腰椎和股骨颈骨质疏松症检出率比较分析

目的：探讨测量部位对骨质疏松症诊断的影响。方法：测量50岁以上人群1087人(男性525例,女性562例)腰椎和股骨颈骨密度,以本次流调骨峰值减去2．5标准差为诊断骨质疏松症标准,分别进行统计,并比较不同测量部位骨质疏松检出率;同时摄T4—L4例位片筛选出压缩性骨折患者,比较不同测量部位骨质疏松检出率。结果：两性随年龄增加,两部位BMD逐渐降低,同年龄组女性骨密度低于男性;男性股骨颈骨密度比腰椎骨密度诊断骨质疏松阳性检出率高,女性腰椎BMD诊断骨质疏松症的检出率高于股骨颈BMD的检出率。结论：女性腰椎BMD诊断骨质疏松敏感性优于股骨颈BMD。     

运动疗法对老年2型糖尿病患者预防骨质疏松的作用

目的探讨运动疗法对老年2型糖尿病患者预防骨质疏松的作用。方法 2009年7月-2013年6月在我院就诊的老年2型糖尿病患者随机分为2组,实验组58人,男性26人,女性32人,平均年龄(77.4±6.9)岁;对照组49人,男性23人,女性26人,平均年龄(76.4±7.1)岁。实验组在常规治疗基础上进行有氧运动、阻抗训练,分别于住院时和运动治疗6个月后进行骨密度检测。结果 (1)对照组治疗前后比较,空腹血糖(FBG)、糖化血红蛋白(HbA1C)、体重指数(BMI)、骨密度(BMD)差异无统计学意义;实验组治疗前后比较,L2-4、股骨颈和Wards三角骨密度较治疗前明显增高,FBG、HbA1C、BMI明显降低,P均0.05。(2)2组治疗前后差值之间的比较,实验组L2-4、股骨颈和Wards三角骨密度差值明显高于对照组,FBG、HbA1C、BMI明显低于对照组,P均0.05。(3)治疗过程中,无肌肉扭伤、关节脱位、骨折等不良事件发生。结论运动疗法对老年2型糖尿病患者预防骨质疏松有一定的作用并且能够某种程度提升患者的生活质量。     

2型糖尿病老年男性患者骨密度变化研究

目的研究2型糖尿病老年男性患者的骨矿面密度（bone mineral density,BMD）变化,探讨影响其骨密度的可能因素。方法应用双能x线骨密度仪测定60例老年男性2型糖尿病患者的腰椎和股骨颈骨密度,并检测血清和尿液中骨代谢及血糖相关的生化指标,分析影响患者骨密度的可能因素。结果依据患者腰椎或股骨颈的骨密度值,骨质疏松的检出率为20％,骨量减少的检出率为53．3％。相关分析显示,年龄、体重、HbAlc均是与腰椎或股骨的BMD相关的变量,其中体重与腰椎的BMD相关性最高（r=0．254,P〈0．01）,HbAlc与股骨的BMD相关性最好（r=-0．224,P〈0．01）。结论老年男性2型糖尿病患者的BMD与年龄、体重、HbAlc相关。     

老年男性2型糖尿病25羟维生素D状况及其与糖代谢和骨密度的相关分析

目的 探讨25羟维生素D在老年男性2型糖尿病(T2DM)患者中的状况,分析其与糖代谢和骨密度的关系.方法 收集老年男性T2DM患者53例(T2DM组),老年男性非糖尿病(NDM)患者51例(NDM组),测定两组患者血生化指标及25羟维生素D水平,双光能X线检测T2DM患者腰椎(L2-4)和左侧股骨近端骨密度.结果 T2DM组血清25羟维生素D水平为(12.38±5.12) μg/L,显著低于NDM组的(17.35±5.52) μg/L,差异有统计学意义(P＜0.05);老年男性T2DM患者血清25羟维生素D水平与空腹血糖、糖化血红蛋白呈负相关(r=-0.225、-0.499,P＜0.05),而与空腹胰岛素、稳态模型胰岛素抵抗指数无明显相关性(r=-0.050、-0.082,P＞0.05);T2DM组骨质疏松患病率(30.19％,16/53)明显高于NDM组(11.76％,6/51),差异有统计学意义(P＜0.05);25羟维生素D与股骨颈、股骨大转子、Ward三角区骨密度呈明显正相关(r=0.773、0.762、0.812,P＜0.05),与腰椎(L2～4)骨密度不相关(r=0.116,P＞0.05).结论 老年男性T2DM患者普遍存在维生素D缺乏.维生素D缺乏或不足不仅影响血糖控制,还增加骨质疏松发生风险.因此,对T2DM患者,尤其是老年患者,应进行常规维生素D检测,对维生素D不足及缺乏的患者及时给予维生素D补充可能对改善糖代谢和防治骨质疏松有益.     

