The Effect of Socioeconomic Position on Bone Health Among Koreans by Gender and Menopausal Status

While studies suggest that socioeconomic position (SEP) influences bone health and risk of osteoporotic fracture in postmenopausal women, few studies have simultaneously examined gender and menopause differences as they relate to SEP and bone health. Here, we investigated the relationship between SEP and bone mineral density (BMD) among Korean men, premenopausal women, and postmenopausal women using the BMD data set (n = 9,995) of the Korean National Health and Nutrition Examination Survey IV. The relationship between SEP and BMD was estimated using analysis of covariance (ANCOVA); adjustments were made for age and body mass index (BMI) in the multivariate models. The relationship between SEP and osteoporosis prevalence was estimated using logistic regression. Relative index of inequality (RII) in osteoporosis was estimated using log-binomial regression. ANCOVA (adjusted for age and for age plus BMI) showed a significant positive association between SEP and BMD among men and postmenopausal women. Logistic regression showed a significant negative association between SEP and osteoporosis prevalence among men and postmenopausal women but not in premenopausal women. The RII, estimated by log-binomial regression, showed the impact of SEP on osteoporosis to be significant in men and postmenopausal women (p < 0.05) but not in premenopausal women. Overall, low SEP was associated with both low BMD and high risk of osteoporosis among men and postmenopausal women. Efforts to reduce the economic burden of morbidity and mortality from osteoporosis should target men and postmenopausal women with low SEP.     

Fracture risk prediction using BMD and clinical risk factors in early postmenopausal women: Sensitivity of the WHO FRAX tool

The aim of this prospective study was (1) to identify significant and independent clinical risk factors (CRFs) for major osteoporotic (OP) fracture among peri‐ and early postmenopausal women, (2) to assess, in this population, the discriminatory capacity of FRAX and bone mineral density (BMD) for the identification of women at high risk of fracture, and (3) to assess whether adding risk factors to either FRAX or BMD would improve discriminatory capacity. The study population included 2651 peri‐ and early postmenopausal women [mean age (± SD): 54 ± 4 years] with a mean follow‐up period of 13.4 years (±1.4 years). At baseline, a large set of CRFs was recorded, and vertebral BMD was measured (Lunar, DPX) in all women. Femoral neck BMD also was measured in 1399 women in addition to spine BMD. Women with current or past OP treatment for more than 3 months at baseline (n = 454) were excluded from the analyses. Over the follow‐up period, 415 women sustained a first low‐energy fracture, including 145 major OP fractures (108 wrist, 44 spine, 20 proximal humerus, and 13 hip). In Cox multivariate regression models, only 3 CRFs were significant predictors of a major OP fracture independent of BMD and age: a personal history of fracture, three or more pregnancies, and current postmenopausal hormone therapy. In the subsample of women who had a hip BMD measurement and who were not receiving OP therapy (including hormone‐replacement therapy) at baseline, mean FRAX value was 3.8% (±2.4%). The overall discriminative value for fracture, as measured by the area under the Receiver Operating Characteristic (ROC) curve (AUC), was equal to 0.63 [95% confidence interval (CI) 0.56–0.69] and 0.66 (95% CI 0.60–0.73), respectively, for FRAX and hip BMD. Sensitivity of both tools was low (ie, around 50% for 30% of the women classified as the highest risk). Adding parity to the predictive model including FRAX or using a simple risk score based on the best predictive model in our population did not significantly improve the discriminatory capacity over BMD alone. Only a limited number of clinical risk factors were found associated with the risk of major OP fracture in peri‐ and early postmenopausal women. In this population, the FRAX tool, like other risk scores combining CRFs to either BMD or FRAX, had a poor sensitivity for fracture prediction and did not significantly improve the discriminatory value of hip BMD alone. © 2010 American Society for Bone and Mineral Research     

