50例绝经后高疾病活动期的女性类风湿关节炎骨密度的临床观察

目的观察绝经后高疾病活动期的女性类风湿关节炎患者骨矿物质密度水平的变化。方法收集50例绝经后女性RA患者一般临床资料,包括年龄、RA病程、绝经年龄、ESR、CRP、RF、抗CCP抗体、DSA28评分及雌二醇水平,应用双能X线吸收法(DXA)测定50例患者腰椎L_(1-4)和左髋关节部位的骨密度,分析其骨密度(BMD)的情况。结果 1.50例绝经后女性RA的DSA28评分大于5.1,属高疾病活动期,骨质疏松组发生率52%;远高于骨量减少组(30%)及骨密度正常组(18%)。2.骨质疏松组的绝经年龄比非骨质疏松组明显提前(P=0.005),抗CCP抗体水平明显升高(P=0.037),有统计学意义,但在年龄、病程、RF、DSA28评分及雌激素方面两者无统计学差异。3.Logistic回归分析结果显示抗CCP抗体(OR值1.025,P=0.041)是绝经后高疾病活动女性RA骨质疏松的独立危险因素。4.骨质疏松组,腰椎总骨密度较髋关节显著降低(P0.001);腰椎组内比较以腰1椎体BMD最低,而后依次为腰2,腰3、腰4(P=0.0003),左髋关节组内比较以大转子BMD最低,而后依次为股骨颈、小转子(P0.0001)。结论绝经后高疾病活动期的女性RA患者存在明显的骨质疏松,以腰椎骨密度(特别L_1)下降最明显;抗CCP抗体可能是高疾病活动期的女性类RA患者发生骨质疏松的危险因素。     

女性类风湿关节炎患者骨密度的研究

目的探讨女性类风湿关节炎(RA)患者骨密度(BMD)的变化和骨质疏松(OP)的发生情况及其与临床指标的相关性.方法采用双能X线骨密度仪,测量了45例女性RA患者和45例女性正常人的前臂、腰椎2～4以及股骨颈、Ward区和大转子的骨矿含量,并同时测定握力、关节功能、X线分期、关节压痛数和肿胀数、日常生活能力评估(以健康评估表HAQ积分表示)和血沉、血清类风湿因子、C反应蛋白、钙、磷、碱性磷酸酶等指标.结果女性RA患者中除股骨Ward区骨量丢失较对照组差异有显著性(P＜0.05)外,其余各测定部位的BMD与对照组间差异无显著性(P＞0.05).45例女性RA患者中发生骨质疏松较非骨质疏松组年龄更大(P＜0.005),关节功能更差(P＜0.01),HAQ积分更高(P＜0.05),握力更低(P＜0.05),CRP更高(P＜0.05).女性RA患者中服用糖皮质激素组与未服用糖皮质激素组间BMD及OP发生情况的差异无显著性(P＞0.05).绝经后女性RA患者的骨量丢失较绝经前明显(P＜0.05);除桡骨远端外,绝经后患者各测定部位BMD均低于绝经前患者(P＜0.05).Logistic Regression分析显示年龄:OR=1.085[(1.019-1.156),P=0.011]和关节功能:OR=4.828[(1.368-17.039),P=0.014]为RA患者骨质疏松发生的相关因素.结论女性RA患者的总体骨量变化与正常人相近,但股骨Ward区的骨量丢失明显高于正常人.其BMD的降低和OP的发生与年龄、绝经和关节炎的严重程度有关.     

