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1.
Femoral Bone Mineral Density, Neck-Shaft Angle and Mean Femoral Neck Width as Predictors of Hip Fracture in Men and Women 总被引:19,自引:6,他引:13
C. Gómez Alonso M. Díaz Curiel F. Hawkins Carranza R. Pérez Cano A. Díez Pérez 《Osteoporosis international》2000,11(8):714-720
The effect of femoral bone mineral density (BMD) and several parameters of femoral neck geometry (hip axis length, neck–shaft
angle and mean femoral neck width) on hip fracture risk in a Spanish population was assessed in a cross-sectional study. All
parameters were determined by dual-energy X-ray absorptiometry. There were 411 patients (116 men, 295 women; aged 60–90 years)
with hip fractures in whom measurements were taken in the contralateral hip. Controls were 545 persons (235 men, 310 women;
aged 60–90 years) who participated in a previous study on BMD in a healthy Spanish population. Femoral neck BMD was significantly
lower, and neck–shaft angle and mean femoral neck width significantly higher, in fracture cases than in controls. The logistic
regression analysis adjusted by age, height and weight showed that a decrease of 1 standard deviation (SD) in femoral neck
BMD was associated with an odds ratio of hip fracture of 4.52 [95% confidence interval (CI) 2.93 to 6.96] in men and 4.45
(95% CI 3.11 to 6.36) in women; an increase of 1 SD in neck–shaft angle of 2.45 (95% CI 1.73 to 3.45) in men and 3.48 (95%
CI 2.61 to 4.65) in women; and an increase of 1 SD in mean femoral neck width of 2.15 (95% CI 1.55 to 2.98) in men and 2.40
(95% CI 1.79 to 3.22) in women. The use of a combination of femoral BMD and geometric parameters of the femoral neck except
for hip axis length may improve hip fracture risk prediction allowing a better therapeutic strategy for hip fracture prevention.
Received: 16 September 1999 / Accepted: 22 February 2000 相似文献
2.
The width of long bone diaphyses apparently increase with age, a phenomenon that is suggested to have some positive impact
on bone strength. On the other hand, these changes in size that are site-specific may cause a deterioration in the local mechanical
integrity of the whole bone. Physical activity and calcium intake are known to be able to modify bone mass and size. It is,
however, not known whether these lifestyle habits can modify the postulated disproportionate changes in bone size. To address
this question, bone mineral content (BMC)-derived estimates of cross-sectional areas (CSA) of femur and radius in 158 premenopausal
(mean age 43, standard deviation 2 years) and 134 postmenopausal (63 (2) years), clinically healthy women with contrasting
long-term histories in physical activity and calcium intake were determined from dual-energy X-ray absorptiometry (DXA) data.
The DXA-obtained BMC correlated strongly with the actual CSA (r= 0.94) determined with peripheral quantative computed tomography. The ratios between functionally interrelated CSA data (i.e.,
(radial shaft CSA/distal radius CSA), (trochanter CSA/femoral neck CSA), (femoral shaft CSA/trochanter CSA) and (femoral shaft
CSA/femoral neck CSA)) were considered primary outcome variables. Neither physical activity nor calcium intake separately
or interactively were associated with any CSA ratio. Age showed no interaction with physical activity or calcium intake but
was independently associated with all CSA ratios, except the ratio of femoral shaft CSA to trochanteric CSA. This study indicated
clearly that a preferential reduction in the cross-sectional area occupied by bone mineral occurs disproportionately at the
long bone ends as compared with diaphyseal sites, and this apparently inherent, age-associated relative loss seems not to
be prevented by physical activity or calcium intake. In particular, given the utmost clinical relevance of the proximal femur
region, an observed loss in femoral neck CSA of about 10% in contrast to about a 5% loss in trochanteric CSA warrants further
investigation regarding its potential role as a predictor for hip fracture. Not only the local differences in bone composition
but also the biomechanical aspects are important factors underlying these apparent changes in CSA at the studied skeletal
sites.
Received: 10 September 1998 / Accepted: 17 March 1999 相似文献
3.
