住院老年男性26例骨密度与雄性激素关系分析

目的:观察老年骨质疏松症与雄激素水平是否有关。方法:住院>60岁的老年男性病人26例,用酶联免疫方法测定性激素,包括睾酮(T)、促性腺激素(FSH、LH)泌乳素(PLT),雌激素(E2)。应用NOLAND双能X线骨密度仪测定骨密度,并进行相关分析。结果:显示睾酮(T)与Ward三角区骨密度(BMD)密切相关,r=0.4075,P<0.025;促黄体生成素(LH)与L2～4BMD密切相关,r=0.4649,P<0.01。结论:雄激素减低是造成老年男性骨质疏松的重要因素之一。     

阿仑膦酸钠对中老年骨质疏松症患者骨密度的影响

背景阿仑膦酸钠是近来所采用的一种试图通过抑制破骨细胞来治疗骨质疏松症的药物,其效果与单纯补钙有何差异,尚待进一步观察.目的观察口服阿仑膦酸钠片对中老年骨质疏松症症状及骨密度的影响,并与葡萄糖酸钙口服液的干预效果比较.设计随机分组,采用自身对照及同期实验对照.单位北京大学深圳医院骨科.对象病例来源于1999-07/2001-07在北京大学深圳医院骨科门诊就诊的中老年骨质疏松症患者68例,选择年龄45岁以上,并排除继发性骨质疏松症患者,有62例患者纳入本次实验,用随机数字法随机分为治疗组(口服阿仑膦酸钠片)32例和对照组(口服葡萄糖酸钙口服液)30例.干预在综合治疗的基础上,治疗组每天给予阿仑膦酸钠片10 mg,对照组给予葡萄糖酸钙口服液,2支/次(每支约含葡萄糖酸钙100 mg,相当于钙9 mg),3次/d,两组疗程均为3个月.根据躯体疼痛改善情况、有无新的骨折发生及骨密度改善情况,分3级进行判定.主要观察指标①两组治疗前后骨密度值比较.②两组疗效比较.③两组不良反应和副作用比较.结果治疗组30例和对照组26例的观察结果纳入分析.①两组治疗前后骨密度值比较治疗组用药3个月,患者的骨密度明显上升,治疗前后比较,差异有显著性意义[(0.667±0.083)和(0.716±0.082)g/cm2;t=2.473,P＜0.01];对照组骨密度治疗前后比较,差异无显著性意义[(0.671±0.081)和(0.680±0.073)g/cm2;t=1.812,P＞0.05];两组治疗后比较,差异有显著性意义(t=2.384,P＜0.01).②两组疗效比较治疗组有效率高于对照组,差异有显著性意义(X2=14.9,P=0.005).③两组不良反应和副作用比较治疗组服药期间有7例患者轻度腹部不适,对照组无任何不良反应.结论阿仑膦酸钠片不仅能抑制骨的吸收,还能促进骨质恢复,增加骨量,可协助治疗中老年骨质疏松症,其疗效较单纯的葡萄糖酸钙口服液好.     

阿仑膦酸钠对中老年骨质疏松症患者骨密度的影响

背景：阿仑膦酸钠是近来所采用的一种试图通过抑制破骨细胞来治疗骨质疏松症的药物,其效果与单纯补钙有何差异,尚待进一步观察.目的：观察口服阿仑膦酸钠片对中老年骨质疏松症症状及骨密度的影响,并与葡萄糖酸钙口服液的干预效果比较.设计：随机分组,采用自身对照及同期实验对照.单位：北京大学深圳医院骨科.对象：病例来源于1999-07/2001-07在北京大学深圳医院骨科门诊就诊的中老年骨质疏松症患者68例,选择年龄45岁以上,并排除继发性骨质疏松症患者,有62例患者纳入本次实验,用随机数字法随机分为治疗组（口服阿仑膦酸钠片）32例和对照组（口服葡萄糖酸钙口服液）30例.干预：在综合治疗的基础上,治疗组每天给予阿仑膦酸钠片10 mg,对照组给予葡萄糖酸钙口服液,2支/次（每支约含葡萄糖酸钙100 mg,相当于钙9 mg）,3次/d,两组疗程均为3个月.根据躯体疼痛改善情况、有无新的骨折发生及骨密度改善情况,分3级进行判定.主要观察指标：①两组治疗前后骨密度值比较.②两组疗效比较.③两组不良反应和副作用比较.结果：治疗组30例和对照组26例的观察结果纳入分析.①两组治疗前后骨密度值比较：治疗组用药3个月,患者的骨密度明显上升,治疗前后比较,差异有显著性意义[（0.667&;#177;0.083）和（0.716&;#177;0.082）g/cm^2;t=2.473,P＜0.01];对照组骨密度治疗前后比较,差异无显著性意义[（0.671&;#177;0.081）和（0.680&;#177;0.073）g/cm^2;t=1.812,P＞0.05];两组治疗后比较,差异有显著性意义（t=2.384,P＜0.01）.②两组疗效比较：治疗组有效率高于对照组,差异有显著性意义（X^2=14.9,P=0.005）.③两组不良反应和副作用比较：治疗组服药期间有7例患者轻度腹部不适,对照组无任何不良反应.结论：阿仑膦酸钠片不仅能抑制骨的吸收,还能促进骨质恢复,增加骨量,可协助治疗中老年骨质疏松症,其疗效较单纯的葡萄糖酸钙口服液好.     

