绝经前期妇女血清PINP、ICTP和25-OH-VitD_3水平的变化及其与BMD的相关性分析

目的：观察绝经前期妇女血清PINP、ICTP和25-OH-VitD3水平的变化,分析其与骨密度（BMD）的相关性。方法：采用双能X线吸收法（DEXA）对67例绝经前期健康女性进行第（1～4）腰椎（L1-4）、左、右髋部（股骨近段＋股骨颈）的BMD测定,并根据BMD测定结果分为BMD正常组和BMD降低组。用放射免疫分析（RIA）测定血清Ⅰ型前胶原氨基端前肽（PINP）、Ⅰ型胶原交联羧基末端肽（ICTP）和25-羟维生素D3（25-OH-VitD3）,分析与各部位BMD的相关性。结果：①19例出现BMD降低（28.4%）,两组间腰椎及左、右髋部BMD差异显著（P〈0.01）;②BMD减低组的PINP和ICTP[分别为（56.9±18.2）μg/L和（3.78±0.83）μg/L]高于BMD正常组[分别为（43.8±15.1）μg/L和（3.45±0.98）μg/L],其中PINP差异显著（P〈0.05）,25-OH-VitD3水平两组间无显著性差异[分别为（25.6±7.8）ng/ml和（27.4±9.2）ng/ml,P〉0.05];③PINP与L1-4、左股骨近段、左股骨颈的BMD呈正相关（r=0.274～0.402,P〈0.05）,ICTP及25-OH-VitD3与BMD无明显相关性（r=-0.226～0.083,P〉0.05）,PINP与25-OH-VitD3呈一定程度的正相关（r=0.395,P〈0.05）。结论：绝经前期妇女有骨转换增高趋势,BMD检查联合骨转换标志物测定有利于识别绝经前期高风险发生骨质疏松的妇女,以指导OP预防性治疗。     

绝经早期妇女血清PINP、ICTP和OC水平与骨密度的关系

目的:分析绝经后1年～5年的绝经早期妇女骨密度(BMD)与血清Ⅰ型前胶原氨基端前肽(PINP)、Ⅰ型胶原交联羧基末端肽(ICTP)和骨钙素(OC)水平的变化特点,探讨骨转换生化指标在绝经早期女性(绝经1～5年)骨质疏松(OP)早期诊断中的价值。方法:采用双能X线骨密度吸收测定仪(DEXA)对90例绝经早期妇女进行不同部位的BMD测定,并根据BMD测定结果分为BMD正常组和BMD降低组;用放射免疫分析,测定血清PINP、ICTP和OC含量,分析与BMD的相关性。结果:36例出现BMD降低(40%);BMD减低组的PINP、ICTP和OC均明显高于BMD正常组,差异有统计学意义(P<0.05);腰椎(L1—4)BMD与ICTP、PINP和OC呈负相关。结论:绝经早期妇女BMD减低者的骨转换增高,妇女绝经后早期定期联检OC、PINP和IC-TP,可早期识别出那些有高骨转换率而致发生骨质疏松风险的人群,以指导及时的预防性治疗,从而可阻挡或延缓OP进程,降低OP的发生率。     

基于双能X线骨密度仪在绝经后妇女椎体脆性骨折中的应用

目的:探讨双能X线骨密度仪(DXA)在绝经后妇女椎体脆性骨折中的应用。方法:通过DXA连续检测274例50岁以上无症状绝经后妇女腰椎(L_1-L_4)、股骨颈和全髋的骨密度(BMD)同时,应用椎体骨折评估软件(VFA)评估椎体脆性骨折;收集所有受检者一般资料。结果:274例受检者经VFA检查发现有103例椎体脆性骨折。(1)单因素分析显示,年龄、绝经年限、绝经年龄及各部位BMD是绝经后妇女椎体脆性骨折的可能影响因子(P0.05);(2)选择单因素分析有统计学意义并经共线性诊断的变量,进一步行多因素二分类Logistic回归分析显示,绝经年限及全髋BMD是椎体脆性骨折的危险因素(P0.05);(3)BMD联合VFA骨质疏松诊断率提高7.3%(P0.05)。结论:绝经年限增加、全髋BMD降低对绝经后妇女椎体脆性骨折有重要的预测价值。对绝经后妇女椎体脆性骨折的防治在重视BMD的同时要联合进行椎体骨折评估,以提高椎体脆性骨折及骨质疏松诊断率。     

