女性绝经年龄骨密度与骨质疏松症的关系

女性绝经后易患骨质疏松症,往往由于极轻微的创伤而导致骨折。为探讨女性绝经年龄骨密度（ＢＭＤ）与骨质疏松症（ＯＰ）的关系,我们观察了１４４例女性开始绝经的不同年龄ＢＭＤ和ＯＰ骨折的发病率。１　对象和方法我们对１９９７年５月至１９９９年３月在我院骨密度室体检的１４４例女性,按开始绝经的年龄不同,分为４组。Ⅰ组：＜４４岁开始绝经３０例,现年龄４５～５２岁,平均年龄４８±３９岁。Ⅱ组：４５～４９岁开始绝经４７例,现年龄４７～５３岁,平均年龄５０±２６岁。Ⅲ组：５０～５４岁开始绝经３５例,现年龄５１～…     

持续运动锻炼对绝经后女性骨密度影响的追踪研究

目的比较不同运动锻炼参与程度的绝经后女性骨密度差异及在12个月间的变化。方法对82名符合条件的社区绝经后女性骨密度进行12个月追踪。研究对象分为锻炼量达标组(n=42)和不达标组(n=40),不达标组进一步分为不锻炼和偶尔锻炼亚组。采用定量超声(QUS)法采集跟骨骨密度T值、Z值、超声传导声速(SOS)、超声宽带衰减(BUA),统计各组骨质疏松不同发生风险等级的人数比,测量时间点为基线、6个月和12个月。结果达标组骨密度各指标水平和骨质疏松高度风险人数比(16.7%)在12个月间基本维持稳定(P0.05);不达标组T值(F=11.877,P=0.000)、Z值(F=7.459,P=0.002)、BUA值(F=4.207,P=0.026)在12个月间均出现显著下降,骨质疏松高度风险人数比由20.0%上升至30.0%。达标组与不达标组T值变化具有明显的组间效应(F=4.268,P=0.042)和时间效应(F=6.378,P=0.004)。偶尔锻炼亚组骨密度各指标水平在12个月间下降幅度低于不锻炼亚组。结论不同运动锻炼参与水平可不同程度地维持绝经后女性骨密度水平或延缓其增龄性流失。持续规律的运动锻炼对绝经后女性骨密度水平具有积极的改善作用。     

绝经后骨质疏松症生存质量的调查研究

目的对约经后骨质疏松症患的生存质量进行调查和评价。方法对４２１名社区绝经后妇女进行腰椎双能Ｘ线扫描测定骨密度,利用ＳＦ－３６生存质量调查量进行了生存质量调查。结果４２１名绝经后妇女中骨质疏松症的发病率为６０％。同时,骨质疏松症患生存质量低于非骨质疏松症患。结论绝经后骨质疏松症患的生存质量与正常人相比下降,生存质量的进一步的研究有可能引入骨质疏松症的诊断与疗产评价。     

运动联合利塞膦酸钠治疗绝经后女性骨质疏松症疗效分析

目的观察广场舞运动联合补充利塞膦酸钠防治绝经后骨质疏松症的疗效。方法 168名绝经后骨质疏松症妇女随机分为实验组和对照组,实验组进行广场舞锻炼联合补充利塞膦酸钠治疗,对照组单纯予以补充利塞膦酸钠治疗。实验前及实验干预后6个月和12个月分别检测两组受试者腰椎L1-4、股骨颈部及Ward区骨密度、VAS疼痛评分、骨代谢指标以及不良反应。结果治疗6个月及12个月,两组患者VAS评分不同程度降低,其中以治疗组骨痛的治疗效果要明显优于对照组(P0.05)。治疗12个月后两组腰椎L1-4、股骨颈部及Ward区骨密度明显升高(P0.05),而治疗组明显高于对照组(P0.05)。治疗后6个月及12月,两组血清OC及NTX I较治疗前比较改善明显(P0.05),和对照组比较,治疗组血清OC及NTX I水平改变更为明显(P0.05);而两组不良反应无明显差异(P0.05)。结论广场舞运动结合补充利塞膦酸钠可以有效改善绝经后骨质疏松症,是一种合适的治疗方案。     

绝经后骨质疏松症女性血清IL-31和腰椎、股骨颈骨密度相关性研究

目的 探索绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)患者血清白介素31(IL-31)水平与骨密度(bone mineral density,BMD)相关性.方法 采用双能X线吸收法对80例OP患者(50～75岁)和90例健康对照者(50～75岁)进行腰椎和股骨颈BMD检测.血清...     