运动对类风湿关节炎伴骨质疏松患者的骨密度及骨代谢的影响

目的探讨类风湿关节炎(rheumatoid arthritis,RA)患者骨密度(bone mineral density,BMD)及骨代谢指标的相关影响因素,观察运动频率对RA伴发骨质疏松(osteoporosis,OP)患者BMD及骨代谢指标的影响。方法回顾性分析45例初诊RA患者的性别、年龄、病程、超敏C反应蛋白(high-sensitivity C-reactive protein,HS-CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、抗环瓜氨酸肽抗体(anti-cyclic cirullinated peptide antibodies,抗CCP抗体)、RA疾病活动性评分(DAS28评分)等指标,观察这些临床因素对RA患者的BMD及血清骨代谢指标的影响。血清骨代谢指标包括β-胶原降解产物(β-C-terminal telopeptide region of collagen type1,β-CTX)、总Ⅰ型胶原氨基端延长肽(I pro collagen N-terminal pro peptide,PINP)、骨钙素(osteocalcin,OC)、25羟维生素D[25-(OH)D],通过电话回访RA患者的康复运动情况,分析运动频率对RA伴OP患者骨密度及骨代谢指标的影响。结果本组RA伴发OP的发生率为46.67%,BMD的下降以腰椎、股骨颈最明显。BMD的改变与年龄、病程、DAS28评分相关,随着年龄的增长、病程的延长、DAS28评分的升高,BMD降低(P0.05)。骨吸收指标β-CTX在年龄≤65岁组、病程≤0.5年组、抗CCP抗体阳性组均升高,差异有统计学意义(P0.01,P0.05);骨形成指标PINP、OC在年龄≤65岁组、抗CCP抗体阳性组均升高,差异有统计学意义(P0.05);25-(OH)D水平在DAS28评分2.6组高于DAS28评分≥2.6组,差异有统计学意义(P0.05)。RA伴OP患者中,经常运动组的全身及腰椎BMD、PINP、OC均高于不运动组,差异有统计学意义(P0.05,P0.01);PINP、OC与经常运动呈正相关(P0.05),β-CTX与抗CCP抗体呈正相关(P0.01)。多元线性回归分析显示全身BMD受血清25-(OH)D水平及运动频率影响明显,随着血清25-(OH)D水平及运动频率的提高,全身BMD呈增加趋势。结论 RA伴发OP的发病率高,骨密度与年龄、病程、疾病的活动、25-(OH)D水平、运动频率相关。RA伴发OP属于高转换型骨代谢异常,在疾病早期、活动期骨破坏和骨形成均加快。运动可促进骨形成、提高骨密度,建议临床应重视在内科治疗基础上的运动治疗。     

Physical training preserves bone mineral density in postmenopausal women with forearm fractures and low bone mineral density

Summary One hundred and twelve postmenopausal women with low bone mineral density (BMD) and forearm fractures were randomized to physical training or control group. After one year the total hip BMD was significantly higher in the women in the physical training group. The results indicate a positive effect of physical training on BMD in postmenopausal women with low BMD. Introduction The fivefold increase in hip fracture incidence since 1950 in Sweden may partially be due to an increasingly sedentary lifestyle. Our hypothesis was that physical training can prevent bone loss in postmenopausal women. Methods One hundred and twelve postmenopausal women 45 to 65 years with forearm fractures and T-scores from −1.0 to −3.0 were randomized to either a physical training or control group. Training included three fast 30-minute walks and two sessions of one-hour training per week. Bone mineral density (BMD) was measured in the hip and the lumbar spine at baseline and after one year. Results A per protocol analysis was performed, including 48 subjects in the training group and 44 subjects in the control group. The total hip BMD increased in the training group +0.005 g/cm2 (±0.018), +0.58%, while it decreased −0.003 g/cm2 (±0.019), −0.36%, (p = 0.041) in the control group. No significant effects of physical training were seen in the lumbar spine. A sensitivity intention to treat analysis, including all randomized subjects, showed no significant effect of physical training on BMD at any site. Conclusions The results indicate a small but positive effect of physical exercise on hip BMD in postmenopausal women with low BMD.     

女性类风湿关节炎患者前臂骨密度测定在诊断骨质疏松中的应用价值及影响因素分析

目的探讨绝经后女性类风湿关节炎患者前臂骨密度扫描的分布规律,并通过与椎体、髋部双能X线(DXA)进行对比,确定其在类风湿关节炎(RA)患者骨质疏松诊断中的价值。方法采用DXA法,同时测量200例女性绝经后RA患者非优势侧前臂远端以及腰椎、左髋部骨密度。比较不同扫描部位之间骨密度值的关系,并探讨以诊断中轴骨密度异常的诊断界值,以及可能影响外周骨密度的因素。结果 (1)200例女性绝经RA患者平均年龄(55.9±13.8)岁。根据中轴DXA结果及骨折病史,170例(85.0%)骨密度异常(T值-1.0)。(2)RA患者中轴骨密度异常组前臂远端骨密度(0.33±0.13)g/cm~2,低于正常组(0.44±0.06)g/cm~2,(t=4.29,P0.01)。(3)病程1年以上、抗CCP抗体阳性RA患者前臂骨密度降低。(4)前臂骨密度与中轴骨密度呈正相关。(5)使用前臂骨密度诊断腰椎和左髋骨质疏松的最佳T值分别为-2.65(敏感度为0.702,特异度为0.774)和-2.50(敏感度为0.741,特异度为0.706)。(6)Logistic回归分析显示,年龄(P=0.012)、病程(P=0.011)、以及抗CCP抗体阳性(P=0.05)分别是造成RA患者前臂BMD异常的独立危险因素。结论 RA患者前臂骨密度可以作为筛查女性类风湿关节炎患者中轴骨质疏松的辅助工具,高龄、疾病病程长以及抗CCP抗体阳性患者更容易出现骨密度下降。     

