Correlates of trabecular and cortical volumetric bone mineral density at the femoral neck and lumbar spine: The osteoporotic fractures in men study (MrOS)

The objective of this cross‐sectional analysis was to examine the correlates of trabecular and cortical volumetric bone mineral density (vBMD) in 3670 community‐dwelling men, mean age 73.6 ± 5.9 years. vBMD was measured by quantitative computed tomography (QCT) and areal BMD by dual‐energy X‐ray absorptiometry (DXA). Demographic, historical, and lifestyle information was obtained by interview, and height, weight, and neuromuscular function were determined by examination. To express the strength of the associations, percent differences (95% confidence interval) were calculated from multivariable linear regression models using the formula 100 (β × unit/mean BMD). Units for continuous variables were chosen to approximate 1 standard deviation (SD). The multivariable linear regression models predicted 15%, 21%, and 20% of the overall variance in trabecular and cortical vBMD of the femoral neck and vBMD of the lumbar spine, respectively. Diabetes was associated with a 16.5% greater trabecular vBMD at the femoral neck and 11% at the lumbar spine but less than 2% for cortical vBMD. For femoral neck trabecular vBMD, the strongest negative correlates were past smoking (?9%), fracture history (?15%), kidney stones (?7%), corticosteroids (?11%), and insulin therapy (?26%). For cortical vBMD, the strongest negative correlate was use of thyroid medication (?2.8%). The strongest negative correlates for lumbar spine trabecular vBMD were fracture history (?5%), antiandrogen use (?19%), height (?8%), and thiazoliainedione use (?22%). Bioavailable estradiol and testosterone levels were positively related and sex hormone–binding globulin was negatively related to trabecular vBMD of the spine. There was no relationship between sex hormones and femoral neck trabecular vBMD. Our conclusion is that correlates of trabecular vBMD and cortical vBMD appear to differ in older men. © 2010 American Society for Bone and Mineral Research     

Candidate gene analysis of femoral neck trabecular and cortical volumetric bone mineral density in older men

In contrast to conventional dual‐energy X‐ray absorptiometry, quantitative computed tomography separately measures trabecular and cortical volumetric bone mineral density (vBMD). Little is known about the genetic variants associated with trabecular and cortical vBMD in humans, although both may be important for determining bone strength and osteoporotic risk. In the current analysis, we tested the hypothesis that there are genetic variants associated with trabecular and cortical vBMD at the femoral neck by genotyping 4608 tagging and potentially functional single‐nucleotide polymorphisms (SNPs) in 383 bone metabolism candidate genes in 822 Caucasian men aged 65 years or older from the Osteoporotic Fractures in Men Study (MrOS). Promising SNP associations then were tested for replication in an additional 1155 men from the same study. We identified SNPs in five genes (IFNAR2, NFATC1, SMAD1, HOXA, and KLF10) that were robustly associated with cortical vBMD and SNPs in nine genes (APC, ATF2, BMP3, BMP7, FGF18, FLT1, TGFB3, THRB, and RUNX1) that were robustly associated with trabecular vBMD. There was no overlap between genes associated with cortical vBMD and trabecular vBMD. These findings identify novel genetic variants for cortical and trabecular vBMD and raise the possibility that some genetic loci may be unique for each bone compartment. © 2010 American Society for Bone and Mineral Research     

Adipose tissue and volumetric bone mineral density of older Afro‐Caribbean men

Although low body weight is a risk factor for osteoporosis‐related fractures, conflicting data exist for the association between adiposity and bone mineral density (BMD). Studies examining these relationships have measured body fat and BMD with dual‐energy X‐ray absorptiometry (DXA), which cannot distinguish subcutaneous adipose tissue area (SAT) from total adiposity or trabecular from cortical bone. To investigate the relationship between adiposity and BMD further, we analyzed body composition and adipose tissue distribution by quantitative computed tomography (QCT) in 1829 Afro‐Caribbean men aged 40 years and older from a population‐based sample. Cortical volumetric BMD, muscle cross‐sectional area, total adipose tissue area (TAT), and percentage SAT were measured at the proximal tibia. Trabecular volumetric BMD was measured at the distal tibia. We used analysis of covariance to test for associations between quartile of the adipose tissue measures and BMD, adjusting for anthropometric, health, and lifestyle factors. Higher TAT was associated with lower cortical BMD in both unadjusted and adjusted models (p < .001). Men with a higher percentage SAT had greater cortical BMD (p < .001). Similar associations were seen between percent SAT and trabecular BMD at the distal tibia. These results indicate that total adiposity is a potentially important correlate of bone mass in older men and that different fat depots may have opposing associations with bone mass. Additional research is needed to better understand the mechanisms underlying the relationship between body fat distribution and bone mass. © 2010 American Society for Bone and Mineral Research.     

