Association between bone mineral density and metabolic syndrome in pre- and postmenopausal women

Metabolic syndrome (MS) has 2 conflicting factors: obesity known to be protective against osteoporosis and an inflammation that activates bone resorption. The aim of this study was to evaluate the difference of bone mineral density(BMD) in women with or without MS according to menopausal state. This is a cross-sectional study of 2,265 women(1,234-premenopausal, 931-postmenopausal) aged over 20 years who visited the Health Promotion Center from January 2006 to December 2009. We measured BMD at the lumbar spine and femoral neck. MS was defined according to the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria. The prevalence of MS was 5.5% in the premenopausal group and 13.5% in the postmenopausal group. In the postmenopausal group, C-reactive protein (CRP) was significantly higher in subjects with MS than those without MS, but it was not in the premenopausal group. In the postmenopausal group, women with MS had a lower BMD at the lumbar spine and femoral neck before or after adjustment. In the premenopausal group, women with MS had a lower BMD at the lumbar spine, but not at the femoral neck. In stepwise linear regression analysis, predictive variables for BMD of the lumbar spine were systolic blood pressure in the premenopausal group and HDL-cholesterol and diastolic blood pressure (DBP) in the postmenopausal group. The predictive variables for BMD of the femoral neck were DBP and waist circumference in the premenopausal group and CRP and DBP in the postmenopausal group. Inflammation might have a more important role in BMD than obesity in the postmenopausal women.     

绝经后妇女代谢综合征对骨密度的影响

目的 观察代谢综合征(MS)对绝经后妇女骨密度(BMD)的影响.方法 通过对长期居住在北京市房山区农村256名绝经后女性进行体格检查,生化检查和BMD检查,根据中华医学会糖尿病分会(CDS)的诊断标准对MS进行诊断,将受检者分为MS组89名,单纯高血压组34名,单纯糖尿病组2名,单纯肥胖或超重组19名,单纯血脂紊乱组13名,非MS组83名,代谢正常组16名,观察MS对BMD的影响,并用多元回归分析年龄以及MS中的血压,TG,血糖,BMI指数与BMD之间的关系.按年龄分组,观察不同年龄阶段骨量的变化.结果 MS组与代谢正常组相比,骨量升高,但两组间骨质疏松发生率无统计学差异;BMI与骨量呈正相关.血压对不同部位产生的作用不同,但均无统计学意义.血糖,TG对骨量的影响无统计学意义.绝经后女性骨密度随年龄增长而降低.结论 MS患者BMD升高,构成MS相关因素与BMD之间的关系复杂,仅BMI与BMD呈显著正相关.     

Simvastatin increases bone mineral density in hypercholesterolemic postmenopausal women

Statins are able to reduce cardiovascular morbility and mortality mainly through their hypocholesterolemic effect. Beyond the inhibition of cholesterol synthesis, the identification of "ancillary" mechanisms has motivated studies evaluating the relationship between the use of statins and the modification of bone mineral density (BMD). To date, clinical trials have provided discordant results. The aim of our study was to evaluate whether simvastatin treatment (40 mg/d) could modify BMD in hypercholesterolemic women (n = 40) after a 2-year treatment as compared with a control group treated only with diet (n = 20) and matched by gender, age, body mass index (BMI), lipids, menopausal age, and BMD and the number of osteopenic, osteoporotic, and normal women (on the basis of T-score value). Exclusion criteria were secondary hyperlipemias and osteoporosis and current or previous therapy with statins, bisphosphonates, and estrogens. The BMD was measured at the lumbar spine and hip by dual energy x-ray absorpiometry (DEXA). In the group treated by simvastatin, BMD, both on the spine and femoral hip, showed a significant increase after 8 and 24 months, respectively (0.878 +/- 0.133 v 0.893 +/- 0.130 and 0.907 +/- 0.132; 0.840 +/- 0.101 v 0.854 +/- 0.101; and 0.863 +/- 0.10, P <.001); there was a percentage increase of 1.7% after 8 months and 3.3% after 24 months at the spine; at the femoral hip, BMD increased 1.6% after 8 months and 2.7% after 24 months. The group treated only with hypolipidic diet demonstrated after 8 and 24 months a slight decrease in BMD both on the spine and femoral hip (respectively, 0.884 +/- 0.175 v 0.872 +/- 0.174 and 0.861 +/- 0.164; 0.860 +/- 0.110 v 0.853 +/- 0.096 and 0.847 +/- 0.095; P <.05). In conclusion, as partly suggested by retrospective or observational data, this longitudinal study indicates that simvastatin treatment exerts a beneficial effect on BMD.     