老年男性2型糖尿病骨代谢分析

[目的]了解老年男性2型糖尿病患者骨代谢变化及影响因素。[方法]用LEXXOS外星人型双能X线骨密度测 定仪测定老年男性76例2型糖尿病人以及72例非糖尿病人的腰椎和髋部骨密度,并用放射免疫法检测血骨钙素、甲状旁 腺激素和睾酮等指标。[结果]糖尿病组与对照组比较,髋部骨密度下降,体质量指数升高、尿钙增高,血睾酮降低(P< 0.05),血骨钙素降低,甲状旁腺激素增高(P<0.01)。[结论]老年男性2型糖尿病患者存在骨密度显著下降,其骨代谢特 点是骨吸收增加,骨形成降低。2型糖尿病血糖控制不良是糖尿病并发骨质疏松症的危险因素之一。     

2型糖尿病合并骨质疏松的相关危险因素分析

目的分析2型糖尿病合并骨质疏松的骨密度变化及其糖代谢相关生化指标分析。方法将86例2型糖尿病患者按照骨密度分为单纯2型糖尿病组和2型糖尿病合并骨质疏松组,比较两组空腹血糖（FBG）、空腹胰岛素（FINS）、糖化血红蛋白（HbA1c）、病程等,并对以上指标与骨密度进行相关性分析。以93例健康体检者作为健康对照组。结果健康体检者骨质疏松发生率明显低于2型糖尿病患者[28．0％（26／93）比59．3％（51／86）],差异有统计学意义（P〈0．05）。2型糖尿病合并骨质疏松组（51例）HbA1c、FINS、骨密度、病程与单纯2型糖尿病组（35例）比较差异均有统计学意义[（8．57±2．59）％比（7．26±1．68）％、（13．21±4．73）μU／L比（17．54±5．91）μU/L、（0．764±0．130）g／cm2比（0．993±0．123）g／cm2、（11．4±6．4）年比（8．6±4．7）年,P〈0．05]。2型糖尿病患者的骨密度与病程、HbA1c、FINS呈负相关（r=-0．306,-0．185,-0．269;P〈0．05或〈0．01）,而与FBG无相关性（P〉0．05）。结论长期血糖控制不良、体内胰岛素水平低下、病程长是2型糖尿病患者易合并骨质疏松的影响因素。     

降糖药物对老年糖尿病患者骨质疏松的临床观察

目的探讨老年2型糖尿病患者骨质疏松的临床特点。方法测定80例老年2型糖尿病患者的骨密度、空腹血糖、骨钙素、碱性磷酸酶、血钙、血磷。结果与老年非糖尿病患者相比,老年2型糖尿病患者的骨密度明显减低,且女性骨密度明显低于男性,差异有显著性,P<0.05;而碱性磷酸酶、血钙、血磷则无明显变化,差异无显著性,P>0.05。结论老年2型糖尿病患者骨密度减低明显,容易发生骨质疏松。     

2型糖尿病患者病程长短与骨密度和骨代谢指标关系的研究

目的研究病程长短对2型糖尿病患者骨密度及骨代谢生化指标的影响。方法随机选择2型糖尿病患者68例,按其病程分为三组,I组：病程〈5年,18例;Ⅱ组：病程5～10年,22例;Ⅲ组：病程〉10年,28例,并随机选择与糖尿病组年龄、体重指数相匹配的非糖尿病对照组18例。采用生化法测定所有研究对象血清总碱性磷酸酶、血钙、血磷、尿钙、尿磷等,应用DPX～L型双能X线法测定腰椎、股骨颈和全身的骨密度。结果不同病程长短的3组2型糖尿病患者性别比例相当,糖化血红蛋白水平和合并下肢血管病变差异无统计学意义。2型糖尿病组较对照组骨密度降低（RO．05）;Ⅲ组腰椎、股骨颈及全身的骨密度较对照组减低（P〈0．05）;I组股骨颈及全身的骨密度均高于Ⅲ组（P〈0．05）。I组、Ⅱ组血钙明显高于Ⅲ组（P〈0．05）,而I组与Ⅱ组血钙比较差异无统计学意义。结论病程大于10年的2型糖尿病患者骨质疏松发生的危险性增加。     