Reduction of bone mineral density in rheumatoid arthritis: A longitudinal study

In the last decade, more accurate quantitative methods to assess bone mass in vivo have become available. We have applied these techniques to assess periodic changes of bone loss in rheumatoid arthritis (RA) patients. In this longitudinal study, 132 female RA patients were divided into two groups. The first group of 90 patients were postmenopausal, with a mean age of 60.2 years (PM group), whereas the second group of 42 patients were premenopausal, with a mean age of 42.7 years (M group). The clinical courses of these patients were followed for an average of 3 years. Bone mineral density (BMD) in the lumbar spine (L2–L4), and the femoral neck were measured by dual-energy X-ray absorptiometry (DXA), and second metacarpal bone mineral density was measured by using densitometric techniques periodically. Reduction of BMD in the lumbar spine was significant in both groups (P<0.01–0.05), but there was no statistical difference between the two groups. The BMD of the femoral neck had a tendency to decrease but this was not significant. The predictors for periodic bone loss in the PM group were aging and nutritional factors, whereas for the M group they were indices of rheumatoid arthritis disease activity.     

影响绝经后女性糖尿病患者骨密度的相关因素研究

目的　探讨影响绝经后女性糖尿病骨密度的相关因素 ,防止骨质疏松的发生发展。方法　按WHO标准选取 80例绝经后女性糖尿病患者 ,按年龄分 40～ 49岁 ,50～ 59岁 ,60～ 69岁 ,≥ 70岁 4个组 ,另外选取同龄健康绝经后女性 60名 ,按上述标准分组作对照。应用双能X线骨密度仪检测受试者右前臂桡骨远端 1 /3点处和第 2～ 4腰椎骨密度 (BMD)。采用放射免疫方法测定雌二醇(E2 )、睾酮 (T)、黄体生成素 (LH)、卵泡刺激素 (FSH)、游离甲状腺激素 (FT3、FT4 ) ,并同时检测空腹血糖(FPG)和糖基化血红蛋白 (HbA1c)、血钙、血磷和碱性磷酸酶 (ALP) ,然后进行统计学处理。结果　①绝经后女性E2 、T随年龄增加而降低 ,LH和FSH升高。糖尿病患者的这种变化更为明显。②绝经后女性糖尿病患者甲状腺功能 (T3,T4 )随年龄增加而减低 ,与BMD(L2 4 )呈正相关 (r=0 550 ,r=0 41 6 ,P<0 0 1 )。③绝经后女性糖尿病患者L2 4 骨密度与血糖水平和糖基化血红蛋白浓度呈负相关 ,(r =-0 467,r=- 0 40 2 ,P <0 0 1 )。结论　绝经后的女性糖尿病患者骨密度降低与年龄、性激素水平、甲状腺功能 ,尤其是血糖控制的程度密切相关     

Effects of ovariectomy and estrogen replacement therapy on arthritis and bone mineral density in rats with collagen-induced arthritis

