vs 0.900 +/- 0.009 g/cm2, P = 0.004) and femoral neck (0.660 +/- 0.006 g/cm2 vs 0.683 +/- 0.006 g/cm2, P = 0.006) than those with high normal TSH levels (2.8-5.0 mU/l), as well as a 2.2-fold increased risk of osteoporosis (95% confidence interval: 1.2-4.0). CONCLUSION: These results suggest that low normal TSH levels may not be physiological for postmenopausal women and, during treatment of hypothyroidism, may not be adequate for avoiding osteoporosis.     

Bone mineral density and serum bone turnover markers in survivors of childhood acute lymphoblastic leukemia: comparison of megadose methylprednisolone and conventional-dose prednisolone treatments

During recent decades, the survival rate after childhood acute lymphoblastic leukemia (ALL) has improved substantially; consequently, the long-term side effects of ALL and its treatment have gained attention, of which osteoporosis is one of the most important. The purpose of the present study was to compare the influence of different treatment protocols that include high-dose methylprednisolone (HDMP) versus conventional-dose prednisolone (CDP) for remission-induction therapy on bone mineral density (BMD) and serum bone turnover markers in survivors of childhood ALL after cessation of chemotherapy. Thirty-six boy and 23 girl survivors, treated for ALL, were cross-sectionally studied, at a mean age of 11.7 years (range 6-19). Group 1 (n = 30) received CDP therapy (prednisolone, 2 mg/kg/day, orally) and group 2 (n = 29) received HDMP therapy (prednol-L, 900-600 mg/m2, orally). All other therapies were similar in both groups. Cranial irradiation was added for high-risk patients as soon as possible after consolidation therapy. We found that mean lumbar spine BMD z score value was -1.75 (0.83) SDS in group 1 and -1.66 (1.21) SDS in group 2. There is no difference between both groups (P = 0.736). The mean BMD z scores of prepubertal and pubertal patients were not significantly different in both groups. Comparison of serum bone turnover parameters of the patients revealed no difference between the two groups. Stepwise regression analysis revealed that lumbar spine BMD z scores was predicted by height SDS and the time past since cessation of therapy, but not age at diagnosis, BMI SDS, cranial radiotherapy, and puberty. Our study results showed that HDMP treatment did not deteriorate the bone mass any more than CDP treatment. These results proved that high-dose steroid therapy over a short period of time in remission-induction treatment would not affect the bone mass any more adversely than would conventional doses approximately 3 years after cessation of chemotherapy.     

The effect of low dose nylestriol-levonorgestrel replacement therapy on bone mineral density in women with postmenopausal osteoporosis

OBJECTIVE: Recently our studies have shown that nylestriol in combination with levonorgestrel prevented bone loss, decreased bone turnover rate and increased the maximal loading of bone without obvious side effects in retinoic acid (RA) induced osteoporotic rats. In addition to the animal experiments, we evaluate the effect of Compound Nylestriol Tablet (CNT) on bone mineral density (BMD) in women with postmenopausal osteoporosis. Compound Nylestriol Tablet, which contains 0.5 mg of nylestriol (cyclopentylethinyl estriol) and 0.15 mg of levonorgestrel per tablet, was authorized as a new anti-osteoporotic agent for clinical trial in postmenopausal osteoporosis. METHODS: One year's clinical observation was performed in 191 eligible patients who were randomly divided into two groups (A and B). In group A, 119 patients were treated for one year with CNT (one tablet per week) and in group B, 72 patients with placebo. Bone mineral density of lumbar antero-posterior spine (L1-L4), lateral spine, total hip and total forearm positions including radius+ulna at the ultra distal areas, mid areas, and one-third areas, were measured before and after treatment. Biochemical parameters and effects of CNT on uterus, and breast were observed. RESULTS: We found that patients treated with CNT had a significant decrease of bone loss in total forearm, including radius+ulna at the ultra distal, mid, and 1/3 areas compared with control subjects (all P < 0.05). An improved BMD tendency could be seen at the lumbar spine. There were no differences in the observed biochemical variables. No side-effects on uterus, or mammary glands observed. None of the patients had uterine bleeding or vertebral fractures during one year's CNT treatment. CONCLUSION: These data suggested that CNT is effective, safe and convenient in treating postmenopausal osteoporosis.     

