跟骨定量超声法评价正常女性骨丢失和骨质疏松患病率

目的　评价正常女性跟骨超声随增龄骨量丢失及骨质疏松患病率。方法　用定量超声法测定了 2 72例正常女性右跟骨宽带超声衰减 (BUA) ,超声声速 (SOS)及骨硬度指数 (STI)。结果女性跟骨峰值骨量出现在 30～ 39岁。 5 0～ 84岁 3组与峰值组以及两两之间比较 ,差异均有显著性(P <0 0 1)。老年组骨质丢失率和骨质疏松患病率分别为 2 6 %～ 37%和 4 2 %～ 6 9%。在各个年龄组中 ,STI丢失率最高 ;STI和BUA骨质疏松检出率相近 ,均大于SOS。结论　跟骨超声的 3项指标均可用于区分绝经前、后的妇女 ;STI检测骨量丢失和OP患病率最敏感     

A precise method for the assessment of tibial ultrasound velocity

We assessed a method for the measurement of ultrasound velocity in cortical bone of the human tibia using a probe designed to minimize the effects of surrounding soft tissues. Of four different measurement values, the maximum velocity (average of the five highest readings) gave the lowest errors of reproducibility in relation to the population variance (standardized coefficient of variation=1.8%). The maximum velocity varied according to the tibial site measured and for practical reasons the mid-tibial site was chosen for further study. The short-term intra- and inter-observer reproducibilities (coefficients of variation) were 0.35% (n=22) and 0.50% (n=27) respectively. Long-term reproducibility over 4 months in 31 subjects was 0.68%. There was no significant difference in maximum ultrasound velocity between the dominant and non-dominant tibia in 78 women (3764±209 vs 3763±199 m/s). Tibial ultrasound velocity was significantly higher in 73 premenopausal women (3999±102 m/s) than in 129 women referred for assessment of postmenopausal osteoporosis (3780±168 m/s), 26 women with steroid-induced osteoporosis (3790±188 m/s) and 4 women with hyperparathyroidism (3575±261 m/s). In premenopausal women, ultrasound velocity did not correlate significantly with age, height, weight or body mass index. In women with postmenopausal osteoporosis, ultrasound velocity decreased with age after the menopause (r=–0.47,p<0.0001) and body weight exerted a weaker protective effect. The apparent annual decrease in velocity with age in postmenopausal osteoporosis (8.5 m/s) was comparable to the error of reproducibility. We conclude that the technique for measuring tibial ultrasound velocity is highly reproducible in relation to the distribution of values in the population and is sensitive to age- and osteoporosis-induced changes in bone. Further studies are required to examine its relationship to other indices of skeletal status to determine the biological and clinical relevance of the technique.     

Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA

Summary Application of the WHO fracture prediction algorithm in conjunction with an updated US economic analysis indicates that osteoporosis treatment is cost-effective in patients with fragility fractures or osteoporosis, in older individuals at average risk and in younger persons with additional clinical risk factors for fracture, supporting existing practice recommendations. Introduction The new WHO fracture prediction algorithm was combined with an updated economic analysis to evaluate existing NOF guidance for osteoporosis prevention and treatment. Methods The WHO fracture prediction algorithm was calibrated to the US population using national age-, sex- and race-specific death rates and age- and sex-specific hip fracture incidence rates from the largely white population of Olmsted County, MN. Fracture incidence for other races was estimated by ratios to white women and men. The WHO algorithm estimated the probability (%) of a hip fracture (or a major osteoporotic fracture) over 10 years, given specific age, gender, race and clinical profiles. The updated economic model suggested that osteoporosis treatment was cost-effective when the 10-year probability of hip fracture reached 3%. Results It is cost-effective to treat patients with a fragility fracture and those with osteoporosis by WHO criteria, as well as older individuals at average risk and osteopenic patients with additional risk factors. However, the estimated 10-year fracture probability was lower in men and nonwhite women compared to postmenopausal white women. Conclusions This analysis generally endorsed existing clinical practice recommendations, but specific treatment decisions must be individualized. An estimate of the patient’s 10-year fracture risk should facilitate shared decision-making. The authors comprise the National Osteoporosis Foundation Guide Committee.     