We investigated the effects of ovariectomy (ovx) and estrogen replacement therapy (ERT) on bone mineral density (BMD) and arthritis severity in rats with collagen-induced arthritis (CIA). Seven-month-old female Sprague-Dawley rats were separated into a sham group (n = 8), CIA group (n = 14), ovx group (n = 10), CIA + ovx group (n = 11), and CIA + ovx + ERT group (n = 14). In these groups, ovx was performed at 7 days, and ERT (17β-estradiol at 20 μg/kg three times per week) was initiated 8 days after sensitization. Every 2 weeks, until 8 weeks after sensitization, arthritis score and hind paw thickness were evaluated, and BMD of the trabecular and cortical bones in the metaphysis and diaphysis of the tibia were measured by peripheral quantitative computed tomography. The arthritis score was highest in the CIA + ovx group at all timepoints after sensitization. The hind paw thickness was significantly higher in the CIA + ovx group than in the CIA group at 8 weeks after sensitization (p < 0.05). Both the arthritis score and hind paw thickness were lower in the CIA + ovx + ERT group than in the CIA + ovx group. BMD in the metaphysis was significantly decreased in both the trabecular and cortical bones in the CIA + ovx group compared with those in the CIA group at 4, 6, and 8 weeks after sensitization. In the CIA + ovx group, trabecular BMD was changed by −34 ± 11%, and cortical BMD changed by −14 ± 7% in the metaphysis at 8 weeks compared with those at 0 week. In the CIA group, changes of BMD in the metaphysis were −7 ± 11% in trabecular bone and 0 ± 7% in cortical bone. These differences of trabecular and cortical bone loss in the metaphysis were significant (both p < 0.01). BMD reduction was significantly less in the CIA + ovx + ERT group than in the CIA + ovx group at 6 and 8 weeks after sensitization. Although BMD in the diaphysis was also reduced in the groups with CIA, the degree of reduction was smaller than in the metaphysis. We conclude that ovx in CIA rats could enhance the severity of arthritis and bone loss, and that ERT could suppress arthritis and bone loss.     

Effect of exercise training and detraining on bone mineral density in postmenopausal women with osteoporosis

We examined the effect of exercise training and detraining on bone mineral density (BMD) in postmenopausal women with osteoporosis. Thirty-five postmenopausal women with osteoporosis, aged 53–77 years, were randomly assigned to three groups: a control group (n = 20), a 2-year exercise training group (n = 8), and an 1-year exercise training plus 1-year detraining group (n = 7). Exercise training consisted of daily brisk walking and gymnastic training. Calcium lactate, 2.0 g, and 1α-hydroxyvitamin D₃, 1 μg were supplied daily to all subjects. No significant differences in initial lumbar BMD, measured by dual-energy X-ray absorptiometry (DXA) were found among the three groups. The mean percent change in BMD compared with the baseline was significantly higher at 1 and 2 years in the exercise training group and at 1 year in the detraining group than in the control group, and did not differ significantly at 2 years between the detraining and control groups. These findings indicate that our exercise training program led to a significant increase in lumbar BMD in postmenopausal women with osteoporosis compared with the control, but that the BMD reverted toward a level that was not significantly different from the control with detraining. Continued exercise training is needed to maintain the bone mass gained through exercise training. Received: May 6, 2000 / Accepted: October 6, 2000     

Positive effect of alendronate on bone mineral density and markers of bone turnover in patients with rheumatoid arthritis on chronic treatment with low-dose prednisone: a randomized, double-blind, placebo-controlled trial

Introduction Alendronate has been described to have a bone-sparing effect in patients treated with moderate and high dosages of prednisone for heterogeneous diseases, however no data are available on groups of patients with the same underlying diseases who receive chronic low-dose prednisone treatment. The objective of the investigation reported here was, therefore, to study the effect of alendronate on bone mineral density (BMD) of the lumbar spine and hips in patients with rheumatoid arthritis (RA) who are on chronic low-dose prednisone treatment. Methods A total of 163 patients with RA, according to the ACR-criteria, were enrolled in a double-blind, placebo-controlled trial. The patients were treated with low-dose prednisone (≤10 mg/day) for at least 3 months. The patients were randomized to receive daily doses of alendronate or placebo: men and premenopausal women received 5 mg alendronate (or placebo) daily; postmenopausal women received 10 mg alendronate (or placebo) daily. All patients received daily calcium (500 mg, or 1000 mg, depending on baseline dietary calcium intake) and vitamin D₃ (400 IU) supplementation. BMD of the lumbar spine (L1–L4) and the (total) hip was measured at baseline and after 6 and 12 months. The primary endpoint was change in BMD of the lumbar spine after 12 months (ITT). At baseline and after 3 and 12 months, serum bone-specific alkaline phosphatase (BAP) and urinary excretion of N-telopeptide (NTX) were measured. Radiographs of the thoracic and lumbar spine were made at baseline and after 12 months and subsequently scored for vertebral deformities. Results The groups were comparable at baseline in age, gender, daily dosage of prednisone, BMD at the spine and the hip and markers of bone turnover, while the number of patients with prevalent vertebral deformities was slightly higher in the alendronate-treated patients (54% versus 39%, not significant). After 12 months, BMD at the lumbar spine had increased by 3.7% in the alendronate-treated patients and decreased by –1.0% in the placebo-treated patients (p<0.0001); at the hip, the changes were +1.0% and –0.1%, respectively (not significant). After 3 months, serum BAP had decreased by 16.9% in the alendronate group versus 3.3% in the placebo group (p=0.0005), while urinary NTX had decreased by 46.4% in the alendronate group versus 12.1% in the placebo group (p<0.0001). After 12 months, no statistically significant difference was found between the groups with respect to number of patients with incident vertebral or non-vertebral fractures. Adverse effects were relatively common in these patients with severe RA: adverse effects were observed in 68% of the alendronate-treated patients and in 73% of the placebo patients (not significant), while serious adverse events were observed in 13% and 17%, respectively (not significant). Conclusion We observed a favourable effect of alendronate on the BMD of the lumbar spine and on the markers of bone turnover in patients with RA treated with low-dose prednisone. These data support the conclusion that the prescribing of alendronate is not only beneficial in patients treated with high-dose prednisone but also in RA patients chronically treated with low-dose prednisone. This trial was financially supported by a grant from MSD, The Netherlands     

