绝经后女性促甲状腺激素水平与骨质疏松性骨折的相关性研究

目的探讨绝经后女性血清促甲状腺激素水平与骨质疏松性骨折的相关性。方法 2011年5月至2011年10月期间对贵阳市云岩区4 073名40岁及以上居民开展问卷调查、体格检查、促甲状腺激素(thyroid stimulating hormone,TSH)检验及跟骨超声骨密度测定等。根据基线TSH水平,将调查对象分为3组,分别是TSH降低组(TSH0.55 mIU/L,71人)、TSH正常组(0.55 mIU/L≤TSH≤4.78 mIU/L,3 113人)、TSH升高组(TSH4.78 mIU/L,889人),比较各组基线特征。随访3年后,根据随访期内是否发生骨折分析不同TSH水平与骨质疏松性骨折的相关性。结果 TSH降低组、TSH正常组、TSH升高组中新发骨质疏松性骨折的人数分别为8例、51例、148例,发病率分别为11.3%、4.8%、5.7%,TSH降低组骨折发病率高于TSH正常组,差异具有统计学意义(P=0.012)。TSH升高组较正常组相比差异无统计学意义。②骨密度T值≤-2.5[OR=1.822,95%CI(1.124,2.954),P=0.004]、血脂异常[OR=1.381,95%CI(1.038,1.836),P0.05]、TSH0.55 mIU/L[OR=2.469,95%CI(1.163,5.243),P0.05]是骨质疏松性骨折的危险因素,校正血脂异常、骨密度T值≤-2.5后,TSH降低组与TSH正常组相比,骨折风险增加2.626倍[OR=2.626,95%CI(1.233,5.592),P0.05]。结论绝经后女性TSH水平降低与骨质疏松性骨折风险增加相关。     

绝经后女性骨密度与脂代谢相关性研究

目的 分析绝经后女性骨密度（BMD)与脂代谢相关性,探讨血脂紊乱对BMD的影响。方法 选择509名自然绝经后女性,未患有影响骨代谢疾病,无长期服用影响骨代谢的药物史,未使用过调脂药物。根据年龄段不同,分为<60岁、60~69 岁、70 ~79岁、>80岁4组,分别测量身高、体重、总胆固醇（TC)、甘油三酯（TG)、低密度脂蛋白胆固醇（LDL-C)和高密度脂蛋白胆固醇（HDL-C),并采用双能X线吸收测定仪测量正位腰椎,左侧股骨颈（Neck)处BMD,采用直线相关分析法分析 BMD和血脂之间的相关性,并控制年龄、体重指数因素后进行偏相关分析。结果 不同年龄组BMD、TC、LDL-C有显著差异。 各年龄组BMD与TC及LDL-C呈负相关,与HDL-C呈正相关,与TG无相关性。校正年龄、体重指数后的偏相关显示BMD仍与TC及LDL-C呈负相关,与HDL-C呈正相关。结论 绝经后女性TC和LDL-C升高与BMD下降密切相关,是骨质疏松的重要影响因素。     

绝经后女性骨质疏松性椎体骨折与腰椎体骨密度的相关性

随着我国步入老龄化社会,骨质疏松症的患病率明显升高。骨质疏松症最严重的危害来自骨质疏松性骨折,绝经后女性尤其多见。由于脊柱独特的解剖学和生物力学特点,骨质疏松患者更易发生椎体骨折。骨密度测量是诊断骨质疏松的金标准。本文通过回顾近年来相关文献,探讨腰椎体骨密度检测对绝经后女性骨质疏松性椎体骨折的意义,发现:绝经后骨质疏松性椎体骨折患者的BMD水平比绝经后骨质疏松症但无脊椎骨折者明显减少;绝经后骨质疏松症患者的BMD水平越低,其发生椎体骨折的风险越高;有椎体骨折史的绝经后骨质疏松症患者的BMD水平与发生再次椎体骨折的风险呈负相关。药物干预通常可明显提高绝经后骨质疏松症患者的BMD水平,同时还可减少椎体骨折的发生。尚存在一些不足:腰椎骨密度可能出现假性增高;需进一步探讨预测骨质疏松性椎体骨折的骨密度阈值;药物干预的研究中BMD水平与椎体骨折发生的相关性并没有得到深入研究;缺少大规模的绝经后骨质疏松性椎体骨折的流行病学,现有研究也大都存在病例收集方法不规范、样本量小、年龄分布存在差异等不足。对绝经后骨质疏松性椎体骨折的深入研究需要多学科共同协作。     

