中国部分地区一般人群标准化骨密度正常参考值研究

目的 调查中国部分地区一般人群标准化骨密度的正常参考值。方法 采用双能 X线骨密度仪,对中国部分地区 20岁以上一般人群随机抽样 2 331例进行骨密度测量。所得结果均进行了标准化处理。结果 确定不同年龄组男女腰椎及股骨近端标准化骨密度的正常参考值及峰值。结论 经计算进一步得出骨质疏松症的标准化骨密度诊断参考值及治疗参考值,为骨质疏松症的临床病因研究和流行病学比较研究奠定基础。     

乳腺癌患病人群种族差异研究进展

乳腺癌是严重威胁女性生命的恶性肿瘤之一。据世界卫生组织国际癌症研究中心(IARC)的统计(GLOBOCAN2002),全球每年新发女性乳腺癌病例达115万,占女性恶性肿瘤病例的23%;死亡41万,占女性恶性肿瘤总死亡病     

中国与美国多种族女性髋部骨量和丢失率的比较

目的比较中国本土女性和美国不同种族女性与年龄相关的骨量及丢失率的差异。方法我们采用DXA骨密度仪测量3614例中国女性髋部各区域的骨密度（BMD）、体积骨密度（vBMD）、骨矿含量（BMC）和骨面积（BA），并与美国第三次国家健康和营养调查（NHANES Ⅲ）报告中的白人、黑人和美国墨西哥女性的资料比较。结果中国女性髋部各区域的BMD和BMC随年龄变化的拟合曲线均显著低于美国各种族女性（P=0．001—0．000）；黑人女性则始终处在最高水平（P=0．000）。在股骨颈，由BMD转换为vBMD表达时，中国女性与黑人的差异由22％缩小到18％，中国女性与白人的差异由7．4％缩小到0．8％，但白人和美国墨西哥人女性的差异由3．2％扩大到9．6％，白人与黑人女性的差异由13％扩大到17％。自人女性股骨颈和总体髋部的骨面积显著大于中国女性、美国墨西哥人和黑人女性（P=0．005～0．000）。到80岁时，各骨骼区域的累计骨丢失率，中国女性、美国墨西哥人、白人和黑人女性分别为-38．9％±1．8％，-34．4％±3．1％，-27．8％±5．9％和-28．4％±4．8％。结论中国本土女性髋部骨量显著低于美国非亚裔种族女性，而累计骨丢失率又显著大于美国非亚裔女性。在股骨颈，中国女性的vBMD与白人女性相似。     

广西南宁地区健康人群骨密度十年前后比较

目的：比较广西南宁地区十年前后健康体检人群骨密度变化及骨质疏松患病率。方法横断面调查2011年1月－2012年6月在广西壮族自治区人民医院进行健康体检的20－80岁人群2524例的骨密度情况,并与十年前1058例横断面调查比较,骨密度检测采用同一台双能X线骨密度仪（ DEXA）。结果男性和女性骨峰值年龄均为30－39岁,与十年前的结果一致。在30－39岁人群组中,十年前后男、女在股骨颈、ward三角、大转子、腰椎（ L2、L3、L4）骨密度值比较无统计学意义;60－80岁的老年总人群、老年男性和老年女性十年前后骨质疏松患病率（16．56％对17．78％,12．30％对18．28％,19．21％对17．31％,均P＞0．05）差异均无统计学意义。结论虽然十年前后环境因素包括生活方式和人们保健意识等发生较大变化,但影响骨代谢的有利因素和不利因素共存,因此,导致男女骨峰值水平和老年骨质疏松患病率无显著性差异。     

