肌注醋酸甲羟孕酮避孕对25～40岁妇女骨矿物质密度的影响

目的:探讨肌肉注射避孕药醋酸甲羟孕酮(DMPA)对骨矿物质密度的影响。方法:随机选择68例应用DMPA避孕的25～40岁女性,每3个月肌注DMPA1次,用药24个月;同时选择59例25～40岁从未应用激素避孕药的女性做为对照,应用双能X光线吸收法测量腰椎和股骨颈骨矿物质密度(BMD)。结果:用药组用药2年后腰椎和股骨颈平均BMD从基础值1.106±0.110g/cm2和0.913±0.100g/cm2下降到1.045±0.103g/cm2和0.855±0.100g/cm2,分别下降了5.5%和5.9%,与对照组相比明显降低(P<0.01)。结论:25～40岁女性肌注醋酸甲羟孕酮避孕导致骨矿物质密度降低。     

口服复方避孕药对青春期女性骨密度的影响

目的:观察复方口服避孕药(COCs)妈富隆(去氧孕烯/炔雌醇)对青春期女性骨矿物质密度(BMD)的影响。方法:接纳150例年龄16～18岁女性应用COCs避孕为观察组,用药24个月;接纳150例年龄16～18岁从未应用激素避孕药女性做对照组;应用双能X-线吸收法测量腰椎和股骨颈BMD。结果:观察组用药2年后腰椎和股骨颈BMD从基础值1.010±0.107g/cm3和0.818±0.089g/cm3降低到1.007±0.108g/cm3和0.813±0.090g/cm3,分别降低了0.29%和0.61%;而对照组则从基础值1.008±0.109g/cm3和0.816±0.087g/cm3增高至1.027±0.106g/cm3和0.824±0.089g/cm3,分别增高了1.88%和0.98%;用药2年后,观察组与对照组相比BMD无明显差异(P>0.05)。结论:青春期女性应用COCs避孕2年对BMD无明显影响。     

育龄妇女应用妈富隆对骨矿物质密度的影响

目的 观察复方口服避孕药妈富隆(Marvelon)对骨矿物质密度的影响.方法 随机选择46例年龄为25～40岁女性应用妈富隆药物24个月;随机选择53例年龄为25～40岁从未应用激素避孕药女性做对照;应用双能X线吸收法测量腰椎和股骨颈骨矿物质密度.结果 用药组用药2年后腰椎和股骨颈平均骨矿物质密度从基础值1.110(0.114g/cm2),0.917(0.088g/cm2)下降到1.106(0.109g/cm2)和0.902(0.091g/cm)2,分别下降了0.36%和1.64%;与对照组相比骨矿物质密度无显著性差异(腰椎t=0.097,股骨颈t=0.516,均P>0.05).结论 年龄为25～40岁女性应用妈富隆避孕药与非激素避孕者相比,其骨矿物质密度无明显差异.     

育龄妇女应用炔雌醇环丙孕酮对骨矿物质密度的影响

目的:观察复方口服避孕药(COCs)炔雌醇环丙孕酮片对骨矿物质密度(BMD)的影响。方法:对55例年龄25～40岁,口服炔雌醇环丙孕酮片避孕24个月的妇女(观察组)应用双能X光线吸收测量腰椎和股骨颈BMD,并以53例年龄25～40岁从未应用激素避孕药妇女(对照组)做对照。结果:观察组腰椎和股骨颈BMD与基础值和对照组相比差异无统计学意义(P>0.05)。结论:年龄25～40岁妇女应用炔雌醇环丙孕酮避孕药避孕与非激素避孕者相比,BMD没有改变。     

左炔诺孕酮皮下埋植避孕对育龄妇女骨矿物质密度的影响

目的:探讨应用左炔诺孕酮皮下埋植剂避孕和非激素宫内节育器(IUD)避孕对育龄妇女骨矿物质密度(BMD)的影响。方法:对比观察126例应用左炔诺孕酮皮下埋植剂的妇女和93例采用非激素IUD避孕妇女腰椎和股骨颈BMD。结果:一般检测特征在两组间类似,左炔诺孕酮皮下埋植剂平均使用期为35.2±6.7个月,与对照组相比,两组BMD差异无统计学意义。结论:左炔诺孕酮皮下埋植避孕对育龄妇女骨矿物质密度无不利影响。     