股骨近端骨质疏松性骨折的手术治疗

目的探讨治疗股骨近端骨质疏松性骨折的最佳手术方式。方法股骨近端骨质疏松性骨折141例,其中内固定治疗85例,骨水泥型双极人工股骨头置换术治疗56例。结果行内固定治疗组优良率为76.5%,行骨水泥型双极人工股骨头置换术患肢功能优良率为94.6%。结论对无手术禁忌证的股骨近端骨质疏松性骨折应尽可能行假体置换术,以提高患者生活质量,减少并发症。     

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。     

绝经后妇女椎体骨折与骨密度的对照研究

目的探讨绝经后妇女骨质疏松性椎体骨折与骨密度的关系。方法随机选择椎体骨折的绝经后妇女120例为骨折组，无椎体骨折的120例绝经后妇女为对照组。两组的年龄、身高、体重等差异无显著性，均行胸腰椎正侧位X线摄片。用双能X线吸收仪（DXA）测量腰椎（L2-4）前后位及髋部骨密度（BMD）和T值。结果骨折组腰椎及髋部BMD和T值均低于对照组（P≤0．05）。结论腰椎BMD降低与绝经后妇女的骨质疏松性椎体骨折相关，髋部骨密度值的降低在一定程度上也能提示骨折的危险性。绝经后骨质疏松妇女应重视BMD变化，预防椎体骨折的发生。     

绝经后女性血清硒水平与骨质疏松骨密度和骨代谢指标相关性研究

目的探索血清硒水平与绝经后妇女骨代谢指标以及腰椎和髋部骨密度之间相关性。方法检测156例正常骨密度和162例骨质疏松症的血清硒、25-羟基维生素D、PTH、骨钙素、PINP、CTX和NTX/Cr等指标水平。腰椎和股骨颈的BMD通过双能X线吸收法测量。探索了血清硒水平与骨密度的关系。结果骨质疏松症女性的血清硒水平低于正常骨密度的女性(P0.05)。在骨质疏松症妇女中,血清硒水平与年龄、绝经年限、BMI、PTH、骨钙素、PINP、CTX和NTX/Cr水平呈负相关,与25-羟基维生素D水平呈正相关。在正常骨密度组,血清硒水平与这些参数均未发现明显的相关性。调整年龄和BMI后,腰椎和股骨颈骨密度与血清硒及25-羟基维生素D水平呈显著正相关,与绝经年限、PTH、骨钙素、PINP、CTX和NTX/Cr呈负相关。对年龄和BMI进行调整后,进行多元回归分析以确定BMD的预测因子,血清硒和PINP、CTX是腰椎和股骨颈骨密度的显著预测因子。结论绝经后女性患者血清硒水平降低与腰椎和股骨颈骨密度降低密切有关。     

绝经后妇女骨质疏松性椎体骨折与腰椎骨密度的关系

目的探讨绝经后妇女骨质疏松性椎体骨折与腰椎骨密度的关系。方法选择骨质疏松性椎体骨折的绝经后妇女23例为骨折组,无椎体骨折的25例绝经后骨质疏松妇女为对照组。两组的年龄、绝经年限、身高、体重、体重指数差异无显著性,均行胸腰椎正侧位X线摄片。用双能X线吸收仪（DXA）测量的腰椎（L2-4）前后位骨密度（BMD）、骨矿含量（BMC）和T值。结果骨折组BMD、BMC和T值均低于对照组（P〈0.01）。结论腰椎BMD降低与绝经后妇女的骨质疏松性椎体骨折相关。绝经后骨质疏松妇女应重视BMD变化,预防椎体骨折的发生。     