The study of bone mineral density and bone turnover markers in postmenopausal women with active rheumatoid arthritis

Abstract

The aim of this study was to investigate determinants of reduced bone mineral density (BMD) in postmenopausal women with active rheumatoid arthritis (RA) and to evaluate whether there are common markers of bone loss. We evaluated BMD of the femoral neck using dual-energy X-ray absorptiometry, and the measured biochemical markers included serum bone-specific alkaline phosphatase (BALP), serum osteocalcin (OC), and serum cross-linked N-telopeptidases of type I collagen (NTx). Serum BALP and NTx concentrations were measured by enzyme-linked immunsorbent assay, and OC was measured using an immunoradiometric assay. One hundred and forty postmenopausal Japanese women who had not received treatment with bisphosphonates or hormone replacement therapy were entered into the study. Thirty-four patients (41.0%) had femoral osteopenia (T score ?1 to ?2.5) and 23 patients (27.7%) had osteoporosis (T < ?2.5). The body mass index of patients with normal BMD (T score ≥ ?1.0) was significantly higher (P < 0.01) than in patients with osteoporosis at the femoral neck. The T score exhibited a significant negative correlation with age and the duration of RA disease. Serum BALP and serum OC, markers of osteoblast function, were negatively related to erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and matrix metalloproteinase-3 (MMP-3). However, serum NTx, a marker of resorptive function, exhibited a positive correlation with ESR, CRP, and MMP-3. From these results, this study suggests that generalized bone loss occurs in active RA and is characterized by evidence of bone resorption that is correlated with the high levels of inflammation. Body mass index, disease duration, and high serum NTx level were common risk factors in osteoporosis of postmenopausal women with RA.     

The study of bone mineral density and bone turnover markers in postmenopausal women with active rheumatoid arthritis

The aim of this study was to investigate determinants of reduced bone mineral density (BMD) in postmenopausal women with active rheumatoid arthritis (RA) and to evaluate whether there are common markers of bone loss. We evaluated BMD of the femoral neck using dual-energy X-ray absorptiometry, and the measured biochemical markers included serum bone-specific alkaline phosphatase (BALP), serum osteocalcin (OC), and serum cross-linked N-telopeptidases of type I collagen (NTx). Serum BALP and NTx concentrations were measured by enzyme-linked immunsorbent assay, and OC was measured using an immunoradiometric assay. One hundred and forty postmenopausal Japanese women who had not received treatment with bisphosphonates or hormone replacement therapy were entered into the study. Thirty-four patients (41.0%) had femoral osteopenia (T score −1 to −2.5) and 23 patients (27.7%) had osteoporosis (T < −2.5). The body mass index of patients with normal BMD (T score ≥ −1.0) was significantly higher (P < 0.01) than in patients with osteoporosis at the femoral neck. The T score exhibited a significant negative correlation with age and the duration of RA disease. Serum BALP and serum OC, markers of osteoblast function, were negatively related to erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and matrix metalloproteinase-3 (MMP-3). However, serum NTx, a marker of resorptive function, exhibited a positive correlation with ESR, CRP, and MMP-3. From these results, this study suggests that generalized bone loss occurs in active RA and is characterized by evidence of bone resorption that is correlated with the high levels of inflammation. Body mass index, disease duration, and high serum NTx level were common risk factors in osteoporosis of postmenopausal women with RA.     

Retraction Note: Effects of alendronate on metacarpal and lumbar bone mineral density,bone resorption,and chronic back pain in postmenopausal women with osteoporosis

Clinical Rheumatology - This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1007/s10067-021-05787-4     

Relation of low bone mineral density and carotid atherosclerosis in postmenopausal women

Due to the lack of convincing data about the association between atherosclerosis and osteoporosis, we evaluated the association between carotid atherosclerosis and bone mineral density in a sample of apparently healthy postmenopausal women who underwent health-screening in our hospital. We also evaluated a bone turnover marker, osteocalcin; we divided the population into 2 groups according to osteocalcin levels. We found a high prevalence of carotid atherosclerosis in subjects with high osteocalcin levels and low bone mineral density.     

