甲状腺功能减退症女性患者骨密度变化的初步探讨

目的观察甲状腺功能减退症女性患者腰椎和髋部骨密度的变化。方法双能X线骨密度仪测定104例甲状腺功能减退症女性患者和123例健康女性的腰椎和髋部骨密度，并对两组测量结果进行分析。结果甲状腺功能减退症女性患者与健康女性腰椎和髋部骨密度差异无显著性（P〉0．05）。结论甲状腺功能减退女性患者与正常女性的骨密度相似。     

女性甲状腺功能亢进症患者的骨密度变化

目的:观察女性甲状腺功能亢进症(甲亢)患者病程及绝经与否对骨密度的影响.方法:采用双能X线骨密度仪测定192例女性甲亢患者腰椎和髋部骨密度,分为绝经前和绝经后两组,按病程长短又分为短程和长程两亚组,并对两组测量结果进行分析.结果:绝经前甲亢病程长者L2及腰椎总体骨密度明显低于病程短者(P<0.05).绝经后甲亢长程组腰椎及髋部各个测量部位的骨密度较短程者显著降低(P<0.05),在L2及髋部其差别尤其显著(P<0.01).结论:病程及绝经与否影响着女性甲亢患者的骨密度.     

女性2型糖尿病患者骨密度变化的分析

目的：研究女性糖尿病患者骨密度的变化，方法：应用美国单能X线骨密度仪测定女性2型糖尿病患者跟骨骨密度与同年龄组女性进行比较，结论：2型糖尿病患者与对照组比较，骨密度明显降低。结论：女性2型糖尿病较易发生骨质疏松。     

模拟失重雌性大鼠骨密度与骨生物力学特性的研究

目的观察模拟失重大鼠骨密度及生物力学特性的变化。方法，4只雌性sD大鼠随机分为：悬吊组（S）和自由活动对照组（C），每组12只，饲养28d后处死，取出L4、L5及双侧股骨，分别进行骨密度和骨生物力学的测定。结果S组与c组相比较，BMD具有显著性差异（P〈0．001）；S组股骨、k的最大载荷、刚度及弹性模量低于C组，差别具有统计学意义（P〈0．001）；S组椎体横断面面积和股骨的截面总面积、皮质骨厚度、骨髓腔面积明显低于C组（P〈0．01）。结论失重或模拟失重状态下雌性大鼠的密质骨和松质骨发生全面骨丢失。     

Low bone mineral density and risk of fracture in white female nursing home residents

CONTEXT: Low bone mineral density (BMD) is a strong risk factor for fracture in community-dwelling white women, but the relationship in white female nursing home residents, for whom fracture rates are highest, is less clear. OBJECTIVE: To assess the relative contribution of low BMD to fracture risk in nursing home residents. DESIGN: Prospective cohort study with baseline data collected April 1995 to June 1997, with 18 months of follow-up. SETTING: Forty-seven randomly selected nursing homes in Maryland. PATIENTS: A total of 1427 white female nursing home residents aged 65 years or older. MAIN OUTCOME MEASURE: Documented osteoporotic fracture occurring during follow-up as a function of baseline BMD measurements higher vs lower than the median, and after controlling for demographic, functional, cognitive, psychosocial, and medical factors. RESULTS: A total of 223 osteoporotic fractures occurred among 180 women. Low BMD and transfer independence were significant independent risk factors for fracture in this nursing home sample (P<.001) and the 2 factors acted synergistically (P =.06) to further increase fracture risk. Compared with women whose BMD was higher than the median (0. 296 g/cm(2)), those whose BMD was lower than the median had an unadjusted hazard ratio for risk of fracture of 2.1 (95% confidence interval [CI], 1.5-2.8); women who were independent in transfer had a hazard ratio of 1.6 (95% CI, 1.2-2.2) compared with women dependent in transfer. Among residents independent in transfer, those with BMD below the median had a more than 3-fold increase in fracture risk compared with those with higher BMD (unadjusted hazard ratio, 3.1; 95% CI, 2.2-4.4). Among residents dependent in transfer, those with BMD below the median had a 60% increase in fracture risk (unadjusted hazard ratio, 1.6; 95% CI, 1.1-2.3). Adjustment for covariates did not alter the BMD-fracture relationship. CONCLUSIONS: Our data indicate that low BMD and independence in transfer are significant predictors of osteoporotic fracture in white female nursing home residents. JAMA. 2000;284:972-977     

