上海市高知女性跟骨骨密度测定：197个结果分析*

背景：研究表明,女性骨峰值低于男性,而不同地区人群骨矿含量存在差异,因此有必要建立各地区不同人群的峰值骨密度。 目的：调查上海市高知女性骨密度随年龄、体质量指数等变化规律。 方法：纳入27~62岁高知女性受试者共197例,5岁为一个年龄段,共分为7组。准确记录各组受试者年龄,身高及体质量,并采用超声波骨密度仪测定各组受试者跟骨骨密度。用逐步回归分析各组骨峰值与年龄、体质量和握力的相关性。 结果与结论：研究结果显示上海市女性骨量峰值出现在38~39岁年龄段。骨密度值的下降率在31~35岁和41~45岁下降幅度最大。逐步回归分析结果显示,上海高知女性骨峰值与年龄、体质量、握力成正相关,年龄对骨峰值的影响最为明显,峰值骨量越低或出现越早,发生骨质疏松的危险越大。结果表明上海市高知女性群体发生骨质疏松的危险性较大。     

深圳市居民4 123人骨密度分析及骨质疏松患病率调查

背景：近年来国内外资料显示骨质疏松患病年龄有年轻化趋势，区域差异较大。 目的：调查深圳市正常人群骨密度的变化规律及骨质疏松的患病率。 设计、时间及地点：横断面调查，于2003-01/2008-02收集在北京大学深圳医院特诊科体检的深圳市汉族居民4 123人的股骨骨密度测量结果。 对象：受试对象共9 938人，符合纳入标准且长居深圳市10年以上的健康体检者4 123人，男1 852人，女2 271人，年龄20~79岁，按10岁为1个年龄段，共分6组。 方法：将受试者性别、出生日期、身高、体质量输入微机，采用Challerger双能X射线骨密度仪及骨密度分析软件测量非优势（左）股骨近端股骨颈、Ward’s三角区、大转子粗隆骨密度值。 主要观察指标：骨密度参考值T值（被测人的骨密度与同性别同年龄人的对照组之差别）及累积丢失率。 结果：股骨近端骨峰值出现在20~29岁。成年人骨累积丢失率为：股骨颈＞Ward’s三角区＞大转子粗隆。在30~39岁组间，男女两性股骨颈和Ward’s三角区的骨密度均呈明显下降趋势；女性50~59岁组间，股骨近端股骨颈、Ward’s三角区、大转子粗隆的骨密度下降速度最快，尤其Ward’s三角区、股骨颈。男性骨密度无明显快速下降年龄段。男女两性随年龄增长骨质疏松症患病率逐渐增高。采用世界卫生组织和中国老年学会骨质疏松委员会制定的骨质疏松症标准，男女两组均在50~79岁及总患病率两独立样本比较，差异有显著性意义（P < 0.05），女性尤其明显（P < 0.01）。 结论：深圳市男女两性在30~39岁间股骨颈、Ward’s三角区骨密度下降明显，女性在50~59岁间骨密度加速下降，应提早加强预防措施。     