绝经后女性骨密度与骨代谢生化指标的相关性分析

目的分析绝经后女性骨密度(bone mineral density,BMD)与骨代谢生化指标的相关性。方法选取西南医科大学附属医院2017年1月至2018年12月收治的绝经后女性患者151例。根据骨密度T值将患者分为骨质疏松组(83例)、骨量低下组(47例)和骨量正常组(21例),比较三组患者骨代谢生化指标的差异,并对各项指标与BMD进行相关性分析。结果骨质疏松组甲状旁腺素(PTH)、Ⅰ型前胶原氨基末端前肽(P1NP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)显著高于骨量低下组和骨量正常组(P0. 05),骨量低下组显著高于骨量正常组(P0. 05)。骨质疏松组体质量指数(bone mass index,BMI)、25(OH) D_3显著低于骨量低下组和骨量正常组(P0. 05),骨量低下组显著低于骨量正常组(P0. 05)。血钙、血磷、骨钙素(BGP)、血清的骨特异性碱性磷酸酶(BALP)在三组之间比较,差异无明显统计学意义(P0. 05)。Spearman相关分析显示,PTH、P1NP、β-CTX与骨密度呈负相关(r=-0. 538,-0. 520,-0. 462,P 0. 05),25(OH) D_3与骨密度呈正相关(r=0. 517,P0. 05),血钙、血磷、BALP、BGP与骨密度无相关性(P0. 05)。结论血清25(OH) D_3、PTH、P1NP、β-CTX与骨密度存在显著相关性,骨代谢生化指标监测有助于绝经后女性骨质疏松的早期诊断。     

The relationship between bone mineral density and ultrasound in postmenopausal and osteoporotic women

The aim of this cross-sectional study was to use a novel method of data analysis to demonstrate that patients with osteoporosis have significantly lower ultrasound results in the heel after correcting for the effect of bone mineral density (BMD) measured in the spine or hip. Three groups of patients were studied: healthy early postmenopausal women, within 3 years of the menopause (n=104, 50%), healthy late postmenopausal women, more than 10 years from the menopause (n=75, 36%), and a group of women with osteoporosis as defined by WHO criteria (n=30, 14%). Broadband ultrasound attenuation (BUA), speed of sound (SOS) and Stiffness were measured using a Lunar Achilles heel machine, and BMD of the lumbar spine and left hip was measured using dual-energy X-ray absorptiometry (DXA). SOS, BUA and Stiffness were regressed against lumbar spine BMD and femoral BMD for all three groups combined. The correlation coefficients were in the range 0.52–0.58, in agreement with previously published work. Using a calculated ratio R, analysis of variance demonstrated that the ratio was significantly higher in the osteoporotic group compared with the other two groups. This implied that heel ultrasound values are proportionately lower in the osteoporotic group compared with the other two groups for an equivalent value of lumbar spine and femoral neck BMD. We conclude that postmenopausal bone loss is not associated with different ultasound values once lumbar spine or femoral neck BMD is taken into account. Ultrasound does not give additional information about patterns of bone loss in postmenopausal patients but is important in those patients with osteoporosis and fractures.     

骨质疏松性骨折与骨密度关系的研究进展

骨质疏松症是老年人的常见病和多发病,其最大的危害是导致骨折的发生。随着老年人口的增加,骨质疏松性骨折的发病率也显著增高,这已经引起了医学研究者的普遍关注。近年来对运用骨密度检测来预测骨质疏松性骨折的研究很多,但是还没有形成一个定论,故对运用骨密度检测来预测骨质疏松性骨折的研究现状作一简单综述。     

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。     

The relationship between osteoarthritis of the hands,bone mineral density,and osteoporotic fractures in elderly women

To study the relationship between osteoarthritis (OA) and osteoporosis (OP), radiographic osteoarthritis lesions of the hands (HOA) were quantified in 300 healthy women, aged 75 years or more, as a subgroup of a cohort originally recruited for a multi-centre study of risk factors for femoral neck fracture. The HOA combined score (i.e. the sum of the grades of joint-space narrowing, osteophytes, erosions and joint misalignment), the osteophytosis score and the joint-space narrowing score were calculated on a radiograph of both hands. Bone mineral density (BMD) was measured using dual-energy X-ray absortiometry (Lunar DPX) at the femoral neck, Ward's triangle and the total body. BMDs of the total spine, lumbar spine, and the upper and lower limbs were derived from the regional analyses of the total body measurement. Correlations between bone mass, HOA scores and other variables were explored by multiple linear regression and stepwise logistic regression analysis. The HOA combined score was positively correlated with increasing age but not with body mass index. In the multiple regression analyses the HOA combined score positively correlated with BMD at all sites, except the femoral neck and Ward's triangle; the osteophytosis score correlated with BMD at all sites; and no correlation was found between BMD and the joint-space narrowing score. According to stepwise logistic regression and after adjustment of BMD for age, women with an HOA combined score higher than 20 had signficantly higher BMD values at all skeletal sites. Sixty-nine women (23%) reported a history of osteoporotic fracture; among them, 20 (6.6%) reported a history of vertebral fracture. The OA score of both subgroups was significantly lower than that of women with no history of fracture. These data suggest that in elderly women the severity of HOA is positively correlated with bone mass and that women with a high score of HOA more rarely report a history of osteoporotic fracture.     

