对绝经妇女钙代谢与骨质疏松症的探讨

骨质疏松是老年人中常见的一种骨科疾病,多发生于女性绝经后,女性发病比男性高数倍.妇女绝经后至老年,约有25.0%患骨质疏松症,多发于绝经后两年后或更长的时间,一旦出现骨质疏松症,将增加骨折的危险,这是绝经后威胁妇女健康的重要变化.     

运动对绝经后妇女骨量和骨代谢影响情况分析

目的:探讨运动对绝经后妇女骨密度和骨代谢的影响,并与药物治疗进行对比。方法:141例绝经后健康妇女随机分成3组,对照组46例,不进行任何干预措施;运动组50例,每周进行4~5次中等强度的体育运动,每次1~2 h;用药组45例,每日服用倍美安1粒+去甲基睾丸素2mg,连续8周。监测桡骨骨密度、AKP、尿CA/CR、尿HYP/CR。结果:运动组运动1年后骨密度明显增高,血AKP升高,尿CA/CR、尿HYP/CR减少,无副作用,用药组显效快且迅速。结论:运动可以提高绝经后妇女骨密度,减少骨丢失,无副作用,费用低,易于被接受,是一种预防绝经后骨质疏松的安全有效的方法,值得大力推广,特别是对于经济条件较差的人群。     

孕酮对绝经后妇女骨代谢的影响

多年来，学者们一致认为绝经后骨质丢失与雌激素减少有关，雌激素替代治疗可减少骨质吸收，缓和或制止绝经后骨质丢失，然而，长期应用雌激素，骨形成表面显著下降，一旦停用，骨质丢失的速度更快，而且雌激素有引起宫内膜增殖、子宫出血，甚至诱发子宫内膜癌的可能，某些患者应绝对禁忌，如：息有雌激素依赖性肿瘤（子宫肌瘤，疑有或已确诊为子宫内膜癌或乳腺癌等）、血栓性疾患、肝功能受损等。孕激素与雌激素联合应用可降低子宫内膜癌的危险性，预防骨质丢失，保存骨量，     

小剂量雌激素加钙预防绝经后妇女骨质疏松症研究

通过深入社区，采用健康教育与预防医疗手段相结合，使23名无雌激素禁忌症，绝经1－5年的妇女，接受小剂量激素（尼尔雌醇片每半月1mg)加钙尔奇D片（每天600mg）口服的预防措施，其中有9名妇女因出血，害怕副作用，白带增多等原因中途停药，其他14名坚持服药者明显改善了更年期症状，骨密度有所增加（差异无显著性）,血清钙素明显下降（P＜0．05）。提示：深入社区，坚持健康教育与预防医疗手段紧密结合，能使更多的绝经后妇女接受HRT；在健康教育的基础上，应用小剂量雌激素加钙和适当运动，对防治绝经后妇女骨质疏松症，提高绝经后妇女的生活质量有较好的保健作用，但尚须扩大样本观察。     

绝经后妇女骨质疏松症的疗效分析

目的:观察密钙息治疗绝经后骨质疏松症的临床疗效。方法:将168例绝经后骨质疏松症患者随机分为试验组80例,隔日肌注密钙息50IU,1个月后改为1次/周,肌注并同时口服钙剂钙尔奇D,每天1次(相当于元素钙500mg),总疗程为6个月;对照组86例,单纯口服同样剂量的钙尔奇D6个月。结果:试验组显效率、总有效率分别为75.29%、96.25%,对照组显效率、总有效率分别为12.52%、73.32%。结论:密钙息治疗绝经后骨质疏松症疗效确切。     

绝经后妇女钙摄入量及膳食来源分布

为了解绝经后妇女膳食钙的摄入量，钙的食物来源以及膳食结构，对济南市区１５４名绝经后妇女进行了７ｄ膳食调查及２４ｈ尿钙测定。膳食调查采用记录和称重相结合的方法，用原子吸收分光光度法测定尿钙，依据《食物成份表》计算１２类食物的平均摄入量以及钙在各类食物中的分布，对膳食钙摄入量与尿钙排出量进行相关分析。结果显示，济南市区绝经后妇女平均每天膳食钙摄入量为３４９±１１２ｍｇ，占ＲＤＡ的４４％，奶类和豆类食品     