北京市东城区289名健康中老年人骨密度测量**★

背景：研究表明，健康男女骨密度峰值出现在大约20~40岁之间，进入中老年后骨量逐渐下降，从而导致骨质疏松症。 目的：分析北京市东城区2个居委会289名健康中老年人骨密度变化及骨质疏松患病特征。 设计：横断面调查。 单位：卫生部北京医院北京老年医学研究所。 对象：于1998-06/09采用整群随机方法选择北京市东城区2个居委会的289名45岁以上健康居民， 男136名，女153名，年龄45~85岁。排除标准：① 肝肾功能异常。②有影响骨代谢的各种因素（如：各种急慢性疾病；长期服用激素、钙剂等药物史；体脂指数小于19 kg/m2或大于28 kg/ m2；长期卧床3个月以上；特殊职业人群）。所有受试对象均对检测项目知情同意。 方法：采用美国Lunar公司的双能X线骨密度仪对所有受试对象进行骨密度测定，部位为左侧股骨近端(股骨颈，大转子，Ward’s三角区)，腰椎2~4前后位。按世界卫生组织提出的骨质疏松症的诊断标准及本攻关项目获得的骨峰值确定各个部位骨质疏松症的诊断标准，股骨径：男性0.665 g/cm2，女性0.677 g/cm2；大转子：男性0.598 g/cm2，女性0.506 g/cm2；Ward’s三角区：男性0.492 g/cm2，女性0.514 g/cm2；腰椎2~4：男性0.760 g/cm2，女性0.835 g/cm2。同时参考“九五”攻关课题获得的骨峰值计算骨量丢失率和骨质疏松的患病率。 主要观察指标：不同性别不同部位受试对象骨密度、骨量丢失率及骨质疏松患病率。 结果：纳入调查对象289名均进入结果分析。①男性的骨密度随年龄增高的趋势不显著，女性骨密度降低以及骨量丢失均十分突出，且以55岁以后更加明显。②按部位分析骨量累积丢失率，男女均依次为Ward’s三角区>股骨径>大粗隆>腰椎2~4。③骨质疏松患病率随年龄明显升高，女性显著高于男性，差异有统计学意义（P < 0.01）。骨质疏松发生以股骨径最高，其次是Ward’s三角区和腰椎2~4。 结论：女性性别和年龄增加，尤其是绝经期是骨质疏松发生的危险因素，股骨径、Ward’s三角区、以及女性腰椎2~4是易发骨质疏松部位。     

青年人群腰椎骨密度及标准差对骨质疏松检出率的影响：多中心、大样本分析

背景: 不同地区骨峰值和标准差不同，对骨质疏松诊断率有较大影响。探讨建立一完整数据库为中国人骨质疏松诊断准确性提供依据。 目的：探讨青年人腰椎骨密度和标准差正常参考值影响骨质疏松症检出率的程度。 设计、时间及地点：调查分析，于1997-01/1999-12分别在北京、上海、广州、南京、嘉兴和成都市完成。 对象：采用前瞻性及回顾性方法对全国6个中心骨密度参考数据库中11 418人进行调查统计分析；男3 666人，女7 752人；年龄20岁~90岁；分别来自北京(2 385人)、广州(1 178人)、上海(1 404人)、南京(2 938人)、成都(1 425人)、嘉兴(2 088人),受试者来源于社区调查、健康体检和健康志愿者。 方法：用GE-Lunar公司的DXA仪测量骨密度，调查全国6个中心11 418人L2~L4腰椎后前位和髋部骨密度，建立了骨密度参考数据库。6个中心的仪器内部精度0.3%~0.7%，仪器间的精度1.1%。 主要观察指标：①6个中心不同年龄组腰椎骨密度分布。②青年人群骨密度及其标准差值对骨质疏松症检出率的影响。 结果：中国汉族女性以腰椎进行骨质疏松症诊断的青年人群的骨密度和标准差值，6个中心，最大差值分别为0.098 g/cm2和0.027 g/cm2。用6个中心及总体各自的青年人平均骨密度和标准差值为参考标准，对同一人群计算T-score和获得的骨质疏松症检出率不相同；发现青年人平均骨密度每变化0.01 g/cm2，则骨质疏松症检出率变化1.6%(呈正相关)，其标准差值每变化 0.01 g/cm2，则骨质疏松症检出率变化4%(呈负相关)。 结论：青年人平均骨密度和标准差值不同引起骨质疏松症检出率也不相同。为了让不同中心的骨质疏松症检出率有可比性,建议同一个类型的骨密度仪,同一个种族,同一个地区用一个设计较完善大样本的参考数据库,以其青年人正常参考值计算T-score。     