海口地区各年龄段人群骨密度变化及中老年骨质疏松患病率调查

目的分析海口地区常住居民各年龄段人群骨密度(bone mineral density,BMD)值变化情况,并调查分析中老年骨质疏松患病率。方法采用多阶段抽样法抽取海口地区常住居民2 176名,采用双能X线检测腰椎正位BMD、左髋部BMD,并根据性别、年龄分组对骨质疏松患病率进行分析,统计中老年(年龄≥46岁)骨质疏松患病率。结果 BMD值随年龄增加呈下降趋势,51岁以上男性BMD值同年龄段内女性,且组间差异有统计学意义(P0.05);男性在66～70岁年龄段BMD明显增加,其中L1～4最明显;女性51～55岁年龄段内BMD值下降最明显。海口地区城市女性Ward’s、Troch的BMD高于农村女性(P0.05)。海口地区中老年人骨质疏松总发生率为58.17%,中老年人骨质疏松发生率随年龄增加呈上升趋势;相同年龄段内,男性骨质疏松发生率低于女性,男性在66～70岁、76～80岁两个年龄段内骨质疏松发生率略下降。骨折发生率随年龄增加呈上升趋势,同年龄段内男性骨折发生率低于女性,女性76～80岁年龄段内骨折发生率最高;脊柱骨折发生率最高,81岁及以上年龄骨折发生率呈下降趋势。结论海口地区常住居民BMD随年龄增加下降,中老年骨质疏松发生率较高,且随年龄增加上升,女性骨质疏松发生率显著高于男性,因此应加强中老年群体干预与健康教育。     

西安市区正常人群骨密度和峰值骨密度的调查

目的通过调查西安市区正常人群的骨密度(BMD)和峰值骨密度(PBD),从而为西安市区骨质疏松症的预防、诊断和治疗等工作提供一定的理论依据。方法随机选择564名年龄20～80岁的健康西安城市人群。男女性别均以10岁为一个年龄段分为6组,用双能X光骨密度仪(HolgicQDR-2000)测量骨密度。结果男性腰椎和髋部PBD值出现在30～岁,女性腰椎及髋部PBD值也出现在30～岁这一年龄段。结论男女性各部位PBD的形成大部分处于30～岁这个年龄段,并经过进一步的计算得出了西安市骨质疏松症的骨密度诊断参考值和低骨量干预参考值。     

峰值骨量的种族差异

目的 了解各种族之间峰值骨量(PBMD)参考值的差异.方法 收集国内外20多个国家和地区不同种族人群的PBMD参考值,比较了三大人种的峰值骨量的数据,并进行了统计学分析.结果 一般来说,黑色人种的峰值骨量最高,其次是白色人种,黄色人种的峰值骨量最低.中东地区的峰值骨量接近白色人种.黄色人种到达峰值骨量的年龄早于黑色人种及白色人种.我国各少数民族之间的峰值骨量也不尽相同,女性的峰值骨量的民族差异明显大于男性.结论 不同国家和地区各种族人群之间的PBMD参考值绝大多数存在种族或地域差异,必须针对不同人口和地区建立相应的骨密度正常参考值.     

包头地区人群骨密度影响因素研究

目的 研究影响包头地区人群骨密度的相关因素。方法 采用病例-对照研究方法。收集来自包头医学院第一附属医院进行健康体检的596例女性和230例男性流行病学资料,用双能X线吸收仪对研究对象进行骨扫描,按骨密度检测值分为正常对照组和骨质疏松及骨量流失组。采用 Logistic回归法分析影响骨密度的相关因素。结果 经Logistic回归分析,饮酒是女性发生骨质疏松的危险因素,吸烟、饮酒是男性发生骨质疏松的危险因素。补钙是人群保护因素。结论 包头地区 男、女性通过补钙均可预防骨质疏松;饮酒与女性骨量流失及骨质疏松显著相关,吸烟、饮酒与男性骨量流失及骨质疏松显著相关。     