Forearm bone mineral density in postmenopausal women with osteoarthritis of the knee

The aims of the present study were to clarify whether postmenopausal women with osteoarthritis (OA) of the knee show higher bone mineral density (BMD) than healthy controls, and to investigate the relationship between BMD and the Kellgren and Lawrence radiological grade in postmenopausal women with OA of the knee. A total of 674 postmenopausal women, 46–90 years of age, were enrolled in the study: 305 patients with OA of the knee and 369 healthy controls. Forearm (distal radius) BMD, measured by dual-energy X-ray absorptionetry (DXA), using a DTX-200 (Osteometer), was significantly higher in the OA group than in the control group (P < 0.001), even when adjusted for age, height, body weight, body mass index, years since menopause, and grip strength (P < 0.01). Analysis of variance (ANOVA) with Fisher's protected least significant difference (PLSD) test showed that BMD in radiological grades 2, 3, and 4 was significantly higher than that in grade 1 (P < 0.05, P < 0.001, and P < 0.05, respectively), and BMD in grade 3 was significantly higher than that in grade 2 (P < 0.01), but BMD in grade 4 was significantly lower than that in grade 3 (P < 0.05). These findings suggest that forearm BMD appears to be significantly higher in postmenopausal women with OA of the knee than in healthy controls. Although BMD may be increased in low to moderate radiological grades of OA, severe grade OA may not always develop from moderate grade OA. Some cases of severe grade OA may be associated with low BMD. Received: May 1, 2001 / Accepted: September 26, 2001     

Bone mineral density after total joint arthroplasty of lower extremities in rheumatoid arthritis patients

We studied the effects on the axial bone mass of total joint arthroplasty (TJA) for lower extremities in 48 female rheumatoid arthritis (RA) patients by using dual-energy X-ray absorptiometry (DXA). Twenty-nine postmenopausal RA patients treated only with nonsteroidal anti-inflammatory drugs (NSAIDs) served as controls. They were studied for an average duration of 63 months. The reduction in the bone mineral density (BMD) of the lumbar spine (L2–4) was significant in both groups (p < 0.01∼0.05), but it was not statistically different between the two groups. The BMD of the femoral neck decreased significantly in both groups (p < 0.01–0.05) after 2 years, but it was not statistically different between the two groups. Our data suggest that TJA slowed the rapid axial bone loss usually associated with advanced RA. Received: 7 February 2000     

绝经后女性握力与骨密度的相关性研究

目的研究绝经后女性握力和骨密度的相关性。方法对120例绝经后女性进行握力测量和骨密度测定,观察≤60岁组、61~70岁组和70岁组的握力和骨密度变化,应用单因素Person相关性分析和散点图研究握力与骨密度的相关性。结果最大握力:≤60岁组25.86±4.77 kg,61~70岁组23.37±4.64 kg,70岁组16.63±5.40 kg。骨密度测定提示:65例股骨颈T值≤-2.5;90例腰椎T值≤-2.5。最大握力与骨密度均随年龄增加而减少。握力与股骨颈和腰椎骨密度呈非常显著正相关。结论绝经后女性握力越大,股骨颈和腰椎骨密度越高。     