High bone mineral density in pycnodysostotic patients with a novel mutation in the propeptide of cathepsin K

Introduction Pycnodysostosis is typically associated with short stature, multiple fractures without adequate trauma and high bone density on x-ray. The increased bone density is due to a genetic defect of cathepsin K, leading to dysfunctional osteoclastic bone resorption and bone remodeling. We wanted to know how this defect influences the trabecular and cortical volumetric bone mineral density of long bones as measured quantitatively by pQCT. Methods Three siblings of a consanguineous family were admitted to our hospital because of multiple fractures. Pycnodysostosis was diagnosed based on the clinical presentation with the characteristic dense appearance of their bones on x-ray. The distal and proximal radius of the patients and of control subjects was scanned using a Stratec XCT-2000 pQCT scanner and data were processed using the software provided by the manufacturer. Genomic DNA was extracted from blood samples of all three patients and their parents. The coding exons of the cathepsin K gene (CTSK) were amplified and sequenced. Results The patients displayed the typical features of pycnodysostosis: Short stature, delay of closure of the fontanelles, hypoplasia of the maxilla, spondylolysis of the lumbar spine, stubby hands and feet and a history of multiple fractures. Volumetric bone density was much higher in pycnodysostotic bone than in the control bones 686 ± 28 mg/cm³ in patients vs. 290 ± 6 mg/cm³ in controls; p = 0.001), especially in the trabecular compartment (733 ± 26 mg/cm³ in patients vs. 195 ± 8 mg/cm³ in controls; p < 0.001), but also in the cortical bone (1108 ± 22 in patients vs. 1020 ± 17 in controls; p < 0.01). In contrast to this finding, the patients displayed an elevation of alkaline phosphatase in the serum and free deoxypyridinoline-crosslinks (DPD) in the urine, suggesting osteomalacia. Sequencing of the cathepsin K gene revealed homozygosity for a novel missense mutation in all three patients predicting the amino acid exchange from arginine to tryptophan at position 46 (R46W). Conclusion We present here for the first time quantitative data on the mineral density of bones of pycnodysostotic patients with a novel mutation in the propeptide of cathepsin K. The elevated bone mineral density in the cortex and the changes in the serum markers suggest an effect of cathepsin K not only on bone volume, but also on bone mineralization. This might in part explain the increased susceptibility to fractures of patients with pycnodysostosis. AFS and CM contributed equally and therefore share first authorship. Funding MA was supported by a grant of the Deutsche Forschungsgemeinschaft (AM 103/9-1).     

骨密度在髋部骨质疏松性骨折风险评估中的价值

目的评估骨密度在髋部脆性骨折风险预测中的临床价值。方法回顾性研究2014年6月至2019年6月在我院创伤骨科住院的老年髋部骨折患者72例,作为病例组,其中股骨转子间骨折31例,股骨颈骨折41例;对照组选择同期我院骨外科门诊老年体检者63例。使用DXA方法测量患者腰椎和健侧髋部(全髋部、转子间、股骨颈、Ward’s区)的骨密度;对照组测量腰椎和左侧髋部骨密度,统计分析测量结果。结果①骨折组腰椎、髋部骨密度均显著低于对照组,差异有统计学意义(P0.01);②转子间骨折组和股骨颈骨折组在腰椎和髋部区域骨密度比较差异均无统计学意义(P 0.05);③骨折组与对照组在转子间区的T值降低比例最大为122.1%,腰椎降低幅度最小为31.3%,余髋部的T值均有不同程度降低;④骨折后髋部和腰椎T值比存在倒置现象;⑤对照组和骨折组髋部骨质疏松程度比较,差异有统计学意义(P0.01);两组患者腰椎骨质疏松程度比较,差异无统计学意义(P0.05)。结论①髋部骨折患者骨密度均显著低于体检者,提示骨密度与髋部骨折具有一定相关性,但与髋部骨折类型无关;②在髋部骨折风险评估中,髋部骨密度相比腰椎更有价值;③当髋部与腰椎T值比出现倒置时,将不可避免发生髋部骨折;④骨量正常的部分患者发生了脆性骨折,而骨质疏松的部分患者却未发生骨折,表明影响骨折发生的因素除了骨密度外,可能和骨骼的微结构有关。     