长沙地区女性促卵泡刺激素水平与骨密度和骨质疏松患病率的关系

目的：调查中国女性年龄相关的血清促卵泡刺激素浓度及其与骨密度和骨质疏松症患病率之间的关系。 方法：于2007-06/2008-06选择自长沙和附近地区20~82岁699名健康的中国女性,排除患有影响骨代谢疾病、服用影响骨代谢药物的个体。其中绝经前妇女464名和绝经后妇女235名,绝经年龄为41~59岁。受试者均知情同意并签定了书面协议书。抽空腹静脉血测定血清卵泡刺激素和黄体生成素浓度。用DXA仪测定腰椎、总髋部、前臂超远端骨密度,评价血清促卵泡刺激素与年龄、骨密度和患骨质疏松症风险的关系。 结果：促卵泡刺激素约从40岁起随增龄而增加,到60岁又随增龄而下降。促卵泡刺激素与不同部位骨骼的骨密度呈显著负相关。在腰椎、总髋部、前臂超远端,促卵泡刺激素四分位数的骨质疏松症平均患病率分别为0.57%,0.43%,27.1%,30.9%。与一分位数和三分位数比较,四分位数的妇女骨质疏松症患病率和患病风险显著增加;与三分位数比较,处于四分位数的妇女骨质疏松症患病率和患病风险也显著增加,特别是在腰椎。 结论：血清促卵泡刺激素水平与骨密度的变化呈负相关,和骨质疏松症的发生呈正相关。     

降钙素受体基因多态性与原发性骨质疏松的相关性★

目的：骨质疏松是多基因调控疾病，峰值骨量达到和骨量丢失均受遗传因素影响。观察山东半岛地区汉族人群降钙素受体Alu-Ⅰ基因多态性各基因型频率及其与骨质疏松的关系，探讨原发性骨质疏松症的遗传易感因素。 方法：试验于2005-06/2007-06在青岛大学医学院附属医院中心实验室完成。①试验对象：选取332名长期居住在山东半岛地区无亲缘关系的汉族人群，纳入标准：健康门诊查体人员、原发性骨质疏松症及原发性骨质疏松症所致骨折患者；患者对试验知情同意。排除标准：各种继发性骨质疏松症；影响骨代谢相关疾病史；服用影响骨代谢药物等。其中骨质疏松合并骨折75例作为骨质疏松性骨折组，余257例经过骨密度测定确定骨量，按骨质疏松诊断标准（骨密度测定值比同性别峰值骨密度均值降低2.5个标准差）分为骨量正常组（n =201）及骨质疏松组（n =56）。②试验方法：应用聚合酶链反应限制性片段长度多态性分析技术测定257名山东半岛汉族成年人和75名骨质疏松性骨折患者降钙素受体基因型，用双能X射线吸收法测定腰椎、股骨颈、粗隆间、Ward’s三角和大转子区等部位的骨密度值。 结果：纳入受试者332人，均进入结果分析。①本试验人群降钙素受体基因型频率分布均符合Hardy-Weinberg 定律(χ2=0.47，P =0.493)。基因型频率分布依次为CC型占89.5%，CT型占10.5%，TT型占0%。②年龄与不同部位骨密度值之间呈负相关（P < 0.01），体质量指数与骨密度值之间呈正相关（P < 0.01），在将年龄和体质量指数进行校正后发现女性CC基因型较CT基因型在ward’s三角区有较高的骨密度（P < 0.05)，骨量正常组各基因型与骨质疏松性骨折组之间差异无显著性意义（P > 0.05)。 结论：山东半岛汉族女性降钙素受体基因型与骨密度之间存在一定关联，降钙素受体C1377T基因多态性可能成为胶东半岛汉族女性发生骨质疏松危险性的遗传标志。     

陕北地区帕金森病现状调查

目的调查陕北地区帕金森病(PD)的患病现状。方法对陕北地区人群进行分层随机抽样,共选取30个调查点共41 538人为调查对象,对其人口学资料和PD患病率进行调查。结果受调查者的PD总患病率57.8/10万,男性患病率为82.8/10万,女性患病率36.0/10万,两者之间差异有统计学意义(χ2=3.910,P0.05);中年以上各年龄段受调查者PD患病率差异有统计学意义(χ2=8.872,P0.05),其中年龄80岁、60~69岁、70~79岁3个年龄段受调查者PD患病率均显著高于50~59岁年龄段(χ2=6.340、7.670、4.639,P0.05)。结论陕北地区PD患病率处于全国中等水平,男性人群的患病率较高,随着年龄的增长,特别是年龄超过60岁时,其PD患病率可出现显著升高。     