骨密度结合股骨近端几何参数预测老年髋部骨折 总被引:2,自引:0,他引:2
目的研究老年人骨密度(Bone mineral density,BMD)值结合股骨近端几何参数是否能提高骨质疏松性髋部骨折危险性的预测。方法将85例绝经后妇女髋部骨折患者按骨折类型分组, 其中52例股骨颈骨折,33例转子间骨折。对照组100例老年女性。在骨盆片上测量股骨近端几何参数,在股骨颈、Ward’s三角和转子处测量BMD值,对结果进行统计学处理分析。结果骨折组的BMD值均低于对照组(P<0.01);股骨干皮质厚度与股骨颈BMD值有相关性(r=0.45,P< 0.01);逐步线性回归分析结果显示股骨距内侧皮质厚度、转子处BMD值、颈干角和Ward’s三角 BMD值相结合是预测髋部骨折最好方法(r=0.74,r2=0.53,P<0.01)。结论骨密度值结合放射学测量股骨近端几何参数能提高对骨质疏松性髋部骨折及骨折类型的预测。 相似文献
4.
Bone Mineral Density and Body Composition in Underweight and Normal Elderly Subjects 总被引:7,自引:1,他引:6
A. Coin G. Sergi P. Benincà L. Lupoli G. Cinti L. Ferrara G. Benedetti G. Tomasi C. Pisent G. Enzi 《Osteoporosis international》2000,11(12):1043-1050
The importance of malnutrition as a risk factor in osteoporosis is emphasized by the evidence that patients with fractures
of the proximal femur are often undernourished. In this study, nutritional status, bone mineral mass and its association with
body composition were investigated in underweight and normal weight elderly subjects. Moreover the hypothesis that malnutrition
in elderly is associated with a higher risk of osteoporosis was tested. The participants were 111 elderly subjects divided
into two groups according to body mass index (BMI): 51 patients were underweight (BMI < 22 kg/m2) while in 60 subjects BMI ranged from 22 to 30 kg/m2. In all patients anthropometric parameters and blood indices of malnutrition and of bone turnover were measured. Fat-free
soft mass (FFSM), fat mass (FM), bone mineral content (BMC) and bone mineral density (BMD) ‘total body’ and at the hip were
obtained by dual-energy X-ray densitometry. Dietary intake was evaluated with the diet history method, while resting energy
expenditure (REE) was measured by indirect calorimetry. Underweight subjects had other signs of malnutrition, such as low
visceral proteins, sarcopenia, and an inadequate energy intake. Moreover they showed a significant reduction of BMC and BMD
compared with normal subjects. In men with BMI <22 kg/m2, T-score was below −2.5 (−3 at femoral neck and −2.7 at total hip) while men in the control group had normal bone mineral
parameters. T-score at different sites was lower in underweight women than in underweight men, always showing values under −3.5, with clear
osteoporosis and a high fracture risk. In healthy women the T-score values indicated the presence of mild osteoporosis. In underweight subjects, low levels of albumin (< 35 g/l) were
associated with higher femoral bone loss. Using a partial correlation model, BMC, adjusted for age, bone area, knee height
and albumin showed a significant association with FM in women (r= 0.48; p < 0.01) and with FFSM in men (r= 0.48; p < 0.05). Albumin, when adjusted for other variables, was significantly correlated (r= 0.52; p < 0.05) with femoral neck BMC only in women. In conclusion, the underweight state in the elderly is associated with malnutrition
and osteoporosis; other factors occurring in malnutrition, besides body composition changes, such as protein deficiency, could
be involved in the association between underweight and osteoporosis. Moreover bone mineral status seems to be related to fat-free
soft mass tissue in men while in women it is much more closely associated with total body fat.
Received: 3 January 2000 / Accepted: 3 July 2000 相似文献
5.
Hip Fracture Risk and Proximal Femur Geometry from DXA Scans 总被引:10,自引:5,他引:5
C. Bergot V. Bousson A. Meunier M. Laval-Jeantet J. D. Laredo 《Osteoporosis international》2002,13(7):542-550
In this retrospective study of hip fracture risk evaluation from hip dual-energy X-ray absorptiometry (DXA) scans, our objectives
were to determine which part of the femoral neck length contributes most to the fracture risk and to define a geometric parameter
better than hip axis length (HAL) for discriminating hip fracture patients. Forty-nine Caucasian women with a nontraumatic
femoral neck fracture were matched on age to 49 normal women and on both age and femoral neck bone mineral density (BMD) to
49 unfractured women. In addition to BMD, geometric parameters including neck–shaft angle, neck width and several HAL segments
were evaluated by discriminant analysis to determine which was the best hip fracture discriminator. Neck–shaft angle had a
limited influence on the hip fracture risk. Age-related bone loss was associated with a neck width increase in unfractured
and fractured patients. HAL was significantly longer in fractured patients and was a significant discriminator between fractured
patients and normal controls. HAL was not significant as a discriminator between fractured and low-BMD unfractured patients.