亚临床甲状腺功能减退症与绝经后女性骨代谢指标的相关性分析

目的探讨亚临床甲状腺功能减退症(SCH)与绝经后女性骨密度及骨代谢相关指标的关系。方法选取2015年1月至2018年6月在空军军医大学西京医院老年病科就诊的138例绝经后女性临床资料,根据患者是否患SCH分为SCH组(68例)和正常对照组(70例)。检测并比较2组患者骨密度相关指标[碱性磷酸酶(ALP)、Ca~(2+)、骨化三醇、骨密度T值(T -1.0为骨密度异常)]以及甲状腺功能相关指标[甲状旁腺激素(PTH)、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPOAb~+)比例]。采用SPSS 18.0统计软件对数据进行分析。相关性采用Spearman相关分析。结果 SCH组及对照组患者骨密度异常率分别为50.0%(34/68)和25.7%(18/70),2组比较差异有统计学意义(P=0.003)。与对照组比较,SCH组患者TSH水平和TPOAb~+比例显著升高(P0.05),但FT3、FT4、PTH及骨代谢相关指标比较,差异无统计学意义(P0.05)。Spearman相关分析显示,TSH、TPOAb~+与ALP、骨化三醇、骨密度T值呈负相关,其中TSH与T值呈高度负相关(r=-0.804,P0.01)。结论 SCH可能引起绝经后女性骨量异常和骨密度测定值降低,这可能与血清TSH水平升高和TPOAb呈阳性有关。     

正常女性与年龄相关的骨转换生化指标和骨密度的关系

目的　探讨女性人群骨转换生化指标 :血清骨特异性碱性磷酸酶 (sBAP)、血清骨钙素(sOC)和尿Ⅰ型胶原氨基末端肽 (uNTX)随年龄变化及其与骨密度 (BMD)之间的关系。方法　用ELISA测定sBAP、sOC和uNTX ,用DXA仪测定腰椎 1～ 4前后位 (AP)、股骨颈 (FN)的BMD。结果( 1)sBAP、sOC和uNTX与年龄呈正相关 ,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好 ,拟合曲线的决定系数 (R2 )为 0 181～ 0 381(P <0 0 0 1)。 ( 2 )按每 10岁年龄段分组发现 :这3个生化指标在 30～ 39岁年龄段最低 ,随后随年龄的增长而升高 ;5 0～ 5 9岁段达最高值。 ( 3)按是否绝经分组结果表明 :绝经后妇女sBAP、sOC和uNTX水平均较绝经前妇女高 (P <0 0 0 1) ,而绝经后妇女的AP、FN部位的BMD都低于绝经前妇女 (P <0 0 0 1)。( 4 )sBAP、sOC与uNTX呈正相关 (P<0 0 0 1) ,sBAP、sOC和uNTX与AP、FN部位的BMD呈负相关 (P <0 0 0 1)。结论　sBAP、sOC和uNTX是反映女性随年龄及绝经变化的骨转换的敏感和较特异的指标 ,能较好地预测BMD ,妇女BMD降低与骨的代谢转换率升高有关。     

绝经后妇女脊椎压缩性骨折与骨密度的关系

目的探讨绝经后妇女脊椎压缩性骨折与骨密度（BMD）的关系。方法为病例一对照研究，入选250例有脊椎压缩性骨折的绝经后妇女，另有250名无脊椎压缩性骨折的绝经后妇女作为对照组。两组均有胸腰椎正侧位X线摄片，并应用双能X线吸收仪检测腰椎1～4和左股骨近端各部位BMD。结果脊椎压缩性骨折组身高、体重、腰椎2～4和股骨近端各部位BMD值均显著低于对照组（均P〈0．01）。腰椎2～4BMD是发生脊柱骨折的预报因子（r=-0．416，P〈0．01）。身高和全髋部BMD与骨折次数和骨折椎体数目呈负相关（均P〈0．01）。按股骨颈和全髋部BMD值，骨折组骨质疏松检出率各为50．8％和50．4％；另外剔除在腰椎2～4发生椎体骨折53例，按腰椎2～4BMD检出骨质疏松占64．5％。同时，腰椎2～4、股骨颈或全髋部BMD值低于-2．5s者发生脊柱压缩性骨折的风险分别是BMD正常者的4．76、2．36和3．52倍。结论腰椎呈低骨量是发生脊椎压缩性骨折的重要危险因素。身高的下降和全髋部低BMD值是骨折发生次数和受累椎体数目的危险因子；对绝经后妇女在重视BMD测量的同时，应重视脊柱X线正侧位检查。     

Predicting bone mineral density of postmenopausal healthy and cirrhotic Italian women using anthropometric variables

Background. Chronic liver diseases, including cirrhosis of the liver, have been shown to cause bone osteometabolic disease giving rise to osteoporosis and osteomalacia.

Aims. To develop mathematical prediction equations for the lumbar-spine, pelvis and total bone mineral density based on the osteoporosis risk factors age and body mass index in cirrhotic and healthy postmenopausal women.

