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1.
Effects of Alendronate on Bone Density in Men with Primary and Secondary Osteoporosis 总被引:5,自引:0,他引:5
Alendronate has been reported to increase bone mineral density (BMD) and reduce fracture risk in women with osteoporosis.
As there are no proven safe and effective treatments available for men with osteoporosis, we compared the effects of alendronate
(10 mg/day) on BMD, measured using dual-energy X-ray absorptiometry, in a 12-month prospective, controlled, open label study
involving (i) men with primary (n= 23) or secondary osteoporosis (n= 18), (ii) postmenopausal women with primary (n= 18) or secondary (n= 21) osteoporosis, and (iii) 29 male and 14 female untreated controls matched by age, height and weight. The patients had
one or more vertebral fractures and ranged in age from 34.6 to 85.1 years. BMD was detectably increased relative to baseline
by 6 months, and increased by comparable amounts in males and females with primary or secondary osteoporosis. At 12 months,
lumbar spine BMD was 5.4%± 1.1% to 7.0%± 2.2% higher in the treated groups compared with baseline and controls (p<0.05 to 0.0001). Trochanteric BMD increased by 2.6%± 1.5% and 3.7%± 1.7% in treated men with primary and secondary osteoporosis,
respectively (p = 0.06 to 0.08), and by 3.9%± 1.3% in treated women with primary osteoporosis (p<0.01) after 12 months. No significant changes were detected at the femoral neck or Ward’s triangle. BMD remained unchanged
in controls. We infer that alendronate has comparable incremental effects on BMD in men and women with primary and secondary
osteoporosis within 12 months of treatment. The changes are in the order of 0.5 SD – effects associated with a clinically
worthwhile reduction in fracture risk. The data provide room for optimism regarding the role of alendronate in the treatment
of osteoporosis in men. Randomized, double-masked and placebo-controlled trials are needed to confirm these preliminary findings
and demonstrate antifracture efficacy using vertebral and nonvertebral fracture rates as the primary endpoint.
Received: 23 February 1999 / Accepted: 2 June 1999 相似文献
2.
In Vivo MRI Measurements of Bone Quality in the Calcaneus: A Comparison with DXA and Ultrasound 总被引:5,自引:0,他引:5
Magnetic resonance imaging (MRI) has shown promise in the assessment of bone architecture. The precision and feasibility
of MRI measurements in osteoporosis in vivo have been assessed in this study. T2′ was calculated from measurements of T2 and
T2* in the calcaneus of 32 postmenopausal women using a gradient-echo sequence PRIME (Partially Refocused Interleaved Multiple
Echo). This sequence allows the measurement of T2 and T2* in one acquisition. In vivo measurements of bone mineral density
(BMD) by dual-energy X-ray absorptiometry (DXA) were made in the calcaneus, spine and femoral neck. The ultrasound parameters
broadband ultrasound attenuation (BUA) and speed of sound (SOS) were also measured in the calcaneus. These three techniques
have not previously been compared in the same study population. The precision of the MRI technique was poor relative to the
DXA and ultrasound techniques, with a CV of 6.9%± 4.4% for T2′ and 5.5%± 3.6% for T2*. Approximately 4% of this is due to
system error as determined by phantom measurements. The postmenopausal women were classified as having low BMD if they had
a lumbar spine (L2–4) BMD of less than 0.96 g/cm2 (more than 2 standard deviations below normal peak bone mass). Calcaneal T2′ was significantly correlated with calcaneal
BMD (r = –0.79, p <0.0001), BUA (r = –0.59, p = 0.0004) and SOS (r = –0.58, p = 0.0006). T2′ was significantly different in postmenopausal women with normal BMD and those with low BMD (p <0.01). However, the difference was of only borderline significance (p <0.06) after adjustment for age and years since menopause.
Received: 8 July 1997 / Accepted: 29 April 1998 相似文献
3.
Primary hyperparathyroidism (PHPT) may result in greater cortical than trabecular bone loss. Ultrasound is able to predict
osteoporotic fracture risk independent of densitometric measurements, but little is known about the changes in ultrasound
variables with PHPT. The aim of our study was to examine the effect of PHPT on ultrasound variables and bone density measurements
at cortical (hand) and trabecular (lumbar spine and heel) sites, and to evaluate their reversibility following surgical treatment.
We recruited 25 postmenopausal women diagnosed with PHPT ages 51–76 years (mean 62 years) and 95 postmenopausal controls ages
57–80 years (mean 67 years). Measurements were made at baseline and 1 year. Speed of sound (SOS) and broadband ultrasound
attenuation (BUA) of the heel were measured using the Lunar Achilles (LA+) and McCue CUBA Clinical (CC). Amplitude-dependent
speed of sound (AD-SoS) and ultrasound bone profile index (UBPI) of the fingers were measured using the IGEA DBM Sonic. Bone
mineral density (BMD) of the hand and lumbar spine (LS) were measured by dual-energy X-ray absorptiometry (DXA). At baseline,
hand BMD, LS BMD and heel BUA were significantly lower and finger UBPI significantly higher in the PHPT patients compared
with controls (p<0.001). There were no differences in Stiffness Index, heel SOS or finger AD-SoS between control and PHPT subjects. At 1 year
postoperatively, there was a mean (±SD) increase in LS and hand BMD of 3 ± 1% (p<0.01). BUA at the heel increased (11 ± 5%, p<0.001), and UBPI of the fingers decreased (17 ± 7%, p<0.001) probably reflecting different modes of attenuation in trabecular (scattering) and cortical (absorption) bone. Stiffness
Index, SOS of the heel and AD-SoS of the fingers did not change. BUA, UBPI and BMD returned towards normal postmenopausal
values following surgery. There were no changes in BMD or QUS variables at 1 year in the control group. Quantitative ultrasound
(QUS) measurements provide different information about bone structure than densitometric measurements and cannot be regarded
as simply reflecting bone density. With further research the combined use of BMD and QUS could improve the assessment of skeletal
status in patients with PHPT before and after surgery.