Cigarette smoking and bone mineral density in older men

Cigarette smoking is cited as having a detrimental effect onbone mineral density (BMD), with associated increased fracturerisk. Most of the data are from studies of women, with few studiesof men. We examined the relationship between BMD and cigarette-smokinghabit in a population-based study of men who were categorizedby self-report as ‘never smokers’, ‘currentsmokers’ and ‘ex-smokers’. BMD was measuredusing dual X-ray absorptiometry (DXA). We examined 453 men aged65–76 years (mean 69.1). Non-smokers (‘never’and ‘ex’ smokers) were heavier than current smokers(p = 0.05). There was no significant relationship between BMDand smoking habit at any site except the trochanter, where currentsmokers had significantly lower BMD than did non-smokers. However,after adjusting for age and weight there was no longer a significantrelationship. BMD did not relate to pack-years of cigarettesmoking. Current smokers consumed significantly more alcoholthan non-smokers (p=0.031), but adjusting for alcohol intakedid not alter the BMD-smoking relationship. Cigarette smokingappears not to affect BMD in this group of older men.     

Effects of alendronate and risedronate on bone mineral density and bone turnover markers in late postmenopausal women with osteoporosis

This study was undertaken to compare the effects of alendronate and risedronate on bone mineral density (BMD) and bone turnover markers (BTMs) in late postmenopausal women with osteoporosis. Thirty women older than 60 y of age were randomly assigned to receive alendronate 10 mg (n=16) or risedronate 5 mg (n=14) on a daily basis. The patients were followed every 3 mo for 12 mo. BMD measurements were taken at baseline and at the end of the study, and BTMs were measured at 3-mo intervals. By the end of the study, there were statistically significant increases in BMD in both groups at all sites at which they were measured (P < .001). However, these differences were not statistically significant between groups. By the end of the study, all BTMs had decreased significantly and to a similar extent in both groups. The most significant change was observed in the third month of the study. A negative correlation was noted between percentage change in bonespecific alkaline phosphatase and femoral neck BMD (r=-0.467). This study reported no difference between the 2 drugs in their effects on BMD and BTMs.     

老年男性骨关节炎骨密度变化相关研究

目的探讨老年男性骨关节炎（osteoarthritis,OA）患者骨密度（Bone mineral density,BMD）变化相关因素。方法选择老年男性膝骨关节炎（Knee osteoarthritis,KOA）患者72例（男性组）、老年女性KOA患者60例（女性组）,检测两组的BMD及男性组生活方式情况、血生化指标、骨代谢指标、双膝数值化X射线、KOA WOMAC（Western Ontario and McMaster Uni-versities）评分等临床资料,应用SPSS 13.0软件包进行统计学分析。结果①男性组BMD高于女性组（P=0.002）,骨量变少率低于女性组（P〈0.001）;②男性组腰椎、股骨颈、Wards三角、大转子、股骨干BMD差异有统计学意义（P〈0.001）,其中Wards三角BMD值最低,腰椎BMD值最高;③喝牛奶、户外运动在男性骨量正常组高于骨量变少组（P=0.031,0.002）;④骨量正常组低密度脂蛋白胆固醇（LDL-C）低于骨量减少组和骨质疏松（osteoporosis,OP）组（P〈0.05）,而碱性磷酸酶（ALP）高于骨量减少组和OP组（P〈0.01）,骨钙素（OC）高于OP组（P=0.01）;⑤老年男性KOA的BMD与体质量指数（BMI）、OC呈正相关,与年龄、LDL-C呈负相关。结论老年男性OA较老年女性OA患者更少伴发OP,老年男性OA患者喝牛奶、户外运动者更不易伴发OP,LDL-C越高、年龄越大越易患OP,老年男性OA伴发的OP主要是成骨细胞活性减低所致,属低转换型,在诊治男性OA过程中更应关注OP。     

Disordered eating, menstrual disturbances, and low bone mineral density in dancers: a systematic review

Hincapié CA, Cassidy JD. Disordered eating, menstrual disturbances, and low bone mineral density in dancers: a systematic review.