Extent of innate dexterity and ambidexterity across handedness and gender: Implications for training in laparoscopic surgery

Background As innate dexterity is considered one of the important predictors of eventual operative competence, an experimental human factors study was conducted to determine innate dexterity and ambidexterity across handedness and gender. Methods 50 medical students (right-handed males, left-handed males, and right-handed females) were recruited as participants in a study designed to assess innate dexterity and degree of ambidexterity for endoscopic manipulations in a validated virtual-reality simulator. All participants performed unilateral and bilateral tasks with both dominant and nondominant hands in random sequence. The outcome measures were execution time, extent of ambidexterity (ambidexterity index), aiming errors, and maximum tissue damage. Results Right-handed males exhibited a greater level of ambidexterity than left-handed males (p = 0.02 for path length, p = 0.001 for angular path) and right-handed females (p = 0.01 for path length, p = 0.02 for angular path), and more-efficient task performance as measured by execution time (p = 0.001 for males and p = 0.03 across gender). The task quality when executed by the dominant hand was best in right-handed males (p = 0.001 vs. left-dominant males and p = 0.03 across gender). No significant difference was observed in terms of precision control and fine movements (aiming errors and maximum tissue damage) between the three groups. Conclusions These findings indicate that training surgical curricula in laparoscopic surgery should be more flexible to accommodate the innate differences across handedness and gender.     

A screening and counseling program for prevention of osteoporosis

Prevention of osteoporosis is an increasingly salient public health concern as our society ages. This report describes the procedures used at an osteoporosis center to which people come for screening and counseling. The patients on whom this report is based were 53 non-smoking women, 1–10 years postmenopausal at the time of their first visit to the center, who chose not to undertake estrogen therapy, and who returned for a second visit in 12–18 months. They were classified as to adequacy of calcium intake (at least 750 mg/day) and exercise (at least 3 h/week of weight-bearing exercise) at both visits; complete data on calcium intake and exercise were available on 46 of the women. Bone densities were measured at the femoral neck and lumbar spine with dual energy X-ray absorptiometry, and at the distal radius with single photon absorptiometry. At the first visit, 67% of the women reported adequate exercise and 43% reported adequate calcium intake. At the second visit, the percentages in the adequate categories had increased to 74% for exercise (p=0.06) and 70% for calcium intake (p=0.02). Age at the first visit was inversely correlated with femoral (r=–0.40,p=0.003) and spinal (r=–0.36,p=0.009) bone densities; the correlation with radial bone density did not achieve significance (r=–0.27,p=0.55). Rather than declining, as would be expected in early postmenopausal women, bone density rose slightly, but not significantly, between visits for all three sites. Neither the first visit values nor the changes between visits were significantly different between groups divided on the basis of adequacy of calcium intake or exercise. These data suggest that bone density is related to age, that a visit to an osteoporosis center may help early postmenopausal women to maintain and improve healthy exercise and eating behaviors, and that bone density does not necessarily decline over a 12–18 month period in women who maintain such behaviors.     

The effect of ankle oedema on bone ultrasound assessment at the heel

Relatively inexpensive, portable bone ultrasound systems are of particular relevance to disabled or elderly subjects, who may have problems with access to other forms of densitometry. The effects of local soft tissues on ultrasound measurements are poorly understood and, as ankle oedema is common in such subjects, we examined its consequences for bone ultrasound readings at the heel. Eleven elderly subjects (mean age 81 years) with below-knee pitting oedema were assessed using a direct-contact bone ultrasound system (CUBAClinical). We made a total of 16 series of readings, 6 unilateral and 5 bilateral. In each series an initial reading was followed by repeated pressure over the measurement site to disperse oedema; subsequent readings were thus subject to a progressively lessening degree of local oedema, until a steady state was eventually reached in which no further oedema could be displaced. Heel width fell by a mean of 6.3 mm between initial and steady-state readings; consistent with the clinical appearance of moderate oedema, pitting to a mean depth of only 3.15 mm. Measurements in the presence of oedema were compared with those after its elimination, and oedema was shown to cause a mean reduction of 23.9 m/s in velocity of sound (VOS) and of 5.5 dB/MHz in broadband ultrasound attenuation (BUA). Both changes were equivalent to a fall by a quarter of one standard deviation of the reference range, and were significant atp<0.05 on pairedt-test. As the severity of oedema will vary through the day, and from day to day, measurement protocols for bone ultrasound should pay attention to the confounding effects of oedema.     