复方口服避孕药对青春期女性骨矿物质密度的影响

目的:观察16～18岁女性应用妈富隆和炔雌醇醋酸环丙孕酮对骨矿物质密度(BMD)的影响。方法:选择376例16～18岁青春期女性,其中127例女性应用妈富隆,134例应用炔雌醇醋酸环丙孕酮,115例应用非激素避孕(对照组),应用双能X线吸收法测量腰椎和股骨颈BMD,比较口服复方避孕药者与对照组女性BMD的改变。结果:用药24个月,应用妈富隆的女性腰椎、股骨颈BMD与基础值相比轻度降低,但差异无统计学意义(P>0.05);而应用炔雌醇醋酸环丙孕酮的女性腰椎和股骨颈BMD与基础值相比轻度增高,差异无统计学意义(P>0.05);与对照组相比,腰椎和股骨颈BMD增加幅度减小。应用妈富隆和炔雌醇醋酸环丙孕酮者与对照组女性相比,腰椎和股骨颈BMD没有明显差异(P>0.05)。结论:16～18岁青春期女性应用妈富隆或炔雌醇醋酸环丙孕酮2年对BMD没有不利影响,但是继续应用是否影响BMD峰值的获得有待进一步研究。     

ERT在长期应用醋酸甲羟孕酮者中的随机对照研究

长期应用醋酸甲羟孕酮(狄波-普维拉,DMFA)和骨矿物质密度(BMD)的降低有关,尤其是腰椎。但病因不明,最可能的解释是由于继发性雌激素的缺失。为此,设计雌激素替代治疗(HRT)随机双盲对照研究,观察长期使用DMPA腰椎BMD降低者口服对BMD的作用。奥克兰地区的38例年龄≤45(平均37)岁、应用DMPA(≥2年)的未绝经妇女参与这项研究,其腰椎BMD均低于青年人的平均水平(≤1.20 g/cm2)。     

长效激素避孕:对骨密度、体重和情绪影响进行评价

为了解长效避孕法,醋酸甲羟孕酮(DMPA)注射针和左旋18甲基炔诺酮(LNG)埋植剂对骨密度、体重和情绪(抑郁症)的影响,作者研究分析了这些问题最近的资料。①DMPA和骨矿密度(BMD):以避孕的剂量应用DMPA,抑制卵巢产生雌二醇(E_2)的妇女担心会发生骨质疏松症。1991年新西兰Candy等对至少应用DMPA 5年的30例妇女与绝经前的对照比较,腰椎和股骨颈BMD     

大豆异黄酮和补充钙对去卵巢大鼠骨密度及肝IGF-1mRNA表达的影响

目的 利用卵巢切除大鼠模型,研究大豆异黄酮和钙对卵巢切除大鼠骨密度及肝脏IGF-1基因表达的影响.方法 将6月龄雌性SD大鼠,按体重随机分成5组假手术组(Sham)、卵巢切除阴性对照组(OVX)、单纯大豆异黄酮组(SI)、单纯碳酸钙组(Ca)、大豆异黄酮加碳酸钙组(SI+Ca).所有大鼠饲以钙含量为3.732g/kg的低钙饮食喂养12周.实验结束时,利用双能X线骨密度扫描仪测量右侧股骨骨密度(BMD),采用逆转录-聚合酶链反应(RT-PCR)方法测定肝脏胰岛素样生长因子-1(IGF-1)基因表达水平.结果 SI+Ca组股骨远心端BMD为(0.263±0.007)g/cm2,Sham组为(0.267±0.008)g/cm2,两组间差异无统计学意义,但这两组BMD均显著性高于OVX(0.245±0.005)g/cm2、SI(0.258±0.011)g/cm2和Ca(0.255±0.004)g/cm2组(P＜0.05).肝脏IGF-1mRNA表达水平在Sham(0.200±0.023)g/cm2、SI(0.278±0.019)g/cm2、Ca(0.302±0.026)g/cm2及SI+Ca(0.231±0.025)g/cm2组中均显著性低于OVX(0.362±0.031)g/cm2,P＜0.05,SI+Ca组IGF-1mRNA表达水平(0.231±0.025)g/cm2低于SI(0.278±0.019)g/cm2和Ca(0.302±0.026)g/cm2两组,并差异有统计学意义.结论 SI+Ca能比单纯喂饲SI或Ca更好地防止卵巢切除大鼠股骨BMD的减小.37.95 mg/kg剂量的SI能够显著抑制由于卵巢切除引起的肝脏IGF-1 mRNA表达水平的上升.     

