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1.
Association Between Colles’ Fracture and Low Bone Mass: Age-Based Differences in Postmenopausal Women 总被引:3,自引:0,他引:3
E. Kanterewicz E. Kanterewicz A. Yañez A. Pérez-Pons I. Codony L. Del Rio A. Díez-Pérez 《Osteoporosis international》2002,13(10):824-828
Colles’ fracture (CF) in postmenopausal women has been linked to low bone mass at the lumbar spine and hip. However, the
diverse methodological approaches of previous studies make the results difficult to compare and thus the implications of CF
in osteoporosis daily clinical practice are not clear. We explored the association between CF and low bone mineral density
(BMD) in an incident case-control study in 58 postmenopausal Spanish women aged 45–80 years with recent CF and in 83 population-based
controls of the same age range. The BMD of ultradistal distal forearm, lumbar spine and hip was measured by dual-energy X-ray
absorptiometry (DXA) and WHO criteria were used to define osteoporosis and osteopenia. BMD was significantly lower in cases
for all three areas (p<0.001). Osteoporosis was more prevalent in cases than controls in the wrist (60% vs. 35%, p<0.001), lumbar spine (47% vs. 20%, p<0.005) and hip (19% vs. 6%, p<0.005). After adjusting for age, menopausal status and body mass index, osteoporosis and osteopenia remained significantly
associated with CF only in women aged 65 years or less (ultradistal forearm OR 5.7 (95% CI 1.2–27.2), lumbar spine OR 3.9
(95% CI 1.1–14.3)). We conclude that CF in postmenopausal women aged 65 or less may be used as a sentinel finding to identify
patients with generalized osteoporosis. Additionally, 70% of all CF patients regardless of their age had low bone mass (T-score<−1SD) in any studied site.
Received: 3 December 2001 / Accepted: 22 May 2002 相似文献
2.
T. M. Link M. Dören G. Lewing N. Meier A. Heinecke E. Rummeny 《Osteoporosis international》2000,11(4):304-309
The purpose of this study was to analyze the midvertebral area of lumbar vertebrae in osteoporotic and nonosteoporotic female
patients and to find out whether the midvertebral area may be used as an additional parameter in the diagnosis of osteoporosis.
In 195 peri- and postmenopausal patients (average age 51.7 ± 5.2 years) trabecular and cortical bone mineral density (BMD)
were determined using quantitative CT (QCT) in L2–4. In addition, midvertebral cross-sectional area was measured in a standardized
fashion on the CT sections and the height of the second lumbar vertebra was determined on the lateral digital radiographs.
Body height and weight were obtained and vertebral fracture status was determined. According to WHO criteria 29 patients (average
age 57.2 years) were considered osteoporotic, 93 osteopenic (average age 52.2 years) and 73 normal (average age 48.6 years).
Body weight and size did not show significant differences between the individual groups. Average midvertebral area was 1278
± 173 mm2 in the osteoporotic patients, 1186 ± 125 mm2 in the osteopenic patients and 1126 ± 127 mm2 in the normals. A correlation of r=−0.39 (p<0.05) was obtained between BMD and area. Thirty-six of 195 patients showed osteoporotic vertebral fractures. Midvertebral
area in these patients was 1266 ± 171 mm2 versus 1159 ± 133 mm2 in the nonfractured females (p<0.05). We therefore conclude that the lumbar midvertebral area is larger in osteoporotic and osteopenic patients compared
with women with normal BMD. In contrast to biomechanical considerations midvertebral area seems not to be suited as an additional
measure of bone strength in vivo.
Received: 8 March 1999 / Accepted: 15 September 1999 相似文献
3.
J. R. Guthrie P. R. Ebeling J. L. Hopper E. Barrett-Connor L. Dennerstein E. C. Dudley H. G. Burger J. D. Wark 《Osteoporosis international》1998,8(3):282-290
Two hundred and twenty-four women (74 pre-, 90 peri-, 60 post-menopausal), aged 46–59 years, from a population-based cohort
participated in a longitudinal study of bone mineral density (BMD). BMD was measured by dual-energy X-ray absorptiometry (DXA)
at the lumbar spine and femoral neck and the time between bone scans was on average 25 (range 14–41) months. The aim of the
study was to assess changes in BMD in relation to changes in normal menopausal status. During the study period women who were
between 3 and 12 months past their last menstrual period (n= 22, late perimenopausal) at the time of the second bone scan had a mean (SE) annual change in BMD of 70.9% (0.4%) at the
lumbar spine and 70.7% (0.6%) at the femoral neck (both p50.05 compared with women who remained premenopausal). In the women who became postmenopausal (n= 42) the mean annual changes in BMD were 72.5% (0.2%) at the lumbar spine and 71.7% (0.2%) at the femoral neck (both p50.0005), and in the women who remained postmenopausal (n= 60) they were 70.7% (0.2%) per year and 70.5% (0.3%) per year respectively (both p50.05), compared with women who remained premenopausal. In the 1–3 years after the final menstrual period (FMP) there was
greater bone loss from the lumbar spine than the femoral neck (p50.05). In women who were menstruating at the time of the second bone scan and whose FMP could be dated prospectively (n= 35), higher baseline oestradiol levels were associated with less lumbar spine bone loss (p50.005). In the women who remained postmenopausal there was an association between baseline body mass index (BMI) and percentage
change per year in femoral neck BMD (p50.05), such that women with higher BMI had less bone loss. In conclusion, during the time of transition from peri- to post-menopause,
women had accelerated BMD loss at both the hip and spine.