Identifying postmenopausal women with osteoporosis by calcaneal ultrasound, metacarpal digital X-ray radiogrammetry and phalangeal radiographic absorptiometry: a comparative study

Identifying women with osteoporosis remains a clinical challenge, as it may not be feasible or cost-effective to recommend dual-energy X-ray absorptiometry (DXA) for all postmenopausal women. In this regard, quantitative ultrasound (QUS) has emerged as an attractive screening tool because of the (relatively) low cost and because QUS and DXA-assessed BMD appear to be equally predictive of future (hip) fracture risk. The objective of this study was to compare the ability of calcaneal QUS to identify osteoporosis with two alternative potential screening methods: digital X-ray radiogrammetry (DXR) and radiographic absorptiometry (RA). We enrolled a total of 221 postmenopausal community-dwelling Caucasian women aged 50–75 years. Bone mineral density (BMD) was measured at the lumbar spine and the total hip regions using DXA. Calcaneal ultrasound attenuation and velocity were assessed using QUS and metacarpal and phalangeal bone density were estimated by the use of DXR and RA, respectively. Receiver operating characteristic (ROC) curves were constructed by calculating the specificity and sensitivity of QUS, DXR, and RA at different cut-point values in discriminating osteoporosis, as defined by a T-score below –2.5 at the spine or hip using DXA, and the areas under the curves (AUCs) were computed. The sensitivity for identifying women with osteoporosis was 67.6% [95% confidence interval (CI), 50.2–82.0%] using QUS and was 76.9% (95% CI, 60.7–88.8%) and 82.9% (95% CI, 67.9–92.8%), respectively, using DXR and RA. The negative predictive value (NPV, the proportion of patients with a negative test who have no osteoporosis) was 90% for QUS, compared with an NPV of 94% for both DXR and RA. These data suggest that metacarpal DXR and phalangeal RA may be as effective as calcaneal QUS for targeting DXA testing in high-risk postmenopausal women.     

Broadband ultrasound attenuation signals depend on trabecular orientation: An in vitro study

Quantitative ultrasound (QUS) techniques have recently been introduced as alternative methods free of ionizing radiation for non-invasive assessment of skeletal status in osteoporosis. We carried out an in vitro study on bone specimens to investigate whether broadband ultrasound attenuation (BUA) signals are associated with bone structure, specifically with the orientation of the trabeculae, and whether this association is independent of the association between orientation and bone mineral density (BMD) as measured by dual-energy X-ray absorptiometry (DXA). BUA and BMD of 10 cubical specimens of purely trabecular bovine bone were examined along the three principal axes. The relative orientation of the trabeculae with respect to the direction of the ultrasound beam was evaluated on high-resolution conventional radiographs employing a semiquantitative ALIGNMENT score ranging from –2 (for perpendicular) to +2 (parallel). BUA variability was 27.6 dB/MHz, reflecting both inter-specimen (18.2 dB/MHz) and intra-specimen (19.4 dB/MHz) variability at comparable levels and to a much lesser extent reproducibility errors (1 dB/MHz). BUA was 44%–54% larger along the axis of the compressive trabeculae as compared with the two perpendicular axes. BMD and ALIGNMENT showed independent significant associations with BUA. A change in ALIGNMENT from perpendicular to parallel corresponded to a difference in BUA of 36.1 dB/MHz. The substantial level of intra-specimen variability suggests that BUA reflects anisotropical characteristics of trabecular bone. The association of BUA and ALIGNMENT indicates that BUA signals depend on trabecular orientation. This association is independent of BMD, indicating that BUA has considerable potential for non-invasive assessment of bone structure and strength, free of ionizing radiation, and for complementing existing bone densitometry examinations.     

Broadband ultrasound attenuation of the calcaneus predicts lumbar and femoral neck density in Caucasian women: A preliminary study

Recent studies have demonstrated the ability of ultrasound techniques to differentiate normal and osteoporotic women. To define the ability of broadband ultrasound attenuation (BUA) of the calcaneus to predict axial bone mass, the ultrasound value was correlated with lumbar vertebral and femoral neck density in 22 Caucasian women. The three measures of bone mass inversely correlated with age: lumbar density (r=0.54), femoral neck density (r=0.65), and BUA (r=0.73). BUA correlated with lumbar (r=0.83) and femoral neck (r=0.87) density. Lumbar vertebral density predicted femoral neck density with a standard error of estimate (SEE) of 0.07 g/cm², and femoral neck density predicted lumbar density with a SEE of 0.09 g/ cm². BUA of the calcaneus was as effective as either axial bone mass measure in predicting the other value: the SEE for lumbar density was 0.09 g/cm² while that for femoral neck density was only 0.06 g/cm². The results of this preliminary study indicate that this rapid, radiation-free technique can accurately predict axial bone mass, and may be of value as an initial procedure to discriminate those women warranting more extensive radiologic evaluations.     