慢性阻塞性肺疾病老年患者骨代谢与基质金属蛋白酶2的相关性研究

目的 探讨慢性阻塞性肺疾病(COPD)患者血清骨代谢指标和基质金属蛋白酶2(MM-2)水平的相关性.方法 选取40例稳定期COPD老年患者为COPD组,30例健康查体者为对照组,采用酶联免疫吸附试验测定患者血清MMP-2、骨碱性磷酸酶(BALP)、抗酒石酸酸性磷酸酶5b(TRACP-5b)、维生素D受体(VDR)水平,采用双能X线骨密度仪对COPD患者进行腰椎(L2～L4)、双侧股骨颈、股骨大转子骨密度测定.结果 40例COPD患者中,骨质疏松19例,占47.5％,骨量减少14例,占35.0％,正常骨密度7例,占17.5％.与对照组比较,COPD组血清MMP-2水平显著上升[(11.94±5.12) μg/L比(7.89±3.38)μg/L],腰椎(L2～L4)、股骨颈及股骨大转子骨密度水平显著降低[(0.94±0.40) g/cm2比( 1.78±0.76) g/cm2、(0.83±0.36) g/cm2比(1.34±0.57) g/cm2、(0.61±0.26) g/cm2比(0.93±0.40)g/cm2],差异有统计学意义(P＜0.05).与对照组比较,COPD组血清BALP、VDR水平显著下降[(3.65±1.56)mg/L比(10.25 ±4.39) mg/L、(263.12±112.7) nmol/L比(633.43±271.47) nmol/L],TRACP-5b水平显著上升[(48.41±20.75) μg/L比(17.03±7.30)μg/L],差异有统计学意义(P＜0.05).COPD患者血清MMP-2水平与腰椎(L2～L4)、股骨颈及股骨大转子骨密度水平呈显著负相关(r=-0.497、-5.164、-0.492,P＜0.05),与TRACP-5b水平呈显著正相关(r=0.518,P＜0.05),与BALP、VDR 水平呈显著负相关(r=-0.468、--0.513,P＜0.05).结论 COPD患者发生骨质疏松与患者体内MMP-2水平增高和对骨代谢的影响有关.     

富铬酵母提取液降低血糖作用观察

目的观察富铬酵母提取液降低2型糖尿病患者血糖的作用。方法将132例2型糖尿病患者，其中男性84例，女性48例，按性别分层后随机分为实验组与对照组。在原治疗方案不变的条件下，实验组加服富铬酵母提取液。剂量以每日含铬200μg计，观察3个月后血糖、胰岛素与糖化血红蛋白的变化。结果口服富铬酵母提取液3个月后，实验组的血糖、胰岛素与糖化血红蛋白与服用前及对照组比较均显著降低。实验组41％、对照组24％的患者空腹血糖降至7．0mmol／L以下，2组比较差异有统计学意义，P〈0．05。结论富铬酵母提取液具有较好的降低2型糖尿病患者血糖的作用，作用机制可能是提高胰岛素的生物效应，或提高胰岛素受体的敏感性，而不是促进胰岛β细胞分泌胰岛素。     

Mother-daughter pairs: spinal and femoral bone densities and dietary intakes

Bone mineral density (BMD) of the lumbar spine (L1-L4) and femur (femoral neck, Ward's triangle, and trochanter) was measured in 37 healthy, white mother-daughter pairs by dual-photon absorptiometry. Mothers and daughters were aged 52 +/- 7 and 25 +/- 4 y (mean +/- SD), respectively. Three-day dietary intakes were evaluated. Significant correlations between mother-daughter pairs for BMD of all lumbar and femoral areas [except for L2 (r = 0.26, P = 0.054)] indicated familial resemblances in bone mineralization. Total calcium intake was significantly correlated with three BMD values for the daughters (L2, femoral neck, and trochanter) but not for the mothers. When mothers were classified as pre- (n = 20) or postmenopausal (n = 17), correlation coefficients for BMD were higher for premenopausal mothers and their daughters and lower for postmenopausal mothers and their daughters, except for the trochanter. The results suggest that the nature of inheritance of bone mass of women may have at least two components, one influencing the level of peak bone mass and one related to bone loss at menopause.     