绝经后妇女骨密度影响因素的相关性分析

目的 探讨沈阳地区绝经后妇女不同部位骨密度值与亚洲人骨质疏松自我筛查工具(OSTA)得分、体表面积(BS)、体重指数（BMI）的关系,判断OSTA评分与绝经后妇女髋关节骨折风险的相关性。方法 采用双能X线骨密度仪测定沈阳地区670例绝经后妇女的骨密度值( BMD),并与OSTA 得分、体表面积、体重指数( BMl)、绝经年限进行Pearson相关性回归分析。应用WHO骨折风险因子评估工具(FRAX)评估绝经后妇女髋关节骨折风险,采用线性图表及Pearson相关性回归分析比较OSTA评分与绝经后妇女髋关节骨折风险是否存在相关性。结果 骨密度与OSTA评分、体表面积、体重指数呈线性正相关,相关性由大到小分别为OSTA评分、体表面积、体重、身高、BMI、年龄、绝经期、肥胖度;骨密度与绝经年限呈线性正相关趋势;OSTA评分与髋关节骨折风险呈负相关。结论 OSTA得分能较好的反映出绝境后妇女骨密度减低的趋势及程度,同时也能预测绝经后妇女髋关节骨折风险的程度,在临床中应对OSTA评分较低患者应采取必要的相关性治疗及干预。     

Unbalanced Diet to Lower Serum Cholesterol Level is a Risk Factor for Postmenopausal Osteoporosis and Distal Forearm Fracture

The purpose of this study was to assess whether dietary changes aimed at reducing serum cholesterol can increase the risk of osteoporosis (OP) and fracture. The study group consisted of 311 postmenopausal women with high serum cholesterol levels and following a diet low in dairy products (calcium intake estimated at less than 300 mg/day) for 27.3 ± 29.1 months. This sample was compared with a case–control group of 622 healthy postmenopausal women paired for age and age at menopause and with a calcium intake estimated at more than 1 g/day. Bone mineral density was measured at the lumbar spine by dual-energy X-ray absorptiometry. Prevalence of OP was significantly higher in women with a low dairy calcium intake (42.1% vs 22.3%; p<0.0001), as was the number of Colles” fractures occurring after menopause (4.5% vs 1.6%; p = 0.008). Multiple logistic regression analyses demonstrated that a diet low in dairy calcium was a risk factor for OP (OR = 2.52, 95% CI 1.84–3.45) and Colles” fracture (OR = 2.72, 95% CI 1.18–6.26). In the low dairy calcium group, diet duration significantly influenced the risk of OP (OR = 1.13, 95% CI 1.01–1.25 for 1 year of diet). No differences in further risk factors for coronary heart disease were found between the groups, but the proportion of women physically active was lower in the women with high serum cholesterol levels. A diet that severely limits calcium intake from dairy products in an attempt to correct raised serum cholesterol levels is a risk factor for postmenopausal OP and Colles” fracture. Dietary intervention methods to lower serum cholesterol in postmenopausal women should maintain an adequate calcium intake by providing calcium from low-fat dairy products or calcium supplements. Received: 16 May 2000 / Accepted: 18 November 2000     

Relationship of body mass index with main limb fragility fractures in postmenopausal women

Body mass index (BMI) has been found to be related to the risk of osteoporotic hip fractures in women, regardless of bone mineral density (BMD). The same relationship is under debate for other limb fragility fractures. Very few studies have investigated the comparison of fracture risk among BMI categories, classified according to the WHO criteria, despite the potential usefulness of such information for clinical purposes. To address these issues we studied 2,235 postmenopausal women including those with fragility fractures of the hip (187), ankle (108), wrist (226) and humerus (85). Statistical analyses were performed by logistic regression by treating the fracture status as the dependent variable and age, age at menopause, femoral neck BMD and BMI as covariates. BMI was tested as a continuous or categorical variable. As a continuous variable, increased BMI had a protective effect against hip fracture: OR 0.949 (95% CI, 0.900–0.999), but carried a higher risk of humerus fracture: OR 1.077 (95% CI, 1.017–1.141). Among the BMI categories, only leanness: OR 3.819 (95% CI, 2.035–7.168) and obesity: OR 3.481 (95% CI, 1.815–6.678) showed a significantly higher fracture risk for hip and humerus fractures, respectively. There was no relationship between ankle and wrist fractures and BMI. In conclusion, decreasing BMI increases the risk for hip fracture, whereas increasing BMI increases the risk for humerus fractures. Leanness-related low BMD and obesity-related body instability might explain the different BMI relationships with these two types of fracture.     