唐山市骨质疏松高龄老人身心健康的现况研究

目的了解唐山市高龄老年人骨质疏松患病情况,分析骨质疏松老年人健康状况及其影响因素。方法采用便利抽样法于2016年7月~2017年1月对唐山市10个社区卫生服务中心直属的32个社区(分布于唐山市区东西南北中)辖区3448名≥75岁老年人进行骨质疏松患病调查及简明健康调查量表(SF-36)、日常生活能力量表(ADL)、健康促进行为方式、孤独量表(UCLA)评定。结果唐山市高龄老年人骨质疏松患病率为11.5%;骨质疏松老年人的SF-36总分评分为(401.8±153.5)分,低于非骨质疏松老年人(456.4±151.2)分,差异有统计学意义(P0.05)。骨质疏松老年人生理功能(54.2±29.0)分、社会功能(24.6±11.7)分、生理职能(44.2±43.8)分、躯体疼痛(68.4±23.5)分、精神健康(63.5±19.9)分、情感职能(46.2±44.2)分、活力(61.8±20.2)分、一般健康(38.9±15.5)分,均低于非骨质疏松老年人,差异有统计学意义(P0.05)。多因素分析结果显示,居住方式、是否因疼痛影响睡眠、日常生活能力、主观幸福感、有无接受过心理咨询、孤独感、收支状况、每天吃适量肉、蛋、鱼、豆类和干果、健康促进行为和尿失禁情况是骨质疏松老年人身心健康的影响因素,差异有统计学意义(P0.05)。结论骨质疏松高龄老人身心健康状况不容乐观,应通过分析其影响因素,有针对性的采取有效措施,实现健康老龄化。     

跟骨超声骨质测量与双能量X线吸收骨密度测量的比较

我们试图通过对跟骨超声骨质测量仪与双能量Ｘ线吸收骨密度测量仪的临床对比，来评价跟骨超声骨质测量仪的敏感性。本文对５６名健康女性同时接受了超声骨质测量仪和双能量Ｘ线吸收骨密度仪的检测。３７例（年龄２６～７６岁）进行了跟骨超声和腰椎骨密度测量，１９例（年龄２６～７０岁）进行了跟骨超声和股骨颈骨密度测量。结果用ＳＹＳＴＡＴ统计软件包进行处理。结果表明：随着年龄的增加，腰椎、股骨颈骨密度及跟骨强度（Ｓｔｉｆｆｎｅｓｓ）均显著下降（Ｐ＜０．０５），两种仪器的阳性检出率无明显差异（Ｐ＜０．０５）。但腰椎和股骨颈ＢＭＤ与跟骨强度（Ｓｔｉｆｆｎｅｓｓ）的相关性适中ｒ＝０．４６５～０．５１３左右。通过逐步多元回归分析显示超声强度（Ｓｔｉｆｆｎｅｓｓ）与ＢＭＤ无关。这表明超声波测量仪主要测量骨的结构变化，而骨密度测量仪则是测量骨量的变化。两种方法相辅相承，共同测量，将更好地预测骨质疏松性骨折的发生。同时超声波具有无放射线损害、价格低廉及良好的敏感性，将越来越受到临床重视。     

定量超声对骨质疏松症诊断价值的Meta分析

目的 系统评价定量超声应用于骨质疏松症诊断的临床价值.方法 荟萃分析,采用Cochrane系统评价的方法,检索Medline(1966~2011年)、EMbase(1966~2010年)、Cochrane图书馆(2010年)及中国生物医学文献数据库CBM(1979~2010年)有关采用定量超声诊断骨质疏松症的临床对照研究文献资料,按照纳入和排除标准限定研究对象,通过QUADAS评分量表进行文献质量评估后,使用Meta-disc 1.4统计软件进行Meta分析,计算汇总敏感性、特异性及其95%可信区间,绘制汇总受试者操作特性曲线,综合评价定量超声应用于骨质疏松症诊断的临床价值.结果 共纳入使用定量超声诊断骨质疏松症的临床对照研究11项(共2219例),汇总敏感性为76%(95%CI,73%～79%),汇总特异性为70%(95%CI,68%～73%),汇总的曲线下面积为0.8232,Q值为0.7565.结论 定量超声用于诊断骨质疏松症具有较高的敏感性且特异性尚可,但尚需更多大样本、多中心临床对照试验数据支持.     

