凝溶胶蛋白与绝经后女性股骨颈及腰椎骨密度的相关性研究

目的探讨凝溶胶蛋白(GSN)在绝经后女性血浆中的水平并分析与股骨颈及腰椎骨密度(BMD)的相关性。方法选取我院2015年1月至2019年5月期间在我院正常体检人员。纳入绝经后女性110名。与此同时,在我院体检中心选择非绝经期女性110例。采用Hologic?QDR-4500 DXA骨密度仪测定股骨颈、腰椎(L_1-L_4)的BMD。BMD数据以g/cm~2和T评分表示。T评分-2.5定义为骨质疏松症,T评分在-1～-2.5间定义为骨量减少,T评分-1定义为骨密度正常(正常BMD组)。骨质疏松症或骨量减少定义为低BMD组,骨密度正常定义为正常BMD组。采用酶联免疫吸附试验(ELISA)测定GSN水平。结果绝经后女性年龄、SBP、DBP、TC、FBS高于绝经前女性(P0.05);而股骨颈-BMD、腰椎(L_1-L_4)-BMD、GSN低于绝经前女性(P0.05)。股骨颈-BMD组中,低BMD组的年龄、吸烟比例、TC、FBS、GSN高于正常BMD组(P0.05);而BMI、HDL低于正常BMD组(P0.05)。腰椎(L_1-L_4)-BMD组中,低BMD组的年龄、TC、FBS、GSN高于正常BMD组(P0.05);而BMI、HDL低于正常BMD组(P0.05)。股骨颈-BMD与年龄、吸烟、FBS、pGSN呈负相关(r=-0.435、-0.301、-0.243、-0.609),与HDL、BMI呈正相关(r=0.395、0.365)。腰椎(L_1-L_4)-BMD与年龄、p GSN呈负相关(r=-0.463、-0.433),与BMI呈正相关(r=0.398)。年龄、BMI、GSN是股骨颈-BMD独立影响因素;年龄、GSN是腰椎(L1-L4)-BMD独立影响因素。结论 GSN是股骨颈-BMD、腰椎(L_1-L_4)-BMD的独立影响因素。因此,GSN水平升高可能预测绝经后女性骨质疏松症的发生及进展。     

影响绝经后女性腰椎骨密度的相关因素研究

目的寻找绝经后女性腰椎骨密度(lumbar spine bone mineral density,LSBMD)的独立相关因素。方法调查212例绝经后女性的伴随疾病,并检测LSBMD、骨代谢、血生化和性激素等指标,筛选绝经后女性LSBMD的独立相关因素。结果绝经后女性LSBMD的独立相关因素包括骨钙素(β=-0.003,P0.01)、体质量指数(β=0.021,P0.01)、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)(β=-0.153,P0.01)和尿酸(β=0.001,P0.05)。结论积极防治COPD,降低血清骨钙素水平,维持合理的尿酸和体质量指数,可能是提高绝经后女性LSBMD的有效方法。     

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.     

Genotypes and clinical aspects associated with bone mineral density in Argentine postmenopausal women

The aim of this study was to determine genotypes and clinical aspects associated with bone mineral density (BMD) in postmenopausal women from Córdoba, Argentina. Polymorphisms were assessed by RFLP-PCR technique using BsmI and FokI for vitamin D receptor gene (VDR) and XbaI and PvuII for estrogen receptor-alpha gene (ERalpha) as restrictases. Sixty-eight healthy, 54 osteopenic, and 64 osteoporotic postmenopausal women were recruited. Femoral neck and lumbar spine BMD were inversely correlated with age in the entire analyzed population. Height was lower in osteopenic and osteoporotic women as compared to healthy women (P < 0.05). Weight and body mass index (BMI) were the lowest in osteoporotic women (P < 0.01 versus healthy group). Serum procollagen type I Nterminal propeptide (PINP) was higher in osteoporotic women as compared to the other groups. Distribution of VDR and ERalpha genotypes was similar in the three groups. Genotype bb (VDR) was associated with low values of lumbar BMD in the healthy group (P < 0.05 versus genotype Bb), and with low values of femoral BMD (P < 0.05 versus genotype BB) in osteoporotic women. BB*Pp interaction was associated with the highest femoral neck BMD (P < 0.05), whereas the bb*xx interaction was associated with the lowest femoral neck BMD in the total population analyzed (P < 0.05). In conclusion, parameters such as age, height, weight, BMI, serum PINP, VDR genotypes, and interactions between VDR and ERalpha genotypes could be useful to predict a decrease in BMD in Argentine postmenopausal women.     