Received: 23 June 1997 / Accepted: 5 November 1997 相似文献
4.
Osteocalcin Gene Polymorphism is Related to Bone Density in Healthy Adolescent Females 总被引:2,自引:0,他引:2
A. Gustavsson P. Nordström R. Lorentzon U. H. Lerner M. Lorentzon 《Osteoporosis international》2000,11(10):847-851
Recently a polymorphism was found in the human osteocalcin gene, and its association with bone mass was investigated in healthy
postmenopausal Japanese women. The osteocalcin gene allelic variant HH was found to be overrepresented in women with osteopenia.
The purpose of this study was to investigate whether the previously demonstrated polymorphism of the osteocalcin gene was
related to bone mineral density (BMD; g/cm2) or osteopenia in a group of 97 healthy Caucasian adolescent females (aged 16.9 ± 1.2 years, mean ± SD). BMD of the left
humerus, right femoral neck, lumbar spine and total body was measured using dual-energy X-ray absorptiometry. The relation
between the allelic variants and bone density was analyzed as presence or absence of the H allele. Presence of the H allele
was found to be related to a lower BMD of the humerus (0.97 vs 1.02, p = 0.03). There was also a strong tendency towards significance at the femoral neck (p = 0.06) and total body (p = 0.11). Using a multiple linear regression and including physical activity, weight, height and years since menarche, presence
of the H allele was found to be an independent predictor of humerus BMD (β=−0.21, p<0.05) and femoral neck BMD (β=−0.23, p<0.01). Using logistic regression, presence of the H allele was also independently associated with a 4.5 times increased risk
of osteopenia (p = 0.03) in the whole group. Osteopenia was defined as at least 1 SD lower bone density than the mean for the whole group
of at least one of the BMD sites measured. We have demonstrated that the osteocalcin HindIII genotype is independently related to bone density in healthy adolescent females. The present study also suggests that
presence of the H allele is predictive of osteopenia at an early age.
Received: 31 January 2000 / Accepted: 25 April 2000 相似文献
5.
O. Sahota D. Pearson S. W. Cawte P. San D. J. Hosking 《Osteoporosis international》2000,11(10):852-857
In this study we report first the concordance and variation in diagnostic osteoporosis classification using multiple skeletal
site measurements compared with the lumbar spine only; and secondly, at the lumbar spine, the variation and diagnostic osteoporosis
reclassification using the lowest individual vertebra T-score compared with the L1–L4 mean T-score. One hundred and fifty early postmenopausal women were evaluated as part of the recruitment for a multicenter osteoporosis
prevention study. Bone mineral density (BMD) was restricted such that no more than 10% of the subjects had a lumbar spine
BMD below 0.8 g/cm2. Forty-seven per cent of the subjects were classified as having low bone mass (T-score ≤−1.0) at the lumbar spine, 63% at the mid-forearm, 39% at the distal forearm and 50% at the hip (p<0.05). The greatest proportion of subjects were categorized as osteoporotic at the lumbar spine, followed by the forearm
and then the hip. Correlation between sites ranged from 0.57 to 0.60 (p<0.01). Eighty-one percent of the subjects had a significant difference between their highest and lowest individual lumbar
vertebra T-score (defined as a difference outside the 90% confidence interval coefficient of variation T-score value). Using the lowest individual lumbar T-score, recategorized 33% of the subjects classified as osteopenic (based on the mean L1–L4 T-score) as osteoporotic, and 23% of those classified as normal as osteopenic (p<0.05). Of all four vertebrae, L2 had the highest T-score in 37.7% of the subjects (mean −0.3) and L4 the lowest in 61% (mean −1.5) (mean difference 1.2 units, 95% CI 0.7 to
1.7). The classification of osteoporosis varies according to skeletal site, with pronounced differences in the early menopausal
population. T-scores are useful for characterizing subjects with the highest risk of osteoporosis but BMD and fracture risk must be recognized
in a continuum. Individual T-scores of the lumbar vertebrae show wide variation in the absence of degenerative spinal disease or vertebral collapse and
the use of the lowest, significantly different, individual lumbar vertebra T-score reclassified over half of the subjects in this study. This poses a great therapeutic dilemma in clinical practice,
particularly if these fractures are at higher risk of future collapse.
Received: 9 November 1999 / Accepted: 27 April 2000 相似文献
6.