唑来膦酸注射液联合金天格胶囊治疗 绝经后骨质疏松症疗效分析

目的 分析唑来膦酸注射液与金天格胶囊联合治疗绝经后骨质疏松症的效果及VAS评分。方法 选取2016年6月~2018年6月本院68例绝经后骨质疏松患者的临床资料,按照数字随机法分为对照组和研究组,各34例。对照组给予唑来膦酸注射液治疗,研究组给予唑来膦酸注射液与金天格胶囊联合治疗,比较两组的实验室相关指标、骨密度及VAS评分。结果 研究组骨密度腰椎（0.92±0.15）g/cm2、股骨颈（0.85±0.17）g/cm2、股骨大转子（0.91±0.13）g/cm2、Ward's三角区（0.81±0.12）g/cm2,高于对照组（0.72±0.11）g/cm2、（0.62±0.08）g/cm2、（0.68±0.11）g/cm2、（0.61±0.08）g/cm2,差异有统计学意义（P＜0.05）;骨钙素（10.28±1.27）ng/ml、骨特异性碱性磷酸酶（20.12±3.06）U/L,异有统计学意义（P＜0.05）;VAS评分（1.66±0.12）分,低于对照组（3.88±1.06）分,差异有统计学意义（P＜0.05）。结论 唑来膦酸注射液联合金天格胶囊治疗绝经后骨质疏松症的临床效果显著,有利于改善患者的骨密度和骨代谢指标,减轻疼痛。     

女性Graves病患者行131Ⅰ治疗前后骨密度及血清骨代谢指标变化的研究分析

目的 分析女性Graves病患者行131Ⅰ治疗前后骨密度及血清骨代谢指标的变化.方法 收集经131Ⅰ治疗的86例女性Graves病患者的资料,根据绝经情况随机分为绝经组和未绝经组,各43例,分别于治疗前、治疗后测量两组的腰椎、髋部骨密度(BMD)及血钙(Ca)、磷(P),甲状旁腺激素(PTH),碱性磷酸酶(ALP),血骨钙素(BGP)等骨代谢指标.结果 131Ⅰ治疗前,两组的BMD及骨代谢指标均有不同程度的改变,组间对比差异无统计学意义(P＞0.05);治疗后,两组的BMD明显上升,骨代谢指标ALP、BGP水平明显降低,未绝经组变化更加明显(P＜0.05),但两组血Ca、P、PTH水平差异无统计学意义(P＞0.05).结论 131Ⅰ治疗可以改善女性Graves病患者的骨密度及骨代谢情况.     

绝经后妇女骨质疏松患者外周血NLR、PLR水平与骨密度的相关性分析

目的:探讨绝经后妇女骨质疏松患者外周血中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)水平与骨密度(BMD)的相关性.方法:选取2018年4月至2020年9月在本院采用双能X线吸收法(DXA)进行BMD检查的166例绝经后妇女为研究对象,依据BMD检查结果将研究对象分为三组:对照组(60例)、骨量减少组(55例)、骨质疏松组(51例).BMD采用双能X线骨密度测定仪进行测定;采用日本Sysmex XE-2100型全自动血细胞分析仪进行血常规检查,计算两组外周血NLR、PLR水平并进行比较;采用Pearson分析外周血NLR、PLR水平与BMD的相关性;采用多因素Logistic回归模型分析绝经后妇女发生骨质疏松的影响因素.结果:对照组、骨量减少组、骨质疏松组腰椎、髋部BMD均依次降低(P<0.05),中性粒细胞、血小板、NLR、PLR均依次升高(P<0.05);Pearson相关分析结果显示,骨质疏松组外周血NLR、PLR水平与腰椎、髋部BMD均呈负相关(P<0.05);多因素Logistic回归分析结果显示,年龄、NLR、PLR均是绝经后妇女发生骨质疏松的危险因素(P<0.05),BMI是保护因素(P<0.05).结论:与绝经后妇女骨量正常者相比,绝经后妇女骨质疏松患者外周血NLR、PLR水平较高,与骨质疏松的发生、发展密切相关,年龄、NLR、PLR均是绝经后妇女发生骨质疏松的危险因素,BMI是保护因素,可能为预防、诊断及治疗绝经后妇女骨质疏松提供参考.     