廊坊地区部分人群骨密度调查分析

目的调查廊坊地区部分人群的骨密度情况,了解相关影响因素对廊坊地区部分健康人群骨密度的变化规律和骨量减少、骨质疏松的发病影响。方法双能X线骨密度仪对中国石油天然气集团公司中心医院1298名体检者右前臂中远1/3处进行骨密度测量,其中男性382名,女性916名,年龄40~76岁,平均年龄53.3±22.7岁,全部数据按性别、年龄分组输入电脑,采用SPSS13.0统计软件,按10岁为1个年龄组,分析各组的骨密度,分析骨质疏松的发病情况,组间比较采用t检验,取P0.05为有统计学意义。结果体重指数、牛奶、豆制品可以对骨密度起到一定的保护作用,吸烟、饮酒等日常生活习惯可以导致骨密度降低。结论体重指数、日常生活习惯、饮食、规律的运动都可以影响骨密度。     

中国丹东地区满族不同年龄人群骨密度及骨质疏松症患病率的调查

目的调查丹东地区满族不同年龄组人群骨密度(bone mineral density,BMD)情况,了解骨质疏松(osteoporosis,OP)患病率及相关危险因素。方法采用美国Osteometer Medi Tech公司生产的DTX-200型双能X线骨密度仪,于2010年9月～12月对732例满族健康人群检测非受力侧前臂尺桡骨远端骨密度,每10岁为一组,获得数据进行统计学分析,同时填写骨质疏松危险因素调查表。结果满族男性BMD在30～39岁达骨峰值,0.619±0.059(g/cm2),女性在40～49岁达骨峰值,0.527±0.068(g/cm2),之后BMD开始下降。50岁后骨量减少的总体发生率男女比较无差异(P>0.05)。但70岁以上女性的OP发病率较同年龄组男性明显升高,差异非常显著(P<0.01)。男性OP的发生与年龄、长期素食正相关,与体重、经常饮牛奶负相关,而女性OP的发生仅与年龄正相关。结论通过对丹东地区满族人群骨密度的调查有助于建立丹东地区满族人群骨质疏松症诊断标准,提供骨质疏松症及其并发症的防治依据。     

Population-based reference values for bone mineral density in young men

Summary Population-based reference values for peak bone mass density in Danish men. BMD of total hip (1.078 ± 0,14 g/cm²) differed significantly from values from National Health and Nutrition Examination Survey III and of total lumbar spine ((1.073 ± 0.125 g/cm²) differed significantly from Hologic values. Introduction Geographic, ethnic, and socio-economic factors are known to affect bone mineral density (BMD) and peak bone mass significantly. Reference values for male peak bone mass are scarce, and the diagnosis of male osteoporosis often relies on values provided by producers of dual-energy X-ray absorptiometry (DXA) equipment. Methods The aim of the present study was 1) to establish population-based reference values for BMD in young men and 2) to study subgroups based on variables with suspected impact on bone metabolism. We included 783 young Caucasian men aged 20 to 30 years in the Odense Androgen Study (OAS). Results Peak BMD was attained within the third decade. Obesity (BMI > 30 kg/m²) was associated with higher BMD. Abuse of anabolic steroids as well as chronic illness was associated with lower BMD. Our population-based reference values for BMD of the total hip (1.078 ± 0.14 g/cm²) differed significantly from published values from National Health and Nutrition Examination Survey III for non-Hispanic white men, while BMD of total lumbar spine (1.073 ± 0.125 g/cm²) differed significantly from Hologic reference values. Conclusions Locally derived reference values are important to avoid false positive or false negative findings during work-up in patients evaluated for osteoporosis.     

Comparison of spine and femur reference data in native Chinese women from different regions of China