Treatment of Postmenopausal Women with Osteoporosis or Low Bone Density with Raloxifene 总被引:3,自引:0,他引:3
P. J. Meunier E. Vignot P. Garnero E. Confavreux E. Paris S. Liu-Leage S. Sarkar T. Liu M. Wong M. W. Draper 《Osteoporosis international》1999,10(4):330-336
Raloxifene, a selective estrogen receptor modulator (SERM), has been shown to improved bone mineral density (BMD) and serum
lipid profiles in healthy postmenopausal women. The objective of this study was to examine the effects of raloxifene on BMD,
biochemical markers of bone metabolism and serum lipids in postmenopausal women with low bone density or osteoporosis. This
Phase II, multicenter, 24-month, double-masked study assessed the efficacy and safety of raloxifene in 129 postmenopausal
women (mean age ± SD: 60.2 ± 6.7 years) with osteoporosis or low bone density (baseline mean lumbar spine BMD T-score: −2.8). Women were randomly assigned to one of three treatment groups: placebo, 60 mg/day raloxifene-HCl (RLX 60) or
150 mg/day raloxifene-HCl (RLX 150) and concomitantly received 1000 mg/day calcium and 300 U/day vitamin D3. At 24 months, BMD was significantly increased in the lumbar spine (+3.2%), femoral neck (+2.1%), trochanter (+2.7%) and
total hip (+1.6%) in the RLX 60 group compared with the placebo group (p<0.05). The RLX 150 group had increases in BMD similar to those observed with RLX 60. A greater percentage of raloxifene-treated
patients, compared with those receiving placebo, had increased BMD (p<0.05). Serum bone-specific alkaline phosphatase activity, serum osteocalcin, and urinary type I collagen:creatinine ratio
were significantly decreased in the RLX-treated groups, compared with the placebo group (p<0.01). RLX 60 treatment significantly decreased serum levels of triglycerides, and total- and LDL-cholesterol levels (p<0.01). The rates of patient discontinuation and adverse events were not significantly different among groups. In this study,
raloxifene increased bone density, decreased bone turnover, and improved the serum lipid profile with minimal adverse events,
and may be a safe and effective treatment for postmenopausal women with osteoporosis or low bone density.
Received: 26 December 1998 / Accepted: 31 March 1999 相似文献
7.
Osteoporosis and Apolipoprotein E Genotype in Older Adults: The Rancho Bernardo Study 总被引:1,自引:0,他引:1
D. G. von Mühlen E. Barrett-Connor D. L. Schneider P. A. Morin P. Parry 《Osteoporosis international》2001,12(4):332-335
Recent studies reported an association between apolipoprotein E (ApoE) 4 and osteoporosis. We examined the association of
ApoE 4 genotype with bone mineral density (BMD), bone loss and fracture risk in 596 men and 332 community-dwelling women aged
45–95 years. Women were postmenopausal and not using estrogen. At the baseline visit, BMD was measured at the ultradistal
and midshaft radius using single photon densitometry, and at the hip and lumbar spine using dual-energy X-ray absorptiometry.
Hip and lumbar spine BMD levels were remeasured 4 years later. Self-reported fractures were confirmed by radiology reports
in 95% of cases. ApoE allele distribution did not vary by age; 25% of men and 20% of women had one ApoE 4 allele. There were
no differences in BMD at the lumbar spine, total hip, ultradistal or midshaft radius in men or women with the ApoE 4 allele
compared with men or women without the ApoE 4 allele. After an average 4 year interval, there were also no differences in
the annualized percent change in BMD at the hip or lumbar spine in men or women with or without an ApoE 4 allele. One or more
clinical fractures were reported by 55 men and 109 women. Fewer, not more, clinical fractures were reported in men and women
with an ApoE 4 allele; these differences were not statistically significant (p= 0.21 and p= 0.62, respectively). These data do not support the hypotheses that there is an association between ApoE genotype and BMD,
bone loss or osteoporotic fractures in older community-dwelling men or women.
Received: 26 July 2000 / Accepted: 13 October 2000 相似文献
8.
Bone Density in an Immigrant Population from Southeast Asia 总被引:9,自引:0,他引:9
M. A. Marquez L. J. Melton III J. M. Muhs C. S. Crowson A. Tosomeen M. K. O’Connor W. M. O’Fallon B. L. Riggs 《Osteoporosis international》2001,12(7):595-604
The epidemiology of bone loss in populations of Asian heritage is still poorly known. This study compared the skeletal status
of a convenience sample of 396 Southeast Asian immigrants (172 Vietnamese, 171 Cambodians and 53 Laotians) residing in Rochester,
Minnesota in 1997 with 684 white subjects previously recruited from an age-stratified random sample of community residents.
Areal bone mineral density (BMD, g/cm2) and volumetric bone mineral apparent density (BMAD, g/cm3) were determined for lumbar spine and proximal femur using the Hologic QDR 2000 instrument for the white population and the
QDR 4500 for Southeast Asian subjects; the machines were cross-calibrated from data on 20 volunteers. Lumbar spine BMD was
7% higher in white than Southeast Asian women ( p < 0.001), and similar results were observed for the femoral neck; lumbar spine BMD was 12% higher in white than nonwhite
men ( p < 0.001). Race-specific discrepancies were reduced by calculating BMAD: for premenopausal women, lumbar spine and femoral
neck differences between whites and Southeast Asians were eliminated; for postmenopausal women the lumbar spine differences
persisted ( p < 0.0001), while femoral neck BMAD was actually higher for Southeast Asians. There were no race-specific differences in femoral
neck BMAD among men of any age ( p= 0.312), but lumbar spine BMAD was less for younger ( p= 0.042) but not older ( p= 0.693) Southeast Asian men. There were differences among the Southeast Asian subgroups, but no clear pattern emerged. Predictors
of lumbar spine BMAD in Southeast Asian women were age ( p < 0.001), weight ( p= 0.015) and gravidity ( p= 0.037). Even after adjusting for bone size using BMAD, 32% and 9% of Southeast Asian women and men, respectively, would
be considered to have osteoporosis at the femoral neck and 25% and 4%, respectively, at the lumbar spine. These findings indicate
a need for culturally sensitive educational interventions for Southeast Asians and for physicians to pursue diagnosis and
treatment to prevent osteoporosis-related disabilities in this population.