High weight or body mass index increase the risk of vertebral fractures in postmenopausal osteoporotic women

In the general population, low body weight and body mass index (BMI) are significant risk factors for any fracture, but the specific association between body weight, BMI, and prevalence of vertebral fractures in osteoporotic women is not fully recognized. Hence, the association between body weight, BMI, and prevalent vertebral fractures was investigated in 362 women with never-treated postmenopausal osteoporosis. All participants underwent measurement of BMI, bone mineral density (BMD), and semiquantitative assessment of vertebral fractures. Thirty percent of participants had ≥1 vertebral fracture. Body weight and BMI were associated with L1–L4 BMD (R = 0.29, P < 0.001 and R = 0.17, P = 0.009, respectively). In logistic regression analysis, BMI was positively associated with the presence of vertebral fractures independent of age and other traditional risk factors for fractures. Including weight and height instead of BMI in the multivariate model, showed weight as a positive and significant covariate of the presence of vertebral fractures (OR = 1.045; P = 0.016; 95% CI 1.008–1.084). BMI was associated with the number of vertebral fractures (rho = 0.18; P = 0.001), this association being confirmed also in the multivariate analysis (β =  0.14; P = 0.03) after correction for smoking, early menopause, family history of fragility fractures and BMD. In conclusion, among postmenopausal women with osteoporosis, body weight and BMI are associated with a higher likelihood of having a vertebral fracture, irrespective of the positive association between weight and BMD.     

新乡市部分社区人群骨质疏松症流行病学调查及相关影响因素Logistic 回归分析

目的了解新乡市部分社区人群骨质疏松症(osteoporosis,OP)的患病情况及相关影响因素,为OP的社区干预提供基础资料。方法应用HOLOGIC公司生产的Sahara定量超声骨密度检测仪测量新乡市部分社区4280名人群右侧跟骨骨密度。通过对受试者进行调查问卷,测量身高、体重、体重指数(BMI),是否服用糖皮质激素及其他影响骨代谢的药物等。单因素Logistic分析,有统计学意义者(P0.1)进一步行二分类Logistic回归分析,计算OR值及其95%置信区间。结果 1 OP总患病率为11.7%,男性8.4%,女性16.3%,OP及低骨量发生率随年龄增加呈上升趋势,同年龄组女性较男性更易发生OP及低骨量;2在男性,单因素分析显示年龄、文化程度、饮酒、咖啡、日饮用牛奶量、BMI、固定锻炼、OP家族史等与OP患病可能相关(P0.1)。二分类Logistic回归分析显示增龄、OP家族史、饮酒为OP可能为危险因素;高文化程度、稳定日牛奶饮用、固定锻炼为OP的可能保护性因素;3在女性,单因素分析显示年龄、文化程度、日饮牛奶量、咖啡、BMI、固定锻炼、绝经年龄及年限是OP的可能影响因子(P0.1);二分类Logistic回归分析显示增龄、绝经状态及BMI是OP的可能危险因素;晚绝经、每日稳定牛奶饮用及锻炼为其可能保护性因素。结论新乡市部分社区OP骨质疏松症的发生随着增龄而增加,女性更为明显。影响男性OP的主要危险因素为家族史和增龄及饮酒;在女性是增龄、绝经及BMI。饮用牛奶和规律锻炼是OP可能保护性因素。在社区一级预防中加强宣教,控制可能导致OP的不良因素,预防和延缓骨质疏松症的发生。     

Obesity and fractures in postmenopausal women

Low body mass index (BMI) is a recognized risk factor for fragility fracture, whereas obesity is widely believed to be protective. As part of a clinical audit of guidance from the National Institute of Health and Clinical Excellence (NICE), we have documented the prevalence of obesity and morbid obesity in postmenopausal women younger than 75 years of age presenting to our Fracture Liaison Service (FLS). Between January 2006 and December 2007, 1005 postmenopausal women aged less than 75 years with a low‐trauma fracture were seen in the FLS. Of these women, 805 (80%) underwent assessment of bone mineral density (BMD) by dual energy X‐ray absorptiometry (DXA), and values for BMI were available in 799. The prevalence of obesity (BMI 30 to 34.9 kg/m²) and morbid obesity (BMI ≥ 35 kg/m²) in this cohort was 19.3% and 8.4%, respectively. Normal BMD was reported in 59.1% of obese and 73.1% of morbidly obese women, and only 11.7% and 4.5%, respectively, had osteoporosis (p < .0001). Multiple regression analysis revealed significant negative associations between hip T‐score and age (p < .0001) and significant positive associations with BMI (p < .0001) and previous fracture (p = .001). Our results demonstrate a surprisingly high prevalence of obesity in postmenopausal women presenting to the FLS with low‐trauma fracture. Most of these women had normal BMD, as measured by DXA. Our findings have important public heath implications in view of the rapidly rising increase in obesity in many populations and emphasize the need for further studies to establish the pathogenesis of fractures in obese individuals and to determine appropriate preventive strategies. © 2010 American Society for Bone and Mineral Research     