Received: 10 September 2001 / Accepted: 31 January 2002 相似文献
4.
The Effects of Pregnancy and Lactation on Bone Mineral Density 总被引:8,自引:0,他引:8
We performed a prospective study of bone mineral density (BMD) in 38 women during their first full-term pregnancy until 12
months postpartum. BMD measurements at lumbar spine [L2–L4 (LS)] and forearm [distal 33% (RD) and ultradistal (RUD) region
of the radius] were made within 3 months before conception, after delivery, and at 6 and 12 months postpartum. In mid-pregnancy
the DXA examination was carried out only at the forearm. Patients were grouped according to duration of lactation as group
I, II or III (0–1, 1–6, 6–12 months respectively). During pregnancy there was a significant difference between baseline and
delivery (p< 0.001) in the LS, RUD and RD BMD values. In group I there was no statistically significant difference in LS BMD between
visits following pregnancy. The RUD BMD loss was recovered by 6 months postpartum (PP6). Group II showed continuous bone loss
from delivery until PP6 at LS and RUD. In group III the LS BMD loss continued throughout the lactation period. The RUD BMD
dropped (4.9%) until PP6 then increased by 3.0% as measured at 12 months postpartum (PP12). There was no significant change
in RD BMD in any of three groups during lactation. At LS bone loss between delivery and PP12 correlated well with the duration
of lactation (r=−0.727; p<0.001). We suggest that calcium needed for fetal skeletal growth during pregnancy was gained from maternal trabecular and
cortical sites and that calcium needed for infant growth during lactation was drawn mainly from the maternal trabecular skeleton
in our patients. The effect of pregnancy and lactation on the maternal bone mass was spontaneously compensated after weaning.
Received: 13 July 2000 / Accepted: 19 April 2001 相似文献
5.
Changes in Bone Density in Patients with Ankylosing Spondylitis: A Two-Year Follow-Up Study 总被引:2,自引:0,他引:2
J. F. Maillefert L. S. Aho A. El Maghraoui M. Dougados C. Roux 《Osteoporosis international》2001,12(7):605-609
The objectives of the study were to determine the 2 year rate of bone changes in patients with ankylosing spondylitis (AS)
and, whether bone loss is related to physical impairment, systemic inflammation, and therapy. Consecutive outpatients fulfilling
the modified New York criteria for AS were included. Baseline assessment included age, disease duration, treatment, clinical,
radiologic and laboratory data. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were determined every 6
months. Persistent systemic inflammation was defined as mean ESR ≥ 28 mm/h or mean CRP ≥ 15 mg/l. Bone mineral density (BMD)
at the lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry, at baseline and year 2. Statistical
analysis compared the baseline and 24 month follow-up BMD data, and determined whether baseline data, and persistent systemic
inflammation during the 2 years, were related to the 24 month percentage changes in BMD. Fifty-four patients (35 men, 19 women;
mean age 37.3 ± 11.3 years, mean disease duration 12.4 ± 8.6 years) were included. After 2 years, BMD did not change at the
lumbar spine (+0.75%± 3.5, p= 0.23), and decreased at the femoral neck (–1.6%± 4, p= 0.006). The 24 month percentage change in femoral neck BMD was related to persistent systemic inflammation, defined using
ESR (mean percentage change –4.1%± 5.7 and –1.2%± 3.9 in patients with and without persistent inflammation; respectively; p= 0.007). These results suggest that persistent inflammation might be an etiologic factor of bone loss in AS.
Received: 15 November 2000 / Accepted: 15 February 2001 相似文献
6.
Bisphosphonates such as etidronate and alendronate are widely accepted as effective agents for the treatment of osteoporosis.
However, some physicians find the choice of which one to use in different patients, and the comparative magnitude of response,
unclear. Fifty postmenopausal women with osteoporosis [group 1: 27 women who had received 3 years of previous cyclical etidronate
treatment, mean age 70.5 years, bone mineral density (BMD) mean T-score lumbar spine (LS) −3.58 and femoral neck (FN) −2.51; group 2: 23 women who had not previously received cyclical etidronate
treatment, mean age 73.7 years, BMD mean T-score LS −3.65 and FN −2.96] were treated with 10 mg alendronate daily, to determine whether pretreatment with etidronate
affected the response to alendronate, and whether patients who did not respond to etidronate, responded to alendronate. There
was a significant increase in LS BMD after 2 years of treatment with alendronate compared with baseline (group 1: 7.84%, p<0.001; group 2: 6.69%, p<0.001), but there was no statistical difference between the groups. In the group 1 patients there was a significant difference
between the initial response (at the LS BMD) to 2 years of cyclical etidronate (1.86%) and later response to 2 years of alendronate
(7.84%) (p<0.0001). The 10 patients who did not respond at the LS to etidronate alone, showed a significantly better response (mean
BMD change +6.3%) when subsequently treated with alendronate (a net difference of 9.3%, p = 0.002). In 15 patients who did not respond at the FN to etidronate alone, the mean response to alendronate was +0.96% (a
difference of 7%, p = 0.004). This study shows that pretreatment with 3 years of cyclical etidronate is not detrimental to the subsequent LS
BMD response to alendronate. There is evidence that alendronate produced a greater bone density response than etidronate,
and patients who did not respond to etidronate with an increase in LS bone density, subsequently did so following alendronate.