珠江三角洲7地市11 760名成年人体质状态调查

目的：调查分析珠江三角洲地区2004/2005成年人体质基本状况。 方法：随机抽测珠江三角洲地区7个地市的成年男女11 760人,年龄20~59岁。每个城市样本量为1 680人,包括农民、城市体力劳动者和城市非体力劳动者3种人群。以每5岁为一年龄组,每一年龄组各监测35人。基本状况评估包括以下指标：身高、体质量和体质量指数、皮褶厚度和腰臀比、血压、脉搏、肺活量、年龄特征、性别差异、城乡差异、肌肉力量、柔韧性、速度灵敏性、反应能力、平衡能力及成年男女体育锻炼的基本情况。 结果：① 45岁前,男性体质量指数值大于女性,体质量指数值依次为城市非体力劳动者＞城市体力劳动者＞农民。②同部位女性皮褶均厚于男性。男性农民同部位皮褶厚度最薄,城市非体力劳动者皮褶厚度最大。③男性的收缩压、舒张压和肺活量均高于同年龄段女性。城市男女的肺活量均好于农村。④男性握力在35~39岁,背力在30~34岁达到最高值;女性握力在40~44岁达到最高值,女性背力在所测试的年龄段随年龄的增长而增加。⑤女性农民柔韧性在40~59岁时明显好于城市女性。⑥成年人在反映速度、灵敏、平衡能力等身体素质的峰值出现在20~24岁年龄段,40岁以后各项身体素质均随年龄增大而呈下降趋势。⑦城市参加体育锻炼人数与农村人数之比是4∶1。 结论：珠江三角洲地区成年人随年龄增长,心肺功能逐步降低,体能呈下降趋势。主要表现在随年龄增长血压增高、肺活量降低。无论城乡、男女各项体能指标均表现相同的年龄变化趋势。     

北京部分汉族男性维生素D受体基因Fok Ⅰ多态性与骨密度的关系

背景：骨质疏松症是受遗传和环境因素共同作用的多因子复杂疾病。维生素D受体基因多态性被认为是调控骨量的重要遗传因素,但在不同种族人群中的研究结果仍存在争议。 目的：观察维生素D受体基因Fok Ⅰ多态性与北京地区部分汉族男性骨密度的关系,以探求北京地区男性骨质疏松症的遗传易感性。 设计、时间及地点：随机对照试验,在2004-09/2007-12在解放军第二炮兵总医院内分泌科和解放军总医院老年病研究所分子生物学实验室共同完成。 对象：筛选2004-09/2006-12长期居住北京地区无血缘关系的20~80岁健康汉族男性230人。 方法：用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)分析法检测受试者维生素D受体基因Fok Ⅰ基因型,使用双能X射线吸收测定法检测随机抽取的100例受试者腰椎和髋部的骨密度。 主要观察指标：①受试者年龄、身高、体质量。②受试者维生素D受体基因Fok Ⅰ基因型。③受试者L2~4椎体、股骨颈、大转子及Wards三角部位骨密度。 结果：受试者维生素D受体基因Fok Ⅰ的基因型及基因频率的分布为FF 36.96%,Ff 46.96%,ff 16.08%,符合Hardy-Weinberg定律;校正年龄、体质量、身高和体质量指数对骨密度的影响后,40~59岁年龄段男性ff基因型组骨密度较FF,Ff基因型低(P=0.037)。其余各年龄段、各部位ff基因型组骨密度大多低于FF,Ff基因型,但差异无显著性意义(P > 0.05)。 结论：北京地区汉族男性维生素D受体基因Fok Ⅰ多态性分型与骨密度之间可能存在一定关联,该项检测对筛查男性骨质疏松症高危人群的意义需进一步研究。     