Objective

To assemble and synthesize the best evidence on the epidemiology, diagnosis, prognosis, treatment, and prevention of disordered eating, menstrual disturbances, and low bone mineral density in dancers.

Data Sources

Medline, CINAHL, PsycINFO, Embase, and other electronic databases were searched from 1966 to 2010 using key words such as “dance,” “dancer,” “dancing,” “eating disorders,” “menstruation disturbances,” and “bone density.” In addition, the reference lists of relevant studies were examined, specialized journals were hand-searched, and the websites of major dance associations were scanned for relevant information.

Study Selection

Citations were screened for relevance using a priori criteria, and relevant studies were critically reviewed for scientific merit by the best evidence synthesis method. After 2748 abstracts were screened, 124 articles were reviewed, and 23 (18.5%) of these were accepted as scientifically admissible (representing 19 unique studies).

Data Extraction

Data from accepted studies were abstracted into evidence tables relating to prevalence and associated factors; incidence and risk factors; diagnosis; and prevention of disordered eating, menstrual disturbances, and/or low bone mineral density in dancers.

Data Synthesis

The scientifically admissible studies consisted of 13 (68%) cross-sectional studies and 6 (32%) cohort studies. Disordered eating and menstrual disturbances are common in dancers. The lifetime prevalence of any eating disorder was 50% in professional dancers, while the point prevalence ranged between 13.6% and 26.5% in young student dancers. In their first year of intensive dance training, 32% of university-level dancers developed a menstrual disturbance. The incidence of disordered eating and low bone mineral density in dancers is unknown. Several potential risk factors are suggested by the literature, but there is little compelling evidence for any of these. There is preliminary evidence that multifaceted sociocultural prevention strategies may help decrease the incidence of disordered eating.

Conclusions

The dance medicine literature is heterogeneous. The best available evidence suggests that disordered eating, menstrual disturbances, and low bone mineral density are important health issues for dancers at all skill levels. Future research would benefit from clear and relevant research questions being addressed with appropriate study designs and better reporting of studies in line with current scientific standards.     

老年男性吸烟与骨转换标志物、骨密度和骨质疏松性骨折风险的关系

目的 调查老年男性吸烟与骨转换标志物、骨密度和骨质疏松性骨折风险的关系.方法 调查576例60～97岁老年男性吸烟等情况,按照是否吸烟分成吸烟组31例和非吸烟组545例.检测两组骨转换标志物[包括I型胶原羧基末端肽交联(CTX)、I型前胶原氨基端前肽(P1NP)和骨钙素(OC)]、骨密度[包括股骨颈骨密度(FNBMD)...     

针药结合对糖皮质激素造模骨质疏松大鼠骨密度、骨含量及骨代谢的影响

目的:探讨针药结合对糖皮质激素造模骨质疏松大鼠骨密度(BMD)、骨含量(BMC)及骨代谢影响的作用原理与机制。方法:选取3月龄雌性SD大鼠40只,体重(170±10)g,随机分为空白对照组、模型组、药物组、针药组,每组10只。各组大鼠连续造模和治疗12周后,扫描测得大鼠腰椎骨密度和骨含量,并用放免法检测血清E2、FSH、LH、CORT、ACTH、CRH的指标水平。结果:模型组大鼠骨密度、骨含量明显低于空白对照组和治疗组(P<0.01),说明骨质疏松模型制作成功;针药结合组腰椎骨密度、骨含量与空白对照组比较差异无显著性意义(P>0.05),与药物组比较有显著性差异(P<0.05);模型组和药物组血清E2、FSH、LH、CORT、ACTH、CRH均明显低于空白对照组和针药结合组(P<0.05)。结论:针药结合疗法疗效优于单一的药物疗法,对糖皮质性骨质疏松症有良好的预防性治疗作用。     

Relationship between low bone mineral density and exercise-induced myocardial ischemia