Vitamin D supplementation and bone mineral density in early postmenopausal women

BACKGROUND: Increased vitamin D intake may preserve or increase bone mineral density (BMD) in older persons. OBJECTIVE: A 2-y double-blind study was undertaken to determine whether weekly administration of 10 000 units of vitamin D(2) maintained or increased BMD in younger postmenopausal women more efficiently than did calcium supplements alone. DESIGN: One hundred eighty-seven women who were >or= 1 y postmenopausal were randomly assigned to take either 1000 mg Ca/d after the evening meal or 1000 mg Ca/d plus 10 000 U vitamin D(2)/wk in a double-blind, placebo-controlled format. The BMD of the proximal forearm, lumbar spine, femoral neck, Ward's triangle, and femoral trochanter was measured at 6-mo intervals by osteodensitometry. RESULTS: During the 2-y period, there was no significant difference in the change in BMD at any site between the subjects taking calcium supplements and those taking calcium plus vitamin D(2). Both groups significantly (P < 0.005) gained BMD in Ward's triangle and the femoral trochanter but significantly (P < 0.005) lost bone in the proximal radius. There was no significant change in the lumbar spine or femoral neck BMD. CONCLUSION: In younger postmenopausal women ( age: 56 y) whose average baseline serum 25-hydroxyvitamin D concentration was well within the normal range, the addition of 10 000 U vitamin D(2)/wk to calcium supplementation at 1000 mg/d did not confer benefits on BMD beyond those achieved with calcium supplementation alone.     

Tea drinking and bone mineral density in older women

BACKGROUND: High caffeine intake is reportedly a risk factor for reduced bone mineral density (BMD) in women. Most studies, however, are from populations in which coffee drinking predominates and is the major caffeine source. Tea contains caffeine but also has other nutrients, such as flavonoids, that may influence bone mass in different ways. OBJECTIVE: We examined the relation between tea drinking and BMD in older women in Britain, where tea drinking is common. METHODS: We measured BMD at the lumbar spine, femoral neck, greater trochanter, and Ward's triangle in 1256 free-living women aged 65-76 y in Cambridge, United Kingdom. Tea drinking was assessed by self-completed questionnaire and women were categorized as tea drinkers or non-tea drinkers. RESULTS: There were 1134 tea drinkers (90.3%) and 122 non-tea drinkers (9.7%). Compared with non-tea drinkers, tea drinkers had significantly greater ( approximately 5%) mean BMD measurements, adjusted for age and body mass index, at the lumbar spine (0.033 g/cm(2); P = 0.03), greater trochanter (0.028 g/cm(2); P = 0.004), and Ward's triangle (0.025 g/cm(2); P = 0.02). Differences at the femoral neck (0.013 g/cm(2)) were not significant. These findings were independent of smoking status, use of hormone replacement therapy, coffee drinking, and whether milk was added to tea. CONCLUSIONS: Older women who drank tea had higher BMD measurements than did those who did not drink tea. Nutrients found in tea, such as flavonoids, may influence BMD. Tea drinking may protect against osteoporosis in older women.     

甲状旁腺激素基因多态性与钙摄入量对青春期女童骨量增长的交互作用

目的:探讨甲状旁腺激素(PTH)基因多态性与钙摄入量对青春期女童骨量增长的交互作用。方法:选择228名9～11.5岁未月经初潮的健康女童进行2年追踪,用双能X线骨密度仪(DEXA)检测对象追踪前后全身、左侧近端股骨(包括股骨颈、大转子、粗隆间和华氏三角区)、L1～L4腰椎骨矿含量和骨密度,采用PCR-RFLP技术检测PTH基因BstBⅠ位点多态性。结果:BB基因型女童L1～L4腰椎骨矿含量增长率、左侧近端股骨、粗隆间和L1-L4腰椎骨密度增长率均高于含b等位基因女童(P=0.022～0.047)。BB基因型女童在高钙摄入(>950mg/d)时,粗隆间骨矿含量(ITBMC)增长率较中等和低钙摄入时分别高29.4%和35.0%,股骨颈骨密度(FNBMD)增长率分别高66.7%和46.2%。而含b等位基因女童的ITBMC和FNBMD增长率在不同钙摄入量之间没有显著性差异。结论:PTH基因BstBⅠ多态性与钙摄入量对青春期女童骨量增长存在交互作用,BB基因型女童高钙摄入可促进其骨量增长。     