长沙地区50岁以上常住居民超重及肥胖的流行病学调查

目的 调查长沙市50岁以上人群超重和肥胖的流行特征,为制定相应的干预措施提供科学依据。方法 采用分层整群随机抽样的方法,以长沙市天心区20个社区作为调查点,对50～90岁常住居民超重和肥胖的相关因素进行调查,并调查不同体质量人群中的高血压分布。结果 该地区人群超重及肥胖患病率分别为38.9%和6.1%,女性超重和肥胖患病率为33.1%和5.3%,男性为46.8%和7.1%,男性明显高于女性（P均＜0.01）。60～69岁人群超重的发生率较50～59岁和70～90岁人群高（P =0.032,0.005）。经多元逐步回归分析发现,年龄、性别、劳动强度、吸烟、饮酒与体质指数（body mass index, BMI）有相关性,高血压的患病率与BMI呈正比。结论 长沙市50岁以上人群超重和肥胖患病率较高,尤其是男性;影响BMI的主要因素有年龄、性别、劳动强度、吸烟和饮酒等;随着BMI增加,高血压患病率增加。     

Bone mineral density and serum levels of 25 OH vitamin D in chronic users of antiepileptic drugs

The aim of this cross sectional study was to evaluate bone mineral density (BMD) and serum levels of 25-hydroxy vitamin D (25OHD) in a group of patients taking antiepileptic drugs (AED) for a seizure disorder. Between May-2001 and January-2003, we evaluated 58 patients (40 women/18 men), 34.4+/-6 years old living in Curitiba or in its metropolitan area, on antiepileptic therapy for 2 to 38 years (10 on monotherapy /48 on multiple drugs regime). The group was matched by age, gender, and bone mass index to 29 healthy subjects (20 women/ 9 men); 34.2+/-5.9 years old. Medical history and physical exam were performed on all subjects with particular information sought about fractures and risks factors for osteoporosis. Blood samples were collected for total serum calcium, albumin, phosphorus, creatinine, total alkaline phosphatase, and liver function tests. BMD of the lumbar spine, femur and forearm was determined by dual energy X-ray absorptiometry (DXA, Hologic QDR 1000). Between February and April-2003, other blood samples were collected to measure 25OHD, intact paratohormone (PTH) and calcium. Unemployment and smoking history were more frequent among patients than among controls (p<0.05). Fifteen patients had a fracture history, all of which occurred during a seizure. The BMD of the lumbar spine (0.975+/-0. 13 g/cm2 vs. 1.058+/-0.1 g/cm2; p<0.03) and of the total femur (0.930+/-0.1 g/cm2 vs. 0.988+/-0.12 g/cm2; p<0.02) was lower in patients than in controls. In 63.5% of patients and in 24.1 % of controls a T-score < -1.0 in at least one site was seen. The AED users had higher total alkaline phosphatase and lower 25OHD (p<0.02). No correlations between BMD and 25OHD were found. The use of phenytoin was correlated with a greater incidence of fractures (RR: 2.38). We conclude that patients on chronic use of AED have alterations in bone metabolism characterized in this study by lower BMD of the lumbar spine and total femur and lower serum concentrations of 25OHD.     

Antiepileptic drug-induced bone loss in young male patients who have seizures

BACKGROUND: Long-term antiepileptic drug (AED) therapy is a known risk factor for bone loss and fractures. Vitamin D deficiency is frequently cited as a cause for bone loss in patients who have seizures. OBJECTIVE: To determine whether men who have seizures, but who are otherwise healthy, suffer substantial bone loss in the hip while taking AEDs. PATIENTS AND METHODS: We prospectively examined femoral neck bone mineral density (BMD) by dual-energy x-ray absorptiometry in 81 consecutive men, aged between 25 and 54 years old (mean age, 45 years), who were attending an outpatient seizure clinic. Low BMD values were analyzed for known risk factors for bone loss. Dual-energy x-ray absorptiometry scans were repeated in 54 patients, 12 to 29 months later (mean, 19 months), to assess the rate of change in BMD over time. RESULTS: Multivariate linear regression analysis revealed that age (P<.001) and time receiving AEDs (P<.003) were the 2 important risk factors associated with low femoral neck BMD. Neither vitamin D deficiency, hypogonadism, cigarette smoking, nor excess alcohol intake were associated with low BMD after correcting for age and time on AEDs. Longitudinal analysis of femoral neck BMD revealed that only those in the youngest age group (25-44 years) showed significant declines in femoral neck BMD (1.8% annualized loss; 95% confidence interval, -3.1 to -0.9; P<.003) while receiving AED therapy. There was no evidence that a specific type of AED was more causally related to bone loss in this group although most patients were taking phenytoin sodium or carbamazepine during the longitudinal assessment. CONCLUSIONS: Long-term AED therapy in young male patients who have seizures causes significant bone loss at the hip in the absence of vitamin D deficiency. Dual-energy x-ray absorptiometry scanning of the hip is useful in identifying patients who are particularly susceptible to rapid bone loss while taking AEDs.     