Patients. Twenty-seven postmenopausal women with liver cirrhosis (Child–Pugh class A) and well-preserved liver function (Late postmenopausal cirrhotic), 27 women matched for age and body mass index (Late postmenopausal healthy) and 27 younger women matched only for body mass index (Early postmenopausal healthy).

Methods. Segmental and total fat mass, lean body mass and bone mineral density were measured for all participant women using dual X-ray absorptiometry.

Results. Segmental and total fat mass and bone mineral density were significantly lower for Late postmenopausal cirrhotic women as compared with Late and Early postmenopausal healthy women. Segmental and total lean body mass were comparable among the three study groups.

Conclusions. The mathematical equations based on the variables age and body mass index were capable of predicting lumbar-spine bone mineral density, pelvis bone mineral density and total bone mineral density for the three groups of postmenopausal women with the lowest standard error of estimation and root mean square residuals of predictions for equations describing the Late postmenopausal healthy group.     

体重、体重指数对健康绝经后妇女骨密度的影响

目的探讨体重和体重指数（BMI）对健康绝经后妇女骨密度（BMD）的影响。方法采用双能X线骨密度仪测量591例健康绝经后女性不同部位的BMD，按BMI不同分为低体重组、正常体重组和肥胖组进行分析。结果各部位的BMD随BMI的增加而增高（P〈0．01）。BMD随年龄的增长而降低（P〈0．01）。肥胖组各部位BMD均比正常体重组和低体重组高（P〈0．05或P〈0．01）。年龄和体重是决定BMD变异的主要因素，年龄与BMD呈负相关，体重与BMD呈正相关，绝经年龄与腰椎正位BMD呈正相关；BMI与BMD无相关性。结论体重是影响绝经后妇女BMD的重要因素。对低体重的绝经后妇女定期监测BMD，有助于早期干预。     

绝经前妇科手术对绝经后妇女骨量的影响

目的探讨绝经前不同术式切除子宫、卵巢与绝经后妇女骨量的关系。方法对2002年4月至2006年3月绝经20年内的妇女绝经前行一侧卵巢切除术18例、单纯子宫切除术者63例,子宫加单侧卵巢切除术者44例,子宫加双侧卵巢切除术者87例,以及同期自然绝经101例妇女进行骨密度测定,并对各组的骨密度和骨质疏松症的发生率进行比较。骨质疏松症的诊断标准为骨密度值低于或等于正常年轻妇女平均骨密度峰值减去2.5个标准差。结果自然绝经组与一侧卵巢切除术组平均年龄分别59.8±6.8,56.5±5.5岁;平均绝经年龄分别为49.8±3.2、49.5±3.9,两组在腰椎、股骨颈、大转子、华氏三角区骨密度差异无统计学意义,且两组骨质疏松症发生率分别为61.4%、50%,两组差异无统计学意义（P〉0.05）。单纯子宫切除术组、子宫加单侧卵巢切除术组、子宫加双侧卵巢切除术组腰椎骨密度分别为0.91±0.17、0.88±0.18、0.80±0.14（g/cm^2）,股骨颈骨密度分别为0.75±0.11、0.77±0.14、0.70±0.12（g/cm^2）,大转子骨密度分别为0.60±0.10、0.62±0.12、0.56±0.10（g/cm^2）,华氏三角区骨密度分别为0.56±0.13、0.59±0.16、0.50±0.12（g/cm^2）。子宫加双侧卵巢切除术组骨密度在腰椎、股骨颈、大转子、华氏三角区明显低于单纯子宫切除术组和子宫加单侧卵巢切除术组;后两组组间差异无统计学意义。单纯子宫切除术组、子宫加单侧卵巢切除、子宫加双侧卵巢切除术组骨质疏松症发生率分别为34.9%、38.6%、62.1%。子宫加双侧卵巢切除术组明显高于单纯子宫切除术组、子宫切除术加单侧卵巢切除术组（P〈0.01）,后两组间差异无统计学意义。结论1.绝经前行单侧卵巢切除后不影响绝经后妇女骨量、骨质疏松症的发生率;2.绝经前子宫切除术者尽可能保留单侧或双侧卵巢,以避免远期骨量降低,骨质疏松症发生率增加。     