60例电解工骨矿物质密度调查

目的了解长期职业接触氟化物对人体骨矿物质密度影响,以便采取相应对策.方法采用法国MEDILINK公司的双能X射线骨密度仪对男性电解工60例进行腰椎和髋关节的骨矿物质密度测量;同时测量同性别、同年龄组无接触工业性氟化物的工人57例.结果接触组骨矿物质密度值为股骨颈(8.49±0.98)kg/m2;腰椎(L3)(8.64±1.25)kg/m2;非接触组为股骨颈(8.54±1.04)kg/m2;L3(8.94±1.15)kg/m2.两者统计学无明显差异.结论氟化物长期接触者骨矿物质密度未发现显著改变.     

The effect of depot medroxyprogesterone acetate (DMPA) on bone mineral density (BMD) and evaluating changes in BMD after discontinuation of DMPA in Chinese women of reproductive age

Background

Depot medroxyprogesterone acetate (DMPA) as a hormonal contraceptive is highly effective and widely used, but it may reduce bone mineral density (BMD) and increase the risk of osteoporosis. We compared BMD between users of intramuscular DMPA and nonhormonal subjects and evaluated the changes in BMD after discontinuation of DMPA.

Study Design

The study included 68 women aged between 25 and 40 years using DMPA for 24 months and 59 women aged between 25 and 40 years using nonhormonal contraception as nonusers of hormonal contraception. Sixty-one women in the DMPA group and 52 women in the nonusers of hormonal contraception group completed the 2-year post-treatment periods. BMD of the lumbar spine and femoral neck was measured every 12 months for 48 months using dual-energy X-ray absorptiometry, comparing mean BMD changes in DMPA users and discontinuers with nonusers.

Results

At 24 months of treatment, as compared to baseline, the mean BMD of DMPA users in lumbar spine and femoral neck decreased by 5.52% and 6.35%, respectively. Lumbar spine and femoral neck BMD in women who used DMPA significantly decreased compared to the nonusers (p<.001). At 24 months after DMPA discontinuation, the mean BMD values in DMPA users increased significantly. Although the values of the lumbar spine and femoral neck BMD in DMPA users were still 1.08% and 2.30%, respectively, below their baseline values, there were no significant difference when compared to nonusers (p>.05).

Conclusion

These results show that BMD declined during use of DMPA in women aged 25 to 40 years. Bone loss occurring with DMPA use is reversible after DMPA discontinuation.     

Long-term depot-medroxyprogesterone acetate and bone mineral density.

The association between long-term use of depot-medroxyprogesterone acetate (DMPA) and bone mineral density (BMD) has been controversial, as seen in three case-control studies in New Zealand, Thailand, and the United Kingdom. In the present case-controlled study of BMD, a group of 67 Chinese women who had used DMPA from 5-15 years was compared with 218 women of the same age range who had not used any steroidal hormones. DMPA users were found to have a significantly lower BMD at lumbar vertebra (L2-4) (0.93 g/cm2), neck of femur (0.69 g/cm2), trochanter (0.59 g/cm2), and Ward's triangle (0.58 g/cm2), as compared with the control group, whose corresponding BMD values were 1.03 g/cm2, 0.83 g/cm2, 0.71 g/cm2, and 0.78 g/cm2, respectively (p < 0.001). The average percentage of bone loss per year was estimated to be 1.1% in L2-4, 2.3% in neck of femur, 2.4% in trochanter, and 3.5% in Ward's triangle. The percentage of bone loss in L2-4 was found to be more pronounced with age. This study provided information that the use of DMPA in a Chinese group for > 5 years in associated with bone loss, and a prospective study is needed to confirm these data, which are different from two case-control studies.     