大鼠坐骨神经切断对后肢骨密度的影响

目的采用pQCT仪器,检测大鼠切断右侧坐骨神经后,左右后肢骨密度含量变化,为废用骨代谢研究提供参考。方法2个月龄的雌性SD大鼠用戊巴比妥钠麻醉后,做右侧坐骨神经切断术,每周称1次体重,6周后处死动物取股骨和胫骨,应用动物专用pQCT仪器,分别对骨骺线3.0和12.0mm处进行测定分析。结果手术后第1周,体重增长较慢,以后的增长速率两组相似;右侧坐骨神经切断引起肌肉明显萎缩,左侧代偿增大;右侧的股骨、胫骨松质骨部位总骨密度明显下降,无论与对照组、还是左侧的比较P<0.01。结论大鼠切断右侧坐骨神经后,通过pQCT仪器测定,能灵敏、精确地获得骨密度的变化,并有效地区分各个不同结构的特征。     

Gender-specific pubertal changes in volumetric cortical bone mineral density at the proximal radius

It is well established that puberty affects the geometry of cortical bone differently in females and males. In the present study we investigated whether there are also gender differences in the volumetric bone mineral density of the cortical compartment (BMDcort). BMDcort was determined at the proximal radial diaphysis in 362 healthy children and adolescents (age 6-23 years; 185 females, 177 males) and in 107 adults (age 29-40 years; 88 women, 19 men) using peripheral quantitative computed tomography (pQCT). The densitometric result for BMDcort was similar in prepubertal girls and boys, but was significantly higher in females after pubertal stage 3. pQCT results for BMDcort are influenced by cortical thickness due to the partial volume effect. Therefore, these gender differences were reanalyzed in groups of subjects of the same developmental stage who were matched for cortical thickness. Thus calculated, no gender difference in BMDcort was detected in prepubertal children. However, adolescent females after pubertal stage 3 and adult women had a 3%-4% higher BMDcort than males at the same developmental stage. BMDcort is an integrated measure of both cortical porosity and mean material density of cortical bone. The metabolic activity of cortical bone (intracortical remodeling) increases cortical porosity and decreases the mean material density of cortical bone. Our results therefore suggest that intracortical remodeling is lower in postpubertal females than in males.     

Aging bone in men and women: beyond changes in bone mineral density

Using peripheral quantitative computed tomography (pQCT) we assessed trabecular and cortical bone density, mass and geometric distribution at the tibia level in 512 men and 693 women, age range 20–102 years, randomly selected from the population living in the Chianti area, Tuscany, Italy. Total, trabecular and cortical bone density decreased linearly with age (p<0.0001 in both sexes), and the slope of age-associated decline was steeper in women than in men. In men, the cortical bone area was similar in different age groups, while in women older than 60 years it was significantly smaller by approximately 1% per year. The total cross-sectional area of the bone became progressively wider with age, but the magnitude of the age-associated increment was significantly higher in men than in women (p<0.001). The minimum moment of inertia, an index of mechanical resistance to bending, remained stable with age in men, while it was significantly lower in older compared with younger women (0.5% per year). The increase in bone cross-sectional area in aging men may contribute to the maintenance of adequate bone mechanical competence in the face of declining bone density. In women this compensatory mechanism appears to be less efficient and, accordingly, the bone mechanical competence declines with age. The geometric adaptation of increasing cross-sectional bone size is an important component in the assessment of bone mechanical resistance which is completely overlooked, and potentially misinterpreted, by traditional planar densitometry.     