绝经后妇女钙摄入量及膳食来源分布

为了解绝经后妇女膳食钙的摄入量,钙的食物来源以及膳食结构,对济南市区154名绝经后妇女进行了7d膳食调查及24h尿钙测定.膳食调查采用记录和称重相结合的方法,用原子吸收分光光度法测定尿钙,依据《食物成份表》计算12类食物的平均摄入量以及钙在各类食物中的分布,对膳食钙摄入量与尿钙排出量进行相关分析.结果显示,济南市区绝经后妇女平均每天膳食钙摄入量为349±112mg,占RDA的44%,奶类和豆类食品虽然钙含量丰富,但摄入量较少.在被调查者中,18%的人钙摄入量不足200mg/d,66%的人不足400mg/d,仅有6%的人大于800mg/d,24h尿钙排出量平均258±83mg/24h,占膳食摄入钙的74%,膳食摄入钙与尿钙排出量无显著相关性(r=0.018,P>0.05).建议绝经后妇女增加奶和豆类食品的摄入量或摄入适量的钙补充剂以使钙的摄入量(RDA)不低于1000～1200mg/d.     

绝经后妇女亦需补锌

绝经后的妇女好发发骨质疏松症是不争的事实,因而雌激素替代疗法兴起,同时补钙和维生素D也成为老年妇女冬季需要注意的问题,对预防骨质疏松症和自发性骨折,确实收到了良好的效果。     

绝经后妇女骨矿含量与骨质疏松性骨折

骨质疏松是绝经后妇女的常见病,其发生率随绝经年限增长而逐渐增高。本文对５０～７０岁正常老年妇女９６例和近期内发生过骨质疏松性骨折的老年妇女４５例的骨矿含量进行了比较。１资料与方法 随机选择５０～７０岁（平均６０．２５±５．４６岁）的非暴力性骨折女性患者４５例,作为骨折组。骨折部位为股骨颈、椎骨、挠骨远端等,每例患者均拍有骨折部位的Ｘ光片。另随机抽取未发生骨折的老年妇女９６例为对照组。两组对象均为绝经后妇女,绝经年限１～１５年不等,均无妇科及肝肾疾病,亦无内分泌系统疾病。近半年内未使用激素类药物。 …     

瘦素和白介素-6在绝经后妇女骨代谢中的作用

目的探讨绝经后妇女骨质疏松的发病机理及瘦素在骨质疏松中的作用。方法志愿者健康女性各年龄组分别为:25~34岁37例,35~44岁31例,45~54岁30例,绝经期5年以上55~65岁40例,各组间BM I差异无显著性。并以绝经期5年以上55~65岁40例与25~34岁育龄女性37例对照,所有研究对象均做腰椎2~4前后位BMD值测定。均空腹抽血,血清Leptin、IL-6、E2、T、FSH、LH、BGP的测定均为放射免疫法。TRAP、ALP为生化法。结果非肥胖女性随着年龄的增大,Leptin呈上升趋势、BGP升高(P<0.01),瘦素相关的成骨增强;绝经后女性FSH上升,E2下降(P<0.001);IL-6、TRAP升高、BMD下降,(P<0.01);绝经后妇女E2下降,骨吸收增强。结论随着女性年龄的增加,瘦素升高,骨钙素升高,骨形成增加,瘦素是女性骨重建中促进骨形成的重要因素之一;绝经后妇女由于受雌激素和瘦素的共同影响,骨形成增强,骨吸收也增强,绝经后妇女的骨质疏松属于高转换型;绝经后妇女雌激素下降,瘦素虽促进骨形成,但雌激素在仍起关键作用,破骨仍占优势,骨吸收大于骨形成,导致绝经后妇女骨质疏松的发生。     

组织选择性雌激素活性调节剂辅助钙剂治疗绝经后骨质疏松症

目的:观察绝经后妇女口服组织选择性雌激素活性调节剂加钙剂治疗骨质疏松症的效果。方法:将90例绝经后骨质疏松症患者随机分为2组,治疗组口服组织选择性雌激素活性调节剂加钙剂,对照组口服钙剂,追踪观察6个月,观察临床症状及骨密度的变化情况。结果:治疗组总有效率93%,明显高于对照组的73%(P<0·05)。治疗组治疗后的骨密度显著增加(P<0·05),与对照组同期比较差异显著(P<0·05)。结论:口服组织选择性雌激素活性调节剂加钙剂治疗绝经后骨质疏松症优于单用钙剂治疗。     