绝经妇女桡骨骨密度变化的多因素分析

目的探讨绝经后骨量丢失的主要危险因素。方法对１５７例绝经后妇女的桡骨骨矿含量与年龄、绝经年龄、身高、体重分别进行简单相关分析和多元线性回归分析。结果桡骨骨矿含量与年龄呈非常显著的负相关（Ｐ＜０．００１），与绝经年龄呈非常显著的正相关（Ｐ＜０．００１），与身高呈显著的正相关（Ｐ＜０．０１），与体重呈显著的正相关（Ｐ＜０．０５）；多元回归中偏回归系数的偏相关系数绝对值的大小依次为：绝经年龄、年龄、身高、体重。结论早绝经是绝经后骨量丢失的主要危险因素     

Oral alendronate increases bone mineral density in postmenopausal women with primary hyperparathyroidism

The effect of biphosphonate therapy on bone mineral density (BMD) in patients with primary hyperparathyroidism (PHP) is unknown. Forty postmenopausal women (mean age, 70 yr) with PHP were randomized to receive alendronate 10 mg/d or placebo for 48 wk, followed by treatment withdrawal for 24 wk. The mean (+/-SD) changes in BMD at femoral neck (+4.17 +/- 6.01% vs. -0.25 +/- 3.3%; P = 0.011) and lumbar spine (+3.79 +/- 4.04% vs. 0.19 +/- 2.80%; P = 0.016) were significantly higher with alendronate at 48 wk. Serum calcium was reduced with alendronate but not placebo (-0.09 vs. +0.01 mmol/liter; P = 0.018). Serum bone-specific alkaline phosphatase activity was lower with alendronate from 12 wk onward and increased 24 wk after treatment withdrawal (21.1 +/- 12.8 to 7.3 +/- 4.9 IU/liter at 48 wk, and 15.0 +/- 14.8 IU/liter 24 wk after withdrawal; P = 0.002 for trend). Osteocalcin concentration decreased at 48 wk and increased 24 wk after alendronate withdrawal (P = 0.019 for trend of change over time) but not with placebo. Urinary N-telopeptide/creatinine ratio decreased with alendronate at 48 wk and increased 24 wk after treatment withdrawal (P = 0.008 for trend). N-telopeptide/creatinine ratio did not change with placebo. Alendronate improves BMD and reduces bone turnover markers in postmenopausal women with PHP.     

Effects of denosumab on bone mineral density and bone turnover in postmenopausal women

CONTEXT: Denosumab is an investigational fully human monoclonal antibody against receptor activator of nuclear factor-kappaB ligand, a mediator of osteoclastogenesis and osteoclast survival. OBJECTIVE: This study evaluated the ability of denosumab to increase bone mineral density (BMD) and decrease bone turnover markers (BTMs) in early and later postmenopausal women with low BMD. DESIGN AND SETTING: This 2-yr randomized, double-blind, placebo-controlled study was conducted in North America. PARTICIPANTS: Subjects included 332 postmenopausal women with lumbar spine BMD T-scores between -1.0 and -2.5. Interventions: SUBJECTS were randomly assigned to receive denosumab sc, 60 mg every 6 months, or placebo. Randomization was stratified by time since onset of menopause (< or =5 yr or > 5 yr). MAIN OUTCOME MEASURES: The primary end point was the percent change in lumbar spine BMD by dual-energy x-ray absorptiometry at 24 months. Additional end points were percent change in volumetric BMD of the distal radius by quantitative computed tomography; percent change in BMD by dual-energy x-ray absorptiometry for the total hip, one-third radius, and total body; hip structural analysis; percent change in BTMs; and safety. RESULTS: Denosumab significantly increased lumbar spine BMD, compared with placebo at 24 months (6.5 vs. -0.6%; P<0.0001) with similar results for both strata. Denosumab also produced significant increases in BMD at the total hip, one-third radius, and total body (P < 0.0001 vs. placebo); increased distal radius volumetric BMD (P < 0.01); improved hip structural analysis parameters; and significantly suppressed serum C-telopeptide, tartrate-resistant acid phosphatase-5b, and intact N-terminal propeptide of type 1 procollagen. The overall incidence of adverse events was similar between both study groups. CONCLUSIONS: Twice-yearly denosumab increased BMD and decreased BTMs in early and later postmenopausal women.     