骨质疏松女性1 455名运动行为分析

背景：早在1989年,世界卫生组织就提出预防骨质疏松的3大原则：补钙、运动疗法和饮食。然而,更多的人却把眼光放在补钙和饮食上,忽略了运动疗法在预防骨质疏松上的重要作用。 目的：分析女性骨质疏松患者运动与腰椎骨密度相关性,进一步明确运动对人体腰椎骨密度的影响。 方法：对2003-08/2005-12在四川大学华西医院康复科门诊及住院女性患者4 383人,用双能X光机测定腰椎骨密度,根据骨密度T值评分,其中1 455例为骨质疏松患者;并对运动时间进行问卷分级,分为经常运动385例、偶尔运动115例、不运动955例,用SPSS12.0统计软件比较不同运动时间与腰椎骨密度关系。 结果与结论：3组骨质疏松患者L2、L3、L4骨密度、平均骨密度及T值均为经常运动组>不运动组>偶尔运动组,T值、平均骨密度组间比较差异有显著性意义(P < 0.05),但骨密度组间比较差异无显著性意义(P > 0.05),L2、L3、L4骨容量及骨总容量均为经常运动组>偶尔运动组>不运动组,但组间比较差异无显著性意义(P > 0.05)。结果提示,女性骨质疏松患者其运动量增加可提高腰椎骨密度,但要明显提高腰椎骨密度需达到一定运动量。     

Bone density and antiepileptic drugs: a case-controlled study.

This case-controlled study explored the relationship between bone mineral density (BMD) and long-term treatment with antiepileptic drugs (AEDs) in older adults with epilepsy. Seventy-eight patients (47 post-menopausal females, 31 males, aged 47-76 years) with epilepsy participated in the study. Each had only ever received treatment with either enzyme-inducing (n = 52) or non-inducing (n = 26) AEDs. Individuals were matched for age, sex, height and weight with a drug-naive control. All patients underwent bone densitometry at the lumbar spine and femoral neck and had blood sampling and urine collected for a range of bone markers. Male patients had lower BMD than controls at the lumbar spine (P < 0.01) and neck of the femur (P < 0.005). Female patients had significantly reduced bone density at the femoral neck (P < 0.05) only. AED usage was independently associated with an overall reduction in bone density at femoral sites and contributed to just over 5% of the variance at the femoral neck. Duration of treatment and type of AED were not independent factors for reduction in BMD. This case-controlled study supports the hypothesis that long-term AED therapy is an independent risk factor for reduced BMD in epileptic patients. Adults receiving treatment for epilepsy are at higher risk of osteoporosis and should be offered bone densitometry.     

Anxiety disorders are associated with reduced bone mineral density in men: Findings from the Geelong Osteoporosis Study

Objective

Certain psychiatric disorders, including depression, appear to impact adversely on bone health. Anxiety disorders are highly prevalent but few studies have examined their effects on bone tissue. This study investigated the effect of anxiety disorders on bone mineral density (BMD).

Methods

This prospective cohort study used data from the Geelong Osteoporosis Study. Participants were women and men aged ≥20 years randomly selected from the electoral roll and followed up for a mean of 14.7 and 11.0 years, respectively. Participants were assessed for a lifetime history of an anxiety disorder using the Structured Clinical Interview for DSM-IV-TR. BMD in the lumbar spine and femoral neck was measured using dual-energy x-ray absorptiometry.