Received: 22 June 1999 / Accepted: 18 January 2000 相似文献
7.
Stiffness in Discrimination of Patients with Vertebral Fractures 总被引:4,自引:0,他引:4
We measured the ultrasound parameters of the heels of 49 women with vertebral fractures and 87 age-matched controls using
an Achilles ultrasound device. Average broadband ultrasound attenuation (BUA), speed of sound (SOS) and Stiffness were significantly
lower in fracture patients (p<0.0001). We also estimated the ultrasound parameters of patients compared with age-matched non-fracture controls and found
the mean BUA to be −1.02 SD below control values. The mean SOS was −0.97 SD and the mean Stiffness was −1.12 SD below control
values.
Femoral bone mineral density (BMD) at the neck, Ward’s triangle and the trochanter, the total-body BMD and L2–4 BMD were
measured with dual-energy X-ray absorptiometry (DXA) and found to be significantly lower in fracture patients (p<0.0001). All correlation coefficients between ultrasound parameters and DXA measurements were >0.5 and statistically significant
(p<0.0001). A stepwise logistic regression with presence or absence of vertebral fracture as the response variable and all ultrasound
– DXA parameters as the explanatory variables indicated that the best predictor of fracture was Stiffness, with additional
predictive ability provided by spine BMD. Sensitivity and specificity of all measures were determined by the areas under the
receiver operating characteristic (ROC) curve, which were 0.76 ± 0.04 for BUA, 0.77 ± 0.04 for SOS, 0.78 ± 0.04 for Stiffness
and 0.78 ± 0.03 for spine BMD. The areas under the ROC curves of BUA, SOS, Stiffness and spine BMD were compared and it was
found that Stiffness and spine BMD were significantly better predictors of fracture than BUA and SOS. These results support
many recent studies showing that ultrasound measurements of the os-calcis have diagnostic sensitivity comparable to DXA, and
also demonstrated that Stiffness was a better predictor of fracture than spine BMD.
Received: 23 September 1997 / Accepted: 10 April 1998 相似文献
8.
S. Gonnelli C. Cepollaro A. Montagnani S. Martini L. Gennari. M. Mangeri C. Gennari 《Osteoporosis international》2002,13(5):415-421
The possibility of using quantitative ultrasound (QUS) in monitoring the response to antiresorptive drugs has yet to be defined.
The aim of the present study was to evaluate whether heel ultrasonography, considering its characteristics of long-term precision,
is able to monitor osteoporotic patients treated with alendronate. We studied 150 postmenopausal osteoporotic women (age 59.6
± 5.3 years) treated with alendronate and calcium (n= 74) or with calcium alone (n= 76) for 4 years. At baseline and after 12, 24, 36 and 48 months, we measured bone mineral density (BMD) at the lumbar spine
by dual-energy X-ray absorptiometry (DXA, Hologic 4500), and speed of sound (SOS), broadband ultrasound attenuation (BUA)
and Stiffness at the calcaneus by Achilles plus. Moreover, the longitudinal precision of QUS parameters was assessed by measuring
10 subjects once a month for 1 year and, on the basis of the coefficients of variation we obtained, we calculated the Least
Significant Change between two measurements. In the alendronate-treated patients, at year 1, BMD increased by 4.2%, SOS by
0.4%, BUA by 1.1% and Stiffness by 3.2%; at year 2, BMD increased by 5.0%, SOS by 0.7%, BUA by 1.4% and Stiffness by 5.7%.
At year 3, BMD increased by 6.2%, SOS by 0.9%, BUA by 1.8% and Stiffness by 7.6%. At the end of the study period, BMD increased
by 7.6%, SOS by 1.2%, BUA by 1.9% and Stiffness by 9.0%. The minimal significant difference between two measurements was 0.8%
for SOS, 5.6% for BUA and 5.0% for Stiffness. Among the QUS parameters, Stiffness showed the greatest total treatment effect
and a longitudinal sensitivity which was only slightly lower than BMD. The MTI, which represents the period between scans
required to show that a ‘true’ change has occurred, was 1.8, 2.7, 11.9 and 2.2 years for BMD, SOS, BUA and Stiffness respectively.
Therefore, although the spinal BMD remains the optimal method, QUS at the heel, and in particular Stiffness, seems to be a
sensitive tool for monitoring the response to alendronate.
Received: 30 August 2001 / Accepted: 29 November 2001 相似文献
9.