Received: 12 October 2000 / Accepted: 15 February 2001 相似文献
9.
Prevention of Bone Loss by Clodronate in Early Postmenopausal Women with Vertebral Osteopenia: A Dose-Finding Study 总被引:1,自引:0,他引:1
M. J. V?lim?ki K. Laitinen K. Laitinen A. Patronen H. Puolijoki H. Puolijoki J. Sepp?nen L. Pylkk?nenand the Probone Study Group 《Osteoporosis international》2002,13(12):937-947
This double-masked, placebo-controlled study was undertaken to determine the efficacy and safety of oral clodronate in the
prevention of bone loss in early postmenopausal women with vertebral osteopenia. Altogether 610 women with a mean age of 53
years were recruited for the study. They were 1–5 years postmenopausal and their lumbar spine bone mineral density (BMD) was
at least 1 standard deviation below the mean of premenopausal women (T-score ≤−1). The subjects were randomized into five study groups to receive either placebo, clodronate 65 mg, 400 mg or 800
mg daily, or intermittent clodronate in 3 month cycles with 400 mg daily for 15 days followed with no treatment for 75 days
for 3 years. One hundred and eighty-seven of 509 women who completed the primary study continued in the extension study of
2 years in which previous placebo users were switched to clodronate 800 mg daily, while previous users of 400 mg or 800 mg
of clodronate used either placebo or 800 mg of clodronate daily. In the primary study clodronate was administered in the evening,
and in the extension 1 h before breakfast on an empty stomach. In the primary study mean changes in lumbar spine BMD were
−3.4% in the placebo group and +0.4% in 800 mg clodronate group [difference between groups at 3 years 3.8% (95% CI 2.7% to
4.9%, p<0.0001)], and in the trochanter area BMD −1.1% in the placebo group, and + 0.4% in the 800 mg clodronate group [difference
between groups at 3 years 1.5% (95% CI 0.05% to 2.9%)]. During the extension study mean changes in lumbar spine BMD were +1.5%
in the clodronate group and −0.2 % in the placebo group [difference between groups 1.7% (CI 0.4% to 3.0%, p = 0.010)] and in trochanter BMD were +2.5% in the clodronate group and no change in the placebo group [difference between
groups 2.1% (CI 0.3% to 3.9%, p = 0.007)]. No statistically significant differences between the placebo and 800 mg clodronate groups were found in the femoral
neck BMD. In the primary study the urinary excretion of type I collagen aminoterminal telopeptide (NTX) decreased by 44% (p<0.0001 compared with placebo) and that of deoxypyridinoline by 18% (p<0.0001) in the clodronate 800 mg group. In the extension study urinary NTX decreased by 51% (p<0.0001) in those who were switched to 800 mg of clodronate and increased by 67% (p<0.0001) in those who stopped using that dose. There was no difference in the frequency of gastrointestinal complaints between
clodronate- and placebo-treated patients in the primary study, but they were more common among women who received clodronate
in the extension phase. Clodronate in daily doses of 400–800 mg caused a slight elevation of aminotransferase levels, usually
within the reference range. In bone biopsies no defect in mineralization was found. In conclusion, clodronate in a daily dose
of 800 mg prevents early postmenopausal bone loss at the sites of the skeleton in which cancellous bone predominates. It effectively
reduces bone resorption and bone turnover rate. Antifracture efficacy of clodronate remains to be established by prospective,
placebo-controlled trials.
Received: 4 March 2002 / Accepted: 9 July 2002 相似文献
10.
Primary hyperparathyroidism (PHPT) may result in greater cortical than trabecular bone loss. Ultrasound is able to predict
osteoporotic fracture risk independent of densitometric measurements, but little is known about the changes in ultrasound
variables with PHPT. The aim of our study was to examine the effect of PHPT on ultrasound variables and bone density measurements
at cortical (hand) and trabecular (lumbar spine and heel) sites, and to evaluate their reversibility following surgical treatment.
We recruited 25 postmenopausal women diagnosed with PHPT ages 51–76 years (mean 62 years) and 95 postmenopausal controls ages
57–80 years (mean 67 years). Measurements were made at baseline and 1 year. Speed of sound (SOS) and broadband ultrasound
attenuation (BUA) of the heel were measured using the Lunar Achilles (LA+) and McCue CUBA Clinical (CC). Amplitude-dependent
speed of sound (AD-SoS) and ultrasound bone profile index (UBPI) of the fingers were measured using the IGEA DBM Sonic. Bone
mineral density (BMD) of the hand and lumbar spine (LS) were measured by dual-energy X-ray absorptiometry (DXA). At baseline,
hand BMD, LS BMD and heel BUA were significantly lower and finger UBPI significantly higher in the PHPT patients compared
with controls (p<0.001). There were no differences in Stiffness Index, heel SOS or finger AD-SoS between control and PHPT subjects. At 1 year
postoperatively, there was a mean (±SD) increase in LS and hand BMD of 3 ± 1% (p<0.01). BUA at the heel increased (11 ± 5%, p<0.001), and UBPI of the fingers decreased (17 ± 7%, p<0.001) probably reflecting different modes of attenuation in trabecular (scattering) and cortical (absorption) bone. Stiffness
Index, SOS of the heel and AD-SoS of the fingers did not change. BUA, UBPI and BMD returned towards normal postmenopausal
values following surgery. There were no changes in BMD or QUS variables at 1 year in the control group. Quantitative ultrasound
(QUS) measurements provide different information about bone structure than densitometric measurements and cannot be regarded
as simply reflecting bone density. With further research the combined use of BMD and QUS could improve the assessment of skeletal
status in patients with PHPT before and after surgery.