甲亢患者骨矿物含量与血清PTH、BGP和CT的关系

为探讨甲亢患者骨矿物含量(BMD)与血清甲状旁腺激素(PTH)、骨钙素(BGP)和降钙素(CT)的关系,以167例甲亢患者为甲亢组,58名正常人为对照组,测定两组BMD和用RIA测定血清BGP、PTH、CT.结果表明,甲亢组的BMD(0.52±0.21g/cm2)和 CT(70.3±12.9ng/L)比正常组(0.79±0.36g/cm2, 102.7±27.4ng/L)下降(P＜0.01).甲亢组血清PTH(30.4±9.6ng/L)和BGP(12.6±4.1μg/L)比对照组(22.8±8.1ng/L,6.3±1.1μg/L)升高(P＜0.01).本文提示,甲亢患者的BMD与血清PTH、BGP、CT水平有关.     

小剂量雌二醇和孕酮对绝经后妇女骨质疏松的疗效研究

目的 :研究小剂量雌二醇和孕酮对绝经后妇女骨质疏松的影响 ,以评估其疗效。方法 :将 6 8例绝经3年以上 ,年龄 (5 2 5 9)岁 ,平均 5 6岁 ,体重指数不超过 2 5 ,经GBD— 92 8单光子骨矿物质密度测定仪测量前臂尺、桡骨远端 1 / 3处的骨矿物质密度 (BMD)的水平 ,诊断为骨质疏松的妇女 ,分成两个组进行治疗。第一组 36例为对照组 ,每天仅用乐力 2 0 0 0mg ,第二组 32例为治疗组 ,每天除用乐力 2 0 0 0mg外 ,加用 1 7βE2 0 5mg和醋酸甲羟孕酮 (MPA) 0 5mg。在治疗前、后 ,所有受试者均经BMD、妇检、阴道B超、阴道细胞学和乳房红外线检查。结果 :所有受试者在治疗前BMD的水平 ( x±s,g/cm2 )为 0 4 6± 0 0 7;治疗 1年后 ,对照组 :0 4 9± 0 0 5 ,均值比治疗前升高 3% ;治疗组 :0 5 2± 0 0 6 ,均值比治疗前升高 6 % ;治疗组中 ,有 1 0例患者在治疗前有轻度乳腺小叶增生 ,9例有 <1cm2 子宫肌瘤 ,在给予 1 7βE2 、MPA和钙剂治疗的同时 ,给予中成药平消胶囊和舒肝散进行治疗。 1年后 ,乳腺小叶增生者有 6例好转 ,4例不变。子宫小肌瘤者 4例略有缩小 ,5例不变。其余所有对象治疗 1年后 ,各项检查均未见异常。结论 :本文结果表明 ,仅用钙剂治疗绝经后妇女骨质疏松的疗效较差 ,钙剂加小剂量 1 7βE2 和M     

妇女隆钙素受体基因型与骨密度的关系

本文欲探讨中国汉族妇女降钙素受体(CTR)基因型频率分布及其与骨密度(BMD)的关系.对北京地区95名健康年轻妇女和127名绝经后妇女,采用聚合酶链反应-限制性片段长度多态性技术(PCR-RFLP)检测CTR基因型,同时通过PCR产物进行测序验证,应用双能X线吸收法测量BMD值.发现汉族妇女CTR基因型频率分布依次为CC、TC、TT(分别占90.5%、8.6%、0.9%),等位基因频率C和T各为94.8%、5.2%.年轻妇女组TC基因型者在腰椎和股骨大转子部位的BMD值均高于CC基因型的相应部位(P<0.05),绝经后妇女组不同基因型各部位BMD值无差别.提示汉族妇女CTR基因型频率分布不同于已报道的其他人种;CTR基因型与BMD间有一定关联.     