N. B. Watts D. K. Jenkins J. M. Visor D. C. Casal P. Geusens 《Osteoporosis international》2001,12(4):279-288
Alendronate therapy in osteoporotic women decreases bone turnover and increases bone mineral density (BMD). Optimal patient
management should include verification that each patient is responding to therapy. Markers of bone turnover and BMD have both
been proposed for this purpose. We have investigated changes resulting from alendronate therapy with an enzyme immunoassay
for bone alkaline phosphatase (BAP) and compared it with total alkaline phosphatase (TAP) and BMD of the lumbar spine, hip,
and total body. Subjects were drawn from a multicenter randomized, placebo-controlled trial of alendronate in postmenopausal
women with osteoporosis. BAP and TAP levels were measured at baseline and following 3, 6 and 12 months of therapy with either
placebo (n= 180) or alendronate 10 mg/day (n= 134). All subjects also received 500 mg/day supplemental calcium. BMD was measured at baseline and following 3, 6, 12, 18,
24 and 36 months of therapy. To compare BAP, TAP and BMD at each site for identifying women that experienced a skeletal effect
of alendronate, we calculated least significant change (LSC) values from the long-term intraindividual variability in each
placebo-treated woman. Median levels of BAP decreased by 34%, 44% and 43% at 3, 6 and 12 months, respectively, in alendronate-treated
women (p<0.0001 compared with baseline and with placebo). These changes were significantly greater (p<0.0001) than changes observed for TAP. Following 6 months of alendronate therapy, 90% of the women had experienced a decrease
in BAP exceeding the LSC compared with only 71% for TAP. The greatest number of women similarly identified with BMD at any
site (i.e. a gain in BMD exceeding the LSC) was 81% for spinal BMD at 36 months. All other sites were less than 70% at 36
months. Short-term changes in BAP and TAP were modestly associated with subsequent changes in BMD at all sites (Spearman’s
rho −0.22 to −0.52, p<0.05). Compared with TAP and BMD, BAP testing rapidly and sensitively identified skeletal effects of alendronate thus enabling
appropriate drug monitoring of osteoporotic women. Though BAP and TAP changes were modestly predictive of BMD changes, the
value of the bone marker tests is their ability to detect rapidly a skeletal effect of therapy.
Received: 19 May 2000 / Accepted: 31 October 2000 相似文献
10.
Alendronate significantly increases bone mass and reduces hip and spine fractures in postmenopausal women. To determine whether
forearm densitometry could be used to monitor the efficacy of alendronate, we examined changes in bone mineral density (BMD)
at the forearm (one-third distal, mid-distal, ultradistal radius) versus changes at the hip (femoral neck, total hip) and
spine (posteroanterior and lateral) in a double-masked, randomized, placebo-controlled clinical trial of 120 elderly women
(mean age 70 ± 4 years) treated with alendronate for 2.5 years. We found that among women in the treatment group, BMD increased
by 4.0–12.2% at the hip and spine sites (all p<0.001), whereas BMD increased only nominally at the one-third distal radius (1.3%, p<0.001) and mid-radius (0.8%, p<0.05), and remained stable at the ultradistal radius. At baseline, forearm BMD correlated with that of the hip (r= 0.55–0.64, p<0.001), femoral neck (r= 0.54–0.61, p<0.001) and posteroanterior spine (r= 0.56–0.63, p<0.001). Changes in radial BMD after 1 year of therapy were not correlated with changes in hip and spine BMD after 2.5 years
of therapy. In contrast, short-term changes in total hip and spine BMD were generally positively associated with long-term
changes in total hip, femoral neck and spine BMD (r= 0.30–0.71, p<0.05). Furthermore, long-term BMD changes at the forearm did not correlate with long-term hip and spine BMD changes, in contrast
to the moderate correlations seen between spine and hip BMD at 2.5 years (r= 0.38–0.45, p<0.01). We conclude that neither short- nor long-term changes in forearm BMD predict long-term changes in overall BMD for
elderly women on alendronate therapy, suggesting that measurements of clinically relevant central sites (hip and spine) are
necessary to assess therapeutic efficacy.
Received: 18 February 1999 / Accepted: 20 May 1999 相似文献
11.
Quantitative Ultrasound of the Tibia Depends on Both Cortical Density and Thickness 总被引:14,自引:0,他引:14
S. Prevrhal T. Fuerst B. Fan C. Njeh D. Hans M. Uffmann S. Srivastav H. K. Genant 《Osteoporosis international》2001,12(1):28-34
This study investigated whether tibial speed of sound (SOS; SoundScan 2000, Myriad Ultrasound Systems, Israel) reflects not
only bone mineral density (BMD) but also tibial cortical thickness, as assessed by dual-energy X-ray absorptiometry (DXA)
and Quantitative CT (QCT) at a site-matched location. The secondary focus of the study was how tibial SOS compares with BMD
at the spine and the hip, the most widely used locations for densitometry. Twenty-two young normal (N) and 23 postmenopausal
women with spinal fractures (Fx) (mean (SD) age 35 (8) and 70 (5) years) underwent quantitative ultrasound (QUS) SOS measurement
at the left tibial midshaft. From site-matched QCT scans (three 3-mm slices spaced along the QUS measurement region), BMD
and cortical thickness were computed (QCT-cBMD, QCT-cTh). The cortex in the CT images was then subdivided into three concentric
and equally spaced bands, and QCT-cBMD was computed separately for each band. DXA was performed at the mid-tibia (TIB BMD),
at the spine (SPINE BMD) and the hip (total hip, HIP BMD). Correlation coefficients between parameters were determined with
least-square linear fits. Intergroup differences were assessed by analysis of covariance, whose r
2 value reflects the percentage variation in the data explained by group assignment. SOS correlated significantly with site-matched
parameters (QCT-cBMD, QCT-cTh and TIB BMD, all r= 0.6, p < 0.001), SPINE BMD and HIP BMD (both r= 0.5, p < 0.001). Multiple regression with both QCT-cBMD and QCT-cTh against SOS yielded r= 0.7 with both parameters contributing significantly. For the cortex band subdivision, SOS correlated better with QCT-cBMD
in the outermost band of the cortex (r= 0.67) than with the more central bands (r= 0.59 and r= 0.53). Group assignment could best explain SPINE BMD (r
2= 0.62) and HIP BMD (r
2= 0.51). SOS was comparable to TIB BMD (r
2= 0.3 vs. r
2= 0.35).: Our findings suggest that the tibial SOS measurement depends on both the thickness and density of the tibia, but
is more strongly influenced by the density of the cortex near the surface than by its interior parts. The power of tibial
ultrasound to discriminate between normal and fracture patients was less than that of spinal and femoral DXA BMD and comparable
to site-matched DXA BMD.