Risk Factors for Perimenopausal Distal Forearm Fracture

This prospective population-based cohort study investigated factors predicting distal forearm fracture (DFF) in perimenopausal women. The study population consisted of 11 798 women from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) Study in Finland. Mean baseline age of these women was 52.3 (SD 2.9) years (range 47–56 years) and 68% were postmenopausal. Three hundred and sixty-eight women (3.1%) had a validated DFF during the 5-year follow-up. Previous wrist fracture, postmenopausal state, age and nulliparity were independent predictors of DFF, while hormone replacement therapy (HRT), dairy calcium and overweight protected against it in multivariate Cox regression analysis: previous wrist fracture increased the DFF risk by 158% (p<0.0001), menopause by 69% (p= 0.002) and age by 6% per year (p= 0.010), whereas the continuous use of HRT decreased the risk by 63% (p= 0.0001), the use of dairy calcium at 1000–1499 mg/day (vs <500 mg/day) by 39% (p= 0.004), overweight (BMI >25 kg/m²) by 36% (p= 0.0002) and parity by 29% (p= 0.031). Combining dichotomous low weight, low use of calcium, non-use of HRT and previous wrist fracture into a risk score gave a dose–response effect by score level: the presence (vs absence) of all four risk factors resulted in a 12-fold DFF risk. Nevertheless, the sensitivity and specificity of the score for detecting DFF remained low. It was concluded that HRT, high nutritional calcium intake and overweight protect against but a history of wrist fracture predisposes to perimenopausal distal forearm fracture. A simple risk factor inquiry would help to identify perimenopausal women at high risk of distal forearm fracture. Received: 7 July 1999 / Accepted: 6 September 1999     

2型糖尿病患者骨密度变化及其相关因素的探讨

目的：研究2型糖尿病（DM）患的骨密度变化，以了解2型DM患是否易合并骨质疏松（OP）及其相关影响因素，方法：采用双能X线骨密度仪，测定80例2型DM及62例性别年龄相匹配的健康前臂、腰椎、股骨颈、ward区以及大转子的骨密度，并对其与年龄，病程，体重指数、绝经年限，空腹血糖，糖基化血红蛋白及部分钙磷调节激素的相关性进行了分析。结果：均经统计学处理分析。结果：80例2DM患的骨密度较健康有不同程度下降，按中国人OP推荐诊断标准，本组有36例（45％）合并OP，OP与非OP组的病程，24h尿蛋白，绝经年龄，FSH、LH水平也存在显性差异（P均＜0．05）。相关性分析结果发现：骨密度与患年龄、病程、绝经年限，FSH、LH呈显负相关（P均＜0．05）。结论：2型DM型患较易发生OP，良好的DM及其并发症治疗对预防OP有益，糖代谢紊乱加速了绝经后妇女OP的发生，控制血糖并适时以激素补充治疗对治疗OP也是必需的，建议糖尿病医生在治疗DM的同时应注意OP防治。     

血清Asprosin水平与绝经后女性骨密度、平衡能力和骨折发生率的相关性

目的 探讨血清Asprosin(白脂素)水平与绝经后女性骨密度(bone mineral density,BMD)、平衡能力和骨折发生率的相关性.方法 回顾性分析海南医学院第一附属医院收治的164例绝经后女性骨质疏松症(osteoporosis,OP)患者的临床资料.记录患者一般临床资料以及骨折发生率、髋部骨密度、平衡...     

Does hormone-replacement therapy prevent fractures in early postmenopausal women?