Prevalent fractures are related to cortical bone geometry in young healthy men at age of peak bone mass

Low areal bone mass is a risk factor for fractures in men. Limited data are available on fractures and bone geometry in men, and the relation with sex steroids is incompletely understood. We investigated prevalent fractures in relation to peak bone mass, bone geometry, and sex steroids in healthy young men. Healthy male siblings (n = 677) at the age of peak bone mass (25 to 45 years) were recruited in a cross‐sectional population‐based study. Trabecular and cortical bone parameters of the radius and cortical bone parameters of the tibia were assessed using peripheral quantitative computed tomography (pQCT). Areal bone mineral density (aBMD) was determined using dual‐energy X‐ray absorptiometry (DXA). Sex steroids were determined using immunoassays, and fracture prevalence was assessed using questionnaires. Fractures in young men were associated with a longer limb length, shorter trunk, lower trabecular BMD, smaller cortical bone area, and smaller cortical thickness (p < .005) but not with bone‐size‐adjusted volumetic BMD (vBMD). With decreasing cortical thickness [odds ratio (OR) 1.4/SD, p ≤ .001] and decreasing cortical area (OR 1.5/SD, p ≤ .001), fracture odds ratios increased. No association between sex steroid concentrations and prevalent fractures was observed. Childhood fractures (≤15 years) were associated with a thinner bone cortex (?5%, p ≤ .005) and smaller periosteal size (?3%, p ≤ .005). Fractures occurring later than 15 years of age were associated with a thinner bone cortex (?3%, p ≤ .05) and larger endosteal circumference (+3%, p ≤ .05) without differences in periosteal bone size. In conclusion, prevalent fractures in healthy young men are associated with unfavorable bone geometry and not with cortical vBMD when adjusting for bone size. Moreover, the data suggest different mechanisms of childhood fractures and fractures during adult life. © 2010 American Society for Bone and Mineral Research     

绝经后妇女桡骨远端骨折术后桡骨短缩与骨密度的相关性研究

目的分析绝经后妇女的骨密度与桡骨远端骨折术后出现桡骨短缩的相关性。方法回顾性分析自2012-01—2014-06行手术治疗的252例绝经妇女桡骨远端骨折,术后均达到解剖复位或基本达到解剖复位,获得1年完整随访。将术后3个月桡骨短缩距离4 mm的患者纳入观察组,其余的按年龄、骨折类型及绝经时间进行1∶1个体匹配,纳入与观察组同样数量的病例进入对照组(术后3个月桡骨短缩距离4 mm)。术前、术后3个月及术后6个月用双能X线骨密度仪对2组健侧桡骨进行骨密度测量。结果观察组骨密度值:术前(0.69±0.14)g/cm2,术后3个月(0.67±0.12)g/cm~2,术后6个月(0.62±0.10)g/cm~2。对照组骨密度值:术前(0.79±0.15)g/cm~2,术后3个月(0.76±0.13)g/cm~2,术后6个月(0.71±0.10)g/cm~2。2组骨密度值随时间增加而降低,且观察组术前(F=7.588,P=0.008)、术后3个月(F=8.520,P=0.005)、术后6个月(F=11.203,P=0.001)骨密度值均低于对照组,差异有统计学意义(P0.05)。结论对于桡骨远端骨折患者术后出现桡骨短缩的原因,骨密度降低是一个不容忽略的重要因素,在术后应重视对低骨密度的患者采取相应措施。     

Bone mineral density predicts osteoporotic fractures in elderly men: the MINOS study