435名女性体检者血清铁蛋白与骨密度的相关性

目的了解正常女性随年龄增长体内铁含量与骨密度变化的关系,分析铁含量与骨密度的相关性。方法收集2011年1月至2012年12月在苏州大学附属第二医院435名22~80岁体检女性血清铁蛋白和骨密度数据。采用电化学发光法检测血清铁蛋白,采用双能X线吸收仪测定骨密度。按每5岁为1个年龄段分组,分别统计各组受试者血清铁蛋白和不同部位骨密度的平均值,观察血清铁蛋白、骨密度随年龄变化的情况。将血清铁蛋白按5等分法分类,运用非条件Logistic回归法,分析随血清铁蛋白升高,发生骨量减少风险的变化。采用多元逐步回归分析、偏相关分析法,了解正常女性血清铁蛋白变化与骨密度的相关性。结果女性血清铁蛋白随年龄增加而增加,骨密度随年龄增加而下降,两者变化趋势在围绝经期、绝经期变化显著。骨量减少组(-2.5T值-1.0)血清铁蛋白平均值显著高于骨量正常组(P0.001),骨质疏松组(T值≤-2.5)血清铁蛋白平均值显著高于骨量减少组(P0.01)和骨量正常组(P0.001)。校正混杂因素后,血清铁蛋白按5等分法分组,非条件Logistic回归显示血清铁蛋白最高组与最低组相比,股骨颈和腰椎发生骨量减少的OR值(95%CI)分别为2.82(1.25~6.38)和2.04(0.92~4.51),提示随血清铁蛋白增加,骨量减少发生的风险增加。多元逐步回归分析显示,与骨密度变化相关指标为年龄、体重、血清铁蛋白和体重指数(BMI),校正年龄、体重、BMI、C反应蛋白(CRP)等混杂因素后,血清铁蛋白与不同部位骨密度均呈显著负相关(P0.05)。结论随着年龄增长,女性血清铁蛋白逐渐升高、骨密度逐渐下降,二者呈显著负相关。血清铁蛋白增高时,骨量减少、骨质疏松发生率升高。     

2型糖尿病患者绝经期的骨密度变化及其相关因素分析

目的 探讨2型糖尿病(T2DM)患者绝经期的骨密度(BMD)变化及其机制，以了解其骨代谢情况及相关因素。方法 采用双能X线骨密度仪测定206例T2DM绝经期妇女及40例年龄、体质指数(BMI)相匹配的健康者的BMI)．收集相关生化指标．并对其与年龄、病程、绝经年限、空腹血糖(FPG)等及部分骨代谢指标进行多元回归分析。结果 206例T2DM绝经期妇女的BMD较健康者有不同程度下降．统计分析发现糖化血红蛋白(HbA1-c)与腰椎2～4(I，2～4)、Ward’s三角、股骨颈、股骨大转子部位的BMD呈负相关：偏回归系数分别为-0．0128(P=0．0007)、-0．0116(P-0．0001)、-0．2292(P-0．0001)、-0．0173(p=0．0007)。餐后2h血糖(2hPG)与I，2～4、WardS三角部位的BMD呈负相关：偏回归系数分别为-0．0249(P-0．0001)．-0．0249(P-0．0001)。空腹胰岛素(Fins)、餐后2hC肽(2hCP)水平与I，2～4、Ward’S三角、股骨颈部位的BMD呈正相关：Fins的偏回归系数分别为0．0128(P=0．0001)、0．0188(P-0．0001)、0．0315(P-0．0001)；2hCP的偏回归系数分别为0．0283(P-0．0001)、0．0052(P=0．0032)、0．0177(P-0．0006)。结论 T2DM绝经期妇女非肥胖者更容易引起BMD下降．除了雌激素的影响外，可能与胰岛功能受损有关，较好地控制血糖和保护胰岛细胞功能对预防骨质疏松症(OP)有益。     

绝经后女性2型糖尿病患者骨密度与大血管并发症的相关性

目的 探讨绝经后女性2型糖尿病患者骨密度与大血管并发症的相关性.方法 对137例符合1999年世界卫生组织(WHO)糖尿病诊断标准的绝经后女性2型糖尿病住院患者,应用骨密度仪测定骨密度和T值,根据有无大血管并发症分2组,比较骨密度和T值.应用多因素非条件Logistic回归分析骨质疏松与大血管并发症的相关性.结果 绝经后女性2型糖尿病合并大血管并发症组的骨密度、T值显著低于不伴有大血管并发症组(P＜0.01～0.05),调整了年龄、血压、血脂、体重指数、糖尿病病程、绝经时间后,经多因素非条件Logistic回归分析显示骨质疏松与大血管并发症仍存在显著的相关性(OR=4.473,95%CI:1.770～11.300).结论 绝经后女性2型糖尿病患者骨密度的降低可能与大血管并发症的发生、发展有关.     