The purpose of this population-based prospective cohort study was to examine the effect of hormone-replacement therapy (HRT) on the risk of fractures. The study population consisted of 7217 postmenopausal women aged 47-56 years (mean, 53.3 years) at baseline from data taken from the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) in Finland. We compared fracture incidences between HRT users and nonusers. A total of 679 (9.4%) women recorded validated fractures during the 5-year follow-up. Of these, 268 (39%) women had a distal forearm fracture. Two thousand six hundred seventy women (37%) had used HRT >6 months during the follow-up--one-half of them continuously. The relative risk, estimated as hazard ratio with Cox regression, was 0.69 (95% CI, 0.58-0.82) for any fracture and 0.49 (0.36-0.66) for distal forearm fracture among HRT users as compared with never-users. After adjusting for age, body mass index (BMI), number of chronic health disorders, fracture history, and time since menopause (independent risk factors) the corresponding risks were 0.67 (0.55-0.81) and 0.53 (0.37-0.74), respectively. The respective adjusted risks for continuous HRT users were 0.62 (0.48-0.79) and 0.41 (0.26-0.67). The adjusted risk of other than distal forearm fracture was 0.74 (0.55-0.98). The results suggest that HRT has a beneficial effect on prevention of fractures in general and on that of distal forearm fracture in particular in early postmenopausal women.     

Poverty is a risk factor for osteoporotic fractures

Summary  This study assesses the possible association between poverty and osteoporosis and/or fragility fractures in a population of postmenopausal women. We found that postmenopausal women with low socioeconomic status had lower values of BMD at the lumbar spine, a higher prevalence of densitometric osteoporosis, and a higher prevalence of total and vertebral fractures. Introduction  Some lifestyles are related to the presence of osteoporosis and/or fragility fractures, whereas poverty is related to some lifestyles. Because of this, we studied the possible association of poverty with osteoporosis and fractures. Methods  This was an observational, cross-sectional study performed in the Canary Islands, Spain. Participants consisted of a total of 1,139 ambulatory postmenopausal women aged 50 years or older with no previous osteoporosis diagnosis and who were enrolled in some epidemiological studies. The prevalence of fractures (vertebral and non-vertebral) and the prevalence of osteoporosis (T-score <–2.5 either at the lumbar spine or the femoral neck). A previously validated questionnaire elicited the most important risk factors for osteoporosis: socioeconomic status, defined by the annual income was also assessed by a personal interview. A dorso-lateral X-ray of the spine was performed, and bone mineral density (BMD) was measured by DXA in the lumbar spine (L2–L4) and proximal femur. Results  Compared to women with a medium and high socioeconomic status (n = 665), those who were classified into poverty (annual family income lower than 6,346.80 Euros, in a one-member family, n = 474), were older and heavier and had lower height, lower prevalence of tobacco and alcohol consumption, lower use of HRT and higher use of thiazides. After correcting for age and body mass index (BMI), women in poverty had lower spine BMD values than women with a medium and high socioeconomic status (0.840 g/cm² vs. 0.867 g/cm², p = 0.005), but there were no statistical differences in femoral neck BMD between groups. The prevalence of osteoporosis was also higher in women in poverty [40.6% vs. 35.6%, (OR 1.35, CI 95%: 1.03; 1.76)] after adjusting by age and BMI. Moreover, 37.8% of women in poverty had a history of at least one fragility fracture compared to 27.7% of women not in poverty (OR: 1.45, CI 95%: 1.11; 1.90). The prevalence of vertebral fractures was also higher in women in poverty 24.7% vs. 13.4%, (OR 2.01, CI 95%: 1.44; 2.81). Conclusions  Postmenopausal women with low socioeconomic status had lower values of BMD at the lumbar spine, and a higher prevalence of densitometric osteoporosis, and a higher prevalence of total and vertebral fractures. Because of this, apart from the well known risk factors for osteoporosis, poverty should be taken into account as a possible risk factor for both osteoporosis and fragility fractures, in order to establish sanitary strategies to protect unfavoured postmenopausal women. This study was support by an unrestricted grant of the Canarian Society of Osteoporosis (SOCAOS SL).     