高原藏族居民跟骨定量超声测定分析

[目的]测定生活在海拔3000m高原的藏族居民的跟骨定量超声参数，了解藏族的骨量变化规律和高原环境对其的影响。[方法]采用UBIS3000型定量超声仪，对夏河县596名藏族居民跟骨定量超声参数进行测定。[结果]超声振幅衰减（BUA）、刚度（STI）、超声声速（SOS）的峰值男性为30～39岁，女性为40-49岁，达到峰值后男女性随年龄增长各项指标快速下降，绝经后女性最为明显。[结论]高原藏族居民峰值骨量高，老年后骨量丢失迅速，发生骨质疏松的危险性增加。     

Lifestyle factors are associated with osteoporosis in lean women but not in normal and overweight women: a population-based cohort study of 1222 women

The aim of the present population-based cohort study was to evaluate the contribution of lifelong lifestyle factors to calcaneal and distal forearm bone mass in elderly women. We studied 1222 of the 1689 eligible home-dwelling women aged 70–73 years. Lifelong occupational and leisure time physical activity, calcium intake, smoking, alcohol intake and medical history were obtained by a self-completed questionnaire. Main outcome measures were broadband ultrasound attenuation (BUA) of the calcaneus and bone mineral density (BMD) of the radius measured once in 1997–1998. The women with BMI ≤ 25.1 kg m² had lower BUA (p < 0.0001) and radial BMD values (p < 0.0001) than women with higher BMI. Lifestyle factors associated with BUA in the leanest women were: low physical activity at work (RR 0.4; 95% confidence interval 0.2 to 0.8), low habitual exercise at the ages 30 years , 50 years and currently (RR 1.5; 1.0 to 2.4; RR 1.5; 1.1 to 2.6; RR 1.7; 1.1 to 2.7), poor mobility (RR 1.9; 1.2 to 3.0), coffee intake ≥ 5 cups/day (RR 1.7; 1.1 to 2.7), type 2 diabetes (RR 0.3; 0.1 to 0.9) and hypertension (RR 0.5; 0.3 to 0.8). Type 2 diabetes protected lean women from lower distal and ultradistal radial bone density (RR 0.3; 0.1 to 0.8; RR 0.1; 0.1 to 0.5). The selected lifestyle factors were not associated with lowered calcaneal or radial bone density in the higher categories of BMI. In conclusion, risk factors for lower calcaneal and radial bone density appear to be different among lean and normal/obese women. Lifelong recreational physical activity, low physical activity at work, type 2 diabetes and hypertension seem to be associated with increased bone density, while high coffee intake may increase the risk of lower bone density in lean elderly women. These factors are potentially modifiable, and intervention studies targeted at this risk category of women are needed.     

The role of ultrasound in the assessment of osteoporosis: A review

Osteoporosis is now being recognized as a silent epidemic and there is an increasing need to improve its diagnosis and management. Quantitative ultrasound (QUS) measurement [broadband ultrasound attenuation (BUA) and velocity] is emerging as an alternative to photon absorptiometry techniques in the assessment of osteoporosis. The fundamental principles governing ultrasound measurements are discussed, and some of the commercially available clinical systems are reviewed, particularly in relation to data acquisition methods. A review of the published in vivo and in vitro data is presented. The general consensus is that ultrasound seems to provide structural information in addition to density. The diagnostic sensitivity of ultrasound measurement of the calcaneus in the prediction of hip fracture has been shown by recent large prospective studies to be similar to hip bone mineral density (BMD) measured with dual-energy X-ray absorptiometry (DXA) and superior to spine BMD. Ultrasound has also been shown to correlate better with the type of hip fracture (intertrochanteric or cervical) than BMD and to provide comparable diagnostic sensitivity to spine BMD in vertebral fractures. It has also been observed that combining the results of both ultrasound and DXA BMD significantly improved hip fracture prediction. Areas where further research is required are identified.     

Knowledge about osteoporosis: assessment, correlates and outcomes

During the last 10 years, we have witnessed an impressive increase in the number of studies examining knowledge about osteoporosis. The aim of the present paper is to examine the status of research on knowledge about osteoporosis by reviewing and analyzing the current literature as it pertains to assessment of knowledge about osteoporosis, factors associated with knowledge, and relationship between knowledge about osteoporosis and participation in health-related behaviors. Finally, future directions in the field are discussed. Many of the studies are still characterized by the lack of a theoretical framework, as well as by various methodological flaws. Serious deficits in knowledge are reported among healthy and diagnosed women and men, as well as among health professionals. Educational interventions are accompanied by an increase in knowledge, but no change in behavior. There is need to expand the research on knowledge about osteoporosis, especially in an effort to increase its impact on the prevention and early diagnosis of the disease. The deficits found in the knowledge of both the general population and among health care professionals, should be addressed by providing updated and reliable information through appropriate health promotion and professional venues.     