OBJECTIVE: To evaluate the relationship between bone mineral density (BMD) and ischemic heart disease and exercise capacity, as assessed by stress testing. PATIENTS AND METHODS: We retrospectively reviewed entries in the echocardiography database for 28,048 consecutive patients who underwent exercise echocardiography for standard clinical indications between August 1, 1998, and October 1, 2003, to determine which of these patients had also undergone dual-energy x-ray absorptiometry to measure femoral neck BMD before the procedure. Of the 1194 patients meeting both criteria, 28 were excluded because of missing data and 24 because they were tested with an exercise protocol other than the Bruce protocol, leaving 1142 patients to be included. RESULTS: Of the included study patients, 643 (56%) had a T score of -1.0 or less (mean age +/- SD, 67 +/- 0 years; 87% women), and 499 (44%) had a T score greater than -1.0 (60 +/- 10 years; 90% women). For every 1-unit decrease in femoral neck T score, a 0.23 minute decrease in treadmill exercise duration was observed, once values had been adjusted for age and other patient characteristics (95% confidence interval [CI], 0.11-0.35; P<.001). Furthermore, for every 1-unit decrease in T score, there was a 22% increased risk of myocardial ischemia after adjustments (hazard ratio, 1.22; 95% CI, 1.06-1.41; P=.004). Overall, after adjustments, patients with a BMD of -1.0 or less who were referred for exercise echocardiography had a 43% greater risk of myocardial ischemia than did patients referred with normal BMD (hazard ratio, 1.43; 95% CI, 1.06-1.94; P=.02). CONCLUSIONS: Lower BMD is associated with myocardial ischemia and decreased exercise capacity during exercise echocardiography. Persons with low BMD who present with symptoms suggestive of cardiovascular disease are more likely to have myocardial ischemia than are those with normal BMD.     

Balance and functional mobility predict low bone mineral density among postmenopausal women undergoing recent menopause with osteoporosis,osteopenia, and normal bone mineral density: A cross-sectional study

The purpose of this study was to determine whether balance and functional mobility independently predict bone mineral density (BMD) in postmenopausal women. BMD at the hip and spine was measured with dual-energy x-ray absorptiometry (DEXA). Participants were assigned into groups (i.e., osteoporosis: n=20; osteopenia: n=20; normal BMD: n=20) according to DEXA T-scores. Participants performed the single leg stance test (SLS), timed-up-and-go (TUG), and 6-meter walking test. An ordinal logistic regression was performed to determine whether the SLS, TUG, 6MWT independently predict BMD, while accounting for age, age at menopause, and body mass index. Three factors predicted low BMD: (1) less time to hold the SLS (odds ratio (OR): 0.50); (2) longer TUG time (OR: 2.85); and (3) older Age (OR: 1.31). Women with recent menopause diagnosed with osteoporosis are at a high-risk for fracture; incorporating the SLS and TUG into risk assessments may enable prompt and targeted intervention.     

老年男性代谢综合征患者血睾酮水平与骨密度及骨转换指标的相关性研究

目的分析老年男性代谢综合征(MS)患者血睾酮(T)水平与骨密度(BMD)及骨转换指标之间的相互关系。方法收集60～90岁老年男性111例,分为MS组(61例)和非MS组(50例)。测定T、N-MID骨钙素(N-MID-OC)、总I型胶原氨基端延长肽(PINP)、血清β-胶原特殊系列(β-CTX)水平,同时使用双能X线骨密度测量仪测量左前臂、左髋部及腰椎的BMD,分析血清T水平与BMD及骨转换指标的相关性。结果 MS组的T、N-MID-OC、PINP、腰椎、髋骨及桡骨BMD水平均低于非MS组(P<0.05),β-CTX高于非MS组(P<0.05),且随着MS组分的增加,血T、N-MID-OC、PINP水平及腰椎、髋部、桡骨BMD平逐渐下降,β-CTX逐渐增高,差异有统计学意义(P<0.05)。相关性分析表明:血清T与N-MID-OC、PINP及腰椎、髋部、桡骨BMD呈正相关,与β-CTX水平呈负相关(P<0.05)。结论老年男性MS患者中血T水平与BMD及骨转换指标密切相关,低T水平可作为老年男性骨质疏松(OP)的预测因子。     

Comparison of calcitonin, alendronate and fluorophosphate effects on ovariectomized rat bone.