Further evaluation on long-term depot-medroxyprogesterone acetate use and bone mineral density: a longitudinal cohort study

Cross-sectional studies on the effects of depot-medroxyprogesterone acetate (DMPA) on bone mineral density (BMD) have been controversial. The present longitudinal cohort study on 59 Chinese women over a period of 3 years has shown that their annual rate of bone loss at 3 sites (0.44% in lumbar spine, 0.40% in neck of femur, 1.05% in Ward's triangle) was substantially less than the projected values (1.1% in lumbar spine, 2.3% in neck of femur, 3.5% in Ward's triangle) in a cross-sectional study that had demonstrated a significant reduction in BMD in DMPA users than the non-user population. The trochanter BMD measurement did not show the projected annual bone loss of 2.4%. The rate of bone loss is probably non-linear, with a rapid loss in the first 5 years and a leveling off afterwards. The duration of DMPA use was not significantly correlated with the rate of bone loss. Multiple linear regression analysis demonstrated that age and body mass index were significant variables in modeling the rate of bone loss in the lumbar spine and neck of femur, but not in the trochanter and Ward's triangle areas. The Z scores also suggested a retardation in bone loss with time and potentially due to the effect of progesterone in decreasing bone turnover that is similar to the situation in postmenopausal women. The present data provide another aspect of reassurance to the long-term use of DMPA.     

Associations between body morphology and bone mineral density in premenopausal women

To investigate whether body morphology, obesity and its long time evolution were associated with lumbar and femoral bone mineral density (BMD) in premenopausal women of the same age. Design: Cross-sectional study. Subjects: 72 healthy premenopausal women born in 1950 (42 years) with a regular physical activity. Measurements: BMD measured by dual-X-ray absorptiometry (DEXA) at lumbar spine and proximal femur; body weight, body mass index (BMI), BMI at 20 years (BMI-20), increase in BMI since age of 20 (BMI->20), body circumferences (breast, waist, hip) and their ratios (WHR, BHR, WBR), smoking and alcohol intake. Results: Lumbar spine BMD did not correlate with any anthropometric measurement. Femoral BMDs correlated positively with weight, BMI, BMI-20, breast, waist, WHR and BHR. The BMI-20 explained the 5% and the current BMI the 13% of variance of total femur BMD. After adjustment for weight or BMI, breast circumference and BHR remained significantly correlated with all femoral BMDs sites except neck. Weight was the best predictor for neck BMD (R² = 0.08; p < 0.02), and BHR for Ward's triangle (R² = 0.12; p < 0.01) and trochanter (R² = 0.10; p < 0.001). Alcohol intake, cigarette smoking, and age of menarche were not related to BMDs. Conclusion: In premenopausal women of the same age, lumbar spine BMD was not associated with any anthropometric measurement. Greater BHR and its long time of evolution may be determinants of greater femoral BMD (trabecular), whereas body weight may be determinant of femoral neck BMD (cortical). Further studies are needed to determine whether large breast to hip ratio may be considered as a protective factor for femoral osteoporosis.     

Long-term depot-medroxyprogesterone acetate and bone mineral density.