亚临床甲状腺功能减退症与绝经后女性骨代谢指标的相关性分析

目的探讨亚临床甲状腺功能减退症(SCH)与绝经后女性骨密度及骨代谢相关指标的关系。方法选取2015年1月至2018年6月在空军军医大学西京医院老年病科就诊的138例绝经后女性临床资料,根据患者是否患SCH分为SCH组(68例)和正常对照组(70例)。检测并比较2组患者骨密度相关指标[碱性磷酸酶(ALP)、Ca~(2+)、骨化三醇、骨密度T值(T -1.0为骨密度异常)]以及甲状腺功能相关指标[甲状旁腺激素(PTH)、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPOAb~+)比例]。采用SPSS 18.0统计软件对数据进行分析。相关性采用Spearman相关分析。结果 SCH组及对照组患者骨密度异常率分别为50.0%(34/68)和25.7%(18/70),2组比较差异有统计学意义(P=0.003)。与对照组比较,SCH组患者TSH水平和TPOAb~+比例显著升高(P0.05),但FT3、FT4、PTH及骨代谢相关指标比较,差异无统计学意义(P0.05)。Spearman相关分析显示,TSH、TPOAb~+与ALP、骨化三醇、骨密度T值呈负相关,其中TSH与T值呈高度负相关(r=-0.804,P0.01)。结论 SCH可能引起绝经后女性骨量异常和骨密度测定值降低,这可能与血清TSH水平升高和TPOAb呈阳性有关。     

绝经后女性身体成分对骨密度的影响

绝经后女性是发生骨质疏松症的高危人群,骨密度除与遗传、性别、年龄、种族、营养、体力活动有关外,还与体质量密切相关,体质量被认为是骨密度的重要保护因素。人身体成分主要由骨骼、肌肉组织和脂肪组织3部分组成。近年研究证实身体成分、特别是肌肉组织和脂肪组织对骨密度影响的程度可能大于体重。本文就绝经后女性身体成分分布特点及对骨密度的影响进行综述。     

雷奈酸锶对绝经后骨质疏松症妇女骨密度的影响

目的观察雷奈酸锶(SR)对绝经后骨质疏松症妇女骨密度的影响。方法采用随机、双盲、安慰剂对照研究,对36例绝经后妇女分为试验组(n=18)和安慰剂组(n=18),分别给予SR 2g/d及安慰剂,共12个月。分别在用药前、用药6个月、用药12个月测定受试者的骨密度。结果与安慰剂组相比,使用SR 6个月后,SR组腰椎的骨密度增加1.98%,安慰剂组增加1.15%,两组比较差异无显著性(P0.05),SR组总髋部的骨密度增加2.22%,安慰剂组增加0.20%,两组比较差异具有显著性(P0.05);使用SR 12个月后,SR组腰椎的骨密度增加4.08%,安慰剂组降低0.53%,两组比较差异具有极显著性(P0.01),SR组总髋部的骨密度增加3.17%,安慰剂组降低0.46%,两组比较差异具有极显著性(P0.01)。共有4例提前终止研究(SR组2例,安慰剂组2例)。结论 SR能增加绝经后骨质疏松症妇女骨密度,服用顺应性好,安全。     

Cut off values of bone mineral density defining postmenopausal women with bone fractures.

OBJECTIVES--To define cut off values of bone mineral density (BMD), measured at different forearm sites by single photon absorptiometry, that discriminated postmenopausal women who have had fractures from those who have not, in order to provide an index of fracture risk for screening purposes. METHODS--BMD values were measured at distal third radius (DTR) and ultradistal radius (UDR) sites in two groups of postmenopausal women. Group 1 (n = 398) had not suffered fractures, and group 2 (n = 354) had appendicular fractures. Results were evaluated using receiver operating characteristic (ROC) curves. RESULTS--BMD values were significantly greater (p < 0.001) at both sites in group 1. Weight was lower in group 2 than in group 1 (p < 0.001). The BMD cut off value was 0.596 g/cm2 at DTR (sensitivity 63%, specificity 72%), and 0.310 g/cm2 at UDR (sensitivity 80%, specificity 80%). Values of area under ROC curves estimated for UDR were greater than for those DTR (p < 0.001). CONCLUSION--For screening purposes the BMD cut off value of 0.310 g/cm2 at the UDR may be useful in identifying women at high risk of fracture in an unselected postmenopausal population. BMD measured at UDR appeared to have a better predictive value than that at DTR.     