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.     

Preferential low bone mineral density of the femoral neck in patients with a recent fracture of the proximal femur

Bone mass is an important determinant of resistance to fractures. Whether bone mineral density (BMD) in subjects with a fracture of the proximal femur (hip fracture) is different from that of age-matched controls is still debated. We measured BMD of the femoral neck (FN) on the opposite side to the fracture, as well as femoral shaft (FS) and lumbar spine (LS) BMD by dual-photon absorptiometry in 68 patients (57 women and 11 men, mean age 78.8±1.0) 12.4±0.8 days after hip fracture following a moderate trauma. These values were compared with BMD of 93 non-fractured elderly control subjects (82 women and 11 men), measured during the same period. As compared with the controls, FN BMD was significantly lower in fractured women (0.592±0.013 v. 0.728±0.014 g/cm²,P<0.001) and in fractured men (0.697±0.029 v. 0.840±0.052,P<0.05). Expressed as standard deviations above or below the mean BMD of age and sex-matched normal subjects (Z-score), the difference in FN BMD between fractured women and controls was highly significant (–0.6±0.1 v. +0.1±0.1,P<0.001). As compared with mean BMD of young normal subjects, BMD was decreased by 36.9±1.4 and 22.4±1.5% (P<0.001) in fractured and control women, respectively. There was no significant difference between FN BMD of 33 women with cervical and 24 with trochanteric hip fractures (0.603±0.017 v. 0.577±0.020). FN BMD was lower than 0.705 g/cm² in 90% of fractured women. The prevalence of fracture increased with decreasing FN BMD, reaching 100% with values below 0.500 g/cm². FS and LS BMD were significantly lower in women with hip fracture than in controls (1.388±0.036 v. 1.580±0.030,P<0.001, for FS, and 0.886±0.027 v. 0.985±0.023,P<0.01, for LS), but these differences were not significant when expressed as a Z-score. In men with a recent hip fracture, FS BMD was significantly lower than in controls (1.729±0.096 v. 2.069±0.062,P<0.01), but the difference at the LS level did not reach statistical significance. These results indicate that both women and men with a recent hip fracture had decreased bone mineral density of the femoral neck, femoral shaft and lumbar spine. However, the difference appeared to be of higher magnitude for the femoral neck suggesting a preferential bone loss at this site.     

颈动脉内膜中层厚度和绝经后妇女骨密度相关性研究

目的探讨绝经后骨质疏松症患者颈动脉内膜中层厚度(CIMT)的差异及CIMT和斑块增大的风险。方法进行横断面研究,包括60位绝经后骨质疏松症妇女和60位非骨质疏松症绝经后妇女。CIMT采用B型超声测量。结果绝经后骨质疏松症妇女与无骨质疏松症妇女的平均CIMT差异无统计学意义(P 0.05)。骨质疏松症组CIMT升高的风险与非骨质疏松症组相似。骨质疏松症妇女斑块出现的风险是正常人的三倍。然而,调整了易使妇女患有心血管疾病的年龄和基础疾病后,两组之间斑块的存在并无显着差异(校正比值比=0.85;95%可信区间0.10～6.464)。结论绝经后妇女与无骨质疏松症患者的平均CIMT无差异。绝经后骨质疏松症女性的CIMT升高风险与无骨质疏松症的绝经后妇女相当。两组之间斑块的存在没有显着差异。     

漯河地区中老年骨质疏松性骨折与股骨近端骨密度相关性研究

目的 调查漯河地区中老年骨密度(BMD)的变化规律和骨折之间的关系。方法 采用法国Medlink公司的的双能X线骨密度仪对漯河地区649名中老年人进行健侧髋部股骨颈、大转子、粗隆间和全髋的骨密度值测量。结果 骨折组各年龄段、各部位的BMD均比非骨折组低（P<0.05）。随着年龄的增长股骨近端骨量逐渐丢失,除了45~组,其余区域各年龄段骨折组的患病率明显高于非骨折组(P<0.05),骨密度值越低,骨折危险性越大。结论 中老年人骨近端骨密度值与发生骨质疏松性骨折之间存在密切关系,不容忽视。