绝经后女性骨质疏松性椎体骨折与腰椎体骨密度的相关性

随着我国步入老龄化社会,骨质疏松症的患病率明显升高。骨质疏松症最严重的危害来自骨质疏松性骨折,绝经后女性尤其多见。由于脊柱独特的解剖学和生物力学特点,骨质疏松患者更易发生椎体骨折。骨密度测量是诊断骨质疏松的金标准。本文通过回顾近年来相关文献,探讨腰椎体骨密度检测对绝经后女性骨质疏松性椎体骨折的意义,发现:绝经后骨质疏松性椎体骨折患者的BMD水平比绝经后骨质疏松症但无脊椎骨折者明显减少;绝经后骨质疏松症患者的BMD水平越低,其发生椎体骨折的风险越高;有椎体骨折史的绝经后骨质疏松症患者的BMD水平与发生再次椎体骨折的风险呈负相关。药物干预通常可明显提高绝经后骨质疏松症患者的BMD水平,同时还可减少椎体骨折的发生。尚存在一些不足:腰椎骨密度可能出现假性增高;需进一步探讨预测骨质疏松性椎体骨折的骨密度阈值;药物干预的研究中BMD水平与椎体骨折发生的相关性并没有得到深入研究;缺少大规模的绝经后骨质疏松性椎体骨折的流行病学,现有研究也大都存在病例收集方法不规范、样本量小、年龄分布存在差异等不足。对绝经后骨质疏松性椎体骨折的深入研究需要多学科共同协作。     

绝经后骨质疏松症患者骨密度及骨代谢参数的调查研究

目的 了解E2和IL－6在骨质疏松症发病中的作用。方法 选择绝经后妇女120例，绝经后有骨质疏松60例（OP组），绝经后无骨质疏松60例（NOP组），另外选择绝经前妇女60例为对照组。对180名妇女雌二醇（E2）、骨密度（BMD）、白细胞介素－6（IL－6）、血清总碱性磷酸酶（ALP）、骨钙素（BGP）、尿羟脯氨酸肌酐比值（尿Hoc/Cr)、尿钙肌酐比值（尿Ca/Cr)等指标进行了测定。结果 绝经后妇女骨形成指标BGP及ALT明显高于对照组妇女，其中ALP在OP组和NOP组间有差异，而BGP在OP组和NOP组间无差异；绝经后妇女骨吸收指标尿HOP／Cr及尿Ca/Cr明显高于对照组妇女，OP组尿HOP／Cr及尿Ca/Cr又明显高于NOP组；绝经后妇女的血清E2的含量明显低于对照组（绝经前妇女），OP组又明显低于NOP组；绝经后妇女血清IL－6的含量明显高于对照组妇女，而OP组又明显高于NOP组。结论 本研究证明E2、IL－6与骨质疏松关系密切，雌激素水平的下降，IL－6分泌增多，是导致骨吸收加速的重要原因之一。     

绝经后骨质疏松症妇女运动干预的研究进展

对有关绝经后骨质疏松妇女运动干预的研究结果进行整理分析,旨在找出适合绝经后妇女预防和治疗骨质疏松症的有效运动方法。运动种类的选择、合适的运动量、运动时间和运动频度对骨密度、平衡功能、肌力、防跌倒等方面有较好的效果。提示运动干预是预防绝经后骨质疏松症最积极的方法。     