The intertrochanter–head center distance (from the intertrochanteric line to the femoral head center) coincides with the femoral
lever arm and includes no segments that adapt to BMD changes, such as the greater trochanter–intertrochanter distance. Among
all tested lengths, this segment was the part of HAL that discriminated best between fractured and low-BMD unfractured patients.
A longer intertrochanter–head center distance increased the risk of femoral neck fracture among low-BMD patients. Including
automatic measurement of this segment in standard DXA protocols may prove useful in identifying patients at high risk for
hip fracture. At present, HAL remains the easier neck length to measure, but automatic evaluation of the intertrochanter–head
center distance must be a goal for future image analysis development.
Received: 11 April 2001 / Accepted: 3 January 2002 相似文献
6.
How Hip and Whole-Body Bone Mineral Density Predict Hip Fracture in Elderly Women: The EPIDOS Prospective Study 总被引:1,自引:0,他引:1
A. M. Schott C. Cormier D. Hans F. Favier E. Hausherr P. Dargent-Molina P. D. Delmas C. Ribot J. L. Sebert G. Breart P. J. Meunier 《Osteoporosis international》1998,8(3):247-254
We conducted a population-based cohort study in 7598 white healthy women, aged 75 years and over, recruited from the voting
lists. We measured at baseline bone mineral density (BMD g/cm2) of the proximal femur (neck, trochanter and Ward's triangle) and the whole body, as well as fat and lean body mass, by dual-energy
X-ray absorptiometry (DXA). One hundred and fifty-four women underwent a hip fracture during an average 2 years follow-up.
Each standard deviation decrease in BMD increased the risk of hip fracture adjusted for age, weight and centre by 1.9 (95%
CL 1.5, 2.3) for the femoral neck, 2.6 times (2.0, 3.3) for the trochanter, 1.8 times (1.4, 2.2) for Ward's triangle, 1.6
times (1.2, 2.0) for the whole body, and 1.3 times (1.0, 1.5) for the fat mass. The areas under the receiver operating characteristic
(ROC) curves were not significantly different between trochanter and femoral neck BMD, whereas ROC curves of femoral neck
and trochanter BMD were significantly better than those for Ward's triangle and whole-body BMD.
emsp;Women who sustained an intertrochanteric fracture were older (84 ± 4.5 years) than women who had a cervical fracture
(81 ± 4.5 years) and trochanter BMD seemed to be a stronger predictor of intertrochanteric ([RR = 4.5 (3.1, 6.5)] than cervical
fractures ([RR = 1.8 (1.5, 2.3]).
emsp;In very elderly women aged 80 years and more, hip BMD was still a significant predictor of hip fracture but the relative
risk was significantly lower than in women younger than 80 years.
emsp;In the 48% of women who had a femoral neck BMD T-score less than –2.5, the relative risk of hip fracture was increased by 3, and the unadjusted incidence of hip fracture
was 16.4 per 1000 woman-years compared with 1.1 in the population with a femoral neck BMD T-score 5–1.
Received: 19 May 1997 / Accepted: 16 October 1997 相似文献
7.
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
8.
Proximal Femur Geometry To Detect and Distinguish Femoral Neck Fractures from Trochanteric Fractures in Postmenopausal Women 总被引:19,自引:4,他引:15
S. Gnudi C. Ripamonti L. Lisi M. Fini R. Giardino G. Giavaresi 《Osteoporosis international》2002,13(1):69-73
Some proximal femur geometry (PFG) parameters, measured by dual-energy X-ray absorptiometry (DXA), have been reported to
discriminate subjects with hip fracture. Relatively few studies have tested their ability to discriminate femoral neck fractures
from those of the trochanter. To this end we performed a cross-sectional study in a population of 547 menopausal women over
69 years of age with femoral neck fractures (n= 88), trochanteric fractures (n= 93) or controls (n= 366). Hip axis length (HAL), neck–shaft angle (NSA), femoral neck diameter (FND) and femoral shaft diameter (FSD) were measured
by DXA, as well as the bone mineral density (BMD) of the nonfractured hip at the femoral neck, trochanter and Ward’s triangle.
In fractured subjects, BMD was lower at each measurement site. HAL was longer and NSA wider in those with femoral neck fractures.