Relation of low bone mineral density and carotid atherosclerosis in postmenopausal women

Due to the lack of convincing data about the association between atherosclerosis and osteoporosis, we evaluated the association between carotid atherosclerosis and bone mineral density in a sample of apparently healthy postmenopausal women who underwent health-screening in our hospital. We also evaluated a bone turnover marker, osteocalcin; we divided the population into 2 groups according to osteocalcin levels. We found a high prevalence of carotid atherosclerosis in subjects with high osteocalcin levels and low bone mineral density.     

Skeletal and mandibular bone mineral density in dentate and edentulous postmenopausal women

Tooth loss is one of risk factors for osteoporosis. Reversibly osteoporotic condition is one of putative risk factors for tooth loss. The balance of bone remodeling in jawbone shift to absorption in systemically osteoporotic individuals and result in enhancement of tooth loss. The presence of tooth and skeletal and mandibular bone metabolism may relate to one another. We investigated the relationship between the presence of the tooth and skeletal and mandibular bone mineral density (BMD) in postmenopausal women. Periodontally healthy and edentulous subjects participated in this study. BMD of the lumbar spine and mandibular bone was determined. The results suggest that the presence of tooth contribute to maintain the BMD of mandibular cortical bone in postmenopausal women. Direct masticatory forces via natural teeth may influence the mandibular cortical bone metabolism and if tooth loss occurs, the bone metabolism may be regulated similar to other skeletal bone.     

Longitudinal changes of bone mineral density and bone turnover in postmenopausal women on thyroxine

OBJECTIVE The skeletal risks of subclinical hyperthyroidism in postmenopausal women on replacement thyroxine remain controversial. The aims of this study were to determine (1) the relationship between bone turnover and TSH levels and (2) whether reduction of thyroxine (T4) dose in postmenopausal women who have suppressed TSH levels is beneficial to bone mineral density (BMD) and bone turnover. DESIGN A prospective study over 2 years of postmenopausal women treated with T4 with an age- and sex-matched healthy control group. PATIENTS AND MEASUREMENTS Sixty-four postmenopausal women, ages 47 to 74 (61 ±9, mean ± SD), on T4 for between 2 and 14 years. Patients were divided into three groups: group 1 (n =23) with normal serum TSH levels, group 2 (n = 18) with suppressed serum TSH levels and group 3 (n =23) with a history of thyroidectomy and suppressed TSH levels (patients with thyroid cancer). Thirty-six age-matched healthy postmenopausal women were recruited as a control group. Bone mineral density (BMD), measured by dual-energy X-ray absorptiometry and bone turnover, were evaluated at baseline and over 2 years in the four groups. Serum TSH levels were measured every 6 to 12 months. In group 2, the dose of T4 was reduced after the baseline measurement and serum TSH levels were remeasured 1 to 4 months later. Serum TSH levels returned to the reference range after the reduction of T4 dose in group 2. RESULTS The serum TSH level, after log transformation, was negatively correlated with serum levels of osteocalcin (BGP), bone alkaline phosphatase (BAP) and urinary cross-linked N-telopeptides pyridinoline of type I collagen (NTx) (linear correlation, r = ?0.41 P < 0.001, r = ?0.29 P =0.01 and r = ?0.26 P = 0.033), respectively. There was no significant difference in BMD and bone turnover between the four groups at either baseline or follow-up (ANOVA, P >0.05). The levels of serum BGP, BAP and urinary NTx decreased whereas lumbar spine and femoral neck BMD increased significantly in group 2 over 2 years (one sample t-test, P =0.0021, 0.034, 0.0017, 0.011 and >0.001, respectively). In group 2, the rates of change of lumbar spine and femoral BMD were increased significantly and the rates of change of serum BGP and urinary NTx were decreased significantly compared with other groups (Scheffe test, P <0.05). CONCLUSIONS In postmenopausal women on T4, bone turnover is related to the serum TSH level and a reduction of T4 dose in those with suppressed serum TSH levels can result in a decrease in bone turnover and an increase in bone mineral density.     