Osteoporosis in men is becoming a public health problem in developed countries. Fracture incidence increases with age, and the number of fractures increases because of the ageing of the population. We assessed the predictive value of bone mineral density (BMD) for osteoporotic fractures evaluated prospectively in a large cohort of elderly men and assessed the sensitivity of the T-score =–2 to detect men who will sustain a fracture. Fracture incidence was evaluated for 90 months in 759 men from the MINOS cohort aged 50 and over at baseline. In 74 men, 77 incident vertebral and peripheral fractures occurred. BMD was measured at baseline at the lumbar spine, hip, whole body and distal forearm. The incidence of osteoporotic fractures increased with age and with decreasing body weight. In men with low BMD (T-score <–2), fracture incidence varied from 2.26 to 3.07 fractures per 100 person-years and was 2.1 to 3.6 times higher than in men with normal BMD. After adjustment for age, body weight and height, baseline BMD was 3.7 to 7.9% ( P <0.05–0.0001) lower at all the sites of measurement in men who sustained a fracture. After adjustment for age, weight and prevalent fractures, BMD was predictive of osteoporotic fractures at all the sites. Odds ratios varied from 1.28 to 1.89 per 1 SD decrease in BMD ( P <0.05–0.0001). The predictive accuracy of BMD for fractures (area under the curve of the receiving operator characteristics adjusted for age, weight and prevalent fractures) varied from 0.643 to 0.712 according to the skeletal site and was higher for the whole body than for other sites. Thus, BMD itself has a limited value for determining men at an increased risk for fracture. The percentage of incident fractures occurring in men with low BMD (T-score <–2) ranged from 13.7% at the trochanter to 44.6% at the ultradistal radius. Conversely, 27 to 45% of incident fractures occurred in men with mildly decreased BMD (T-score between –1 and –2). In conclusion, BMD predicts osteoporotic fractures in men independently of age, body weight and prevalent fractures. However, the sensitivity of BMD to detect men at high risk of fracture is low. More studies on the predictors of fractures in men, such as bone architecture, morphology, biochemical markers of bone turnover and hormonal levels, are necessary.     

Correlations of calcaneal QUS with pQCT measurements at distal tibia and non-weight-bearing distal radius

Quantitative ultrasound (QUS) is used for prediction for risks of osteoporotic fractures at various skeletal sites, irrespective of weight-bearing or non-weight-bearing skeletons. In the current study, we investigated the correlation between calcaneal QUS measurements (BUA, VOS, and Soundness) and volumetric trabecular, cortical, and its integral bone mineral density (tBMD, cBMD, and iBMD) using peripheral quantitative computed tomography (pQCT) of the weight-bearing distal tibia and non-weight-bearing distal radius in 198 healthy Chinese women between 40 and 62 years of age. Results showed that BUA, VOS, and Soundness measured by calcaneal QUS were significantly correlated with tBMD, cBMD, and iBMD of both distal tibia and distal radius (r = 0.210–0.447; all P < 0.01). The correlation coefficients of all the individual parameters between calcaneus and distal tibia were correspondingly higher (r = 0.214–0.447; all P < 0.01) than that of distal radius (r = 0.210–0.368; all P < 0.01). QUS Soundness showed the highest correlation (r = 0.447; P < 0.01) with tBMD of distal tibia when comparing with all other parameters between these two measurement devices. Stronger within-device correlations (r = 0.640–0.764; all P < 0.01) were found in pQCT measurements between distal tibia and radius. In addition, the largest and significant age-related decline was found in tBMD of the distal radius measured by pQCT and Soundness of the QUS measurement in the postmenopausal group. In conclusion, heel QUS measurement demonstrated slightly better correlation with trabecular bone of the weight-bearing skeleton than that of the non-weight-bearing skeleton measured by pQCT.     

Postmenopausal women with osteopenia have higher cortical porosity and thinner cortices at the distal radius and tibia than women with normal aBMD: An in vivo HR‐pQCT study