With logistic regression the age-adjusted odds ratio (OR) for a 1 standard deviation (SD) decrease in BMD was significantly
associated at each measurement site with femoral neck fracture (femoral neck BMD: OR 1.9, 95% confidence interval (95% CI):
1.4–2.5; trochanter BMD: OR 1.6, 95% CI 1.2–2.0; Ward’s triangle BMD: OR 1.7, 95% CI 1.3–2.2) and trochanteric fracture (femoral
neck BMD: OR 2.6, 95% CI 1.9–3.6; trochanter BMD: OR 3.0, 95% CI 2.2–4.1; Ward’s triangle BMD: OR 1.8, 95% CI 1.4–2.3). Age-adjusted
OR for 1 SD increases in NSA (OR 2.2, 95% CI 1.7–2.8) and HAL (OR 1.3, 95% CI 1.1–1.6) was significantly associated with the
fracture risk only for femoral neck fracture. In the best predictive model the strongest predictors were site-matched BMD
for both fracture types and NSA for neck fracture. Trochanteric BMD had the greatest area (0.78, standard error (SE) 0.02)
under the receiver operating characteristic curve in trochanteric fractures, whereas for NSA (0.72, SE 0.03) this area was
greatest in femoral neck fractures. These results confirm the association of BMD with proximal femur fracture and support
the evidence that PFG plays a significant role only in neck fracture prediction, since NSA is the best predictive parameter
among those tested.
Received: 24 April 2001 / Accepted: 1 August 2001 相似文献
9.
J. Leppälä P. Kannus S. Niemi H. Sievänen I. Vuori M. Järvinen 《Osteoporosis international》1999,10(4):337-342
High peak bone mass and density in early adulthood is an important protective factor against osteoporotic fractures in later
life, but it is not known whether injuries to growing bones adversely affect the attainment of peak bone mass and density.
The purpose of this study was therefore to examine with dual-energy X-ray absorptiometry the areal bone mineral density (BMD)
of the injured and uninjured extremity (the femoral neck, trochanter area of the femur, distal femur, patella, proximal tibia
and distal tibia), lumbar spine and distal radius of young adults with a history of an early-life femoral shaft fracture and
to find out whether the fracture had affected the attainment of peak bone density of these patients. Thus, the BMD and clinical
status of 41 patients (28 men, 13 women) who had sustained a femoral shaft fracture in childhood or adolescence (between 7
and 15 years of age, average 13 years before the study) were examined. The fracture had led to a statistically significant
difference in BMD between the injured and uninjured side distal to the fracture site (men/women: distal femur, −3.7%/−3.9%;
patella, −3.1%/−5.9%; proximal tibia, −2.0%/−4.6%; distal tibia, −3.4%/−5.2%), whereas the proximal femur did not show such
differences. The male patients’ spinal BMD was significantly lower (−7.9%) than that in their age-, height- and weight-matched
healthy controls. The female patients’ spinal BMD tended to be fairly comparable (−1.6%) to that of the controls (NS). In
summary, this study indicates that early-life femoral shaft fracture results in a moderate (−2% to −6%) long-term side-to-side
BMD difference distal to the fracture site. Patients’ spinal BMD values also tend to be lower than that of controls. Thus,
a femoral shaft fracture sustained in childhood or adolescence seems to disturb somewhat the attainment of peak bone density,
the important predictor of osteoporotic fractures in later life.
Received: 23 December 1998 / Accepted: 1 April 1999 相似文献
10.
Loss of Bone Density and Lean Body Mass after Hip Fracture 总被引:20,自引:3,他引:17
K. M. Fox J. Magaziner W. G. Hawkes J. Yu-Yahiro J. R. Hebel S. I. Zimmerman L. Holder R. Michael 《Osteoporosis international》2000,11(1):31-35
Few studies of bone loss have assessed the amount of loss directly after a hip fracture. The present prospective study was
conducted to determine changes in bone mineral density (BMD) and muscle mass shortly after fracture and through 1 year to
assess short-term loss and related factors. The setting was two acute care teaching hospitals in Baltimore, Maryland, and
subjects were 205 community-dwelling women with a new fracture of the proximal femur between 1992 and 1995. Bone density of
the nonfractured hip and whole-body and body composition were measured by dual-energy X-ray absorptiometry at 3 and 10 days
and 2, 6 and 12 months after admission. Mean BMD of the femoral neck was 0.546 ± 0.007 g/cm2 at baseline. Average loss of femoral neck BMD from baseline was 2.1% at 2 months, 2.5% at 6 months and 4.6% at 12 months.