The association between long-term use of depot-medroxyprogesterone acetate (DMPA) and bone mineral density (BMD) has been controversial, as seen in three case-control studies in New Zealand, Thailand, and the United Kingdom. In the present case-controlled study of BMD, a group of 67 Chinese women who had used DMPA from 5-15 years was compared with 218 women of the same age range who had not used any steroidal hormones. DMPA users were found to have a significantly lower BMD at lumbar vertebra (L2-4) (0.93 g/cm2), neck of femur (0.69 g/cm2), trochanter (0.59 g/cm2), and Ward's triangle (0.58 g/cm2), as compared with the control group, whose corresponding BMD values were 1.03 g/cm2, 0.83 g/cm2, 0.71 g/cm2, and 0.78 g/cm2, respectively (p < 0.001). The average percentage of bone loss per year was estimated to be 1.1% in L2-4, 2.3% in neck of femur, 2.4% in trochanter, and 3.5% in Ward's triangle. The percentage of bone loss in L2-4 was found to be more pronounced with age. This study provided information that the use of DMPA in a Chinese group for > 5 years in associated with bone loss, and a prospective study is needed to confirm these data, which are different from two case-control studies.     

Dietary iron positively influences bone mineral density in postmenopausal women on hormone replacement therapy

The associations of dietary intakes of iron and calcium on change in bone mineral density (BMD) were examined over 1 y in healthy nonsmoking postmenopausal women (mean age 55.6 +/- 4.6 y) stratified by hormone replacement therapy (HRT) use (HRT, n = 116; no HRT, n = 112). BMD was measured at lumbar spine L(2)-L(4), trochanter, femur neck, Ward's triangle, and total body using dual-energy X-ray absorptiometry at baseline and 1 y. Mean nutrient intakes were assessed using 8-d diet records. All women received 800 mg/d of supplemental elemental calcium. Regression analyses examined the effects of iron and calcium intakes on BMD change adjusting for years past menopause, baseline BMD, weight change, exercise, and energy intake. The interaction of iron with calcium on BMD change was assessed using tertiles of iron and calcium intake and estimated marginal mean change in BMD. Iron was associated (P < or = 0.05) with greater positive BMD change at the trochanter and Ward's triangle in women using HRT. Calcium was associated (P < or = 0.05) with BMD change at the trochanter and femur neck for women not using HRT. In women using HRT in the lowest tertile of calcium intake, change in femur neck BMD increased linearly as iron intake increased. In women not using HRT, BMD increased in the women in the highest tertile of calcium intake. We conclude that HRT use appears to influence the associations of iron and calcium on change in BMD.     

中国成人吸烟与骨密度相关性的Meta分析

摘要:目的　探讨吸烟是否影响中国成人骨密度（BMD）。方法　检索研究中国成人吸烟与骨密度关系的文献,采用Meta分析方法进行分析。结果　11篇文献共5122名观察对象纳入分析:吸烟者腰椎、股骨颈及Ward's区BMD低于非吸烟者,差异有统计学意义（P＜0.0001）;亚组分析显示男性与女性吸烟者的股骨颈BMD低于非吸烟者,50岁及以上吸烟者股骨颈BMD低于非吸烟者,生态学与病例-对照亚组吸烟者的股骨颈BMD低于非吸烟者,病例-对照亚组吸烟者的腰椎BMD低于非吸烟者,以上差异均有统计学意义（P＜0.0001）。结论　吸烟与中国人群的腰椎、股骨颈和Ward's区的骨密度降低相关,特别是50岁及以上的成人,同时,吸烟女性的股骨颈骨密度比男性降低更显著。     

维生素D受体基因起始密码子多态性与体力活动对青春期女童骨量增长的交互作用

目的 探讨维生素D受体(VDR)基因起始密码子(Fok I位点)多态性与体力活动对青春期女童骨量增长的交互作用.方法 选择228名9～11.5岁未月经初潮的健康女童进行2年追踪,应用双能X线骨密度仪检测对象追踪前后全身、左侧近端股骨(包括股骨颈、大转子、粗隆间和华氏三角区)和L1～L4腰椎骨密度,应用PCR-RFLP技术检测VDR基因Fok I位点多态性.结果 本次研究的有效观察人数为176名.Fok I位点多态性与骨密度(BMD)2年增长率没有关联.在低体力活动水平(<1197 kJ/d)时,FF基因型女童左侧近端股骨骨密度(THBMD)和股骨颈骨密度(FNBMD)增长率低于Ff+ff基因型女童,差异有统计学意义;体力活动与THBMD和FNBMD增长率有关联,但仅限于FF基因型女童.结论 VDR基因Fok I多态性与体力活动水平对青春期女童骨量增长存在交互作用,低体力活动水平的FF基因型女童可能是骨量增长较低的危险人群,体力活动能促进FF基因型女童骨量增长.