Received: 10 September 2001 / Accepted: 31 January 2002 相似文献
11.
Variations in Bone Density among Persons of African Heritage 总被引:3,自引:0,他引:3
L. J. Melton III M. A. Marquez S. J. Achenbach A. Tefferi M. K. O’Connor W. M. O’Fallon B. L. Riggs 《Osteoporosis international》2002,13(7):551-559
The epidemiology of bone loss in populations of African heritage is still poorly known. We compared a convenience sample
of 47 African-American (AA) residents of Rochester, Minnesota (32 women, 15 men) and 66 recent immigrants from Somalia (all
women) with 684 white subjects (349 women, 335 men) previously recruited from an age-stratified random sample of community
residents. Areal bone mineral density (BMD, g/cm2) and volumetric bone mineral apparent density (BMAD, g/cm3) were determined for lumbar spine and proximal femur using the Hologic QDR 2000 for white subjects and the QDR 4500 for the
others; the instruments were cross-calibrated from data on 20 volunteers. Lumbar spine BMD was 18% higher in AA (p<0.001) and 4% lower in Somali (p= 0.147) than white women. Femoral neck BMD was 27% higher in AA women but also 11% greater in Somali women (both p<0.001) compared with whites. Lumbar spine BMD was 6% higher (p= 0.132) and femoral neck BMD 21% higher (p<0.001) in AA than white men. No Somali men were studied. After correcting for bone size differences, both lumbar spine (p<0.01) and femoral neck BMAD (p<0.001) were greater for Somali than white women, but the difference between Somali and AA women persisted. Lumbar spine and
femoral neck BMAD values also remained significantly greater for AA women (both p<0.001) and men (p<0.05; p<0.001) compared with whites. Weight was associated with BMAD at both skeletal sites in all groups, but adjustment for differences
in weight did not reduce the discrepancy in BMAD values between Somali and AA women or between the latter group and whites.
This heterogeneity among different ethnic groups of African heritage may provide an opportunity for research to better explain
race-specific differences in bone metabolism.
Received: 4 September 2001 / Accepted: 11 January 2002 相似文献
12.
S. A. Beardsworth C. E. Kearney S. A. Steel J. Newman D. W. Purdie 《Osteoporosis international》1999,10(4):290-294
In two recent case–control studies premature greying of the hair was associated with a lowering of bone mineral density (BMD)
and osteopenia, suggesting that this might be a clinically useful risk marker for osteoporosis. We report a further re-examination
of this proposal in 52 prematurely grey-haired women from East Yorkshire who responded to an advertisement inviting them for
bone densitometry. Thirty-five had no clinical or drug history that could influence bone density. All were Caucasian with
a mean age of 52.8 years. In the group as a whole the mean BMD values at the lumbar spine and femoral neck were no different
from those of a young adult, but there was a trend toward a greater than average BMD than that of the local age-matched population
(p= 0.097 and 0.218, respectively). Twenty women were premenopausal, with an average age of 45.3 years. Mean BMD values at the
lumbar spine and femoral neck in this group were no different from those of young adults. There was, however, a trend toward
a BMD greater than that of the local age-matched population at the femoral neck (p= 0.117). Fifteen women were postmenopausal with an average age of 62.9 years and an average age at menopause of 51.1 years.
Mean BMD values at both the lumbar spine and femoral neck in this group were lower than those of young adults, but no different
from those of the local age-matched population. In conclusion, our group of prematurely grey-haired women had average BMD
for their age, and we are therefore unable to support the proposed clinical usefulness of premature greying as a risk marker
for osteoporosis.
Received: 1 December 1998 / Accepted: 11 March 1999 相似文献
13.