The average loss of BMD in the intertrochanteric region was 2.1% at 12 months. Total lean body mass decreased by 6% while
fat mass increased by 3.6% by 1 year after the fracture. These findings indicate that significant loss in BMD and lean body
mass occur shortly after hip fracture while body fat increases. Continued loss was evident throughout the 1 year of follow-up.
This loss of both bone density and muscle mass may lead to new fractures.
Received: 1 February 1999 / Accepted: 20 May 1999 相似文献
11.
S. L. Hui L. Zhou R. Evans C. W. Slemenda M. Peacock C. M. Weaver C. McClintock C. C. Johnston Jr 《Osteoporosis international》1999,9(3):200-205
This study characterizes the rates of growth and loss of bone mass as a function of age in white females. It combines longitudinal
data from several studies of bone mass on healthy white female subjects ranging from age 6 to 90 years. Rates of change in
bone area, bone mineral content (BMC) and bone mineral density (BMD) are estimated separately for the spine and the femoral
neck of each individual using linear regression. The individual rates of change are then fitted as a nonparametric function
of age using weighted moving averages, resulting in a curve of age-specific mean change as a function of age. When the curves
of BMD were compared between the hip and the femoral neck, the cessation of bone growth and the onset of bone loss were found
to occur at an earlier age at the hip than at the spine. No significant differences in the ages of maximum rates of growth
or maximum loss were found between the two skeletal sites. This information will be useful for designing interventions to
promote bone growth or retard bone loss.
Received: 2 December 1997 / Accepted: 22 May 1998 相似文献
12.
G. M. Fogelholm H. T. Sieva¨nen T. K. Kukkonen-Harjula M. E. Pasanen 《Osteoporosis international》2001,12(3):199-206
Weight loss may lead to bone loss but little is known about changes in bone mass during regain of reduced weight. We studied
changes in bone mineral density (BMD) and bone mineral content (BMC) during voluntary weight reduction and partial regain.
The study consisted of three phases: a 3 month weight reduction with very-low-energy diet (VLED), a 9 month randomized, controlled
walking intervention period with two training groups (target energy expenditure 4.2 or 8.4 MJ/week) and a 24-month follow-up.
The participants were premenopausal women with a mean body mass index of 34.0 (SD 3.6) kg/m2. Seventy-four of 85 subjects completed the whole study. Total body, lumbar spine, proximal femur and dominant radius BMD
and BMC were measured with dual-energy X-ray absorptiometry (DXA). The mean weight loss during VLED was 13.2 (3.4) kg, accompanied
by unchanged total body BMC and decreased lumbar, trochanteric and radial BMD (p<0.05). During months 3–36, an average of 62% of the weight loss was regained, total body BMC decreased and trochanteric BMD
increased (p<0.05). At the end of the study, total body BMC and lumbar and femoral neck BMD were lower than initially (p<0.05). Weight change throughout the study correlated significantly with the change in radial (r= 0.54), total body (r= 0.39) and trochanteric (r= 0.37) BMD. Exercise-group assignment had no effect on BMD at weight-bearing sites. In conclusion, the observed changes in
BMD and BMC during weight reduction and its partial regain were clinically small and partly reversible. More studies are needed
to clarify whether the observed weight changes in BMD and BMC are real or are artifacts arising from assumptions, inaccuracies
and technical limitations of DXA.
Received: 20 April 2000 / Accepted: 20 September 2000 相似文献
13.