绝经后骨质疏松症妇女运动干预的研究进展

对有关绝经后骨质疏松妇女运动干预的研究结果进行整理分析，旨在找出适合绝经后妇女预防和治疗骨质疏松症的有效运动方法。运动种类的选择、合适的运动量、运动时间和运动频度对骨密度、平衡功能、肌力、防跌倒等方面有较好的效果。提示运动干预是预防绝经后骨质疏松症最积极的方法。     

坤泰胶囊辅助治疗对绝经后骨质疏松症妇女骨密度、骨代谢和激素水平的影响

目的探讨坤泰胶囊辅助治疗对绝经后骨质疏松症患者骨密度、激素水平和骨代谢的影响。方法 150例绝经后骨质疏松症患者被随机分为治疗组、联合治疗组和对照组,每组50例。治疗组给予雷洛昔芬,联合治疗组给予雷洛昔芬加坤泰胶囊治疗,治疗12个月。检测治疗后两组患者髋部及腰椎的骨密度(bone mineral density,BMD)改变,同时测定血清雌二醇(estradiol,E2)、黄体生成素(luteinizing hormone,LH)、促卵泡剌激素(follicle stimulating hormone,FSH)、骨钙素(OC)和I型胶原交联C-末端肽(CTX-1)的水平,并记录治疗期间出现的药物不良反应。结果对照组的腰椎和髋部BMD在1年后较基线时有不同程度降低,比较差异有统计学意义(P0. 05);治疗1年后,治疗组和联合治疗组髋部及腰椎BMD都有不同程度的升高,且组间比较差异有明显的统计学意义(P0. 05);同时治疗组和联合治疗组血清CTX-1水平均降低,OC水平均升高,两组比较有明显的统计学意义(P0. 05);各组血清FSH和LH水平均降低,E2水平升高,两组比较有明显的统计学意义(P0. 05)。两组患者治疗时均未发现明显药物不良反应。结论坤泰胶囊辅助治疗有助于降低骨转换率,改善性激素水平,改善绝经后女性骨质疏松患者髋部及腰部的骨密度。     

Effect of walking exercise on bone metabolism in postmenopausal women with osteopenia/osteoporosis

The purpose of this prospective study was to determine whether moderate walking exercise in postmenopausal women with osteopenia/osteoporosis would affect bone metabolism. Fifty postmenopausal women, aged 49–75 years, with osteopenia/osteoporosis were recruited: 32 women entered the exercise program (the exercise group) and 18 served as controls (the control group). The exercise consisted of daily outdoor walking, the intensity of which was 50% of maximum oxygen consumption, with a duration of at least 1h with more than 8000 steps, at a frequency of 4 days a week, over a 12-month period. Lumbar (L2–L4) bone mineral density (BMD) was measured at the baseline and every 6 months with dual-energy X-ray absorptiometry (DXA) in both groups. Serum bone-specific alkaline phosphatase (BAP) and urinary cross-linked N-terminal telopeptides of type I collagen (NTX) levels were measured at baseline and at months 1, 3, 6, 9, and 12 by EIA and ELISA, respectively, in the exercise group, and urinary NTX level was measured at the baseline and every 6 months in the control group. There were no significant differences in baseline characteristics including age, height, body weight, bone mass index, years since menopause, lumbar BMD, and urinary NTX level between the two groups. Although no significant changes were observed in lumbar BMD and the urinary NTX level in the control group, lumbar BMD in the exercise group was increased as compared with the control group, but was sustained from the baseline. In the exercise group, the urinary NTX level rapidly responded to walking exercise from month 3, and this reduction was sustained until month 12, followed by reduction in the serum BAP level. A moderately negative correlation was found between the percent change in the urinary NTX level at month 3 and that in lumbar BMD at month 12 in the exercise group. This study clearly demonstrates that the mechanism for the positive response of lumbar BMD to moderate walking exercise in postmenopausal women with osteopenia/osteoporosis appears to be the suppression of bone turnover, and that an early change in the urinary NTX level may be useful to predict the long-term response of increasing lumbar BMD to exercise, although its efficacy for lumbar BMD may be quite modest.     