Results

Eight hundred and ninety women and 785 men participated in the study. Adjusting for sociodemographic, biometric and lifestyle factors, medical comorbidities and medication use, anxiety disorders were associated with reduced BMD at the lumbar spine (partial η² = 0.006; p = 0.018) and femoral neck (partial η² = 0.006; p = 0.003) in men. These associations became non-significant when men with a history of comorbid mood disorders were excluded from the analysis. There was no significant association between anxiety disorders and BMD in women (p ≥ 0.168).

Conclusions

Anxiety disorders are associated with reduced BMD in men. This effect may be mediated by comorbid depression.     

Bone mass in young adults with Down syndrome

Background Down syndrome (DS) is a frequent cause of intellectual disability. With the increasing life expectancy of these patients, concerns have been raised about the risk of osteoporosis. In fact, several investigators have reported a reduced bone mass in DS. However, the results may be confounded by comorbid diseases, and differences in lifestyle habits and body size. Therefore, we planned to determine anthropometric and lifestyle factors influencing bone mineral density (BMD) in young adults with DS. Methods Thirty‐nine patients with DS (mean age 26 years) and 78 controls were studied. Areal BMD was measured by dual x‐ray decsitometry (DXA); volumetric BMD at the lumbar spine and femoral neck was estimated with published formulae. Results DS patients had lower areal BMD than controls at all regions (spine, hip and total body). Height and projected bone area were also lower. There were no differences between both groups regarding estimated volumetric BMD at the femoral neck. However, spine volumetric BMD was also lower in DS than controls. In multivariate analysis, DS, male sex, little physical activity and low sunlight exposure were associated with lower spine volumetric BMD; on the other hand, fat mass and sunlight exposure were associated with femoral neck volumetric BMD. Conclusion This study shows that patients with DS had a reduced areal BMD, but it is in part a consequence of the reduced body size, particularly at the femoral neck. Physical activity and sunlight exposure are associated to volumetric BMD and should be stimulated in order to maintain an adequate bone mass in these patients.     

男性血清抵抗素、脂联素水平与骨密度的关系：232名资料分析

目的：调查分析长沙地区232名健康男性志愿者血清抵抗素、脂联素水平与骨密度的关系。 方法：随机选择长沙地区汉族健康男性志愿者232名，对调查方案均知情同意，排除患有影响骨代谢疾病、服用影响骨代谢药物者。用酶联免疫吸附试验测定受试者血清脂联素、抵抗素水平；用DXA测定总体、腰椎正位、总髋部骨密度，全身扫描测定体脂水平及瘦体质量。分析血清脂联素、抵抗素水平与体脂及各部位骨密度的关系；利用逐步多元线性回归分析各部位骨密度的影响因素。 结果：抵抗素与体脂无相关性。脂联素与体脂呈负相关(r= -0.216，P < 0.05)，校正年龄与体质量指数后，相关性消失(r= -0.006，P > 0.05)。脂联素与总体、腰椎正位、总髋部骨密度呈负相关，校正年龄与体脂后，相关性存在。抵抗素与总体、腰椎正位、总髋部骨密度无相关性。多元线性回归分析显示脂联素是男性各部位骨密度的独立影响因素。 结论：抵抗素与体脂及各部位骨密度均无相关性。脂联素与体脂相关，与各部位骨密度呈负相关，是男性各部位骨密度的独立影响因素。     