Is the metatarsal fracture in postmenopausal women an osteoporotic fracture? A cross-sectional study on 113 cases

To evaluate whether metatarsal fracture in postmenopausal women can be related to osteoporosis, a sample of 113 postmenopausal women with metatarsal fracture due to minor trauma were recruited. Demographic and clinical data were compared with a control group of 339 healthy age-matched women and with a sample of 224 women with wrist fracture. In all women, bone mineral density (BMD) was measured at the lumbar spine by dual-energy X-ray absorptiometry. The average age of the metatarsal fracture group was slightly lower than that of the wrist fracture group (56.9 vs 58.4 years). Women with metatarsal and wrist fracture had a significantly higher age at menarche, lower age at menopause and lower body mass index when compared with controls. In both fracture groups BMD was significantly lower compared with controls. In stepwise logistic regression models, factors associated with metatarsal fracture risk were age at menopause (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.81–0.92) and BMD (OR per — 1 SD 2.44; CI 1.92–3.11). Factors associated with wrist fracture risk included age at menopause (OR 0.89; CI 0.84–0.93) and BMD (OR per — 1 SD 2.65; CI 2.17–3.24). The similarities existing in risk factors and their estimates between a well-recognized osteoporotic fracture such as wrist fracture and metatarsal fracture, support the hypothesis that the latter can be included among osteoporotic fractures.     

绝经后女性2型糖尿病患者腰椎骨质疏松的影响因素研究

目的探讨绝经后女性2型糖尿病(type 2 diabetes mellitus,T2DM)患者腰椎骨质疏松(osteoporosis,OP)的影响因素。方法选取2018年3月至2019年10月在武汉科技大学附属孝感医院内分泌科住院的绝经后女性T2DM患者186例为研究对象,按腰椎骨密度T值分为骨质疏松组(OP组)和非骨质疏松组(NOP组)。收集一般资料(年龄、身高、体重、妊娠次数、生育次数、绝经年龄、DM病程、DM家族史、高血压、脂肪肝);血检指标(Hb A1c、FPG、Fins及生化);采用双能X线骨密度仪测量腰椎的骨密度T值和腰椎、股骨的骨髓脂肪含量(LFC、FFC)。分析OP组和NOP组指标的差异及腰椎OP的影响因素。采用SPSS 26.0软件进行统计学分析,使用t检验、非参数检验、卡方检验,Pearson和Spearman相关性分析,二元Logistic回归分析,P0.05为差异有统计学意义。结果 OP组年龄、FFC、ALP、HBDH、LDH、绝经年限、妊娠次数、生育次数高于NOP组(P 0.05),OP组体质量指数(BMI)、GGT低于NOP组(P0.05);两组在FPG、Fins、Hb A1c、DM病程、DM家族史、高血压、脂肪肝、LFC、UA、Ca~(2+)、Mg~(2+)、TC、TG、CK上没有差异(P0.05)。腰椎骨密度的二元Logistic回归分析显示,年龄、FFC、ALP、绝经年限、生育次数是腰椎OP的危险因素(OR值分别为1.131、1.072、1.029、1.127、1.857),BMI是腰椎OP的保护因素(OR值为0.913)。结论年龄、FFC、ALP、绝经年限、生育次数是腰椎OP的危险因素,BMI是腰椎OP的保护因素。     

昆明女性髋部骨密度及骨质疏松调查

目的　调查昆明成年女性髋部骨密度 (BMD)变化 ,对骨质疏松 (OP)进行筛查研究。方法　用双能X线骨吸收仪 (DEXA)测量健康女性 330名 ,左股骨颈 (Neck)、沃氏三角 (Ward s)和大转子(Troch) 3区的BMD值。结果　髋部 3区BMD峰值年龄均在 2 0～ 2 9岁 ,峰值水平Neck >Ward s >Troch ;BMD值 30岁后随年龄下降 ,绝经后 (5 0～ 5 9岁组 )失骨率显著升高 ,分别为 2 0 2 % /年 (W )、1 .32 % /年 (N)、1 0 7% /年 (T) ,70～ 79岁再次失骨加速 ,>80岁组累计失骨率 5 2 83% (W)、4 0 95 %(N)、39 97% (T)。OP筛查 :以 2 5s为标准 ,<5 0岁无OP ,之后随年龄上升 ,以Ward s三角最敏感 ;≥5 0岁患病率为 30 %～ 5 0 %。结论　 30岁前达BMD峰值 ,绝经后骨丢失加快 ,存在老年第二失骨加速期 ,提示绝经和年龄先后起决定性作用 ,5 0岁后骨质疏松开始出现。筛查OP的敏感性依次为Ward s>Neck >Troch。     