Inappropriate Reference Range for Peak Bone Mineral Density in Dual-energy X-ray Absorptiometry: Implications for the Interpretation of T-scores 总被引:1,自引:0,他引:1
An inappropriate reference range for peak bone mineral density (BMD) may result in identification of an incorrect proportion
of subjects with osteopenia and osteoporosis at dual-energy X-ray absorptiometry (DXA). In this study, we assessed the prevalence
of low BMD in Turkish young adults with respect to local population reference range T-scores and the US reference range T-scores. The BMD values of lumbar spine (L1–L4) and proximal femur (femoral neck, intertrochanter, trochanter, Ward”s triangle
and total) were measured by DXA in 323 healthy young adults (171 women, 152 men) aged 19–25 years. The World Health Organization
criteria for the diagnosis of osteopenia (−2.5 <T-score <−1) and osteoporosis (T-score ≤−2.5) were applied. In women, the means of the US reference range T-scores were significantly lower than zero at the spine and proximal femoral sites (p<0.0001). In men, the means of the US reference range T-scores were significantly lower than zero at the spine, femoral neck, intertrochanter, total femur (p<0.0001) and trochanter (p<0.05), but not at Ward”s triangle (p=0.92). When the diagnoses were based on local population reference range T-scores instead of the US reference range T-scores, the prevalence of low BMD (T-score <−1) in women fell from 50.3% to 14.0% at the lumbar spine and from 60.8% to 14.6% at the femoral neck, and in men
from 42.8% to 15.8% at the lumbar spine and from 30.9% to 17.1% at the femoral neck. Our data suggest that individual populations
should use their own reference range T-scores to avoid misdiagnoses of osteopenia and osteoporosis by DXA.
Received: 4 November 1999 / Accepted: 29 March 2000 相似文献
14.
J. M. Thompson G. W. Modin C. D. Arnaud N. E. Lane 《Calcified tissue international》1997,61(5):377-381
Chronic steroid use results in osteoporosis, and postmenopausal women are believed to be at a high risk for steroid-induced
bone loss. The purpose of this study was to determine predictors of bone mineral density (BMD) in postmenopausal women on
both chronic steroid and hormone replacement therapy. Seventy-six postmenopausal women (≥3 years postmenopausal, ≥2 years
of steroid treatment of ≥5 mg/day of prednisone, and ≥1 year of hormone replacement therapy) were recruited into this study.
Measurements of BMD of the lumbar spine and femoral neck were obtained in all subjects. Risk factors for osteoporosis were
obtained by questionnaire. Discriminant analysis was performed to determine predictors of BMD. Osteoporosis, defined by a
T score of <−2.5, was present in the lumbar spine or femoral neck in 34 of the 76 subjects. Based on these criteria, women
with osteoporosis were significantly older, were more years postmenopausal, and had a lower body mass index (BMI) than women
who did not have osteoporosis. Predictors of osteoporosis for both the femoral neck and spine included a low BMI (P < 0.05),
more years postmenopausal (P < 0.01), and more years on steroids (P < 0.01). Low BMI was the only significant predictor of osteoporosis in the lumbar spine (P < 0.05), whereas for the femoral neck both years on steroids (P < 0.05) and BMI (P < 0.05) were significant predictors of low BMD. In summary, not all postmenopausal women on chronic steroid and hormone replacement
therapy are osteoporotic but a low BMI, more years on steroids, and more years postmenopausal were significant predictors
of osteoporosis in these subjects.
Received: 8 November 1997 / Accepted: 21 May 1997 相似文献
15.
Serum Bone Alkaline Phosphatase and Calcaneus Bone Density Predict Fractures: A Prospective Study 总被引:11,自引:0,他引:11
P. D. Ross B. C. Kress R. E. Parson R. D. Wasnich K. A. Armour I. A. Mizrahi 《Osteoporosis international》2000,11(1):76-82
The aim of this study was to assess the ability of serum bone-specific alkaline phosphatase (bone ALP), creatinine-corrected
urinary collagen crosslinks (CTx) and calcaneus bone mineral density (BMD) to identify postmenopausal women who have an increased
risk of osteoporotic fractures. Calcaneus BMD and biochemical markers of bone turnover (serum bone ALP and urinary CTx) were
measured in 512 community-dwelling postmenopausal women (mean age at baseline 69 years) participating in the Hawaii Osteoporosis
Study. New spine and nonspine fractures subsequent to the BMD and biochemical bone markers measurements were recorded over
an average of 2.7 years. Lateral spinal radiographs were used to identify spine fractures. Nonspine fractures were identified
by self-report at the time of each examination. During the 2.7-year follow-up, at least one osteoporotic fracture occurred
in 55 (10.7%) of the 512 women. Mean baseline serum bone ALP and urinary CTx were significantly higher among women who experienced
an osteoporotic fracture compared with those women who did not fracture. In separate age-adjusted logistic regression models,
serum bone ALP, urinary CTx and calcaneus BMD were each significantly associated with new fractures (odds ratios of 1.53,
1.54 and 1.61 per SD, respectively). Multiple variable logistic regression analysis identified BMD and serum bone ALP as significant
predictors of fracture (p = 0.002 and 0.017, respectively). The results from this investigation indicate that increased bone turnover is significantly
associated with an increased risk of osteoporotic fracture in postmenopausal women. This association is similar in magnitude
and independent of that observed for BMD.
Received: 18 June 1999 / Accepted: 21 June 1999 相似文献
16.