女性类风湿关节炎患者手腕骨密度检查与超声腕关节骨侵蚀及炎症评分的相关性

目的：分析类风湿关节炎(rheumatoid arthritis,RA)患者手腕双能X线(dual-energy X-ray absorptiometry,DXA)检查结果,与关节超声影像学评分比较,以确定其与RA关节炎症以及骨侵蚀的相关性。方法：80名女性类风湿关节炎患者采用双能X线法检测非优势手腕部骨密度(bone mineral density, BMD)以及椎体、髋部骨密度,同时检测同侧以及双侧腕关节超声,扫描桡腕关节、中线腕骨间、尺腕关节,并分别记录腕关节滑膜增生、肌腱炎、骨侵蚀等情况,使用彩色多普勒进行关节炎评分。结果：(1)80名女性RA患者中,平均年龄(54.6±13.3) (27.0~80.0)岁,病程48(12~116)个月,体重指数（body mass index, BMI) (23.0±4.0) (14.8~31.2) kg/m2。RA患者腕部BMD低于正常对照［(0.297±0.121)vs.(0.420±0.180) g/cm2,P<0.01］。(2)早期RA腕部骨密度高于长病程RA［(0.326±0.103) vs.(0.285±0.132) g/cm2,P<0.01］,腕部严重骨质疏松发生率低于长病程RA(47.8% vs. 64.9%,P<0.05),超声发现腕骨侵蚀发生率低于长病程RA(39.1% vs.56.1%,P<0.01)。(3)高疾病活动度组腕关节骨密度低于中度活动以及缓解患者［(0.267±0.140) g/cm2 vs.(0.280±0.126) g/cm2,(0.267±0.140) g/cm2 vs.(0.320±0.103) g/cm2］,差异均具有统计学意义(P<0.05)。高疾病活动度组RA患者与中度活动组患者抗环胍氨酸多肽抗体(anti-cyclic citrullinated peptide antibody,ACPA)阳性比例分别为85%和92.6%,均高于缓解组患者81.8%,差异具有统计学意义(P<0.05)。患者DAS28ESR(disease activity score 28 joint count)与腕部BMD呈负相关(r=-0.288,P<0.01)。(4)RA患者腕部BMD与脊柱和髋部BMD均呈正相关(r=0.634,P<0.01,r=0.795,P<0.01);腕部BMD与疾病病程呈负相关(r=-0.286,P<0.01), 与DAS28 ESR呈负相关(r=-0.301,P<0.01)。早期RA腕部BMD和髋部BMD呈正相关(r=0.95,P<0.05),且相关系数较高。(5)骨质疏松组患者类风湿因子(rheumatoid factor,RF)、ACPA阳性比例高于骨量减少组(分别为75.5% vs.55.6%,P<0.05和100% vs. 83.3%,P<0.05)。骨质疏松组RA患者疾病活动度DAS28ESR高于骨量减少组(5.3±1.8 vs. 4.6±2.5,P<0.01)。骨质疏松组患者经超声探查发现腕部存在滑膜炎(61.5% vs. 51.7%, P<0.05)、肌腱炎(14.3% vs.10.0%, P<0.05)以及骨侵蚀(54.2% vs. 46.2%, P<0.05)的比例均高于骨量减少组,差异具有统计学意义。(6) 超声发现腕部骨侵蚀患者与未见骨侵蚀患者相比,出现骨侵蚀患者手腕部BMD低于未见骨侵蚀患者［(0.333±0.107) g/cm2 vs. (0.264±0.125) g/cm2,P<0.01］,滑膜炎多普勒评分高于未见骨侵蚀组(4.53±1.40 vs. 2.55±2.66,P<0.01)。此外,与未见骨侵蚀组患者相比,出现骨侵蚀RA患者,病程更长［(96.0±104.7)月vs.(66.2±78.0)月, P<0.05］,RF阳性率高(81.0% vs. 53.8%,P<0.01)、ACPA抗体阳性率高(92.7% vs. 79.5%,P<0.05),疾病活动度DAS28ESR更高(5.4±1.8 vs. 4.2±2.0,P<0.05),出现同侧腕关节滑膜炎的比例更高(75.6% vs.30.8%,P<0.01),此外,同侧腕关节出现严重骨质疏松的比例更高(75.0% vs. 46.4%,P<0.01), 差异均具有统计学意义。(7) 以骨密度值为结果变量,对影响患者骨密度值的因素进行多元回归分析显示,年龄(P=0.001)、病程(P=0.017)、DAS28ESR(P=0.021)以及ACPA(P=0.05)分别是造成患者手腕BMD异常的相关危险因素。结论：女性RA患者腕部BMD与疾病的病程以及炎症程度相关,ACPA抗体高滴度患者更容易出现骨密度下降。     

Vertebral deformities in female patients with osteoporosis: influence of trauma and bone mineral density

Aging societies have an increased incidence of fractures caused by osteoporosis. Vertebral compression fractures occur most frequently in the thoracolumbar vertebrae of elderly individuals. The severe pain caused by this type of fracture causes many patients to become bedridden. However, the initial pain generally diminishes after around 1 month and is replaced by dull pain in the lumbar and lumbosacral regions. We carried out a cross-sectional and longitudinal study of these fractures in 328 female outpatients with osteoporosis. All subjects initially presented at our hospital with back pain and bone mineral density measurements were taken using both dual energy X-ray absorptiometry and quantitative computed tomography. Our main findings were as follows. Decreased BMD appears to be one cause of vertebral body deformities. However, we found it difficult to predict whether deformities will progress or cause additional deformities of adjacent vertebral bodies, because the key contributing factors include not only BMD and age but also lifestyle and activity patterns. In addition, none of the drug administration methods investigated here resulted in a notable increase in BMD.     