Received: 25 February 2000 / Accepted: 5 July 2000 相似文献
12.
Reference Database for Bone Speed of Sound Measurement by a Novel Quantitative Multi-site Ultrasound Device 总被引:2,自引:0,他引:2
The nonuniform skeletal involvement in osteoporosis argues for multi-site evaluation. The Sunlight Omnisense (Sunlight Ultrasound
Technologies, Israel) is a multi-site device that measures speed of sound (SOS) at the appendicular skeleton. We report the
reference database for SOS at the radius (RAD), tibia (TIB), metatarsus (MTR) and phalanx (PLX). The database was obtained
from 1521 healthy Israeli women (age 20–90 years) out of 2051 respondents. SOS was determined in 97.6% of the participants
at the PLX, 96.4% at the TIB, 93.6% at the RAD and 85.1% at the MTR; it was not measurable in 0.5%. Short-term coefficient
of variation was lowest at the RAD and always less than 1%. Maximal SOS was noted at 35–45 years of age in three of the sites
(RAD 4169 m/s, MTR 3663 m/s, PLX 4047 m/s, respectively) but 10 years earlier at the TIB (3939 m/s). In the perimenopausal
period (age 46–55 years), SOS was always lower in post- as compared with premenopausal women (p<0.05). Immediately following the menopause, SOS annually declined close to the short-term CV: 16, 34, 37 and 13 m/s at the
RAD, PLX, MTR and TIB, respectively. The average age-stratified SOS values at various measurement sites were highly correlated
at the population level (0.96–0.99), but less so at the individual level (0.40–0.57). Therefore, multi-site SOS measurements
are better than single-site assessment. After 79 years of age, the average T-score at the RAD and PLX was <−2.5. This is similar to that of dual-energy X-ray absorptiometry (DXA)-determined spine bone
mineral density (BMD) and somewhat lower than hip BMD. Equivalent T-score curves obtained by percentile adjustment of SOS at various sites to that of the RAD (at age group 60–69 years) reveal
convergence and indicate that 52–68% of women older than 79 years are osteoporotic. In conclusion, multi-site peripheral SOS
measurements reveal age-dependent bone changes with a high degree of measurement precision and indicate a prevalence of osteoporosis
similar to that obtained by DXA.
Received: 25 August 1999 / Accepted: 10 February 2000 相似文献
13.
Bone Metabolism and Gonad Function in Male Patients Undergoing Liver Transplantation: A Two-Year Longitudinal Study 总被引:2,自引:0,他引:2
A. Floreani A. Mega L. Tizian P. Burra P. Boccagni V. Baldo S. Fagiuoli R. Naccarato G. Luisetto 《Osteoporosis international》2001,12(9):749-754
Osteodystrophy is a major complication of end-stage liver disease, especially in postmenopausal women. Our aim in this study
was to evaluate bone metabolism and gonad function in men undergoing orthotopic liver transplantation (OLTx). Twenty-three
consecutive men (mean age 48 ± 13 years) evaluated for OLTx were studied, assessing the following parameters at baseline and
3, 6, 12 and 24 months after OLTx: lumbar spine (L2–L4) bone mineral density (BMD), parathyroid hormone (PTH), osteocalcin
(BGP), 25-hydroxyvitamin D (25OHD), free testosterone (FT) and gonadotropins (FSH, LH). At baseline, 12 patients (52%) had
a T-score <–2.5 SD and the mean BMD was 0.806 ± 0.11 g/cm2 (range 0.470–1.045 g/cm2). The BMD was lower 3 months after OLTx and significantly higher 12 and 24 months after OLTx. A significant increase in serum
BGP was observed at 6, 12 (p<0.05) and 24 months (p<0.005) after OLTx. The mean serum PTH level was 26.6 ± 3.1 pg/ml at baseline and increased significantly at 12 and 24 months
(to 49.4 ± 9.9 and 61.2 ± 10.1 pg/ml, respectively; p<0.05). 25OHD serum levels were low at baseline and returned to the normal range after 12 and 24 months (baseline, 8.73 ±
1.54 ng/ml; 12 months, 16.4 ± 2.6 ng/ml; 24 months, 17.67 ± 3.1 ng/ml; p<0.05). FT was significantly lower at baseline than in a group of 10 healthy controls (5.09 ± 10.99, vs 10.3 ± 1.1 pg/ml;
p<0.0001). After OLTx a significant increase in FT was recorded at 6, 12 (p<0.05) and 24 months (p<0.005). FT was not correlated with BMD, however. After OLTx an increase in FSH and LH was observed (but failed to reach statistical
significance) at 3 and 6 months, followed by a slight reduction at 12 and 24 months. Thus a high proportion of men with end-stage
liver disease do have osteoporosis. After OLTx, an early recovery of gonad function is observed, followed by an increase in
bone mass, which occurs from the sixth month onward.