The aim of this study is to explore the differences of BMD reference curves at various skeletal sites among Chinese women from different regions of China and to investigate the feasibility of establishing a unified national BMD reference database for Chinese women. We measured BMD at the posteroanterior (PA) lumbar spine, femoral neck, trochanter and Wards triangle by dual-energy X-ray absorptiometry bone densitometer in 3,422 Changsha women of South Central China, aged 20–84 years. The documented BMDs of reference populations of women in all other areas included Shanghai ( n =2,111) and Nanjing ( n =3,174) in the East, Shenyang ( n =1,213) in the Northeast, Kunming ( n =523) in the Southwest, Chongqing ( n =811) in the Midwest and Xian ( n =1,320) in the Northwest. We adopted the cubic regression as the fitting model for reference curves of BMD that varied with age, conducted conversions of BMD measured by various bone densitometers from different manufacturers and compared the differences between standardized BMD (sBMD) reference curves and combined ones for women from different areas. Our results revealed that by comparing variances in women from different areas, the average variances of non-standard BMD were 0.8–30.8% at the PA spine, 0.7–24.5% at the femoral neck, 0.6–29.9% at the trochanter and 1.1–54.7% at Wards triangle, while average variances of sBMD either significantly decreased or disappeared (0.8–3.9% at the PA spine, 0.7–8.6% at the femoral neck, 0.6–8.3% at the trochanter and 1.1–29.9% at Wards triangle). The sBMD reference curves were highly positive-dependent with combined ones ( r =0.913–0.999, P =0.000). At the PA spine and trochanter, the effect of combined sBMD curves presented well in women from different areas, except for those from Shanghai at the PA spine and Shenyang at the trochanter, indicating that sBMD curves were significantly different from pooled ones; at the femoral neck and Wards triangle, the effect of combined sBMD reference curves was poor, indicating that sBMD curves demonstrated significant differences from pooled ones in women from a majority of these areas. We conclude that, in high density population areas, sBMD reference curves showed no significant geographic differences in women from various regions. In women from different areas, sBMD reference curves present good pooled results at the PA spine and trochanter. The less ideal combining effect of the sBMD curves at both femoral neck and Wards triangle might be caused by the intrinsic differences from the different measuring instruments.     

Femoral and whole-body bone mineral density in middle-aged and older Norwegian men and women: suitability of the reference values

The aim of this study was to compare bone mineral density (BMD) in a population-based sample of middle-aged and older Norwegians, with reference values provided by the manufacturer of the densitometer (Lunar) in order to evaluate whether these reference values are suitable for Norwegians. Additional aims were to estimate the prevalence of osteoporosis. Bone mineral density of the hip and total body was measured by dual-energy X-ray absorptiometry in 2303 men and 3105 women 47–50 and 71–75 years old, respectively, in western Norway, as part of the Hordaland Health Study (HUSK). Of these, 3403 white individuals were free of medications or diseases known to influence bone metabolism (reference group). Compared with the Lunar reference population, men and older women had a slightly but significantly lower BMD of trochanter and total femur and middle aged women had significantly higher total body BMD. Except for the higher mean BMD of total body among middle-aged women and the uniformly lower BMD values of Wards triangle, the deviations from the reference values of the manufacturer were less than 4%. Approximately 2.6% of middle-aged men vs 0.9% of middle-aged women were classified as osteoporotic on the basis of BMD of femoral neck. While the BMD values for femoral neck in this healthy Norwegian population are similar to the reference population of Lunar, the values of trochanter and total femur are lower in all groups except middle-aged women; however, the discrepancies are not of sufficient magnitude to warrant rejection of this commonly used database among Norwegians. Use of the young adult means from the Lunar reference database classified a higher proportion of middle-aged men than women as osteoporotic and osteopenic.     

女性不同骨骼部位骨密度峰值和参考图的建立方法

目的建立女性不同骨骼部位骨密度(BMD)参考图和确定峰值BMD(PBMD). 方法 用DXA QDR 4500A型扇形束骨密度仪测量3378例5～96岁女性腰椎前后位(AP)和仰卧侧位、髋部和前臂的BMD,用8种回归模型拟合BMD随年龄的变化,找出最佳拟合模型方程建立参考图和确定PBMD.结果三次回归模型拟合程度最佳,即方程的决定系数(R2)最大.我们应用拟合曲线建立了BMD参考图,拟合曲线方程计算各骨骼部位最高的BMD(A方法)和BMD最高的5岁年龄组(B方法)及年龄横断面(C方法)计算PBMD,发现在大多数骨骼部位,三种方法计算的PBMD的差异有显著性.结论此研究建立了女性不同骨骼部位BMD参考图.应用拟合曲线方程计算PBMD(A方法)可获得符合骨骼部位特异性的真正的PBMD,不同方法计算PBMD将对PBMD和诊断骨质疏松产生严重影响.     