女性类风湿关节炎患者骨密度变化的影响因素

目的:探讨女性类风湿关节炎(RA)患者骨质疏松(OP)的危险因素及其与临床指标的相关性。方法:使用双能X线骨密度仪测定115例女性RA患者和101名健康女性L1～L4、股骨颈、全髋等部位骨密度(BMD),并观察患者的疾病活动指标和实验室指标。结果:女性RA患者患OP发生率高于健康女性(P0.01),其各部位BMD均低于对照组(P0.05～P0.01)。OP组RA患者各部位BMD均明显低于非OP组(P0.01)。OP组患者年龄更大、绝经年数更长、病程和晨僵时间更长、疼痛关节数更多、HAQ平均积分更高、关节功能和X线分期更差(P0.05～P0.01)。RA组OP性骨折的概率明显高于健康女性(P0.01),使用糖皮质激素的RA患者第L1～L4的BMD低于未使用患者(P0.05)。Logistic Regression分析显示绝经[OR=4.582(1.503～13.974),P0.01]和X线分期[OR=2.267(1.233～4.167),P0.01]为RA患者OP发生的主要危险因素。结论:女性RA患者发生OP和骨折风险均显著高于健康女性,其OP的发生和多因素相关,绝经年数更长、X线分期较差、使用糖皮质激素是RA患者发生OP的主要危险因素。     

Practical issues in bone mineral density testing

Osteoporotic fractures are a source of morbidity and mortality among postmenopausal women. Clinicians must strive to identify women at risk for osteoporotic fracture and institute proper prophylactic or treatment regimens to decrease the incidence of fractures. The advent of more sensitive, less expensive, and portable bone mineral density assessment techniques, coupled with new strategies for identifying risk factors, has made it easier for clinicians to diagnose this debilitating disease before a fracture occurs. The hope is that bone mineral density testing will result in the early identification of women at risk for osteoporosis, thereby reducing the incidence of osteoporotic fractures.     

定量超声测定跟骨骨密度对骨质疏松性骨折的判断价值及其与血清骨代谢、骨转化指标的相关性

目的：分析定量超声测定跟骨骨密度(BMD)对骨质疏松性骨折的判断价值,并探讨BMD与患者血清骨代谢、骨转化指标的相关性。方法将2013年8月至2015年8月期间在北京大学深圳医院接受检查治疗的骨质疏松性骨折患者72例作为观察组,另取同期在本院接受健康体检、不伴骨质疏松的老年人群68例作为对照组,比较两组患者的定量超声下BMD值、血清骨代谢、骨转化指标值的差异,并进一步分析BMD与骨质疏松性骨折患者病情的关系。结果观察组患者的BMD为(0.23±0.04) g/cm2、25羟维生素D (25OHD)为(39.27±4.51) nmol/L、骨钙素N端中分子片段(N-MID)为(56.18±7.29) ng/mL、人降钙素(HCT)为(2.41±0.32) ng/L,均相应低于对照组的(0.35±0.05) g/cm2、(57.63±6.92) nmol/L、(82.55±9.04) ng/mL、(3.17±0.42) ng/L,而碱性磷酸酶(ALP)为(56.27±6.19) IU/L、Ⅰ型前胶原N末端前肽（PINP）为(42.18±5.29)μg/L、抗酒石酸酸性磷酸酶(TRAP)为(4.63±0.53) U/L、β-胶原降解产物(β-CTX)为(64.39±7.11) ng/mL,均高于对照组的(27.45±3.38) IU/L、(24.76±3.08)μg/L、(3.11±0.37) U/L、(45.28±5.29) ng/mL,差异均有统计学意义(P<0.05)。经一元线性回归分析发现,骨质疏松性骨折患者的BMD值与血清25OHD、N-MID、HCT值呈正相关(r=0.627、0.701、0.598),与ALP、PINP、TRAP、β-CTX呈负相关(r=-0.582、-0.672、-0.693,P<0.05)。结论定量超声测定跟骨骨密度可以客观判断骨质疏松性骨折的严重度,其与患者的血清学指标存在良好的相关关系,可以作为临床病情监测及预后判断的可靠手段。     

Bone densitometry in assessment of bone mineral density

Osteoporosis is a serious disease characterized by low bone mineral density. Osteoporosis affects 24 million people annually and may be responsible for devastating hip, wrist and spinal fractures. Bone mineral density is considered the best predictor for osteoporotic fracture. Progress has been made toward noninvasive assessment of bone mineral density to provide early diagnosis of osteoporosis. A variety of methods are used to assess bone mineral density. These methods are presented and dual energy X-ray absorptiometry is discussed in detail.     