雌激素水平与绝经女性并发骨质疏松症的相关性研究

目的:探讨雌激素水平与绝经女性并发骨质疏松症的关系。方法:选择2010年2月～2011年2月在北华大学第一临床医院诊治的绝经后骨质疏松患者30例,年龄49～69岁,平均57.8岁,绝经后2～23年,平均13.2年。骨密度测量结果符合世界卫生组织制定的骨质疏松诊断标准。选择30例未伴发骨质疏松的绝经后妇女为对照组。选择DEXA(Lunar,US)骨密度仪对两组妇女行骨密度测量,并取清晨空腹静脉血检测血清雌二醇(E2),肿瘤坏死因子-α(TNF-α)及白介素-6(IL-6)水平。比较两组妇女骨密度(BMD)、E2、TNF-α及IL-6水平,并对E2水平与BMD、TNF-α及IL-6水平行相关分析。结果:①观察组患者骨密度及血清E2均值分别为(0.53±0.08)g/cm2和(25.58±7.85)ng/L,明显低于对照组(P<0.05)。观察组患者血清TNF-α及IL-6平均为(5.63±4.10)ng/L和(109.86±46.34)ng/L,明显高于对照组(P<0.05)。②观察组及对照组血清E2水平均与骨密度呈明显正相关(P<0.05),血清E2水平与血清TNF-α及IL-6水平呈明显负相关(P<0.05)。结论:雌激素水平与绝经后女性骨密度呈负相关,雌激素能通过多种途径影响骨组织代谢,绝经后女性体内雌激素水平明显下降,能够导致骨质疏松,应该采取积极的预防和治疗措施。     

阿托伐他汀联合降钙素对绝经期女性骨质疏松患者骨代谢指标的影响

目的探讨阿托伐他汀联合降钙素对绝经期女性骨质疏松患者骨代谢指标的影响。方法选取2017年2月-2018年2月来温州市中西医结合医院就医的绝经期骨质疏松症患者126例随机分为研究组和对照组各63例,对照组采用降钙素、钙尔奇D3片及骨化三醇胶丸进行治疗,研究组在对照组基础上采用阿托伐他汀进行治疗,以此观察两组患者治疗后骨密度、骨代谢指标以及并发症的发生率。结果治疗前两组腰椎L2-4、FN及Ward三角区BMD动态水平差异无统计学意义(P>0. 05);治疗后两组腰椎L2-4、FN及Ward三角区BMD动态水平均高于治疗前,且研究组高于对照组,差异均有统计学意义(P<0. 05)。治疗前两组AKP、OC、TP1NP以及PTH的水平差异无统计学意义(P>0. 05);治疗后两组AKP、OC、TP1NP以及PTH的水平低于治疗前,且研究组低于对照组,差异均有统计学意义(P<0. 05)。治疗后研究组不良反应发生率4. 8%低于对照组的15. 9%,差异有统计学意义(P<0. 05)。结论采用阿托伐他汀与降钙素联合治疗绝经期OP女性患者能有效对其骨吸收进行抑制,对骨形成具有一定的促进作用,从而达到临床治疗目的。     

绝经前合理应用维生素D和钙剂与绝经后妇女骨密度的关系

目的:调查绝经前后妇女的体成分与绝经年龄、身高及应用维生素D和钙剂后骨密度的关系。方法:采用1∶1配对设计方法,将196例妇女分为绝经期前未用维生素D和钙剂者和用维生素D和钙剂者两组,采用米尺和磅秤测量两组妇女的身高和体重,采用双能X线骨密度仪检测两组妇女的骨质疏松值,采用超声骨密度仪检测两组妇女的左侧跟骨的超声速度、骨硬度指数和低骨量。观察两族妇女体内骨密度指标。结果:绝经前后不同年龄组妇女体质指数、超声速度、骨硬度指数、低骨量及骨质疏松值比较差异有统计学意义(P<0.05)。应用维生素D和钙剂的妇女骨密度较未应用维生素D和钙剂的妇女同年龄组相比,骨质疏松值有所下降。结论:绝经前后妇女合理应用维生素D和钙剂安全、有效,可早期预防骨质疏松,值得推荐,特别适用于绝经后妇女。     