中国长沙地区女性多骨骼部位骨密度参考值横断面调查

目的 横断面调查中国长沙地区女性多骨骼部位骨密度（BMD）随年龄的变化，建立诊断骨质疏松症（OP）参考数据库。方法 用DXA QDR－4500A型扇形束骨密度仪测定2702例5－96岁女性腰椎前后位（AP）和仰卧侧位、髋部及前臂38个不同区域的BMD。结果 按每5岁年龄分组分析的结果显示，38个不同骨骼区域的峰值BMD分别出现在20－24岁至40－44岁之间，其中髋部（股骨颈除外）最早（20－24岁），前臂（超远端除外）最晚（40－44岁）。结论 不同骨骼区域峰值BMD出现的年龄各异。     

Comparison of areal and estimated volumetric bone mineral density values between older men and women

We compared areal bone mineral density (BMD) of the total body (TBMD), antero-posterior lumbar spine at L3 (APS), lateral spine at L3 (LS) and femoral neck (FN). In order to understand better the effect of gender-related size differences on BMD, we also compared the estimated volumetric BMD at L3 (VLS) and the femoral neck (VFN). Subjects were asymptomatic women (n=22) and men (n=44) with an age range of 58–79 years. BMD at each site was measured by dual-energy X-ray absorptiometry using a Hologic 2000 in array mode. Results of the statistical analyses (ANOVA) showed the men to have significantly greater BMD at all areal sites [APS, LS (p<0.05); FN (p<0.01); TBMD (p<0.001)]. The two estimated volumetric comparisons, however, showed no gender differences. Results demonstrate how measures from areal BMD measures can be misleading when comparing groups of different size. In older men and women planar measures may overestimate gender differences in BMD.     

Racial difference in the correlates of bone mineral content/density and age at peak among reproductive-aged women

Summary  Racial/ethnic differences were observed in age at peak bone density and their correlates, with whites peaking at least 5 years earlier at the femoral neck than black and Hispanic women. Race-specific standards generated in this study could be useful when interpreting bone densitometry data in young women. Introduction  The influence of race/ethnicity on bone measurements has not been widely examined. This study identifies age and amount of bone accumulated at peak density and their correlates by race/ethnicity. Methods  Bone mineral content (BMC) and bone mineral density (BMD) of the spine and femoral neck were measured by dual X-ray absorptiometry in 708 white, black, and Hispanic reproductive-aged women. Race-specific nonlinear models were used to describe the relationship between age and bone measurements, after adjusting for body weight and height. Log-transformed bone measurements were used to determine predictors based on multiple linear regression. Results  Predictors, which were race and site specific, included age, age at menarche, body weight, height, months of depot medroxyprogesterone acetate use, weight-bearing exercise, and alcohol use. Women of all races gained BMC and BMD at the spine up to 30–33 years of age. BMC and BMD of the femoral neck peaked among white women earlier (≤16 years) than among blacks (BMC 22 years; BMD 21 years) and Hispanics (BMC 29 years; BMD 20 years). Conclusion  Age at peak bone mass and its correlates differ by race/ethnicity. Race-specific standards generated in this study could be useful when interpreting bone densitometry data in young women. This work was supported by the National Institute of Child Health and Human Development grants R01HD39883 and K24HD043659 awarded to ABB and General Clinical Research Centers (GCRC) program, National Center for Research Resources, NIH, M01RR000073.     