The effects of calcitonin, alendronate and fluorophosphate preventive treatment on ovariectomized rat femur were studied by comparing densitometric, mechanical, mineralogical and histomorphometric data. Sixty retired breeder female Sprague-Dawley rats, aged 10 months, were randomly divided into six groups. A group (baseline) was euthanized at the beginning of the study as a baseline group; four groups were ovariectomized and one was sham-operated (sham) and considered as a sham-aged group. A group of ovariectomized rats was used as a sham-therapy control (OVX) and received only deionized drinking water, while the other three received: a) salmon calcitonin (SCN) at a dose of 2 IU/kg/d s.c. (OVX + SCN); b) alendronate sodium salt (ALN) at a dose of 6 microg/kg/d administered by gavage (OVX + ALN); and c) L-glutamine monofluorophosphate (G-MFP) and calcium at a rate of 1:30 F/Ca at a dose of 0.21 mg F/6.30 mg Ca per kg/d by gavage (OVX + MFP). Significant increases (P < 0.05) of about 15 and 27% in femoral proximal epiphysis bone mineral density (BMD) of the OVX + ALN group were observed versus healthy groups and the OVX group, respectively. The OVX + ALN group also showed significant increases in femoral mid-diaphysis BMD when compared to OVX (18%, P < 0.001), OVX + SCN (14%, P < 0.05) and OVX + MFP (18%, P < 0.001) groups. In the OVX + MFP group, the three-point bending test demonstrated significant increases (P < 0.05) in maximal load of 21 and 22% when compared to the OVX and OVX + SCN groups, respectively. Also, stiffness data showed significant increases of the OVX + MFP (17%) and sham (14%) groups in comparison with the OVX group. A decrease in Mg (42%, P < 0.05), and increases in Ca (15%, P < 0.0001) and PO4 (8%, P < 0.005) content were found by comparing OVX + MFP and OVX groups. Trabecular bone volume results showed significant increases by comparing OVX + ALN and OVX groups (12.20%, P < 0.0005), as well as control groups. Tested agents were able to reduce the bone loss due to estrogen deficiency, but this did not always produce an increase in strength of the treated bone. Alendronate treatment prevented a decrease in bone mineral density and maintained bone mechanical properties after ovariectomy without impairment of bone mineralization in aged rats.     

老年男性甲状旁腺激素基因多态性与骨密度的相关性研究

目的:探讨甲状旁腺素(PTH)基因多态性与中国广东地区部分汉族男性人群骨密度的相关性.方法:随机筛选年龄65～86岁,(70.09±6.69)岁,广州男性264例,采用双能X线吸收法测其全身、腰椎2～4、股骨颈、Ward'三角和大转子区等部位的骨密度(BMD)值,并采用聚合酶链反应限制性片段长度多态性方法检测外周血白细胞基因组PTH基因型.结果:264例受试对象中,PTH基因BB型181例(68.6%)、Bb型73例(27.6%);和bb型10例(3.8%).PTH基因BstBI基因型分布符合Hardy-Wenbeng平衡定律.三种不同的基因型相互之间的骨密度均无统计学意义(P>0.05).结论:探讨甲状旁腺素(PTH)基因多态性与广东地区汉族老年男性人群骨密度关系不密切,不能作为筛查和预示骨质疏松症的遗传易感位点.     

Relationships between serum adiponectin, leptin, resistin, visfatin levels and bone mineral density, and bone biochemical markers in Chinese men

BACKGROUND: Adiponectin, leptin, resistin, and visfatin, as the main circulating peptides secreted by adipose tissue, are potential contributors to bone metabolism. We investigated whether these serum adipocytokines levels are associated with BMD and bone turnover biochemical markers in 232 Chinese men (20-80 y). METHODS: Serum adiponectin, leptin, resistin, and visfatin levels were determined by ELISA. RESULTS: Leptin had a positively correlation with fat mass, and remained significant after adjustment for age and BMI. There was a significant negative weak correlation between adiponectin and fat mass, and disappear after adjustment for age and BMI. Resistin and visfatin were not significantly correlated with fat mass. In the multiple linear stepwise regression analysis, lean mass and adiponectin, but not leptin, resistin and visfatin, were independent predictors of BMD. The significant positive correlations between adiponectin and bone-specific alkaline phosphatase (BAP), bone cross-linked N-telopeptides of type collagen (NTX) were found, and remained significant after adjustment for age and fat mass. CONCLUSIONS: Adiponectin was an independent predictor of BMD in Chinese men, and positively correlated with bone turnover biochemical markers. It suggested that adiponectin exert a negative effect on bone mass in men.     

双能X线骨密度仪与定量CT测量骨密度的比较

骨质疏松必须有症状、体征、实验室检查(骨代谢生化和激素指标等),X线片等方法的帮助,特异的定量的诊断骨质疏松的手段是骨密度测量,没有骨密度的支持是不能诊断骨质疏松。有创的骨组织形态计量法的手段难于在临床上推广,目前广泛应用的是各种无创性骨密度测量手段。故而临床中骨密度的测定目前主要是双能X线骨密度仪(dual-X-rayabsorptiometry,DXA)与定量CT,但DXA与定量CT测量骨密度的争论由来已久。文章拟从两者的测量方式、原理及临床运用中遇到的问题作一综述。