Males have larger skeletal size and bone mass than females, despite comparable body size. 总被引:5,自引:0,他引:5
Jeri W Nieves Carmelo Formica Jamie Ruffing Marsha Zion Patricia Garrett Robert Lindsay Felicia Cosman 《Journal of bone and mineral research》2005,20(3):529-535
Gender differences in fractures may be related to body size, bone size, geometry, or density. We studied this in 18-year-old males (n = 36) and females (n = 36) matched for height and weight. Despite comparable body size, males have greater BMC and BMD at the hip and distal tibia and greater tibial cortical thickness. This may confer greater skeletal integrity in males. INTRODUCTION: Gender differences in fractures may be related to body size, bone size, geometry, or density. We studied this in males (n = 36) and females (n = 36; mean age = 18 years) pair-matched for height and weight. MATERIALS AND METHODS: BMC, bone area (BA), and BMD were measured in the spine and hip using DXA. Distal tibia was measured by pQCT. RESULTS AND CONCLUSIONS: Males had a higher lean mass (92%) compared with females (79%). No gender differences were observed for vertebral BMC or vertebral height, although males had greater width and thus BA at the spine. Males had greater BMC and BA at the femoral neck and total femur (p < 0.02). Geometric variables of the hip including neck diameter and neck-axis length were also greater in males (p < 0.02). There was greater cross-sectional moment of inertia, safety factor, and fall index in males (all p < 0.02). Males had greater tibial BMC, volumetric BMD, and cortical area and thickness compared with females (p < 0.01), with both greater periosteal circumference (p = 0.011) and smaller endosteal circumference (p = 0.058). Statistically controlling for lean mass reduced gender differences, but males still had 8% higher hip BMD (p = 0.24) and 5.3% higher total tibial BMD (p = 0.05). A subset of males and females were matched (n = 14 pairs) for total hip BA. Males in this subset still had greater BMC and BMD at the total hip (p < 0.05) than females, despite similar BA. In summary, despite comparable body size, males have greater BMC and BMD than females at the hip and distal tibia but not at the spine. Differences in BMC and BMD were related to greater cortical thickness in the tibia. We conclude that differences in bone mass and geometry confer greater skeletal integrity in males, which may contribute to the lower incidence of stress and osteoporotic fractures in males. 相似文献
14.
Correlation of Bone Density to Strength and Physical Activity in Young Men with a Low or Moderate Level of Physical Activity 总被引:4,自引:0,他引:4
The objective of this study was to evaluate the relationship among bone mineral density (BMD), physical activity, muscle
strength, and body constitution, in young men with a low or moderate level of physical exercise. Another aim was to investigate
whether the head is unaffected by physical activity. The subjects consisted of 33 Caucasian healthy men, mean age 24.8 ± 2.3
years. BMDs of the total body, lumbar spine (L2-L4), femoral neck, Ward's triangle and trochanter, humerus, and head were
measured using dual-energy-X-ray absorptiometry (DXA). Bivariate correlations were measured among the different BMD sites
and age, weight, height, body mass index (BMI), fat mass, lean body mass, amount of physical activity (hours/week), hamstrings
strength, and quadriceps strength. Significant predictors were found for all BMD sites except the head. Using all these variables,
only 6% of the variation in BMD of the head could be explained, whereas 46% (total body), 31% (humerus), 17% (lumbar spine),
38% (femoral neck, Ward's), and 41% could be explained for the trochanter. Physical activity and muscle strength were found
to be independent significant predictors of BMD of the total body and the sites at the proximal femur. These results suggest
that at the time of peak bone mass attainment, physical activity is an important predictor of the clinically relevant proximal
femur in young men with a low or moderate level of physical activity. Furthermore, since head BMD was not related to the level
of physical activity, we suggest that head BMD may be used as an internal standard, to control for selection bias, in studies
investigating the effect of physical activity on bone mass.
Received: 5 February 1996 / Accepted: 24 September 1996 相似文献
15.
The effect of 18 months of training on the ovarian hormone concentrations and bone mineral density (BMD) accrual was assessed
longitudinally in 14 adolescent rowers and 10 matched controls, aged 14–15 years. Ovarian hormone levels were assessed by
urinary estrone glucuronide (E1G) and pregnanediol glucuronide (PdG) excretion rates, classifying the menstrual cycles as ovulatory or anovulatory. Total
body (TB), total proximal femur (PF), femoral neck (FN) and lumbar spine (LS) (L2–4) bone mass were measured at baseline and
18 months using dual-energy X-ray densitometry. Results were expressed as bone mineral content (BMC), BMD and bone mineral
apparent density (BMAD). Five rowers had anovulatory menstrual cycles compared with zero prevalence for the control subjects.
Baseline TB BMD was significantly higher in the ovulatory rowers, with PF BMD, FN BMD and LS BMD similar for all groups. At
completion, the LS bone accrual of the ovulatory rowers was significantly greater (BMC 8.1%, BMD 6.2%, BMAD 6.2%) than that
of the anovulatory rowers (BMC 1.1%, BMD 3.9%, BMAD 1.6%) and ovulatory controls (BMC 0.5%, BMD 1.1%, BMAD 1.1%). No difference
in TB, PF or FN bone accrual was observed among groups. This study demonstrated an osteogenic response to mechanical loading,
with the rowers accruing greater bone mass than the controls at the lumbar spine. However, the exercise-induced osteogenic
benefits were less when rowing training was associated with low estrogen and progesterone metabolite excretion.