IL-33与绝经后骨质疏松女性骨密度和骨代谢指标相关性研究

目的 探索血清白细胞介素-33(IL-33)与绝经后骨质疏松女性骨密度和骨代谢指标相关性。方法 采用酶联免疫吸附法测定50例绝经后骨质疏松患者和50例正常绝经后妇女血清IL-33水平。采用双能X线骨密度仪(DXA)测量患者和对照组的骨密度(BMD)。检测维生素D、钙、碱性磷酸酶(ALP)、甲状旁腺激素(PTH)水平,以及1型胶原C末端肽(CTX)和1型前胶原N端前肽(P1NP)等骨转换指标。结果 在绝经后骨质疏松症女性中,IL-33水平显著低于健康对照组[(3.53±2.45) pg/mL vs (13.72±5.39) pg/mL,P=0.007];Spearman相关分析表明血清IL-33水平与年龄、BMI、PTH、CTX和P1NP水平呈负相关,与腰椎BMD和股骨颈BMD呈正相关。多元回归分析表明,年龄、BMI、腰椎BMD、PTH、股骨颈BMD和血清CTX和P1NP水平是骨质疏松症患者血清IL-33水平降低的独立预测因子。结论 血清IL-33降低是绝经后骨质疏松患者股骨颈和腰椎骨密度降低和骨转换增速的危险因素。     

铁过载对绝经后骨质疏松患者骨密度和骨代谢的影响

目的 观察铁过载对绝经后骨质疏松患者骨密度和骨代谢的影响。方法 将234名绝经后妇女按照骨密度（bone mineral density, BMD）分为正常组、骨量减少组和骨质疏松组。分析铁过载对年龄、绝经年数、血钙(Ca)、磷(P)、体质量指数（bone mass index,BMI）、肝肾功能、葡萄糖代谢、脂质代谢、炎症反应、BMD、抗酒石酸酸性磷酸酶5b(TRACP-5b)、ALP、Ⅰ型胶原交联C端肽(β-CTX)和Ⅰ型胶原交联N端肽(PINP)的影响。结果 与正常组相比,骨量减少组和骨质疏松组血清铁蛋白(Fer)显著升高(P<0.05)。Fer水平与BMD呈负相关(P<0.05)。TRACP-5b水平在骨质疏松组明显高于正常组(P<0.05)。与正常组相比,骨质疏松症组的ALP水平显著升高(P<0.05)。与骨量减少组相比,骨质疏松组血清β-CTX水平明显升高(P<0.05);且骨质疏松组的PINP水平显著高于正常组(P<0.05)。更重要的是,血清Fer和PINP之间存在正相关(P<0.05);血清Fer和β-CTX之间呈正相关(P<0.05)。结论 铁过载对绝经后骨质疏松患者骨密度和骨代谢均有显著影响。     

Effect of alendronate on bone mineral density and bone turnover in Thai postmenopausal osteoporosis

Alendronate has recently been approved for the prevention and treatment of postmenopausal osteoporosis, and its efficacy has been demonstrated in many Western countries. Our present study was performed to evaluate the effect of alendronate on bone mineral density (BMD) and its tolerability in Thais. Eighty postmenopausal women with osteoporosis participated in this study. After giving informed consent, the subjects were randomly allocated either 10mg alendronate or placebo in a double-blind fashion. All patients received a supplement of 500mg elemental calcium daily. BMD at the lumbar spine, femoral neck, and distal forearm was measured at baseline and 6 and 12 months after treatment. Biochemical markers of bone resorption were determined at baseline and 6 months after treatment. Baseline characteristics were similar in both alendronate- and placebo-treated groups. Ten subjects discontinued the study. Of 70 subjects, 32 received 10mg alendronate daily and the remaining subjects received placebo. At 1 year, BMD in the alendronate-treated group had increased from baseline by 9.2%, 4.6%, and 3.1% at lumbar spine, femoral neck, and distal forearm, respectively. These percentages were greater than those in controls (4.1%, 0.6%, and 1.0%, respectively). Urinary N-terminal telopeptide (NTx)-I and serum C-terminal telopeptide (CTx)-I levels decreased in both groups after 6 months of treatment. However, more reduction was demonstrated in the alendronate-treated group (71.9% vs. 28.4%, P 0.01, and 84.7% vs. 33.1%, P 0.01, respectively). Compliance with treatment and drug tolerability were good in both alendronate and placebo groups. We concluded that treatment with alendronate 10mg daily for Thai postmenopausal women with osteoporosis significantly increased BMD at all skeletal sites and reduced biochemical markers of bone resorption. It was well tolerated without any serious side effects.     