跟骨超声骨质测量与双能量X线吸收骨密度测量的比较

我们试图通过对跟骨超声骨质测量仪与双能量Ｘ线吸收骨密度测量仪的临床对比，来评价跟骨超声骨质测量仪的敏感性。本文对５６名健康女性同时接受了超声骨质测量仪和双能量Ｘ线吸收骨密度仪的检测。３７例（年龄２６～７６岁）进行了跟骨超声和腰椎骨密度测量，１９例（年龄２６～７０岁）进行了跟骨超声和股骨颈骨密度测量。结果用ＳＹＳＴＡＴ统计软件包进行处理。结果表明：随着年龄的增加，腰椎、股骨颈骨密度及跟骨强度（Ｓｔｉｆｆｎｅｓｓ）均显著下降（Ｐ＜０．０５），两种仪器的阳性检出率无明显差异（Ｐ＜０．０５）。但腰椎和股骨颈ＢＭＤ与跟骨强度（Ｓｔｉｆｆｎｅｓｓ）的相关性适中ｒ＝０．４６５～０．５１３左右。通过逐步多元回归分析显示超声强度（Ｓｔｉｆｆｎｅｓｓ）与ＢＭＤ无关。这表明超声波测量仪主要测量骨的结构变化，而骨密度测量仪则是测量骨量的变化。两种方法相辅相承，共同测量，将更好地预测骨质疏松性骨折的发生。同时超声波具有无放射线损害、价格低廉及良好的敏感性，将越来越受到临床重视。     

不同民族及部分生活因子对骨密度的影响

目的　确定部分生活因子对不同民族骨密度影响因素的影响 ,以便指导骨质疏松症的防治工作。方法　对新疆乌鲁木齐、伊犁、乌苏、吐鲁番地区 787例 2 0～ 70岁汉族、维吾尔族、哈萨克族健康人用问卷方法进行生活因子的调查 ,并用QCT法测定腰椎松质骨密度 (BMD)值 ,将有关的调查结果进行统计学处理。结果　 (1 )各民族相比较 ,哈、维女性BMD高于汉族女性 (P <0 0 5) ;(2 )各民族均未见吸烟、饮酒对BMD的影响 ;(3)维族男性、女性和哈族男性及汉族女性体重与BMD呈负相关 (P <0 0 1 ) ;汉族女性身高与BMD呈正相关 (P <0 0 1 ) ;(4)汉族女性参加体育锻炼者的骨密度高于不参加体育锻炼者 ;(5)汉族人群中 ,每天饮用牛奶 50 0g以上者的骨密度高于每天饮用 50 0g以下或不饮用牛奶者。结论　 (1 )不同民族BMD有差异 ;(2 )吸烟、饮酒不影响BMD ;(3)身高、体重是BMD的影响因素 ;(4)运动可增加骨密度。我们认为健康的生活习惯可预防骨密度降低     

绝经后女性的体成分与年龄和绝经的关系及其对不同部位骨密度的影响

目的 调查绝经后女性的体成分与年龄、绝经年龄、绝经年限和腰椎、髋部BMD之间的关系.方法 用双能X线骨密度仪测量919例绝经后女性的体成分、正位腰椎和髋部BMD.结果 下身脂肪量、全身脂肪量和全身瘦组织量与年龄、绝经年龄和绝经年限都相关(P＜0.05～0.01),但只有绝经年限进入体成分的多元逐步回归方程,采用复合或三次回归模型拟合优度最佳.体成分随绝经年限的延长有下降趋势.绝经10年以上女性的下身脂肪量和全身瘦组织量显著减少,分别较绝经年限5年以内女性下降8.6%和3.1%.所有部位的体成分与所测区域的BMD 均呈正相关(P＜0.05～0.01),控制体重变量后,仅有全身脂肪量与腰椎BMD 呈正相关(P＜0.05),而全身瘦组织量与髋部BMD 呈正相关(P＜0.05).多元逐步回归分析发现体成分是影响腰椎和髋部BMD的一个重要因素,但对腰椎BMD影响最大的是全身脂肪量,而对髋部BMD影响最大的是全身瘦组织量.BMD 越低者,全身脂肪量和全身瘦组织量也越低,组间比较有显著性差异.结论 绝经后女性的体成分与年龄、绝经年龄、绝经年限和腰椎、髋部BMD相关,其中,绝经年限对体成分的影响最大,体成分组分对BMD的影响存在部位差异.