Effects of skeletal size of the lumbar spine on areal bone density,volumetric bone density,and the diagnosis of osteoporosis in postmenopausal women in China

To understand the effects of skeletal size of the lumbar spine on areal bone mineral density (aBMD), volumetric bone mineral density (vBMD), and the diagnosis of osteoporosis in postmenopausal women, we measured the projected bone area, bone mineral content (BMC), aBMD, and vBMD at the anteroposterior and lateral lumbar spines in a population of 1081 postmenopausal Chinese women, 42 to 86 years of age. The results indicated that, at the anteroposterior and lateral lumbar spine, there were significant positive correlations between bone area and both BMC (r = 0.606; P = 0.000 and r = 0.610; P = 0.000) and aBMD (r = 0.270; P = 0.000 and r = 0.182; P = 0.000), but not vBMD (r = –0.055; P = 0.000 and r = 0.000; P = 0.929). When bone area at the anteroposterior spine changed by ±1 SD, the BMC, aBMD, and vBMD correspondingly changed by 28.2%, 10.1%, and 1.69% on the basis of their respective means. When a variation of ±1 SD was observed in bone area at the lateral spine, BMC and aBMD, correspondingly changed by 25.9% and 6.18% on the basis of their respective means, while vBMD indicated no change. Through comparisons among large-, intermediate-, and small-bone area groups, significant differences were found in the means of subjects heights, weights, BMC, and vBMD at the anteroposterior and lateral lumbar spines, as well as in the detection rates of osteoporosis by aBMD (P = 0.000). Detection rates of osteoporosis by aBMD at the anteroposterior spine and by aBMD at the lateral spine, and by vBMD were 44.1%, 55.5%, and 49.7%, respectively, in the total population; 31.4%, 41.7%, and 53.7%, respectively, in the large-bone area group; 43.3%, 55.9%, and 50.5%, respectively, in the intermediate-bone area group; and 61.7%, 70.0%, and 42.5%, respectively, in the small-bone area group. No significant differences were found in the detection rates of osteoporosis by vBMD among the groups. The results of multiple linear regression revealed that the major factors influencing skeletal size and aBMD of the lumbar spine were height and weight. Therefore, in menopausal women of the same ethnic group and age, the skeletal size of the lumbar spine would have significant influence upon aBMD and the diagnosis of osteoporosis, i.e., the larger the spinal size, the greater the aBMD and the lower the osteoporosis detection rate, while, conversely, the smaller the skeletal size, the smaller the aBMD and the higher the osteoporosis detection rate. When we use aBMD of the lumbar spine to diagnose osteoporosis in a population with different body sizes, we need to take this body size difference into account. When we use vBMD to diagnose osteoporosis, the effect of body size on BMD will diminish.     

Replication of previous genome‐wide association studies of bone mineral density in premenopausal American women

Bone mineral density (BMD) achieved during young adulthood (peak BMD) is one of the major determinants of osteoporotic fracture in later life. Genetic variants associated with BMD have been identified by three recent genome‐wide association studies. The most significant single‐nucleotide polymorphisms (SNPs) from these studies were genotyped to test whether they were associated with peak BMD in premenopausal American women. Femoral neck and lumbar spine BMD were determined by dual‐energy X‐ray absorptiometry in two groups of premenopausal women: 1524 white women and 512 black women. In premenopausal white women, two SNPs in the C6orf97/ESR1 region were significantly associated with BMD (p < 4.8 × 10^?4), with suggestive evidence for CTNNBL1 and LRP5 (p < .01). Evidence of association with one of the two SNPs in the C6orf97/ESR1 region also was observed in premenopausal black women. Furthermore, SNPs in SP7 and a chromosome 4 intergenic region showed suggestive association with BMD in black women. Detailed analyses of additional SNPs in the C6orf97/ESR1 region revealed multiple genomic blocks independently associated with femoral neck and lumbar spine BMD. Findings in the three published genome‐wide association studies were replicated in independent samples of premenopausal American women, suggesting that genetic variants in these genes or regions contribute to peak BMD in healthy women in various populations. © 2010 American Society for Bone and Mineral Research     