Received: 8 December 1998 / Accepted: 15 March 1999 相似文献
16.
Femoral Neck and Intertrochanteric Fractures Have Different Risk Factors: A Prospective Study 总被引:3,自引:0,他引:3
The aim of this study was to determine whether both types of hip fracture, femoral neck and intertrochanteric, have similar
risk factors. A prospective cohort study was carried out on community-dwelling elderly women in four areas of the United States:
Baltimore, MD; Pittsburgh, PA; Minneapolis, MN and Portland, OR. The participants were 9704 Caucasian women, 65 years and
older, of whom 279 had fractured their femoral neck and 222 had fractured their trochanteric region of the proximal femur.
The predictors used were the bone mass of the calcaneus and proximal femur, anthropometry, history of fracture (family and
personal), medication use, functional status, physical activity and visual function. The main outcome measures were femoral
neck and intertrochanteric fractures occurring during an average of 8 years of follow-up. In multivariate proportional hazards
models, several risk factors increased the risk of both types of hip fracture; including femoral neck bone density and increased
functional difficulty. In hazard regression models that directly compared risk factors for the two types of hip fracture,
calcaneal bone mineral density (BMD) predicted femoral neck fractures more strongly than intertrochanteric fractures (OR =
1.16; 95% CI = 1.02–1.31). Steroid use and impaired functional status also predicted femoral neck fractures instead of intertrochanteric
fractures. Poor health status (OR = 0.74; 95% CI = 0.55–1.00) predicted intertrochanteric fractures more strongly than femoral
neck fractures. We conclude that femoral neck fractures are largely predicted by BMD and poor functional ability while aging
and poor health status predispose to intertrochanteric fractures.
Received: 8 February 2000 / Accepted: 10 June 2000 相似文献
17.
M. Blum S. S. Harris A. Must S. M. Phillips W. M. Rand B. Dawson-Hughes 《Osteoporosis international》2002,13(8):663-668
Subjects exposed to environmental tobacco smoke have been found to be at increased risk for several health problems. Whether
exposure to passive tobacco smoke is associated with reduced bone mineral density (BMD) is unknown. In order to examine this,
we measured BMD in 154 healthy premenopausal women (age range 40–45 years). BMD of the total hip, femoral neck, lumbar spine
and total body was measured by dual-energy X-ray absorptiometry (DXA). Data were collected on exposure to household tobacco
smoke from age 10 years to the present as well as on other lifestyle factors related to bone mass. We found that 67.5% of
the subjects had a history of household tobacco smoke exposure. Subjects exposed to household tobacco smoke had a mean adjusted
BMD that was significantly lower at the total hip (p= 0.021) and femoral neck (p= 0.018) compared with subjects who were not exposed. In addition, duration of household tobacco smoke exposure was negatively
associated with BMD at the total hip (p = 0.010), femoral neck (p= 0.004), lumbar spine (p = 0.037) and total body (p = 0.031). Subjects exposed to household tobacco smoke for 15 years or more had mean adjusted BMD that was 4% lower at the
total body, and more than 8% lower at the total hip, femoral neck and lumbar spine, compared with subjects who were not exposed.
In conclusion, household tobacco smoke exposure during adolescence and young adulthood was found to be negatively associated
with BMD at the total hip and femoral neck, and duration of exposure was negatively associated with BMD at the total hip,
femoral neck, lumbar spine and total body in premenopausal women.
Received: 17 December 2001 / Accepted: 16 February 2002 相似文献
18.