Effects of hormone replacement therapy on bone mineral density in postmenopausal women with primary hyperparathyroidism: four-year follow-up and comparison with healthy postmenopausal women

BACKGROUND: Long-term treatment of patients with asymptomatic primary hyperparathyroidism remains controversial, but the presence of osteoporosis is regarded as an indication for parathyroidectomy. Hormone replacement therapy (HRT) is a possible alternative therapy in osteopenic postmenopausal women with the disorder, and results of short-term studies suggest a beneficial effect on bone mass comparable to that achieved by parathyroidectomy. Longer-term data are required to further assess the efficacy of this treatment in chronic stable primary hyperparathyroidism. METHODS: We report the results of the extension from 2 to 4 years of a randomized, placebo-controlled trial of HRT in postmenopausal women with primary hyperparathyroidism. Of 23 postmenopausal women with primary hyperparathyroidism, 11 received active HRT with conjugated equine estrogen, 0.625 mg/d, and medroxyprogesterone acetate, 5 mg/d, and 12 received placebo. Bone mineral density was measured throughout the skeleton at 6-month intervals using dual-energy x-ray absorptiometry in these women and in 50 normocalcemic age-matched control subjects. None of the 23 patients withdrew during the extension period. RESULTS: Changes in bone mineral density were more positive in those taking HRT than placebo, with the between-group differences at 4 years being 4.6% in the total body, 7.5% in the lumbar spine, 7.4% in the femoral neck, 8.2% in the femoral trochanter, 6.8% in the legs, and 7.0% in the forearm (P<.01). At skeletal sites composed predominantly of cortical bone, there was a progressive divergence of the 2 groups. Biochemical markers of bone turnover remained lower throughout the study in women taking HRT. When rates of bone loss were compared between the placebo group and healthy women of comparable age, bone loss tended to be more marked throughout the skeleton in women with hyperparathyroidism, but only in the total body and its legs subregion was this difference significant. CONCLUSIONS: Hormone replacement therapy is efficacious in the long-term management of osteopenia in postmenopausal women with primary hyperparathyroidism and thus represents an important new therapeutic option for asymptomatic patients who do not have other indications for surgery. Bone loss seems to be accelerated in untreated primary hyperparathyroidism.     

Reduced bone mineral density in Japanese premenopausal women with systemic lupus erythematosus treated with glucocorticoids

We evaluated bone mineral density (BMD) in Japanese female patients with systemic lupus erythematosus (SLE) and assessed the influence of the use of glucocorticoids. Lumbar BMD was measured by dual x-ray absorptiometry (DXA) in 60 premenopausal females who previously had been receiving glucocorticoid therapy. Therapeutic- and disease-related variables for SLE were analyzed and bone resorption or formation markers were measured. Osteoporosis was defined as a T-score below 2.5 SD by DXA; 12 patients (20%) showed osteoporosis, and 30 (50%) had osteopenia. Compared with the nonosteoporotic group (n = 48), the osteoporotic group (n = 12) had a significantly longer duration of glucocorticoid treatment (P = 0.01), a cumulative prednisolone dose (P = 0.002), and an SLE damage index (SLICC/ACR). There was no difference in the incidence of osteoporosis either with or without the previous use of methyl-prednisolone pulse or immunosuppressive drugs. There was a significant positive correlation between urinary type I collagen cross-linked N-telopeptides (NTx) and serum bone-specific alkaline phosphatase (BAP) (r = 0.404, P = 0.002), but these bone metabolic markers showed no difference between the osteoporotic and nonosteoporotic groups. A good significant negative correlation was shown between BMD and the cumulative glucocorticoid dose (r = −0.351, P = 0.007). Stepwise logistic regression analysis showed that the cumulative glucocorticoid intake was independently associated with osteoporosis. Glucocorticoid-induced osteoporosis was frequently observed in Japanese SLE patients, as in Caucasian populations. The cumulative glucocorticoid dose was associated with an increased risk for osteoporosis. Bone metabolic markers such as NTx and BAP were not influenced by glucocorticoid treatment and could not predict current osteoporosis in SLE patients. Received: October 18, 2001 / Accepted: April 8, 2002 Correspondence to:S. Banno