Total lymphocyte count and femoral bone mineral density in postmenopausal women

In vitro studies showed that several cytokines produced by the immune system can play a relevant role in modulating bone turnover, thus affecting the health of bone tissue. Our aim was to evaluate the association between total lymphocyte count (TLC) and femoral bone mineral density (BMD) in a sample of postmenopausal women. We studied 114 out of 124 consecutive, caucasian, home-dwelling, apparently healthy postmenopausal women referred for osteodensitometry by general practitioners. Femoral BMD was measured by dual-energy X-ray absorptiometry at five sites. A significant positive correlation (p 0.001) was observed between TLC and BMD (T score) measured the five sites: total proximal femur (r = 0.45), trochanter (r = 0.43), intertrochanteric region (r = 0.38), femoral neck (r = 0.49), and Wards triangle (r = 0.42). With a linear multiple regression model, TLC adjusted for age, weight, height, body mass index, and erythrocyte sedimentation rate showed a significant association with femoral BMD assessed at each of the five sites. The R² values ranged from 0.33 with BMD measured at Wards triangle to 0.51 with BMD measured at the trochanter. The significance of the association between TLC and BMD ranged from P 0.001 with BMD measured at the femoral neck to P 0.05 with BMD measured at the intertrochanteric area. The results were similar when BMD was expressed as either a Z score (in the 110 of the 114 women aged 84 years or younger) or as absolute values. Our data show a positive association between TLC and femoral BMD in a sample of apparently healthy, postmenopausal women, supporting the view of a close connection between the immune system and bone tissue.     

血清维生素K1水平与绝经后女性腰椎骨密度相关性分析

目的探讨绝经后女性骨密度与血清维生素K1水平之间的相关性。方法使用标准化的酶联免疫吸附试验(ELISA)试剂盒测量46例绝经后骨质疏松女性和30名绝经后健康对照女性的血清维生素K1水平。检测腰椎(1～4)的骨密度(bone mineral density, BMD)。结果绝经后骨质疏松女性组血清维生素K1水平明显低于正常对照组(P0.05),绝经后骨质疏松女性血清维生素K1浓度与腰椎BMD呈正相关(R=0.545,P=0.003);绝经后正常对照组血清维生素K1浓度与腰椎BMD呈正相关(R=0.513,P=0.009)。维生素K1对骨质疏松症的诊断敏感性和特异性分别为91%和98%(截止值:0.853 ng/mL);维生素K1的ROC曲线下面积(AUC)为0.985,奇数比为18.88。结论维生素K1与诊断绝经后骨质疏松症呈负相关。     

基于VIBE-Dixon技术的女性腰椎脂肪测量及其与骨密度的相关性

目的应用磁共振脂肪定量技术评估女性腰椎骨质疏松程度与骨密度(BMD)的相关性。方法将121名健康女性研究对象按年龄分为21～30岁组(n=17)、31～40岁组(n=11)、41～50岁组(n=24)、51～60岁组(n=63)、61～70岁组(n=6)。以DXA测量L_1-L_4椎体骨密度,以VIBE-Dixon技术测量L1-L4椎体骨髓脂肪分数。比较不同组间骨髓脂肪分数差异,同时分别对骨髓脂肪分数与BMD、年龄进行相关性分析。另外,分别对BMD、骨髓脂肪分数与绝经年限做相关性分析。结果组间差异有统计学意义(F值:14.541,P0.001)。骨髓脂肪分数与年龄之间存在相关性(r=0.659,P0.001);骨密度随脂肪分数上升呈下降趋势;随绝经年限的延长,BMD呈下降趋势,骨髓脂肪分数呈上升趋势。结论 VIBE-Dixon能定量测量妇女腰椎椎体脂肪含量,可间接评估骨质疏松程度;与DXA的结果具有相关性。     

Factors associated with trabecular bone score in postmenopausal women with type 2 diabetes and normal bone mineral density