Moderate physical activity is associated with higher bone mineral density in postmenopausal women

OBJECTIVES: To determine the associations between different levels of habitual physical activity, hormone replacement therapy (HRT), and bone mineral density (BMD) in postmenopausal women. DESIGN: Cross-sectional. SETTING: Academic medical center. PARTICIPANTS: Twenty sedentary women, 20 active nonathletic women, and 23 endurance-trained athletes, all of whom were postmenopausal, with half of each group on and half not on HRT. MEASUREMENTS: BMD and body composition determined by dual energy x-ray absorptiometry, maximal oxygen consumption (VO2max), dietary history by questionnaire, and vitamin D receptor (VDR) genotyping on deoxyribonucleic acid. RESULTS: Body weight was higher in the active nonathletic than in the sedentary and athletic women. Body fat was lower and VO2max higher in the athletic women than in the sedentary and the active nonathletic women. Physical activity level was significantly associated with BMD in three of the five measurements taken (L1-L4 lumbar spine, trochanter, total body; all P < .05). These differences were also generally significant after adjusting for body weight. The association between physical activity status and BMD at the neck of the femur and Ward's triangle bordered on significance (P = .07-.09). At most sites, the active nonathletic women had higher BMD than did the sedentary and athletic women. HRT was significantly associated only with total body BMD (P < .05). The groups were similar in terms of dietary habits (protein, calcium, sodium, phosphorus intake); VDR genotypes; and family, smoking, and nutritional histories. CONCLUSION: Given the similarity of the groups with respect to other factors that affect BMD, it appears that prolonged low-to-moderate-intensity physical activity, but not the same number of years of higher-intensity training for competitive events, was independently associated with higher BMD.     

绝经前妇科手术对绝经后妇女骨量的影响

目的探讨绝经前不同术式切除子宫、卵巢与绝经后妇女骨量的关系。方法对2002年4月至2006年3月绝经20年内的妇女绝经前行一侧卵巢切除术18例、单纯子宫切除术者63例,子宫加单侧卵巢切除术者44例,子宫加双侧卵巢切除术者87例,以及同期自然绝经101例妇女进行骨密度测定,并对各组的骨密度和骨质疏松症的发生率进行比较。骨质疏松症的诊断标准为骨密度值低于或等于正常年轻妇女平均骨密度峰值减去2.5个标准差。结果自然绝经组与一侧卵巢切除术组平均年龄分别59.8±6.8,56.5±5.5岁;平均绝经年龄分别为49.8±3.2、49.5±3.9,两组在腰椎、股骨颈、大转子、华氏三角区骨密度差异无统计学意义,且两组骨质疏松症发生率分别为61.4%、50%,两组差异无统计学意义（P〉0.05）。单纯子宫切除术组、子宫加单侧卵巢切除术组、子宫加双侧卵巢切除术组腰椎骨密度分别为0.91±0.17、0.88±0.18、0.80±0.14（g/cm^2）,股骨颈骨密度分别为0.75±0.11、0.77±0.14、0.70±0.12（g/cm^2）,大转子骨密度分别为0.60±0.10、0.62±0.12、0.56±0.10（g/cm^2）,华氏三角区骨密度分别为0.56±0.13、0.59±0.16、0.50±0.12（g/cm^2）。子宫加双侧卵巢切除术组骨密度在腰椎、股骨颈、大转子、华氏三角区明显低于单纯子宫切除术组和子宫加单侧卵巢切除术组;后两组组间差异无统计学意义。单纯子宫切除术组、子宫加单侧卵巢切除、子宫加双侧卵巢切除术组骨质疏松症发生率分别为34.9%、38.6%、62.1%。子宫加双侧卵巢切除术组明显高于单纯子宫切除术组、子宫切除术加单侧卵巢切除术组（P〈0.01）,后两组间差异无统计学意义。结论1.绝经前行单侧卵巢切除后不影响绝经后妇女骨量、骨质疏松症的发生率;2.绝经前子宫切除术者尽可能保留单侧或双侧卵巢,以避免远期骨量降低,骨质疏松症发生率增加。     