男性吸烟与骨密度及骨生化指标关系的调查与分析

目的探讨男性吸烟与骨密度及骨生化指标关系。方法用DXA仪测定腰椎及髋部BMD，用ELISA测定389例20~80岁健康男性血清骨特异性碱性磷酸酶（sBAP）、血清骨钙素（sOC）和I型胶原氨基末端肽（sNTX）。结果腰椎正住总体、腰椎侧住、髋部总体、股骨颈及Ward＇s区BMD均与年龄呈显著负相关（均P〈0．05）。各部位BMD均在20～29岁年龄组最高，29岁之后随增龄而缓慢下降；40~0岁各年龄组之间的BMD差异无显著性。除腰椎侧住BMD外，吸烟组其他各部住BMD显著低于非吸烟组；吸烟组的sOC和BAP显著高于非吸烟组，两组之间的sNTX差异无显著性。校正年龄与BMI后，烟龄与腰椎正位，髋部总体，股骨颈及Ward＇s区BMD均呈显著负相关（P〈0．05）。每日吸烟量与腰椎正住及Ward’s区BMD呈显著负相关（P〈0．05）。结论男性随年龄增长骨量丢失。男性吸烟者骨生化指标与骨转换水平增高，骨量丢失加速。吸烟等生活方式增高骨转换水平，影响骨转换的增龄性变化并加速骨量的丢失。吸烟是骨质疏松的一个危险因素。预防骨质疏松症（OP）应提倡戒烟。     

女性2型糖尿病患者骨密度及临床相关因素分析

目的:探讨女性2型糖尿病(type 2 diabetes mellitus,T2DM)患者的骨密度(BMD)变化及临床相关因素对BMD的影响。方法:采用双能X线骨密度仪测定127例女性T2DM患者和78例非糖尿病对照者正位腰椎(L₂~L₄)及股骨近端(Neck、Ward's区、G.T.)的BMD,按年龄和病程分组进行比较,并对糖尿病患者的BMD与年龄、绝经年限、体重指数(BMI)、病程、糖化血红蛋白A₁c(HbA₁c)、血脂等指标进行多元逐步回归分析。结果:50~59岁组女性T2DM患者各部位BMD均高于对照组(P<0.05~P<0.01);60~69岁和70~79岁组L₂、股骨近端BMD,以及70~79岁组L₃BMD均高于对照组(P<0.05~P<0.01);各年龄组Ward's区BMD测定值明显低于腰椎、Neck和G.T.(P<0.01)。T2DM病程≤ 5年、6~10年和>10年组各部位BMD差异均无统计学意义(P>0.05)。T2DM患者年龄与腰椎BMD均呈负相关(P<0.05~P<0.01),绝经年限与Neck、Ward's区、G.T.BMD呈负相关(P<0.01),BMI与Neck、Ward's区、G.T.BMD呈正相关(P<0.01),病程、HbA₁c、血脂与BMD无显著相关。结论:女性T2DM患者绝经后各部位BMD明显高于或不低于非糖尿病对照者;年龄大、绝经年限长是T2DM患者BMD降低的危险因素;BMI是T2DM患者BMD的保护性因素。     

Fluvastatin increases bone mineral density in postmenopausal women

Although several studies have reported a lower risk of osteoporotic fracture in hypercholesterolemic patients (WHO IIa) treated with statin, longitudinal studies on the effects of statins on bone are lacking. The aim of the present study was to evaluate bone mineral density (BMD) and bone turnover changes induced by 3-year fluvastatin treatment in postmenopausal women. Twenty-eight consecutive postmenopausal non-diabetic, normotensive hypercholesterolemic women (64.0±3.6 years) were treated for 36 months with 30 mg/day fluvastatin and 28 non-diabetic, normotensive normocholesterolemic age- and body mass index-matched postmenopausal women served as the control subjects. The result revealed a significant increase of the BMD as compared with the level at the base line (p< 0.001) in the fluvastairn-treated group, from 6 months on ward after the start treatment. Significant differences of the BMD were found between the controls and fluvastatin-treated group (p< 0.001) were at 6, 12, 24 and 36 months after the start of the study. In conclusion our results, although obtained small sample of postmenopausal hypercholesterolemic women, suggest a probable favorable effect of fluvastatin on bone formation and BMD.