Received: 3 October 2000 / Accepted: 21 March 2001 相似文献
14.
C. Roux C. Pelissier J. Fechtenbaum S. Loiseau-Peres C. L. Benhamou 《Osteoporosis international》2002,13(3):241-248
In this 2-year, randomized study, we compared the efficacy and tolerability of tibolone 2.5 mg (n= 75), tibolone 1.25 mg (n= 76) and estradiol 2 mg plus norethindrone acetate 1 mg (E2/NETA; n= 74) for preventing bone loss in postmenopausal women. Bone mineral density (BMD), measured by dual-energy X-ray absorptiometry,
and bone remodeling markers were assessed every 6 months. Side-effects were assessed quarterly. After 24 months, the mean
increase (± SD) in lumbar spine BMD from baseline was 3.6%± 2.9%, 1.9%± 3.5% and 6.8%± 4.5% in the tibolone 2.5 mg, tibolone
1.25 mg and E2/NETA groups, respectively. All pairwise differences were significant. The proportion of responders (women with a change from
baseline in lumbar spine BMD of ≥−2% after 2 years) was 95.7%, 89.0% and 98.5% with tibolone 2.5 mg, tibolone 1.25 mg and
E2/NETA, respectively. Similar results were obtained for femoral BMD, although the difference between tibolone 2.5 mg and E2/NETA was not significant at 24 months. Decreases in bone remodeling markers were similar in the three groups. Vaginal bleeding
was more common in the E2/NETA group (33.8%) than with tibolone 2.5 mg (12.0%) or tibolone 1.25 mg (9.2%), as was breast pain (23.0%, 2.7% and 2.6%,
respectively). Each treatment effectively prevented bone loss. Overall, tolerability of tibolone was better than with E2/NETA, because of less frequent vaginal bleeding and breast pain. This may promote long-term adherence.
Received: 6 July 2001 / Accepted: 3 October 2001 相似文献
15.
Quantitative ultrasound (QUS) has been proposed as a tool which can measure both the quantitative and qualitative aspects
of bone tissue and can predict the future risk of osteoporotic fractures. However, the usefulness of QUS in long-term monitoring
has yet to be defined. We studied a group of early postmenopausal women over a 4-year period. Thirty subjects were allocated
to hormone replacement therapy and 30 selected as controls matched for age, years past the menopause (YPM) and bone mineral
density (BMD) at the anteroposterior spine (AP spine). The mean age of the subjects was 52.4 years (SD 3.9 years), mean YPM
4.0 years (SD 3.2) and all subjects had a BMD T-score above −2.5 SD (number of standard units related to the young normal mean population). BMD was measured at baseline
and annually by dual-energy X-ray absorptiometry (DXA) at the AP spine and total hip, and QUS carried out at the calcaneus,
measuring broadband ultrasound attenuation (BUA), speed of sound (SOS) and Stiffness. Mean percentage changes from baseline
were assessed at 2 and 4 years. The overall treatment effect (defined as the difference in percentage change between the two
groups) was: AP spine BMD, 11.4%; total hip BMD, 7.4%; BUA, 6.4%; SOS, 1.1%; and Stiffness, 10.4% (p<0.01). To compare the long-term precision of the two techniques we calculated the Standardized Precision, which for QUS was
approximately 2–3 times that of DXA, for a given rate of change. The ability of each site to monitor response to treatment
was assessed by calculating the Treatment Response Index (Treatment Effect/Standardized Precision), which was: AP spine BMD,
10.4; total hip BMD, 3.9; BUA, 3.1; SOS, 0.3; and Stiffness, 4.2. This was then normalized for AP spine BMD (to compare the
role of QUS against the current standard, AP Spine BMD), which was: total hip BMD, 0.38; BUA, 0.30; Stiffness, 0.40 (p<0.01); and SOS, 0.03 (NS). In summary, QUS parameters in the early menopause showed a similar rate of decline as AP spine
BMD and total hip BMD measured by DXA. Hormone replacement therapy results in bone gain at the AP spine and total hip, and
prevents loss in BUA and SOS measured by QUS at the calcaneus. QUS has a potential role in long-term monitoring, although
presently the time period to follow individual subjects remains 2–3 times that for DXA, for a given rate of change. Anteroposterior
spine remains the current optimal DXA monitoring site due to its greater rate of change and better long-term precision.
Received: 20 January 1999 / Accepted: 14 June 1999 相似文献
16.