G. Martínez Díaz-Guerra F. Hawkins A. Rapado M. A. Ruiz Díaz M. Díaz-Curiel 《Osteoporosis international》2001,12(3):178-184
Osteoporosis in men is a significant health problem, and factors associated with bone mass are being investigated. Although
osteoporosis is a typical feature of hypogonadism, the influence of testosterone levels and other hormonal factors on bone
mass of eugonadal males is unknown. Our aim was to identify several anthropometric and hormonal predictors that could be responsible
for the variability in bone mineral density (BMD) in healthy men. One hundred elderly men (age 68 ± 7 years) were investigated
in this cross-sectional study. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral
sites (femoral neck, Ward’s triangle, trochanter, intertrochanter and total femur). Anthropometric measures were obtained
including: weight, height, body mass index (BMI), waist–hip ratio and testicular volume. Hormonal data measures were total,
free and bioavailable testosterone, dihidrotestosterone, estradiol, sex hormone binding globulin (SHBG), insulin-like growth
factor I (IGF-I), intact parathyroid hormone (iPTH) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3). One subject was excluded because primary hypogonadism was found. SHBG levels were increased in 53.5% of men, and 8% showed
a mild increase in iPTH levels. Twenty-eight subjects had densitometric criteria of osteoporosis (T-score ≤−2.5). All BMD sites were positively correlated with body weight (r= 0.29–0.48, p<0.001) and BMI (r= 0.24–0.47, p<0.001). A negative correlation between SHBG levels and intertrochanter (IT) and total femur (TL) BMD was found (r=−0.24 and r=−0.22, p<0.05). After adjusting for age and BMI, SHBG and IGF-I levels were negatively correlated (r=−0.33, p<0.001). In multiple linear regression analysis independent predictors of bone mass were body weight, SHBG and iPTH levels.
The best predictive model accounted for 24–40% of the observed variability of BMD. However, most of the BMD variability was
explained by body weight. In conclusion, in our study body weight, SHBG and iPTH levels were predictors of BMD in healthy
elderly men.
Received: 9 June 2000 / Accepted: 27 September 2000 相似文献
19.
S. M. F. Pluijm M. G. Dik C. Jonker D. J. H. Deeg D. J. H. Deeg G. J. van Kamp P. Lips P. Lips 《Osteoporosis international》2002,13(9):701-709
The aim of this study was to examine whether the presence of apolipoprotein E ε4 (ApoE ε4) is associated with a lower bone
mineral density (BMD), lower quantitative ultrasound (QUS) measurements, higher bone turnover and fracture risk, and whether
these relations are modified by gender and age. A total of 1406 elderly men and women (≥65 years) of the Longitudinal Aging
Study Amsterdam (LASA) participated in this study. In all participants, QUS measurements were assessed, as well as serum osteocalcin
(OC) and urine deoxypyridinolin (DPD/Cr urine). Follow-up of fractures was done each three months. In a subsample (n = 604), total body bone mineral content (BMC) and BMD of the hip and lumbar spine were measured. In addition, prevalent vertebral
deformities were identified on radiographs. In women, the presence of ApoE ε4 was associated with significantly lower femoral
neck BMD (g/cm2; mean ± SEM; ε4+, 0.64 ± 0.01 vs. ε4−, 0.67 ± 0.01; p= 0.04), lower trochanter BMD (g/cm2; mean ± SEM; ε4+, 0.58 ± 0.01 vs. ε4–, 0.61 ± 0.01; p= 0.01) and lower total body BMC (g; mean ± SEM; ε4+, 1787 ± 40.0 vs. ε4–, 1863 ± 23.8; p= 0.04). Women with ApoE ε4 also had a higher risk of severe vertebral deformities (OR=2.78; 95%CI: 1.21–6.34). In men, the
associations between ApoE status and both hip BMD and QUS depended on age. Only among the younger men (65–69 years) was the
presence of ApoE ε4 associated with lower BMD values. Bone markers and fractures were not associated with ApoE ε4 in either
women, or men. In conclusion, this large community-based study confirms the importance of ApoE ε4 as a possible genetic risk
factor related to BMD and vertebral deformities and demonstrates that its effect is gender related, and depends on age in
men only.
Received: 6 July 2001 / Accepted: 2 April 2002 相似文献
20.
J. A. Pasco S. Panahi M. J. Henry E. Seeman G. C. Nicholson M. A. Kotowicz 《Osteoporosis international》1999,9(6):557-559
Hip axis length (HAL) has been reported as an independent risk factor for hip fracture. Later puberty may increase bone size
because of delayed epiphyseal fusion. We sought to identify associations between bone size at the proximal femur with age
at menarche and other indices of growth such as stature. Femoral neck dimensions were measured from dual-energy X-ray absorptiometry
scans of the proximal femur in a random sample of 203 premenopausal Caucasian women (age 20–30 years). There were no associations
between age at menarche and HAL, femoral axis length (FAL) or femoral neck width (FNW). Age at menarche was associated with
height (r= 0.2, p= 0.02). Variations in HAL, FAL and FNW do not appear to be related to age at menarche.
Received: 4 August 1998 / Accepted: 25 November 1998 相似文献