BACKGROUNDOsteoporosis and type 2 diabetes (T2D) have been recognized as a widespread comorbidity leading to excess mortality and an enormous healthcare burden. In T2D, bone mineral density (BMD) may underestimate the risk of low-energy fractures as bone quality is reduced. It was hypothesized that a decrease in the trabecular bone score (TBS), a parameter assessing bone microarchitecture, may be an early marker of impaired bone health in women with T2D.AIMTo identify clinical and body composition parameters that affect TBS in postmenopausal women with T2D and normal BMD.METHODSA non-interventional cross-sectional comparative study was conducted. Potentially eligible subjects were screened at tertiary referral center. Postmenopausal women with T2D, aged 50-75 years, with no established risk factors for secondary osteoporosis, were included. BMD, TBS and body composition parameters were assessed by dual-energy X-ray absorptiometry. In women with normal BMD, a wide range of anthropometric, general and diabetes-related clinical and laboratory parameters were evaluated as risk factors for TBS decrease using univariate and multivariate regression analysis and analysis of receiver operating characteristic (ROC) curves.RESULTSThree hundred twelve women were initially screened, 176 of them met the inclusion criteria and underwent dual X-ray absorptiometry. Those with reduced BMD were subsequently excluded; 96 women with normal BMD were included in final analysis. Among them, 43 women (44.8%) showed decreased TBS values (≤ 1.31). Women with TBS ≤ 1.31 were taller and had a lower body mass index (BMI) when compared to those with normal TBS (Р = 0.008 and P = 0.007 respectively). No significant differences in HbA1c, renal function, calcium, phosphorus, alkaline phosphatase, PTH and 25(ОН)D levels were found. In a model of multivariate linear regression analysis, TBS was positively associated with gynoid fat mass, whereas the height and androgen fat mass were associated negatively (all P < 0.001). In a multiple logistic regression, TBS ≤ 1.31 was associated with lower gynoid fat mass (adjusted odd ratio [OR], 0.9, 95% confidence interval [CI], 0.85-0.94, P < 0.001), higher android fat mass (adjusted OR, 1.13, 95%CI, 1.03-1.24, P = 0.008) and height (adjusted OR, 1.13, 95%CI, 1.05-1.20, P < 0.001). In ROC-curve analysis, height ≥ 162.5 cm (P = 0.04), body mass index ≤ 33.85 kg/m² (P = 0.002), gynoid fat mass ≤ 5.41 kg (P = 0.03) and android/gynoid fat mass ratio ≥ 1.145 (P < 0.001) were identified as the risk factors for TBS reduction.CONCLUSIONIn postmenopausal women with T2D and normal BMD, greater height and central adiposity are associated with impaired bone microarchitecture.     

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。     

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...     

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。     

绝经后活动性类风湿性关节炎患者低骨密度的相关危险因素分析

目的分析绝经后活动性类风湿性关节炎(rheumatoid arthritis,RA)患者出现低骨密度相关的危险因素。方法研究对象为106例患有活动性RA的绝经后妇女,患者按体质量指数(BMI)分组:I组消瘦(18.5～24.9 kg/m~2,n=36),II组超重(25.0～29.9 kg/m~2,n=35),III组肥胖(30.0 kg/m~2,n=35)。检测这些患者的股骨BMD和血清BTM水平:骨钙素(OC)和I型胶原交联C-端肽片段(CTX)和骨桥蛋白(OPN)、抵抗素、高敏C反应蛋白、白细胞介素-6、肿瘤坏死因子(TNF)-a。结果与较瘦的女性相比,肥胖女性的总股骨BMD和总T评分显然更高(P0.05);发现BMD和CTX水平与体重存在显著相关性(P0.05)。调整股骨颈BMD后,BMI与TNF-α水平呈负相关(P0.05)。骨钙素水平与抵抗素呈负相关(P0.05),CTX水平与OPN呈正相关(P0.05);并发现BTM和BMD与其他炎症指标之间的关联。观察到OPN水平与体重、腰围和绝经后时间之间呈负相关性(P0.05)。结论本研究结果表明,体重和OPN、抵抗素和TNF-α在绝经后活动性RA患者的骨密度降低中起重要作用。     

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.     

Vitamin D receptor gene BsmI-polymorphism in Finnish premenopausal and postmenopausal women: its association with bone mineral density,markers of bone turnover,and intestinal calcium absorption,with adjustment for lifestyle factors

 Bone mineral density (BMD) is regulated by genetic and environmental factors. Sixty percent to 80% of bone mass is suggested to be under polygenetic control, but the role of individual genes seems to be modest. Several studies have indicated that the vitamin D receptor (VDR) gene has a role in the regulation of BMD and bone metabolism, but the results are very controversial. We studied the associations between BsmI-polymorphism of the VDR gene and BMD and bone metabolism in 24 premenopausal (aged 22–45 years) and 69 postmenopausal (aged 48–65 years) Finnish women. The BMD of the lumbar spine and femoral neck and bone turnover markers were measured, and the intestinal calcium absorption was investigated, using a method based on the absorption of non-radioactive strontium. The genotype distribution was 16%, BB; 34.5%, Bb; and 49.5%, bb, which differs from the genotype distribution found in other Caucasian populations, but is similar to earlier Finnish reports. The winter value of 25-hydroxyvitamin-D (25-OH-D) was highest for the BB genotype in both age groups (analysis of covariance [ANCOVA]; premenopausal women P = 0.5, postmenopausal women P = 0.03, and for the groups combined P = 0.02). Lumbar spine BMD and intestinal strontium absorption were highest for the BB genotype in both age groups, but these results were nonsignificant. The markers of bone metabolism did not differ significantly between the VDR genotypes. The BB genotype had the best vitamin D status, which could explain the differences in calcium absorption between the genotypes. However, the conclusions of our study are limited because of the small number of subjects. Received: January 24, 2000 / Accepted: June 7, 2002 Offprint requests to: C. Lamberg-Allardt     