尿戊糖素水平与绝经后骨质疏松症患者骨密度相关性研究

目的 探讨尿戊糖素水平与绝经后骨质疏松症患者骨密度(bone mineral density,BMD)的相关性.方法 选择2016年4月至2019年5月在我院就诊的骨质疏松症患者80例为观察组,同期在我院体检的健康绝经后妇女80名为对照组.采用酶联免疫吸附法测定血清尿戊糖素和骨代谢指标水平.采用双能X线骨密度仪测量各研...     

绝经后女性骨密度与骨代谢生化指标的相关性分析

目的分析绝经后女性骨密度(bone mineral density,BMD)与骨代谢生化指标的相关性。方法选取西南医科大学附属医院2017年1月至2018年12月收治的绝经后女性患者151例。根据骨密度T值将患者分为骨质疏松组(83例)、骨量低下组(47例)和骨量正常组(21例),比较三组患者骨代谢生化指标的差异,并对各项指标与BMD进行相关性分析。结果骨质疏松组甲状旁腺素(PTH)、Ⅰ型前胶原氨基末端前肽(P1NP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)显著高于骨量低下组和骨量正常组(P0. 05),骨量低下组显著高于骨量正常组(P0. 05)。骨质疏松组体质量指数(bone mass index,BMI)、25(OH) D_3显著低于骨量低下组和骨量正常组(P0. 05),骨量低下组显著低于骨量正常组(P0. 05)。血钙、血磷、骨钙素(BGP)、血清的骨特异性碱性磷酸酶(BALP)在三组之间比较,差异无明显统计学意义(P0. 05)。Spearman相关分析显示,PTH、P1NP、β-CTX与骨密度呈负相关(r=-0. 538,-0. 520,-0. 462,P 0. 05),25(OH) D_3与骨密度呈正相关(r=0. 517,P0. 05),血钙、血磷、BALP、BGP与骨密度无相关性(P0. 05)。结论血清25(OH) D_3、PTH、P1NP、β-CTX与骨密度存在显著相关性,骨代谢生化指标监测有助于绝经后女性骨质疏松的早期诊断。     

Endogenous sex steroids and bone mineral density in healthy Greek postmenopausal women

The aim of this study was to assess the association of endogenous sex steroids with bone mineral density (BMD) in healthy postmenopausal women not on hormone therapy. A total of 884 postmenopausal women aged 42–71 years were studied in a cross-sectional design. Parameters assessed were follicle-stimulating hormone, luteinizing hormone, estradiol, total testosterone, sex hormone-binding globulin, free estrogen index (FEI), free androgen index (FAI), Δ4-androstendione (Δ4A), dehydroepiandrosterone sulfate (DHEAS), bone alkaline posphatase, and bone mineral density at the lumbar spine (L-BMD) and femoral neck (N-BMD). Estradiol and FEI associated positively with both L-BMD and N-BMD (r = 0.21–0.47, P < 0.01). These associations remained significant after adjustment for age, years since menopause, and body mass index. FAI correlated positively with both L-BMD and N-BMD (r = 0.18 and 0.33, respectively; P < 0.01). At the multivariate analysis, however, FAI remained the significant determinant only for N-BMD. Δ4A associated positively with N-BMD (r = 0.27, P = 0.001), whereas DHEAS showed no association with BMD at either site. Thus, endogenous steroids are significant determinants of postmenopausal BMD. Endogenous estradiol may be more important for lumbar spine BMD, whereas endogenous androgens are associated mainly with femoral neck BMD.     