绝经期妇女骨密度改变与血浆白细胞介素-6关系的探讨

目的观察绝经后妇女骨密度 (BMD)改变与血浆白细胞介素 -6(IL -6)的关系。方法应用单光子骨密度仪测量非优势前臂尺桡骨中远端1/3交界处桡骨BMD ,小于0.601g/cm2则诊断为骨质疏松 ,据此将38名绝经期妇女分为绝经后非骨质疏松组和绝经后骨质疏松组两组 ,测定其外周血IL-6浓度及其他代谢指标。结果两组年龄、身高、体质量、体质量指数、血钙、血磷、血清总雌二醇、总睾酮均无显著性差异 (P>0.05)。绝经年限、血总碱性磷酸酶 (ALP)、血清骨钙素 (BGP)、骨密度、血浆IL -6浓度有显著性差异(P<0.05)。结论绝经后雌激素水平下降 ,血浆IL -6分泌增加 ,促进骨吸收增加 ,随时间的延长导致骨质疏松形成。     

Changes in bone mineral density during and after 3 years' use of tamoxifen or toremifene

OBJECTIVES: To study the effects of tamoxifen and toremifene on bone mineral density (BMD) in postmenopausal women with breast cancer. METHODS: Seventy patients with stage II-III breast cancer were randomized to start either tamoxifen (n = 36; 20 mg per day) or toremifene (n = 34; 40 mg per day) for 3 years. BMD in the lumbar spine and in the proximal femur was measured by dual-energy X-ray absorptiometry both before and during the treatment and 1 year after the discontinuation of the anti-estrogens. RESULTS: The baseline BMD measurements were comparable between the groups. In 3 years, lumbar BMD decreased by 1.7% in tamoxifen (P = 0.048) and 3.0% in toremifene (P = 0.001) users (ns between the groups), and femoral neck BMD by 0.9% (P = 0.040) and 1.3% (P = ns), respectively. The use of hormone replacement therapy (HRT) until the diagnosis of breast cancer was associated with decreases in lumbar BMD during anti-estrogen regimen (4% at 3 years) in contrast to unchanged lumbar BMD in women with no previous use of HRT. During the 1st year after the cessation of anti-estrogen, lumbar BMD did not change at all in either group whereas femoral BMD decreased in both the groups at the rate of 1.5-3.2%, as expected. CONCLUSIONS: We conclude that tamoxifen (20 mg) and toremifene (40 mg) have similar bone-sparing efficacy that in lumbar spine extends up to 1 year after the cessation of these regimens. This effect is not seen in lumbar spine BMD in those postmenopausal women who discontinue HRT at the time of breast cancer diagnosis.     

A prospective,randomized, placebo-controlled study of the dose effect of oral estradiol on bone mineral density in postmenopausal Chinese women

OBJECTIVES: One of the long-term consequences of estrogen deficiency in postmenopausal women is an increased risk of osteoporosis. Fractures of the hip and lumbar spine are associated with considerable morbidity and mortality. Estrogen replacement therapy reduces the risk of osteoporosis, but there is no clear agreement on the most appropriate doses to be used. The aim of this study was to compare changes in bone mineral density (BMD) measurements using conventional and lower dose estradiol. METHODS: A prospective, randomized, placebo-controlled 12-month study of the effect of 1 and 2 mg estradiol on BMD in 152 hysterectomized postmenopausal Chinese women with no contraindication to the use of estrogen replacement therapy. RESULTS: Over 12 months, spinal BMD in placebo treated patients decreased by a mean of 2% from baseline (-0.02+/-0.03 g/cm(2)) while it increased by 2% in the 1 mg (0.02+/-0.03 g/cm(2)) and 3% in the 2 mg group (0.03+/-0.03 g/cm(2)). Mean changes in BMD over 12 months in the hip were -0.02+/-0.02 g/cm(2) (-2%), 0.01+/-0.02 g/cm(2) (+1%) and 0.01+/-0.03 g/cm(2) (+1%) in the placebo, 1 and 2 mg estradiol groups, respectively (P<0.05). Relative to placebo, increases in BMD in both 1 and 2 mg groups were statistically significant for both spine and hip (P<0.05). However, there was no significant difference in the increase in BMD between the 1 and 2 mg doses for either lumbar spine or hip (P=0.82, 0.53, respectively). CONCLUSION: The results of our study show that a 1 mg dose of oral estradiol is effective in preventing bone loss in postmenopausal Chinese women.     