Prevalence of osteoporosis and its reproductive risk factors among Jordanian women: a cross-sectional study

Extensive differences in the osteoporosis epidemiological pattern among geographic and ethnic groups have been reported. The evidence concerning association of multiple pregnancies, lactations, and other menstrual history factors with low bone mineral density (BMD) remains inconclusive. Previous local studies addressing these issues in Jordan are very restricted. We present a cross-sectional study of Jordanian women who visited outpatient clinics between August 2000 and August 2002 at two community hospitals in Amman City. BMD measurement was performed for all subjects, while comprehensive appraisal of clinical issues related to reproductive status and past medical history was carried out using a structured questionnaire administered to 50% of the subjects. We also attempted to examine the current hypothesis of possible influence of hyperlipidemia and thyroid abnormalities on decreased BMD. According to WHO criteria, 119 (29.6%) were identified as having osteoporosis, 176 (43.8%) were osteopenic, and 107 (26.6%) had normal BMD. The multiple-linear regression analyses at different bone sites revealed that age, years of menopause, low-density lipoprotein (LDL), and follicle-stimulating hormone (FSH) have strong independent associations with decreased BMD at all lumbar and femoral neck regions. The negative effect associated with number of children (live births) and frequency of lactations was only evident at femoral neck. Although years of menstruation, age at menopause, days of menstrual cycle, number of pregnancies, and duration of hormone replacement therapy (HRT) were positively correlated with BMD, they had weaker associations than previous variables. Moreover, in the final multivariable logistic regression model, variables which rendered significantly independent risk factors after adjustment for age and BMI were: current smokers of more that 25 cigarettes/day, postmenopausal women irrespective of HRT use, menopausal years of 5 year intervals, natural early menopause, gastrointestinal disease, rheumatoid arthritis, osteoarthritis, hypertension, and thyroid replacement therapy. Ever-lactation, frequent lactation of 4 or more times, duration of lactation interval of 1–6 months and clinical hyperthyroidism were significant protective factors. Hysterectomy with or without oophorectomy, premature ovarian failure, gravidity, menstrual flow pattern, family history of osteoporosis, clinical hypothyroidism, hyperlipidemia, HRT, and corticosteroids therapy were not independent predictors of osteoporosis among our population. It was concluded that the prevalence of this worldwide public health problem among the Jordanian female population is extremely high, and is even found in younger age categories compared to previous international surveys. Though, the number of pregnancies in our multiparous female population showed a negative impact on femoral neck BMD, no evidence of increased risk of osteoporosis among ever-pregnant women was noted. Conversely, the current data analysis highlight many potential risk factors including associated medical illnesses, and other hormonal alterations experienced during menopausal period. Therefore, increased health awareness and intensive screening programs are mandatory for early detection of low bone mass.     

Bone mineral density, body mass index, postmenopausal period and outcomes of low back pain treatment in Korean postmenopausal women

Women going through menopause experience bone loss and increased musculoskeletal pain, including low back pain. This study explored the relationships between bone mineral density (BMD) and body mass index (BMI), postmenopausal period and outcomes of treatment for low back pain in postmenopausal Korean women. On examining the medical records of 78 postmenopausal women hospitalized for low back pain, investigators found that women with low BMD were older and had been postmenopausal for longer periods than women with normal BMD. Postmenopausal length was positively correlated with pain scores at day 15 and 20 post-admission (P = 0.011 and 0.006) and negatively correlated with T-scores (P = 0.002). BMI was positively correlated with T-scores (r = 0.283, P = 0.022). In conclusion, age, postmenopausal length and BMI correlate with BMD in Korean women suffering from LBP. Larger studies investigating the associations between menopause, BMD, BMI and LBP seem desirable. Moreover, evidence-based therapeutic approaches should be explored for BMD and LBP management.     