葛根素对绝经后骨质疏松大鼠骨代谢、骨密度及骨生物力学的影响

目的研究葛根素对绝经后骨质疏松大鼠骨代谢、骨密度及骨生物力学的影响,探讨中医药防治绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)的作用机制。方法48只大鼠随机分为正常组、去卵巢组、骨化三醇组和葛根素组,12只/组,构建绝经后骨质疏松大鼠动物模型并给予不同药物干预8周,正常组和去卵巢组:5 mL/kg 0.9%NaCl,ih,qd;葛根素组:葛根素35 mg/kg,ih,qd;骨化三醇组:骨化三醇0.25μg,po,qd,连续给药6周。检测各组大鼠血清骨代谢指标、骨组织(BMD、BMC)和骨生物力学指标,SP法检测各组骨组织ER表达,HE观察骨组织形态学变化。结果去卵巢组大鼠血清骨代谢指标、腰椎和股骨BMD和BMC、股骨骨生物力学指标较正常组显著降低(P<0.05),骨化三醇组和葛根素组上述指标较去卵巢组均显著增高(P<0.05),葛根素组上述指标较骨化三醇组均增高(P<0.05)。去卵巢组大鼠骨组织ER蛋白表达较正常组显著降低(P<0.05),骨化三醇组和葛根素组ER蛋白表达较去卵巢组均显著增高(P<0.05),葛根素组ER蛋白表达较骨化三醇组均增高(P<0.05)。去卵巢组骨皮质明显变薄,骨小梁稀疏纤细或断裂,排列紊乱,髓腔明显扩大,造血细胞明显减少。葛根素组骨皮质结构较完整,骨小梁数目增多,致密均匀粗壮,连接成网状,髓腔变小,造血细胞增多。结论葛根素通过提高绝经后骨质疏松大鼠雌激素水平,调节骨代谢,提高骨量和骨密度,改善骨生物力学性能和骨形态学结构,起到抗PMOP的疗效和骨保护作用。     

身体成分对绝经后女性骨密度和骨骼肌量的影响

目的 基于双能X线骨密度仪测量的身体成分分析,探讨影响绝经后女性骨密度和骨骼肌量的共同因素,为绝经后骨质疏松和肌少症的协同防治提供思路。方法 纳入2015年1月至2020年10月在中山大学附属第一医院进行身体成分分析的171例绝经后女性,根据全身骨密度和相对骨骼肌肉指数(relative skeletal muscle index,RSMI)分为正常组(T值≥-1且RSMI＞5.45 kg/m2)、肌少组(T值≥-1且RSMI≤5.45 kg/m2)、骨量异常组(T值＜-1且RSMI＞5.45 kg/m2)和肌少/骨量异常组(T值＜-1且RSMI≤5.45 kg/m2)。采用单因素方差分析比较4组一般资料和身体成分差异,Pearson相关分析研究身体成分与骨密度和RSMI的相关性,多元线性回归分析探索影响骨密度和RSMI的共同因素。结果 4组在体脂率(percent body fat,PBF)、脂肪量(fat mass,FM)、脂肪指数(fat mass index,FMI)、瘦组织(lean mass,LM)、瘦组织指数(lean mass index,LMI)、骨矿盐含量(bone mineral content,BMC)、Android/Gynoid区域脂肪比率和休止代谢率(resting metabolic rate,RMR)的整体比较中差异均有统计学意义(P＜0.05)。调整混杂因素后,PBF、FM、FMI与骨密度和RSMI呈不同程度负相关,LM、LMI、BMC、RMR与骨密度和RSMI呈正相关。多元线性回归显示高PBF、低LM和低BMC是骨密度和RSMI的共同危险因素。结论 绝经后女性骨密度与骨骼肌量变化密切相关,针对影响二者的共同危险因素采取干预措施可能有利于绝经后骨质疏松和肌少症的协同防治。