J. R. Guthrie P. R. Ebeling J. L. Hopper E. Barrett-Connor L. Dennerstein E. C. Dudley H. G. Burger J. D. Wark 《Osteoporosis international》1998,8(3):282-290
Two hundred and twenty-four women (74 pre-, 90 peri-, 60 post-menopausal), aged 46–59 years, from a population-based cohort
participated in a longitudinal study of bone mineral density (BMD). BMD was measured by dual-energy X-ray absorptiometry (DXA)
at the lumbar spine and femoral neck and the time between bone scans was on average 25 (range 14–41) months. The aim of the
study was to assess changes in BMD in relation to changes in normal menopausal status. During the study period women who were
between 3 and 12 months past their last menstrual period (n= 22, late perimenopausal) at the time of the second bone scan had a mean (SE) annual change in BMD of 70.9% (0.4%) at the
lumbar spine and 70.7% (0.6%) at the femoral neck (both p50.05 compared with women who remained premenopausal). In the women who became postmenopausal (n= 42) the mean annual changes in BMD were 72.5% (0.2%) at the lumbar spine and 71.7% (0.2%) at the femoral neck (both p50.0005), and in the women who remained postmenopausal (n= 60) they were 70.7% (0.2%) per year and 70.5% (0.3%) per year respectively (both p50.05), compared with women who remained premenopausal. In the 1–3 years after the final menstrual period (FMP) there was
greater bone loss from the lumbar spine than the femoral neck (p50.05). In women who were menstruating at the time of the second bone scan and whose FMP could be dated prospectively (n= 35), higher baseline oestradiol levels were associated with less lumbar spine bone loss (p50.005). In the women who remained postmenopausal there was an association between baseline body mass index (BMI) and percentage
change per year in femoral neck BMD (p50.05), such that women with higher BMI had less bone loss. In conclusion, during the time of transition from peri- to post-menopause,
women had accelerated BMD loss at both the hip and spine.
Received: 23 June 1997 / Accepted: 5 November 1997 相似文献
17.
Pregnancy and Lactation Confer Reversible Bone Loss in Humans 总被引:5,自引:0,他引:5
The influence of pregnancy on bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry (DXA) in 73 women
(mean age 29 years, range 20–44 years) postpartum. Fifty-five age-matched women served as controls. The influence of lactation
was evaluated in 65 of the delivered women who were followed with repeated measurements, a mean of 4.5 ± 0.1 and 11.5 ± 0.1
months after the delivery. The influence of multiple pregnancies was evaluated in 39 premenopausal women (mean age 38 years,
range 31–54 years) with a minimum of four pregnancies (range 4–7). Fifty-eight age-matched healthy premenopausal women with
a maximum of two pregnancies (range 0–2) served as controls. Data are presented as mean ± SEM. BMD data are adjusted for differences
in total fat mass and total lean mass. Lumbar spine BMD was 7.6 ± 0.1% and total body BMD 3.9 ± 0.1% lower in women postpartum
compared with controls (both p<0.001). BMD did not decrease significantly in non-breastfeeding mothers. Mothers breastfeeding for 1–6 months decreased femoral
neck BMD by 2.0 ± 1.0% during the first 5 months postpartum (p<0.001). No further BMD loss was seen between 5 and 12 months postpartum. Femoral neck BMD 12 months after delivery was 1.3
± 0.8% lower than after delivery in mothers breastfeeding for 1–6 months (p= 0.05). Mothers breastfeeding for more than 6 months decreased Ward’s triangle BMD by 8.5 ± 1.0% and lumbar spine BMD by
4.1 ± 0.8% during the first 5 months postpartum (both p<0.05). No further BMD loss was seen between 5 and 12 months postpartum. Femoral neck BMD 12 months after delivery was 4.0
± 1.1% lower and Ward’s triangle BMD 5.3 ± 1.9% lower than after delivery in mothers breastfeeding for more than 6 months
(both p<0.05). BMD loss was higher during the first 5 months following delivery in the lactating women compared with the non-lactating
women (p< 0.05 comparing lumbar spine BMD loss in lactating mothers versus non-lactating mothers). However, in women with a minimum
of four pregnancies the BMD was no lower than in age-matched women with fewer pregnancies. Total duration of lactation was
not correlated with the present BMD. In summary, pregnancy seem to confer a low BMD with additional BMD loss during 5 months
of lactation. Even if complete restoration in BMD was not reached within 5 months of weaning, women with four pregnancies
or more had a BMD no lower than women with two pregnancies or fewer. We conclude that neither an extended lactation period
nor multiple pregnancies could be used as a risk factor when predicting women at risk for future osteoporosis.
Received: 15 November 2000 / Accepted: 21 March 2001 相似文献
18.
Quantitative Ultrasound Measurements of the Tibia and Calcaneus in Comparison with DXA Measurements at Various Skeletal Sites 总被引:2,自引:0,他引:2
The performance of quantitative ultrasound (QUS) measurements of the tibia and calcaneus was studied in 109 elderly people
(age range 65–87 years). Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured at the calcaneus and
SOS was assessed at the tibia. Short-term precision of tibial QUS was studied in 16 volunteers. The coefficient of variation
(CV) was 0.4% and the standardized CV (sCV) was 4.4%. We compared the calcaneal and tibial QUS measurements with bone mineral
density (BMD) measurements of the lumbar spine, femoral neck, trochanter and total body assessed by dual-energy X-ray absorptiometry
(DXA). Calcaneal QUS correlated better with BMD at various skeletal sites than tibial QUS. Calcaneal BUA showed higher correlations
with BMD values of the lumbar spine, femoral neck, trochanter and total body than calcaneal and tibial SOS (r= 0.48–0.64, r= 0.30–0.47, r= 0.35–0.47, respectively; p<0.001). Body weight modified the relationships between calcaneal and tibial QUS and BMD measurements of the hip. Higher body
weight was associated with higher BMD values at the femoral neck and trochanter for the same calcaneal and tibial QUS values.