大豆异黄酮对绝经后妇女骨的影响

目的 从临床角度研究大豆异黄酮对兰州地区绝经后妇女骨的影响。方法 在兰州地区筛选出绝经后妇女60人,随机分为大豆异黄酮组(SIF)和对照组(Control),每人每天服用大豆异黄酮90mg或者同等剂量安慰剂,时间6个月。抽血检测血清碱性磷酸酶和血清钙、磷,超声测定胫骨中段骨密度（BMD）。 结果 血清碱性磷酸酶显著下降（P<0.05）,血清钙显著升高（P<0.05）,胫骨中段BMD显著升高（P<0.05）。结论 大豆异黄酮可增加绝经后妇女骨密度,减少骨丢失。因而可以预防治疗骨质疏松症。     

绝经妇女骨密度变化与雌激素、生长激素水平的相关关系初探

收集61饲病例，分为生育年龄组13例，绝经前组10例，绝经后组38例，均进行血碱性磷酸酶(ALP)、血钙(Ca)、血磷(P)、雌二醇(E2)、促卵泡素(FSH)、生长激素(GH)及空腹尿钙／尿肌酐(尿Ca／Cr)测定，其中3组进行定量CT测定腰椎骨密度(BMD)，分别为13、7、28例；其中绝经后组中10侧患者服用尼尔雌醇(CEE3)3个月：结果显示绝经后妇女BMD显著下降，其BMD与E2及GH呈正相关．在绝经早期组中BMD与尿Ca／Cr值呈负相关．诨步回归分析显示绝经年限对绝经后妇女BMD影响最大，其次为GH；服CEE3 3个月后血ALP显著下降，尿Ca／Cr显著下降，GH升高。本文提示GH的下降是绝经后骨代谢变化的膨响因素之：CEE，能有效防止绝经后妇女的骨丢失，但长期应用有待进一步的研究。     

Effects of 5-year treatment with elcatonin and alfacalcidol on lumbar bone mineral density and the incidence of vertebral fractures in postmenopausal women with osteoporosis: a retrospective study

 The purpose of this retrospective study was to compare the effects of long-term treatment (5 years) with elcatonin and alfacalcidol on bone mineral density (BMD) and the incidence of vertebral fractures in postmenopausal women with osteoporosis. Fifty-six osteoporotic women, more than 5 years after menopause and 58–79 years of age, were enrolled in the study and allocated to an elcatonin treatment group (20 units IM, weekly; n = 30) or an alfacalcidol treatment group (1 μg/day, daily; n = 26). BMD of the lumbar spine (L2-L4) was measured by dual energy X-ray absorptiometry at baseline and every year for 5 years. There were no significant differences in age, body mass index, years since menopause, BMD, or number of prevalent vertebral fractures at baseline between the two groups. One-way analysis of variance with repeated measurements showed no significant longitudinal changes in BMD in either group, suggesting that both treatments sustained the BMD over 5 years. Two-way analysis of variance with repeated measurements also showed no significant differences in longitudinal changes in BMD between the two groups, suggesting that the effects of the two treatments on BMD were similar. However, the number of incident vertebral fractures per patient was significantly lower in the alfacalcidol treatment group than in the elcatonin treatment group (0.80 ± 1.19 and 2.08 ± 2.73, respectively; P < 0.05). These findings indicate that both treatments appeared to sustain lumbar BMD similarly over a 5-year period in postmenopausal women with osteoporosis, but alfacalcidol treatment may be superior to elcatonin treatment regarding the incidence of vertebral fractures. Further study with prospective observations are needed to confirm the results of the present study. Received: April 2, 2002 / Accepted: July 13, 2002 Offprint requests to: J. Iwamoto     

风湿活动度预测绝经后女性类风湿关节炎患者骨密度的研究

目的探讨能够预测绝经后女性类风湿关节炎(Rheumatoid Arthritis RA)患者骨质疏松的指标。方法收集100例绝经后女性RA患者一般临床资料包括年龄、病程、血沉、C反应蛋白、类风湿因子、抗环瓜氨酸肽抗体、关节疼痛数目、关节肿胀数目,采用双能量X线骨密度仪测量腰椎、股骨及全身总的平均骨密度,比较临床资料并分析可能影响骨密度的因素。结果1.绝经后女性类风湿关节炎患者骨质疏松比例为33%,骨量减少比例47%,骨量正常比例20%。2.骨质疏松组的年龄、病程、血沉、关节疼痛数目、DAS28均高于非骨质疏松组,且有统计学意义。3.采用Logistic回归分析结果显示,年龄和DAS28是绝经后女性RA患者骨密度的独立危险因素。4.骨密度T值为诊断骨质疏松的金标准绘制受试者工作曲线,计算DAS28、年龄诊断骨质疏松的切点为5.3分和59.5岁。结论风湿活动度和年龄对于绝经后女性RA患者有较强的骨质疏松预警作用。     