绝经后妇女脊椎压缩性骨折与骨密度的关系

目的探讨绝经后妇女脊椎压缩性骨折与骨密度（BMD）的关系。方法为病例一对照研究，入选250例有脊椎压缩性骨折的绝经后妇女，另有250名无脊椎压缩性骨折的绝经后妇女作为对照组。两组均有胸腰椎正侧位X线摄片，并应用双能X线吸收仪检测腰椎1～4和左股骨近端各部位BMD。结果脊椎压缩性骨折组身高、体重、腰椎2～4和股骨近端各部位BMD值均显著低于对照组（均P〈0．01）。腰椎2～4BMD是发生脊柱骨折的预报因子（r=-0．416，P〈0．01）。身高和全髋部BMD与骨折次数和骨折椎体数目呈负相关（均P〈0．01）。按股骨颈和全髋部BMD值，骨折组骨质疏松检出率各为50．8％和50．4％；另外剔除在腰椎2～4发生椎体骨折53例，按腰椎2～4BMD检出骨质疏松占64．5％。同时，腰椎2～4、股骨颈或全髋部BMD值低于-2．5s者发生脊柱压缩性骨折的风险分别是BMD正常者的4．76、2．36和3．52倍。结论腰椎呈低骨量是发生脊椎压缩性骨折的重要危险因素。身高的下降和全髋部低BMD值是骨折发生次数和受累椎体数目的危险因子；对绝经后妇女在重视BMD测量的同时，应重视脊柱X线正侧位检查。     

Serum uric acid level and bone mineral density in Iraqi postmenopausal women

BackgroundThe role of uric acid (UA) in bone mineral density (BMD) has been investigated with diverse results.Aim of the workTo study the relation between serum UA and BMD in Iraqi postmenapausal women.Patients and methodsThe study involved 151 Iraqi postmenapausal women recruited from Baghdad Medical City. Serum UA was measured on two occasions and subjects were categorized into four quartiles according to the serum concentrations. BMD was measured by dual energy x-ray absorptiometry (DXA) and T-score calculated at the lumbar spine (L1-L4) and right femoral neck.ResultsThe mean age of the subjects was 53 ± 9.1 years, body mass index was 31 ± 3.68 and the menopause duration was 8.13 ± 5.86 years. Their mean serum UA level was 4.72 ± 1.35 mg/dl. 56 (37.1%) subjects were osteopenic and 34 (22.5%) were osteoporotic. The mean BMD increased significantly across the quartiles; the highest was in the fourth UA quartile (highest) for both the lumbar spine and right femoral neck. The percentage of women with osteoporosis and osteopenia were lowest in the fourth UA quartile. UA was significantly associated with BMD at L1-L4 spine (p = 0.04) and right femoral neck (p = 0.004) and with the corresponding T-scores (p = 0.008 and p = 0.01 respectively). After adjusting for confounding factors for UA on BMD, only the association of UA with L1-L4 BMD (β = 0.03, p = 0.01) and T-value (β = 0.32, p = 0.009) was still significant.ConclusionHigher serum UA levels were associated with higher BMDs at the lumbar spine suggesting that it may have a beneficial effect on the bone density.     

Cushing's syndrome and bone mineral density: lowest Z scores in young patients

Background: Patients with Cushing's syndrome have a high prevalence of osteoporotic fractures. Little is known about factors determining bone mineral density (BMD) in these patients. Objective: To evaluate which factors influence BMD at the time of diagnosis of Cushing's syndrome. Methods: In 77 consecutive patients with Cushing's syndrome with a median age of 41.1 (interquartile range 31.1 to 52.2) years we measured BMD of the lumbar spine and the femoral neck at the time of diagnosis. From the medical records we obtained information on possible predictors of BMD. We compared BMD with a reference population by means of the Z score. Adjustment for other variables than age and sex was made with linear regression models. Results: Patients with Cushing's syndrome had a low Z score in both the lumbar spine (-1.07 SD (95% CI -1.43 to -0.71 SD )) and in the femoral neck (-0.81 SD (95% CI -1.06 to -0.55 SD )). 82% of patients had osteopenia at one or both sites (T score lower than -1 SD ), including 31% with osteoporosis (T score -2.5 SD or lower). The main determinant of the Z score at both sites and for both sexes was age. Z score increased by about 0.4 SD per decade. 81% of patients.