Bone mineral density at various anatomic bone sites in women receiving combined oral contraceptives and depot-medroxyprogesterone acetate for contraception

The association between users of combined oral contraceptives and depot-medroxyprogesterone acetate (DMPA) for contraception and bone mineral density (BMD) has been controversial because of variations among studies. Like other studies, this cross-sectional study compares BMD in users of combined oral contraceptives and DMPA with that in nonusers. Unlike previous studies, we defined long-term use as >2 years, and we measured more bone sites than previous studies including lumbar spines, femurs, and forearms. The study group consisted of 59 women aged 30 years to 34 years who had been using combined oral contraceptives for 57.36 ± 27.02 months with a minimum period of 24 months, 34 women of the same age who had been using DMPA as contraceptive for 55.76 ± 35.31 months, and 62 women of the same age who had not used any steroid hormonal contraceptives for more than 6 months. BMD was measured by dual energy photon absorptiometer at lumbar spine 2–4, neck of femur, Ward’s triangle of femur, greater trochanter of femur, ultradistal radius, and distal ulnar, respectively. Age, body mass index, and lifestyles of both groups were matched with nonusers. Mean BMD at lumbar spine (L2–4) in the DMPA users was significantly lower than in the controls (1.031 ± 0.090 vs. 1.096 ± 0.116, P = 0.007). There were no significant differences in BMD values at bone sites other than lumbar spine between DMPA users and the controls. There were no significant differences in BMD values at all bone sites between combined oral contraceptives users and the controls. We conclude that combined oral contraceptives are not associated with changes in values of BMD, while DMPA is associated with decreased BMD only at lumbar spine. We comment that steroid hormonal contraceptives are safe to use for long-term contraception regarding bone mass effects.     

北京城区老年绝经妇女维生素D与骨矿密度的关系

目的 分析北京城区老年绝经妇女维生素D水平与其身体各部位骨密度(BMD)的关系.方法 在2008年5月至7月,采用整群随机抽样方法 抽取北京3个城区所辖17个礼区的60岁以上老年绝经妇女400名(年龄的中位数为67.8岁),采用美国DioSorin放射免疫试剂盒测定血清25-羟基维生素D[25(OH)D]浓度,根据血清25(OH)D浓度将对象分为维生素D缺乏组[A组,25(OH)D≤25 nmol/L]、不足组[B组,25 nmol/L<25(OH)D≤50 nmol/L]、适宜组[C组,50 nmol/L<25(OH)D≤75 nmol/L]和维生素D充足组[D组,25(OH)D>75 nmol/L].采用双能X线吸收法(DEXA)测定全身、腰椎(L_(2～4))和股骨近端的BMD.结果 血清25(OH)D浓度为(36.0±14.6)nmol/L,全身和股骨颈BMD分别为(0.829±0.090)、(0.679±0.106)g/cm~2.A、B、C+D组全身BMD分别为(0.811±0.077)、(0.825±0.088)、(0.864±0.112)g/cm~2(F=16.93,P<0.01),股骨颈BMD分别为(0.666±0.107)、(0.673±0.099)、(0.725±0.117)g/cm~2(F=18.36,P<0.01),血清25(OH)D浓度与全身、股骨颈BMD呈正相关(r值分别为0.17、0.18,P值均<0.05).结论我国老年妇女维生素D营养状况与腰椎、股骨近端、髋部以及四肢BMD密切相关.     

Further evaluation on long-term depot-medroxyprogesterone acetate use and bone mineral density: a longitudinal cohort study

Cross-sectional studies on the effects of depot-medroxyprogesterone acetate (DMPA) on bone mineral density (BMD) have been controversial. The present longitudinal cohort study on 59 Chinese women over a period of 3 years has shown that their annual rate of bone loss at 3 sites (0.44% in lumbar spine, 0.40% in neck of femur, 1.05% in Ward's triangle) was substantially less than the projected values (1.1% in lumbar spine, 2.3% in neck of femur, 3.5% in Ward's triangle) in a cross-sectional study that had demonstrated a significant reduction in BMD in DMPA users than the non-user population. The trochanter BMD measurement did not show the projected annual bone loss of 2.4%. The rate of bone loss is probably non-linear, with a rapid loss in the first 5 years and a leveling off afterwards. The duration of DMPA use was not significantly correlated with the rate of bone loss. Multiple linear regression analysis demonstrated that age and body mass index were significant variables in modeling the rate of bone loss in the lumbar spine and neck of femur, but not in the trochanter and Ward's triangle areas. The Z scores also suggested a retardation in bone loss with time and potentially due to the effect of progesterone in decreasing bone turnover that is similar to the situation in postmenopausal women. The present data provide another aspect of reassurance to the long-term use of DMPA.     