喝牛奶与绝经后妇女骨密度关系的临床研究

目的 探讨喝牛奶与绝经后妇女骨密度的相关性。方法 随机选择1478例福州汉族绝经后妇女,喝牛奶组795例,不喝牛奶组683例,双能X线骨密度仪测定腰椎、股骨颈、大转子和Ward区骨密度,SPSS 18.0统计软件分析喝牛奶与不同部位骨密度的关系。结果 ①喝牛奶组与不喝牛奶组两组比较,结果为年龄、体重、质量指数有差异。②腰椎骨密度与年龄、体重指数、喝牛奶、体重进行逐步回归分析（y=0.843-0.003×年龄-0.010×BMI+0.006×体重+0.016×喝牛奶,β=0.392,回归系数t检验P=0.000）,体重对腰椎骨密度影响较大。③体重、体重指数、年龄为协变量,喝牛奶为变量,行协方差分析,喝牛奶组腰椎BMD（0.754±0.138g/cm2）明显高于不喝牛奶组（0.742±0.113g/cm2）,统计学有显著性差异(F=5.935,P=0.015),股骨颈骨密度无差异。④喝牛奶组骨质疏松患病率为69.18%,不喝牛奶组患病率为71.16%,两者比较无差异（P=0.42）。结论 喝牛奶可维持绝经后女性腰椎高骨密度,这类人群适量饮用牛奶,一定程度上,具有预防骨质疏松的作用。     

Characteristics of lifetime factors,bone metabolism,and bone mineral density in patients with hip fracture

Seventy-four postmenopausal women with nonpathological hip fracture were recruited to a study in which they were compared for lifetime factors, some biochemical measurements of bone metabolism, and bone mineral density (BMD), with 40 age-adjusted controls without fracture. The fracture patients were less independent; their walking ability was weaker; their vision was poorer; they had more general diseases (strokes, diabetes, malignant diseases, heart and vascular diseases); more of them had had deliveries; and they were using significantly more loop diuretics, and antidepressant, neuroleptic, and diabetes drugs than the controls. Thirty-seven patients and 19 controls were excluded from the statistical comparison of BMD and the biochemical measurements of bone metabolism because they had had treatments with calcium, vitamin D, bisphosphonates, estrogens, calcitonin, or corticosteroids, and one fracture patient was excluded for primary hyperparathyroidism. The BMD of the upper femur was significantly lower in the fracture group compared with the control group. Serum total calcium (S-Ca) and serum vitamin D (S-25-(OH)-D) were significantly lower and the levels of calcitonin (S-CT) significantly higher in the fracture group than in the control group, but none of the bone formation markers showed significant differences between the study groups. A comparison of patients with cervical and trochanteric fractures showed BMD to be significantly lower in the upper femur in the trochanteric fracture group. There were no significant differences in the biochemical measurements (with the exception that S-CT was higher in the cervical fracture group), nor in the lifetime factors between the fracture types. In conclusion, some lifetime factors and low S-Ca, low S-25-(OH)-D, high S-CT, and low BMD of the upper femur seem to be related to the risk of hip fracture, and low BMD and low S-CT seem to be related to the trochanteric fracture type in postmenopausal women.     

应用FRAX工具评估类风湿关节炎患者骨折风险及其风险因素的相关性研究

目的探讨骨折风险评估工具(FRAX)预测类风湿关节炎(RA)患者骨质疏松性骨折的临床应用价值并对其骨折风险因素进行相关性分析。方法回顾性分析2015年1月至2016年2月期间经确诊的74例类风湿关节炎患者以及正常对照组76例的相关临床指标以及骨密度值;评估FRAX对类风湿关节炎患者的骨折风险预测值以及FRAX与类风湿临床风险因素之间的关系。结果类风湿组股骨颈、腰椎的骨密度值均低于对照组,而类风湿组中10年主要骨质疏松性骨折发生概率和10年髋部骨折发生概率均高于对照组。多重线性回归分析提示FRAX评分与易激动、口味偏淡、体重指数、S-CTX具有一定的相关性。结论 FRAX工具对临床评估RA患者骨质疏松性骨折风险、预后评价等方面具有良好的应用价值。