After adjustments for body weight correlations of tibial and calcaneal QUS with BMD improved and were very similar. This suggests
that correction for body weight is important and could add to the predictive value of QUS measurements.
Received: 16 July 1997 / Accepted: 8 July 1998 相似文献
19.
W. A. Bauman A. M. Spungen J. Wang R. N. Pierson Jr E. Schwartz 《Osteoporosis international》1999,10(2):123-127
Acute immobilization is associated with rapid loss of bone. Prevailing opinion, based on population cross-sectional data,
assumes that bone mass stabilizes thereafter. In order to address whole-body and regional skeletal mass in long-term immobilization,
monozygotic twins were studied, one of each twin pair having chronic spinal cord injury (SCI) of a duration ranging from 3
to 26 years. The research design consisted of the co-twin control method using 8 pairs of identical male twins (mean ± SD
age, 40 ± 10 years; range 25–58 years), one of each set with SCI. The twins were compared by paired t-tests for total and regional bone mineral content (BMC) and bone mineral density (BMD) measured by dual-energy X-ray absorptiometry.
Linear regression analyses were performed to determine the associations of age or duration of injury with the differences
between twin pairs for total and regional skeletal bone values. In the SCI twins, total-body BMC was significantly reduced
(22%± 9%, p<0.001), with the predominant sites of reduction for BMC and BMD being the legs (42%± 14% 35%± 10%, p<0.0001), and pelvis (50%± 10% and 29%± 9%, p<0.0001). Duration of SCI, not age, was found to be linearly related to the degree of leg bone loss in SCI twins (BMC: r
2= 0.60, p<0.05; BMD: r
2= 0.70, p<0.01). Our findings suggest that pelvic and leg bone mass continues to decline throughout the chronic phase of immobilization
in the individual with SCI, and this bone loss appears to be independent of age.
Received: 28 September 1998 / Accepted: 28 December 1998 相似文献
20.
Allogeneic Bone Marrow Transplantation is Associated with a Preferential Femoral Neck Bone Loss 总被引:1,自引:0,他引:1
N. Buchs C. Helg C. Collao B. Chapuis D. Slosman J.-P. Bonjour R. Rizzoli 《Osteoporosis international》2001,12(10):880-886
Osteoporosis is a major complication of organ transplantation. Little is known about the risk of developing osteoporosis
in bone marrow transplant (BMT) recipients. We studied early and late changes in bone mineral density (BMD), as well as biochemical
markers of bone remodeling, in patients at the time of allogeneic BMT (alloBMT) and up to 13 years thereafter. In a cross-sectional
study, 102 patients (40 women, 62 men, mean age ± SEM, 38.9 ± 1.6 years) were segregated into a first group (A, n= 48) and evaluated before or during the first weeks (mean ± SD 0.3 ± 0.1 month, range –0.5 to 3 months) following alloBMT,
and a second group (B, n= 54) studied 60.1 ± 5.6 months (range 6–156 months) following alloBMT. Lumbar spine (LS) BMD was similar in groups A and
B and was within normal limits. In contrast, femoral neck (FN) Z- and T-scores were significantly decreased in group B compared with group A (–0.68 ± 0.14 vs –0.03 ± 0.14 SD and –0.84 ± 0.14 vs
–0.22 ± 0.14 SD, respectively; p≤0.002). Osteopenia (T-score between –1 and –2.5 SD) was present in 35% of group A and 43% of group B patients (NS). Osteoporosis (T-score <–2.5 SD) was detected in 7% of group B patients, but in none of those in group A (p= 0.05). In a longitudinal study, 56 subjects were evaluated at the time of alloBMT, and 33 and 23 were studied 6 or 12 months
later, respectively (13 women, 20 men, 37.5 ± 1.6 years). All were treated with supplements of calcium and vitamin D. Amenorrheic
women received hormone replacement therapy (HRT). Three-monthly pamidronate infusions were given to 15 men and 10 non-amenorrheic
women who were osteopenic/osteoporotic or had elevated baseline bone turnover markers. Mean baseline LS and FN Z- and T-scores were within normal range. Six months after BMT, FN BMD decreased by 4.2 ± 0.7% (p<0.001), and whole body BMD and bone mineral content by 1.5 ± 0.4% and 3.1 ± 0.6%, respectively (p≤0.0001). Twelve months after the graft, there was no further significant bone loss and only FN BMD decrease remained significantly
different compared with baseline (–5.6 ± 1.1%, p≤0.0001). These results indicate that the risk of decreased BMD is higher for the femoral neck than the lumbar spine and whole
body levels in patients with allogeneic bone marrow transplantation, and that bone loss occurs mainly during the first 6 months
after the graft.
Received: 9 February 2001 / Accepted: 23 May 2001 相似文献