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。     

131例40岁以上绝经前女性的骨密度及骨代谢指标特点分析

目的了解广州地区40岁以上绝经前女性的骨密度及骨代谢指标的临床特点。方法在2017年3月至2017年4月份纳入广州市社区骨质疏松症流行病学调查的1170名女性人群中,选取资料齐全、符合入选标准的131名绝经前女性(43～59岁)作为研究对象。记录并分析患者身高、体重、体质量指数、腰围、臀围等一般资料,检测血清钙、磷、碱性磷酸酶、甲状旁腺素、骨钙素、Ⅰ型前胶原氨基端前肽、Ⅰ型胶原羧基端肽、25羟维生素D等骨代谢指标,应用双能X线吸收法测量腰椎1-4及左股骨近端的骨密度,并分别应用T值及Z值进行诊断。结果应用T值诊断:骨量正常组55例(42.0%),骨量减少组67例(51.1%),骨质疏松组9例(6.9%)。应用Z值诊断:骨量正常组128例(97.7%),低骨量组3例(2.3%)。与骨量正常组相比,骨质疏松组的身高、体重、体质量指数、腰围、臀围差异均无统计意义。3组之间的Ca、P、25(OH) D、PTH的水平差异无统计学意义。与骨量正常或骨量减少组相比,骨质疏松组的破骨指标β-CTX有上升的趋势,而成骨指标ALP、OC、PINP水平则显著上升,且差异均具有统计学意义。结论应用T值诊断骨质疏松症的敏感性高于Z值,本研究人群发生的骨质疏松症为绝经前特发性骨质疏松症,绝经前特发性骨质疏松症的发病与Ca、P、25(OH) D、PTH无显著关联性,骨代谢的高转换状态可能是发病的主要机制,遗传性因素可能是发病的主要原因。     

Plasma renin activity is associated with bone mineral density in premenopausal women

Bone mineral density (BMD), plasma renin activity (PRA) and dietary calcium and sodium were evaluated in 47 Caucasian premenopausal women. All subjects were free of any disorder or medications known to affect calcium or bone metabolism. Those subjects with low PRA (<1.3 ng/ml) had 4.3% lower BMD at the distal radius (p=0.03). Other skeletal sites appeared to have lower BMD in subjects with low PRA but these differences were not statistically significant. There was a tendency for the low PRA group to have a lower dietary intake of calcium (p=0.06) as compared with the normal PRA group (≥1.3 and <4.0 ng/ml). Positive correlations were found between calcium intake and PRA (r=0.26,p=0.09); and between calcium/sodium intake and distal radial BMD (r=0.31,p=0.04), mid-radial BMD (r=0.30,p=0.04), total hip BMD (r=0.23,p=0.12) and total body BMD (r=0.27,p=0.07). This study provides preliminary evidence that a sodium intake >3400 mg/day, as evidenced by the suppression of PRA, may affect bone mass and the effect may be modified by the level of calcium intake. Additional research is needed to replicate our findings with a larger sample size.     

血浆凝溶胶蛋白与绝经后妇女的髋部骨密度相关性研究

目的探索血浆凝溶胶蛋白(GSN)水平与中国人群的髋部骨密度(BMD)相关性。方法我院就诊的患者(55岁)为研究组(A组),按照是否患有骨质疏松症分为骨质疏松症组(OP组,BMD T评分≤-2.5)和BMD正常组(NBMD组,BMD T评分≥-1)两组;随后将所有女性患者分为小于70岁(B组)和大于70岁(C组)两组;检测血清指标和血浆GSN水平。结果 A组中,在总受试者(P=0.116)和男性及女性之间没有观察到血浆GSN水平的差异(P=0.977)。Pearson相关分析显示B组和C组的血浆GSN与BMD之间呈现负相关性(r=-0.19,P=0.018)。BMD与PINP(r=-0.35,P=0.002)、年龄(r=-0.38,P0.001)和BMI(r=0.70,P0.001)显著相关。GSN与BMD呈显著的负相关(r=-0.26,P=0.033)。结论血浆GSN与中国绝经后妇女的髋部BMD密切相关,血浆GSN可能是骨质疏松症的潜在风险生物标志物。