Increases in cortical porosity (Ct.Po) and decreases in cortical thickness (Ct.Th) are associated with increased bone fragility. The purpose of this study was to validate an autosegmentation method for high‐resolution peripheral quantitative computed tomography (HR‐pQCT) scans to measure Ct.Po and Ct.Th and use it to compare Ct.Po and Ct.Th between pre‐ and postmenopausal women with normal, osteopenic, and osteoporotic areal bone mineral density (aBMD). The Ct.Po and Ct.Th measurements were validated using cadaver forearms (n = 10) and micro‐computed tomography (µCT) as the gold standard. The analysis was applied to distal radius and tibia HR‐pQCT scans from a subset of participants from the Calgary, Alberta, cohort of the Canadian Multicentre Osteoporosis Study (n = 280, 18 to 90 years). Analysis of covariance compared Ct.Po and Ct.Th outcomes between 63 normal premenopausal (dual‐energy X‐ray absorptiometry femoral neck T‐score > ?1), 87 normal postmenopausal, 121 osteopenic postmenopausal, and 9 osteoporotic postmenopausal women. Linear regression analysis and Bland‐Altman plots were used to assess the agreement between the HR‐pQCT and µCT measurements, resulting in r² values of 0.80 for Ct.Po and 0.98 for Ct.Th. At both sites, Ct.Po was higher in postmenopausal (all groups) than in premenopausal women (3.2% to 12.9%, p < .001). Ct.Th was not significantly different between normal premenopausal and postmenopausal women at either site; however, both osteopenic and osteoporotic women had thinner (?12.8% to ?30.3%, p < .01), more porous (2.1% to 8.1%, p < .001) cortices than normal postmenopausal women. Our method offers promise as a valuable tool to measure Ct.Po and Ct.Th in vivo and investigate associations among cortical bone structure, age, and disease status. © 2010 American Society for Bone and Mineral Research.     

Comparison of sex steroid measurements in men by immunoassay versus mass spectroscopy and relationships with cortical and trabecular volumetric bone mineral density

In men, measurement of serum testosterone and estradiol levels with immunoassays correlated with mass spectroscopic measurements, and correlations of sex steroids with volumetric bone mineral density were similar. INTRODUCTION: While immunoassays have been used extensively for measurement of serum testosterone (T) and estradiol (E(2)) levels, there is concern about their specificity, particularly at low E(2) levels as present in men. METHODS: We compared T and E(2) measured by mass spectroscopy to levels measured by immunoassay in men (n = 313, age 22 to 91 years) and related these to volumetric bone mineral density (vBMD) at various skeletal sites. RESULTS: Serum T and non-SHBG bound (or bioavailable) T levels by immunoassay correlated well with the corresponding mass spectroscopy measurements (R = 0.90 and 0.95, respectively, P < 0.001); the correlations for serum E(2) measured using the two techniques were less robust (R = 0.63 for total E(2) and 0.84 for bioavailable E(2), P < 0.001). Overall relationships between serum bioavailable T and E(2) levels with vBMD at various skeletal sites were similar for the immunoassay and mass spectroscopic measures. CONCLUSIONS: Although E(2) levels with immunoassay correlate less well with the mass spectroscopic measurements than do the T measurements in men, our findings indicate that the fundamental relationships observed previously between vBMD and the sex steroids by immunoassay are also present with the mass spectroscopic measurements.     

辛伐他汀对桡骨远端骨折老年女性骨密度及骨折愈合的影响

目的探讨辛伐他汀对老年女性桡骨远端骨折骨密度及骨折愈合的影响。方法分析98名桡骨远端骨折老年女性术前及术后3个月健侧桡骨远端1/3处骨密度,依据术后是否口服辛伐他汀治疗其他内科疾患分为辛伐他汀治疗组(56例)及对照组(42例)。结果治疗前辛伐他汀组与对照组健侧桡骨远端1/3处骨密度差异无统计学意义(P0.05)。治疗3个月后辛伐他汀组健侧桡骨远端1/3处骨密度与治疗前骨密度相比差异具有统计学意义(P0.05);对照组健侧桡骨远端1/3处骨密度均值增高,与初始时差异无统计学意义(P0.05)。治疗3个月后辛伐他汀组与对照组两组间骨密度差异无统计学意义(P0.05)。通过卡方检验分析发现辛伐他汀组与对照组相比骨折愈合数存在统计学差异,辛伐他汀可以促进骨折愈合;分析两组间治疗前后骨质正常、骨量减少、骨质疏松数之间差异无统计学意义,辛伐他汀不影响骨质疏松患病率。结论桡骨远端骨折老年女性应用辛伐他汀(20 mg/d)可以改善桡骨远端骨密度、促进骨折愈合,但不影响骨质疏松患病率。     