Pathways of transmission of ultrasound energy through the distal metaphysis of the second phalanx of pigs: An in vitro study

Ultrasound (US) has been studied by several researchers to assess its possible use in screening for osteoporosis; among other sites the phalanxes have been proposed as a possible site for investigation with US. In the present experimental work we studied the morphostructural characteristics of the second phalanx of the pig; then, in vitro, we investigated the behaviour of an ultrasound signal at 1.25 MHz crossing the distal metaphysis of the second phalanx. In particular, we studied the effects of milling or drilling on US velocity, and on the energy and shape of the signal generated by the US at the receiving probe. We demonstrated that the US velocity decreases by an average of 496 m/s (–21%) when axial perforations are made in the central marrow. A decrease is also noted in the number of peaks, and the normalized energy of the US signal received falls on average by 11.3 mV µs (–84%). The characteristics of the signal at the receiving probe can be broadly reconstituted if, after extensive drilling, the bone cavity is filled with polymerized styrene resin. In contrast, if phalanx milling is performed to remove the outermost bone tissue, the normalized energy increases by 15.5 mV µs (+84%) and the velocity of US increases by 163 m/s (+7%). It was also noted that the complexity of the signal received (i.e. number of peaks) and the signal normalized energy depend on the integrity of the bone structures traversed. The results reported here provide useful indications for interpreting the findings of clinical investigations with US, most specifically those performed on the phalanx of the hand.     

Ultrasound attenuation of the Os calcis in women with osteoporosis and hip fractures

Summary Bone ultrasound attenuation of the calcaneus, and vertebral and femoral bone density measured by dual photon absorption were determined in 22 women with osteoporosis, 10 women with hip fractures, and 29 normal, age-matched controls to determine the utility of the ultrasound technique as an indicator of axial osteopenia. Vertebral and femoral neck density and bone ultrasound attenuation were significantly decreased (P<0.01) in the women with osteoporosis and those with hip fractures. The sensitivity and specificity of bone ultrasound attenuation was 80% at a value of 50 dB/MHz. At 90% specificity the sensitivity of bone ultrasound attenuation was 65%. The results of this pilot study suggest that ultrasound attenuation, a safe, simple, and radiation-free procedure, may be utilized as an indicator of decreased axial bone mass.     

The association of patellar ultrasound transmissions and forearm densitometry with vertebral fracture,number and severity: The saunders county bone quality study

Ultrasonic measures of bone have been available for clinical research purposes for nearly 10 years, yet there still seems to be a need to compare ultrasound with the accepted gold standard of densitometry. Recently there have been published reports showing that ultrasound measures are associated with both appendicular and hip fracture, in particular after adjustment for densitometry measures. We present here a comparison between speed of sound through the patella and forearm bone densitometry, using their association with prevalent vertebral fractures in a population-based study of women and men. The prospective phase of the Saunders Bone Quality Study includes 1401 women and men who had baseline spine radiographs, patellar ultrasound, and forearm densitometry measurements. Multivariate forward logistic regression was used to determine the age-adjusted odds of vertebral fracture, the number of fractures, and the severity of these fractures, when patellar ultrasound and each of four forearm densitometry measures were entered into the model. Age is the most important factor associated with vertebral fractures, their number, and severity for women, while age is not significantly related to vertebral fractures for men. Of the bone status measures, patellar ultrasound entered the logistic regression models more consistently than any other measure except ulnar bone mineral density for women. The ultrasound measure entered every model for men. We conclude that patellar ultrasound velocity is more consistently associated with the odds of vertebral fractures than radius bone mineral content.     

痩素与骨质疏松症研究现状

骨质疏松症为一种全身代谢性骨病,其发生与多因素有关,是多种遗传基因、激素及细胞因子共同作用的结果。瘦素(leptin,LEP)是脂肪细胞分泌的基因产物,可表达于骨组织中,通过直接和间接作用参与骨代谢。笔者阐述瘦素对骨代谢的关系及其在骨质疏松症中的作用。