老年2型糖尿病合并骨质疏松症患者发病韵相关因素分析

目的探讨老年2型糖尿病合并骨质疏松症患者发病的相关危险因素。方法对本院106例老年2型糖尿病合并骨质疏松症患者的年龄、体重指数（BMI）、糖尿病病程与其骨密度（BMD）进行相关因素分析。结果老年2型糖尿病合并骨质疏松症患者中,80岁组的腰椎[（0．756±0．099）g／cm^2]、股骨颈[（0．658±0．111）g／cm^2]及Wards三角[（0．525±0．064）g／cm^2]BMD值较60岁组[（0．883±0．112）g／cm^2、（0．781±0．130）g／cm^2、（0．6274±0．118）g／cm^2]明显下降（P〈0．05）。低体重组（BMI≤20kg／m^2）的腰椎[（0．738±O．114）g／cm^2）]、股骨颈[（0．664±O．112）g／cm^2）]BMD值较正常体重组[（0．816±0．138）g／cm^2、（0．727±0．134）g／cm^2]明显下降（P〈0．05）。糖尿病病程〉10年组的腰椎[（0．743±O．122）g／cm^2]、股骨颈[（0．719±0．147）g／cm^2]BMD值较病程〈5年组[（0．886±0．132）g／cm^2、（0．792±0．122）g／cm^2]明显下降（P〈0．05）。骨密度与年龄、糖尿病病程呈负相关（P〈0．05）,与体重指数呈正相关（P〈0．05）。结论老年2型糖尿病合并骨质疏松症患者发病与高龄、低体重指数、糖尿病病程长的危险因素密切相关。     

金天格胶囊联合鲑降钙素对老年性骨质疏松症骨代谢及骨密度的影响

目的 分析金天格胶囊联合鲑降钙素注射液对老年骨质疏松症患者骨代谢及骨密度的影响.方法 选择2018年9月-2019年9月本院收治的老年骨质疏松症患者80例,按随机对照原则分为两组,各40例.对照组给予鲑降钙素注射液治疗及口服利塞膦酸钠片治疗,在此基础上,观察组给予金天格胶囊治疗,均治疗3个月,对比两组骨代谢[β-胶原降...     

中老年男性雄激素部分缺乏综合征患者的骨密度改变及其影响因素的研究

目的 探讨中老年男性雄激素部分缺乏综合征（partial androgen deficiency in the aging male,PADAM）患者的骨密度（bone mineral density,BMD）特点及其影响因素.方法 采用双能X线骨密度仪（dual energy X-ray absorptiometry,DEXA）测定186例中老年PADAM患者和125例年龄、体重指数（body mass index,BMI）相匹配的健康中老年人的腰椎及股骨颈骨密度,收集相关生化、性激素及骨代谢指标,并对其与年龄、身高、体重、BMI、性激素水平及部分骨代谢指标进行多元逐步回归分析.结果 （1）PADAM组患者腰椎BMD与健康对照组差异无统计学意义（P＞0.05）,但股骨颈各部位BMD均较健康对照组明显降低[Neck：（0.831±0.136）g/cm2 vs（0.954±0.143）g/cm2,Ward＇s：（0.712±0.127）g/cm2 vs（0.811±0.149）g/cm2,Troch：（0.697±0.124）g/cm2 vs（0.764±0.131）g/cm2,P＜0.05）].（2）PADAM组及健康对照组骨量减少的发生率分别为48.9%、36%,骨质疏松的发生率分别为33.3%、20.8%.（3）PADAM患者腰椎BMD与BMI呈正相关;而股骨颈各部位BMD均与年龄呈负相关,与BMI、雄激素水平呈正相关（P＜0.05）.结论 PADAM患者股骨颈各部位骨密度明显降低.高龄、低体重指数和低雄激素水平为PADAM患者BMD降低的危险因素.