Memory impairments with adjuvant anastrozole versus tamoxifen in women with early-stage breast cancer

OBJECTIVE: Hormones have been implicated as modulators of cognitive functioning. For instance, results of our previous work in women with breast cancer showed that cognitive impairment was more severe and involved more memory domains in those who received adjuvant tamoxifen therapy compared with women who received chemotherapy alone or no adjuvant therapy. Recently aromatase inhibitors such as anastrozole have been used in lieu of tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor-positive, early-stage breast cancer. Plasma estrogen levels are significantly lower in women who receive anastrozole compared with those who receive tamoxifen. We hypothesized, therefore, that anastrozole would have a more profound effect on cognitive function than tamoxifen, a mixed estrogen agonist/antagonist. DESIGN: To test this hypothesis we compared cognitive function in women with early-stage breast cancer who received tamoxifen with those who received anastrozole therapy in a cross-sectional study. We evaluated cognitive function, depression, anxiety, and fatigue in 31 postmenopausal women with early-stage breast cancer who were between the ages of 21 and 65 years and treated with tamoxifen or anastrozole for a minimum of 3 months. RESULTS: The results showed that women who received anastrozole had poorer verbal and visual learning and memory than women who received tamoxifen. CONCLUSIONS: Additional, prospective studies are needed to validate and confirm the changes in cognitive function associated with hormone therapy for breast cancer.     

Association between breast cancer and bone mineral density: the Dubbo Osteoporosis Epidemiology Study

BACKGROUND: The association between bone mineral density and breast cancer was investigated in a nested case-control study, involving 30 breast cancer cases and 120 controls, aged 68+/-6 (mean +/-S.D.) years, as part of the Dubbo Osteoporosis Epidemiology Study (Australia). METHODS: Bone mineral density (BMD, g/cm(2)) at the femoral neck and lumbar spine was measured by dual energy X-ray absorptiometry. Anthropometric data and reproductive history were collected by direct interview using a structured questionnaire. RESULTS: In univariate conditional logistic regression analysis, lower age at menarche, longer overall duration of lifetime ovulation and higher bone density were associated with higher risk of breast cancer. Among the breast cancer cases, 20% of subjects had lumbar spine BMD greater than 1.20 g/cm(2) (or 2.5 S.D. above the mean) compared with less than 1% of the controls. After adjusting for the effects of duration of lifetime ovulation and body mass index, each 0.1 g/cm(2) increase in lumbar spine and femoral neck BMD was associated with a 2.1-fold (95% CI: 1.3-3.4) and 1.5-fold (1.0-2.4) respectively, higher risk of breast cancer. Further adjustment for age at menarche, hormone replacement therapy, and parity did not alter the result. Thus, postmenopausal BMD, which is affected by lifetime exposure to estrogen, is also related to risk of breast cancer. Importantly, it is estimated that estrogen therapy in osteoporotic women, even if raising the risk of breast cancer by 70% as suggested by some studies, would not elevate their risk to the level experienced by their non-osteoporotic counterparts. CONCLUSION: While the mechanism of this relationship remains to be explored, these data support the concept that lifetime exposure to estrogen is an indicator of risk of both breast cancer and osteoporosis. However, the use of estrogen in osteoporosis treatment would not elevate the risk of breast cancer in osteoporotic women up to the level experienced by their non-osteoporotic counterparts.     

健康及髋关节骨折老年妇女股骨颈骨密度的比较

目的了解健康与骨质疏松性髋关节骨折老年妇女股骨颈骨密度，并估计健康妇女髋轴长度(HAL)以取得其正常值。方法用双能X线吸收法(DXA)测量38例髋关节骨折组及108例正常对照组老年妇女的股骨颈骨密度(BMD)和髋轴长度(HAL)，进行组间比较。分析正常组妇女此两项指标间的关系及分别与年龄、身高间的关系。另对216例20～59岁健康妇女测量髋轴长度以取得其正常值。结果髋关节骨折老年妇女组股骨颈BMD为(0.6019±0.1187)g/cm     

Effects of tamoxifen on bone mineral density in postmenopausal women with breast cancer.