Relationships between bone geometry,volumetric bone mineral density and bone microarchitecture of the distal radius and tibia with alcohol consumption

PurposeChronic heavy alcohol consumption is associated with bone density loss and increased fracture risk, while low levels of alcohol consumption have been reported as beneficial in some studies. However, studies relating alcohol consumption to bone geometry, volumetric bone mineral density (vBMD) and bone microarchitecture, as assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT), are lacking.MethodsHere we report an analysis from the Hertfordshire Cohort Study, in which we studied associations between HR-pQCT measures at the distal radius and tibia and alcohol consumption in 376 participants (198 men and 178 women) aged 72.1–81.4 years.ResultsA total of 30 (15.2%), 90 (45.5%) and 78 (39.4%) men drank minimal/none (< 1 unit/week), low (≥ 1 unit/week and < 11 units/week) and moderate/high (≥ 11 units/week) amounts of alcohol respectively. These figures were 74 (41.8%), 80 (45.2%) and 23 (13.0%) respectively in women for minimal/none (< 1 unit/week), low (≥ 1 unit/week and < 8 units/week) and moderate/high (≥ 8 units/week). At the distal radius, after adjustment for confounding factors (age, BMI, smoking status, dietary calcium intake, physical activity and socioeconomic status and years since menopause and HRT use for women), men that drank low alcohol had lower cortical thickness (p = 0.038), cortical vBMD (p = 0.033), and trabecular vBMD (p = 0.028) and higher trabecular separation (p = 0.043) than those that drank none/minimal alcohol. Similar differences were shown between minimal/none and moderate/high alcohol although these only reached statistical significance for the cortical parameters. Interestingly, after similar adjustment, women showed similar differences in the trabecular compartment between none/minimal alcohol and low alcohol at the distal tibia. However, women that drank moderate/high alcohol had significantly higher trabecular vBMD (p = 0.007), trabecular thickness (p = 0.026), and trabecular number (p = 0.042) and higher trabecular separation (p = 0.026) at the distal radius than those that drank low alcohol.ConclusionsOur results suggest that alcohol consumption (low and moderate/high) may have a detrimental impact on bone health in men in both the cortical and trabecular compartments at the distal radius with similar results in women in the trabecular compartment between none/minimal alcohol and low alcohol at the distal tibia suggesting that avoidance of alcohol may be beneficial for bone health.     

抗骨质疏松对老年性桡骨远端骨折的临床疗效

目的探讨抗骨质疏松对老年性骨质疏松性桡骨远端骨折的治疗效果。方法对84例老年原发骨质疏松性桡骨远端骨折患者先测定股骨颈骨密度值,随机分为治疗组（44例）及对照组（40例）,根据病情选用手法或手术复位。治疗组予肌注鲑鱼降钙素（密盖息）,口服阿仑膦酸钠片（固邦）、阿法骨化醇胶丸及钙尔奇D600片,对照组不予抗骨质疏松治疗,仅予安慰剂：肌注VitB1,口服VitC、VitE、VitAD胶丸。两组共使用药物10周,患者每15天行X线照片检查,观察骨折断端骨痂生长情况并进行疗效对比;治疗10周后再次测定股骨颈骨密度值并进行比较。结果治疗组治疗8周后与对照组比较,骨痂形成时间短,数量明显增加,骨皮质增厚,骨折愈合时间分别为：治疗组（6.8±1.5）周,对照组（8.5±2.5）周,差异有显著性（P〈0.05）;治疗组骨密度治疗前（0.618±0.092）g/cm^2,治疗后（0.643±0.088）g/cm^2,治疗前后差异有显著性（P〈0.05）;对照组治疗前BMD（0.620±0.085）g/cm^2,治疗后BMD（0.626±0.091）g/cm^2,治疗前后差异无显著性（P〉0.05）;两组治疗后比较差异有显著性（P〈0.05）。结论对老年性骨质疏松性桡骨远端骨折进行抗骨质疏松治疗,能促进骨痂提早形成,增加骨痂生成数量,增加骨密度,改善骨结构,提高骨的生物力学特性和抗骨折线力,增加骨折稳定性,减少外固定时间。     

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.