Bone mineral density in children, adolescents, and young adults with epilepsy

Purpose:   The aim of this study was to assess bone mineral density (BMD) in a large population of children, adolescents, and young adults with epilepsy alone or in association with cerebral palsy and/or mental retardation.
Methods:   Ninety-six patients were enrolled in the study. The group comprised 50 males and 46 females, aged between 3 and 25 years (mean age 11 years). The control group consisted of 63 healthy children and adolescents (23 males, 40 females), aged between 3 and 25 years (mean age 12.1 years). Patients underwent a dual-energy x-ray absorptiometry (DEXA) scan of the lumbar spine (L1–L4) and the z scores were calculated for each patient; the t score was considered for patients 18 years of age or older.
Results:   Abnormal BMD was found in 56 patients (58.3%), with values documenting osteopenia in 42 (75%) and osteoporosis in 14 (25%). A significant difference emerged between epileptic patients and the control group in BMD, z score, and body mass index (BMI) (p = <0.001). Lack of autonomous gait, severe mental retardation, long duration of antiepileptic treatment, topiramate adjunctive therapy, and less physical activity significantly correlated with abnormal BMD.
Discussion:   This study detected abnormal BMD in more than half of a large pediatric population with epilepsy with or without cerebral palsy and/or mental retardation. The clinical significance of these findings has yet to be clarified.     

Negative impact of high cumulative glucocorticoid dose on bone metabolism of patients with myasthenia gravis

This current study aimed to evaluate the frequency of low bone mass, osteopenia, and osteoporosis in patients with myasthenia gravis (MG) and to investigate the possible association between bone mineral density (BMD) and plasma levels of bone metabolism markers. Eighty patients with MG and 62 controls BMD were measured in the right femoral neck and lumbar spine by dual-energy X-ray absorptiometry. Plasma concentrations of osteocalcin, osteopontin, osteoprotegerin, tumor necrosis factor (TNF-α), interleukin (IL)-1β, IL-6, dickkopf (DKK-1), sclerostin, insulin, leptin, adrenocorticotropic hormone, parathyroid hormone, and fibroblast growth factor (FGF-23) were analyzed by Luminex®. The mean age of patients was 41.9 years, with 13.5 years of length of illness, and a mean cumulative dose of glucocorticoids 38,123 mg. Patients had significant reduction in BMD of the lumbar, the femoral neck, and in the whole body when compared with controls. Fourteen percent MG patients had osteoporosis at the lumbar spine and 2.5% at the femoral neck. In comparison with controls, patients with MG presented lower levels of osteocalcin, adrenocorticotropic hormone, parathyroid hormone, sclerostin, TNF-α, and DKK-1 and higher levels of FGF-23, leptin, and IL-6. There was a significant negative correlation between cumulative glucocorticoid dose and serum calcium, lumbar spine T-score, femoral neck BMD, T-score, and Z-score. After multivariate analysis, higher TNF-α levels increased the likelihood of presenting low bone mass by 2.62. MG patients under corticotherapy presented low BMD and altered levels of bone markers.     

Bone mineral density and vitamin D status in Parkinson’s disease patients

Bone loss is more common in Parkinson’s disease (PD) than in the general population. Several factors may be involved in the development of bone loss, including malnutrition, immobilization, low body mass index, decreased muscle strength, vitamin D deficiency and medication use. This study investigates the prevalence of osteoporosis and possible risk factors associated with bone loss in early stage PD. In 186 PD patients (Hoehn and Yahr stage 1–2.5, mean age 64.1 years, 71 % men) bone mineral density (BMD) measurements were performed with DEXA. T- and Z-scores were calculated. Univariate linear regression analysis was performed to identify variables that contributed to BMD. 25-OH-vitamin D status of PD patients was compared with 802 controls (mean age 63.3 years, 50 % men) using linear regression analysis. Osteoporosis (11.8 %) and osteopenia (41.4 %) were common in PD patients. Mean Z-score for the hip was 0.24 (SD 0.93), and for the lumbar spine 0.72 (SD 1.91). Female gender, low weight, and low 25-OH-vitamin D were significantly correlated with BMD of the hip and lumbar spine. PD patients had lower 25(OH)D serum levels than controls (B = ?10, p = 0.000). More than half of the patients with early stage PD had an abnormal BMD. Female gender, low weight, and low vitamin D concentration were associated with bone loss. Furthermore, vitamin D concentrations were reduced in PD patients. These results underscore the importance of proactive screening for bone loss and vitamin D deficiency, even in early stages of PD.