Risk Factors for Osteoporosis Related to their Outcome: Fractures

The aim of the study was to determine to what extent easy obtainable bone mineral density (BMD)-related risk factors are associated with the occurrence of fractures and to what extent changes in these determinants during a patient”s lifetime are relevant. A cross-sectional population-based study was carried out on 4725 postmenopausal women, 50–80 years of age, registered with 23 general practitioners (GPs). The women were questioned and examined. BMD of the lumbar spine was measured using dual-energy X-ray absorptiometry (QDR-1000, Hologic). We analyzed the total population as well as a random sample of 1155 women for whom additional data were collected on recalled weight at age 20–30 years and on self-reported height. Body mass index (BMI) was estimated in two ways: (1) objective BMI [= measured weight/(measured height)²]; (2) recalled BMI [= recalled body weight at age 20–30/(self-reported height)²]. Fractures (dependent variable) were categorized as: (1) fractures sustained during the patient”s lifetime; (2) fractures after the age of 50 years; (3) fractures that had occurred during the 5 years before BMD measurement took place. Multivariate stepwise backward and forward logistic regression analyses, using fractures as the dependent variable, were performed with all discrete and non-discrete variables (divided into quartiles). The relationship between the presence of osteoporosis and the presence of fractures was related to the changes in BMI (recalled BMI versus objective BMI). More advanced age, positive family history of fractures and BMD had a positive association with the presence of fractures. Low recalled BMI was a statistically significant predictor of “fractures during the patient”s lifetime” and of “fractures after the age of 50”. Hysterectomy was associated with a higher prevalence of “fractures during the patient”s lifetime”. Perimenopausal complaints in the history seemed to be associated with a lower prevalence of “fractures after the age of 50”. Moderate (and heavy) occupational exercise in the past were associated with the presence of fractures “after the age of 50” and “fractures during the past 5 years”. Sporting activities in the past showed a slightly positive relationship with the presence of “fractures during the patient”s lifetime” and “fractures after the age of 50”. Bivariate analysis revealed that current smokers had not sustained significantly more fractures than current nonsmokers, but within the subgroup of current smokers, the prevalence of fractures was significantly higher among those women who had smoked for more than 35 years. Smoking was statistically significantly associated with early menopause. Early menopause was not statistically significantly related to the presence of osteoporosis but appeared to be statistically significantly associated with the prevalence of fractures in the age categories over 65 years. The absolute risks of sustaining one or more fractures ranged from 3% to 44%. Women in the lowest quartile of recalled and objective BMI were often osteoporotic (40%). In this category, women with normal BMD had a statistically significant lower fracture risk than osteoporotic women. Women with a possibly decreased BMI were most often osteoporotic and had sustained more “fractures during the past 5 years” than expected. Women who had (probably) always been obese were less often osteoporotic and had a much lower fracture risk. It is concluded that decreased BMI is associated with a higher risk of developing fractures at an older age. Prevention of fractures should include fall prevention. In addition, in lean women treatment of low BMD is important. Received: April 2000 / Accepted: January 2001     

Bone mineral density in old age: the influence of age at menarche and menopause

Being aware that age at menarche, age at menopause, and length of fertile period influence bone mineral density (BMD) in the early postmenopausal period, we have failed to find any earlier studies where such an influence on the axial skeleton has been studied in old age when the incidence of hip fracture starts to increase. A large cohort of women, all 75 years old (n = 1044) participated in the Malmö Osteoporosis Prospective Risk Assessment (OPRA) Study. The BMD of the lumbar spine and femoral neck was assessed by a dual-energy X-ray absorptiometry (DXA) technique. Age at menarche and at menopause was recalled with a questionnaire. Also, data on estrogen medication was collected. We found that, after excluding ever-users of potent estrogens (n = 49), there was a small but significant correlation of early menarcheal age with high BMD of the lumbar spine (r = –0.08; P = 0.017) and femoral neck (r = –0.10; P = 0.002) at age 75. Excluding the extremes (5% of the women) with very early or very late menarche, age at menarche no longer influenced the BMD in old age (r = –0.06; P = 0.113). Age at menopause had no influence on the BMD of the lumbar spine (r = 0.04; P = 0.246) or femoral neck (r = 0.00; P = 0.985), at age 75. The length of the fertile period did not influence BMD in old age. The influence of menarcheal or menopausal age on BMD at age 75 was not substantially altered after including body mass index (BMI) in a multiple regression model. Age at menarche or menopause seems to be of limited or no importance as a risk factor for osteoporosis when subjects are age 75 or older.