Serum albumin has been found to be positively correlated with bone mass in small studies of ambulatory men or women with
diagnosed osteoporosis. In this study the relation between serum albumin and bone mineral density (BMD) was examined in 1593
white, community-dwelling men and women aged 50–95 years. BMD was determined using single-photon absorptiometry (SPA) at the
ultradistal radius and the midshaft radius, and using dual-energy X-ray absorptiometry (DXA) at the hip and spine. Albumin
was measured from a fasting blood sample using the Technicon SMA 12 autoanalyzer. Mean albumin levels in both men and women
decreased significantly with increasing age. All but four values were within the normal range (3.5–5.0 g/dl). BMD decreased
with increasing age at all sites. In both sexes there was weak positive correlation between serum albumin and BMD in the unadjusted
model (Pearson's rvalues <0.3, p values <0.005). After age adjustment, however, the relationship was no longer significant (Pearson's r values <0.05, p values >0.18). Men and women were divided into three sex-specific categories – osteoporotic, osteopenic and normal – based
on World Health Organization criteria in relation to young adult means (normal, BMD > –1 SD; osteopenia, BMD between –1 SD
and –2.5 SD; osteoporosis, BMD <–2.5 SD). Mean albumin values did not differ significantly across the three BMD categories
in men or women. BMD levels stratified for albumin levels and calcium supplement status (a marker for osteoporosis awareness)
also did not differ. Albumin levels were also not associated with a history of low-trauma fractures. In summary, there was
no age-independent association between serum albumin within the normal range and low BMD or fractures in community-dwelling
healthy older adults. We conclude that previously reported associations most likely reflect inadequate adjustment for the
age-related decrease in albumin levels and the selection of very frail osteoporotic subjects.
Received: 7 October 1997 / Revised: 21 January 1998 相似文献
17.
Prevention of Bone Loss with Risedronate in Glucocorticoid-Treated Rheumatoid Arthritis Patients 总被引:2,自引:0,他引:2
R. Eastell J.-P. Devogelaer N. F. A. Peel A. A. Chines D. E. Bax N. Sacco-Gibson C. Nagant de Deuxchaisnes R. G. G. Russell 《Osteoporosis international》2000,11(4):331-337
The aim of the study was to assess risedronate’s effect on bone mineral density in postmenopausal women with rheumatoid arthritis
receiving glucocorticoids. We carried out a two center, 2 year, double-masked, placebo-controlled trial with a third year
of nontreatment follow-up. We studied 120 women requiring long-term glucocorticoid therapy at >2.5 mg/day prednisolone randomized
to treatment with daily placebo; daily 2.5 mg risedronate; or cyclical 15 mg risedronate (2 out of 12 weeks). At 97 weeks,
bone mineral density was maintained at the lumbar spine (+1.4%) and trochanter (+0.4%) in the daily 2.5 mg risedronate group,
while significant bone loss occurred in the placebo group (–1.6%, p= 0.03; and 4.0%, p<0.005, respectively). At the femoral neck, there was a nonsignificant bone loss in the daily 2.5 mg risedronate group (–1.0%)
while in the placebo group bone mass decreased significantly (–3.6%, p<0.001). The difference between placebo and daily 2.5 mg risedronate groups was significant at the lumbar spine (p= 0.009) and trochanter (p= 0.02) but did not reach statistical significance at the femoral neck. Although not significantly different from placebo
at the lumbar spine, the overall effect of the cyclical regimen was similar to that of the daily 2.5 mg risedronate regimen.
Treatment withdrawal led to bone loss in the risedronate groups that was significant at the lumbar spine. A similar number
of patients experienced adverse events (including upper gastrointestinal events) across treatment groups and risedronate was
generally well tolerated. Thus risedronate preserves bone mass in postmenopausal women with rheumatoid arthritis receiving
glucocorticoids while patients receiving a placebo have significant bone loss.
Received: 2 June 1999 / Accepted: 29 September 1999 相似文献
18.
Bone Mineral Density and Vertebral Fractures in Men 总被引:1,自引:0,他引:1
E. Legrand D. Chappard C. Pascaretti M. Duquenne C. Rondeau Y. Simon V. Rohmer M.-F. Basle M. Audran 《Osteoporosis international》1999,10(4):265-270
In women, many studies indicate that the risk of vertebral fragility fractures increases as bone mineral density (BMD) declines.
In contrast, few studies are available for BMD and vertebral fractures in men. It is uncertain that the strength of the relationship
between BMD and fractures is similar in magnitude in middle-aged men and in postmenopausal women. In the present study, 200
men (mean age 54.7 years) with lumbar osteopenia (T-score <−1.5) were recruited to examine the relationships between spine BMD and hip BMD and the associations of BMD with vertebral
fractures. Lumbar BMD was assessed from L2 to L4, in the anteroposterior view, using dual-energy X-ray densitometry. At the
upper left femur, hip BMD was measured at five regions of interest: femoral neck, trochanter, intertrochanter, Ward’s triangle
and total hip. Spinal radiographs were analyzed independently by two trained investigators and vertebral fracture was defined
as a reduction of at least 20% in the anterior, middle or posterior vertebral height. Spinal radiographs evidenced at least
one vertebral crush fracture in 119 patients (59.5%). The results of logistic regression showed that age, femoral and spine
BMDs were significant predictors of the presence of a vertebral fracture. Odds ratios for a decrease of 1 standard deviation
ranged from 1.8 (1.3–2.8) for spine BMD to 2.3 (1.5–3.6) for total hip BMD. For multiple fractures odds ratios ranged from
1.7 (1.1–2.5) for spine BMD to 2.6 (1.7–4.3) for total hip BMD. In all models, odds ratios were higher for hip BMD than for
spine BMD, particularly in younger men, under 50 years. A T-score <−2.5 in the femur (total femoral site) was associated with a 2.7-fold increase in the risk of vertebral fracture while
a T-score <−2.5 in the spine was associated with only a 2-fold increase in risk. This study confirms the strong association of
age and BMD with vertebral fractures in middle-aged men, shows that the femoral area is the best site of BMD measurement and
suggests that a low femoral BMD could be considered as an index of severity in young men with lumbar osteopenia.