BACKGROUND AND METHODS. Tamoxifen, a synthetic antiestrogen, increases disease-free and overall survival when used as adjuvant therapy for primary breast cancer. Because it is given for long periods, it is important to know whether tamoxifen affects the skeleton, particularly since it is used extensively in postmenopausal women who are at risk for osteoporosis. Using photon absorptiometry, we studied the effects of tamoxifen on the bone mineral density of the lumbar spine and radius and on biochemical measures of bone metabolism in 140 postmenopausal women with axillary-node-negative breast cancer, in a two-year randomized, double-blind, placebo-controlled trial. RESULTS. In the women given tamoxifen, the mean bone mineral density of the lumbar spine increased by 0.61 percent per year, whereas in those given placebo it decreased by 1.00 percent per year (P less than 0.001). Radial bone mineral density decreased to the same extent in both groups. In a subgroup randomly selected from each group, serum osteocalcin and alkaline phosphatase concentrations decreased significantly in women given tamoxifen (P less than 0.001 for each variable), whereas serum parathyroid hormone and 1,25-dihydroxyvitamin D concentrations did not change significantly in either group. CONCLUSIONS. In postmenopausal women, treatment with tamoxifen is associated with preservation of the bone mineral density of the lumbar spine. Whether this favorable effect on bone mineral density is accompanied by a decrease in the risk of fractures remains to be determined.     

Denosumab

Denosumab is a fully human monoclonal IgG(2) antibody that binds to receptor activator of nuclear factor-κB ligand (RANKL) and inhibits bone resorption due to RANKL-mediated osteoclastogenesis. In Europe, subcutaneous denosumab is indicated for cancer treatment-induced bone loss in men with prostate cancer and in postmenopausal women with breast cancer. In a large (n= 1468), well designed, multinational, phase III trial in adult patients with prostate cancer who were receiving androgen-deprivation therapy, bone mineral density (BMD) at the lumbar spine was significantly improved from baseline after 24 (primary endpoint) and 36 months of treatment with subcutaneous denosumab (60 mg once every 6 months), relative to that with placebo. Moreover, the risk of new vertebral fracture was significantly reduced by 62% in the denosumab group compared with the placebo group. In breast cancer patients receiving aromatase inhibitor therapy (n =252), subcutaneous denosumab (60 mg once every 6 months) significantly improved BMD at the lumbar spine from baseline after 12 (primary endpoint) and 24 months of treatment relative to placebo in a pivotal phase III trial. There were significant improvements in BMD at all skeletal sites, including the lumbar spine, total hip, and femoral neck, after 24 and 36 months' denosumab treatment in prostate cancer patients and after 12 and 24 months' treatment in breast cancer patients. In general, these improvements occurred irrespective of baseline characteristics, including age, duration of hormone ablation therapy, and baseline BMD. Denosumab treatment was generally well tolerated for up to 24 months in breast cancer patients and for up to 36 months in prostate cancer patients.     

Aromatase inhibitors in breast cancer

Estrogens play important roles in breast cancer development and progression. In postmenopausal women, traditional endocrine therapies such as tamoxifen have sought to inhibit estrogen action by targeting the estrogen receptor itself. However, newer treatments are evolving that target estrogen production in postmenopausal tissues through inhibition of the aromatase enzyme. Clinical data demonstrate that these aromatase inhibitors are superior to tamoxifen as adjuvant therapy for breast cancer and have now replaced tamoxifen as first line therapy in a number of treatment regimens for postmenopausal breast cancer patients.     

Bone mineral density in breast cancer patients with positive estrogen receptor tumor status

AIM: The aim was to investigate bone mineral density (BMD) in breast cancer patients with positive estrogen receptor (ER) tumor status. METHODS: The participants were 110 postmenopausal breast cancer patients with positive estrogen receptor (ER+) tumor status. Two hundred and sixty-one age-matched, healthy postmenopausal women, all of whom were selected from our pooled data, served as controls. Age, age at menopause, years since menopause (YSM), height, weight, and body mass index (BMI, wt/ht(2)) were recorded. Lumbar spine (L2-4) BMD and Z-score were assessed by dual-energy X-ray absorptiometry. RESULTS: Bone mineral density in breast cancer patients was significantly higher than that in controls (0.89+/-0.12 g/cm(2) versus 0.84+/-0.16 g/cm(2), P<0.01). The Z-score in breast cancer patients was also higher than that in controls (110+/-13.6% versus 100+/-9.8%, P<0.001). Higher BMD and Z-score in breast cancer patients remained significant after adjusting for age, YSM, and BMI (P<0.05). CONCLUSIONS: Postmenopausal breast cancer patients with positive ER tumor status have higher BMD. Positive ER tumor status may be associated with higher cumulative exposure to estrogen.