Received: 27 October 1998 / Accepted: 22 February 1999 相似文献
19.
N. E. Lane S. Sanchez H. K. Genant D. K. Jenkins C. D. Arnaud 《Osteoporosis international》2000,11(5):434-442
The purpose of this study was to test the ability of early changes in markers of bone turnover to predict subsequent changes
in bone mineral density (BMD) induced by parathyroid hormone fragment, PTH (1–34), in postmenopausal osteoporotic women treated
with estrogen and glucocorticoids. Forty-nine postmenopausal women with chronic, inflammatory diseases and BMD T-scores ≤–2.5 at the lumbar spine or femoral neck who were concurrently treated with estrogen ≥ 1 year and prednisone 5–20
mg/day for ≥ 1 year participated. Subjects were randomized to treatment with human PTH (1–34) 400 IU/day or to a control group
for 1 year and followed for an additional year. Serum and urine were collected at baseline and 1, 3, 6, 9, 12, 18 and 24 months
for measurement of bone alkaline phosphatase (BAP), osteocalcin (OC) and deoxypyridinoline (DPD). We constructed an Uncoupling
Index (UI) from all three markers (UI = [Z
BAP+Z
OC]/2 –Z
DPD, where the Z-score for each marker in each subject was calculated from the mean and standard deviation of the study population at baseline).
BMD of the lumbar spine and hip was measured at baseline and every 6 months thereafter by dual-energy X-ray absorptiometry
(DXA) and annually by quantitative computed tomography (QCT; spine only). BMD of the spine, but not hip (total, femoral neck
or trochanter), and levels of all three markers increased significantly as a result of PTH treatment (p<0.01 compared with controls). The resorption response lagged behind that of formation as evidenced by a significant increase
(p<0.05) in the UI for the first 9 months of treatment. The UI values and changes from baseline to 1, 3 and 6 months in BAP,
OC and DPD were correlated with the 12- and 24-month changes in spine BMD measured both with QCT and with DXA (Spearman’s
rank coefficients ≤0.76; p<0.05). Most PTH-treated subjects could be identified as biochemical responders by least significant change analysis. Following
1 month of therapy, BAP and OC identified 65% and 81% as responders, respectively. The responder rates were 79%, 79% and 75%
for BAP, OC and DPD, respectively by 6 months. Responders exhibited a high level of diagnostic accuracy for predicting a gain
in BMD (areas under the receiver operating characteristic curves exceeding 0.79 for QCT and 0.70 for DXA), but not the magnitude
of the gain. These data suggest that serial bone marker measurements may be useful in identifying skeletal responders to an
anabolic therapy, such as PTH, in estrogen-replete postmenopausal women with glucocorticoid-induced osteoporosis.
Received: 27 July 1999 / Accepted: 2 November 1999 相似文献
20.
M. M. Boomsma C. A. Stegeman A. B. Kramer M. Karsijns D. A. Piers J. W. Cohen Tervaert 《Osteoporosis international》2002,13(1):74-82
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a relapsing-remitting disease, which is treated with
corticosteroids (CS) in combination with cyclophosphamide. One of the major side-effects of this treatment is osteoporosis,
which may result in the increased occurrence of fractures. In the present study we measured the prevalence of reduced bone
mineral density (BMD) in a cross-sectional cohort of patients and correlated BMD findings with cumulative doses of CS and/or
cyclophosphamide. BMD was measured by dual-energy X-ray absorptiometry (DXA) of the lumbar spine, radius and proximal femur
between January 1998 and December 1999. Cumulative doses of CS and cyclophosphamide were calculated by chart review. Ninety-nine
consecutive patients (48 men, 51 women) aged 55 ± 16 years (mean ± SD) were studied 50 months (median; range 0–400 months)
after a diagnosis of ANCA-associated vasculitis had been made. Sixty-nine patients were treated with 10.7 g (median cumulative
dose; range 0.4–67.2g) of CS, and 88 patients were treated with 34.1 g (median cumulative dose; range 0.8–324.3g) of cyclophosphamide.
Fifty-seven percent of the patients had osteopenia (T-score: –1 to –2.5 SD), and 21% had osteoporosis (T-score: <−2.5 SD) at least at one site. Thirty-four of 37 (92%) postmenopausal women, 9 of 14 (64%) premenopausal women, and
34 of 48 (71%) men had either osteopenia or osteoporosis. The mean age- and sex-adjusted BMD (Z-score) of the proximal femur in men was found to be significantly lower than zero. Cumulative dose of CS therapy showed an
inverse relation with Z-scores at the lumbar spine (p= 0.035) and proximal femur (p = 0.011). Cumulative dose of cyclophosphamide was not correlated with Z-scores. Osteopenia and osteoporosis are thus frequently observed in patients with ANCA-associated vasculities. However, only
in men is the mean Z-score significantly lower than zero. Cumulative dose of CS therapy is significantly associated with bone loss at the spine
and femur.
Received: 26 March 2001 / Accepted: 1 August 2001 相似文献