Bone mass density,subsequent risk of colon cancer and survival in postmenopausal women

OBJECTIVES: To test the hypothesis that high bone mass density (BMD), a potential marker for cumulative exposure to endogenous estrogen, calcium and vitamin D intake, is associated with a lower risk of colon cancer, and that women with a lower BMD are likely to develop a more aggressive form of colon cancer, as defined by mortality. STUDY DESIGN AND SETTING: BMD was measured in three different sites (Ward's triangle, trochanter, femoral neck) in 1,471 women 60 years of age. All incident cases of colon cancers were identified through record-linkage of cancer registry. The women were followed for a mean of 9.5 years. RESULTS: Overall 31 cases of colon cancer were observed among 28.6 expected (standardized incidence ratio (SIR) = 1.09, 95% confidence interval: 0.79-1.25). The SIR decreased with increasing BMD showing a significantly decreasing risk of 20% for women who were at the higher BMD comparatively to women who were at the lower BMD in all the skeletal sites. The 10-year survival rates showed that survival was increasing with increased BMD, but not significantly. CONCLUSION: The findings suggest that postmenopausal women with lower BMD have an increased risk of colon cancer. The biological mechanisms linking bone mass to colon cancer risk are not clear.     

Calcium metabolism in postmenopausal osteoporotic women is determined by dietary calcium and coffee intake.

Eighty-five patients, age 48 to 77 y with postmenopausal crush fracture osteoporosis, were investigated using a 7-d combined calcium balance and 47Ca tracer-kinetic turnover method taking the dermal calcium loss into account. Individual dietary records were obtained based on a 4-d registration at home before hospital admission and on questioning by a dietitian. The following dietary constituents were estimated: energy content, protein, methionine, cysteine, calcium, phosphate, magnesium, coffee, fiber and vitamin C. All patients were served individual diets based on the dietary records during study. Dietary calcium was measured in duplicates of all the meals served. All urine and feces were collected and analyzed for calcium content. The 47Ca kinetic data were analyzed according to a modification of the expanding calcium pool model. The overall calcium balance correlated significantly to energy content (r = 0.31, P less than 0.005), protein (r = 0.22, P less than 0.05), calcium (r = 0.28, P less than 0.01), phosphate (r = 0.27, P less than 0.02) and coffee (r = -0.21, P less than 0.05). However, a multiple backward linear regression analysis disclosed that only calcium (rp = 0.38, P less than 0.0005) and coffee intake (rp = -0.25, P less than 0.05) significantly influenced calcium balance. The equation was: calcium balance (mmol/d) = 0.14 x (dietary calcium, mmol/d) - 0.0016 x (coffee intake, mL/d) - 3.62. A coffee intake in excess of 1000 mL could induce an extra calcium loss of 1.6 mmol calcium/d, whereas intakes of 1-2 cups of coffee per day would have little impact on calcium balance.     

大豆异黄酮对更年期妇女膳食干预

目的：通过人体膳食干预试验，从临床上观察确定大豆异黄酮对更年期围绝经期妇女骨质疏松的作用。方法：试验对象80例随机分为大豆异黄酮组和安慰组，试验对象按时按量服用24周并进行追踪观察。结果：大豆异黄酮组桡骨和胫骨骨密度明显增加，有统计学意义。而安慰剂对照组桡骨和胫骨骨密度不但没有增加，而且稍有下降。结论：通过此次研究证实大豆异黄酮可以作为雌激素替代物促进成骨细胞生长，使骨密度得到增加，可以防治更年期围绝经期妇女骨质疏松。     

The protective effect of calcium on bone mass in postmenopausal women with high selenium intake

Objective

Nutritional factors, especially the two essential nutrients calcium and vitamin D, have been shown to play an important role in bone health. We wanted to determine the possible protective effect of calcium intake in adequate amounts on bone mass as assessed by quantitative ultrasound in postmenopausal women who also have a high intake of selenium.

Setting

Health district of Cáceres, Spain.

Participants and Study Design

335 postmenopausal women aged 60.9 (SD = 8.1) years. Women were stratified based on the vitamin D, vitamin E, calcium intake and the calcium/protein and calcium/phosphorous index.

Measurements

Bone status (Ad-SoS measured at the phalanges) was assessed with an ultrasound device model DBM Sonic 1200R. Food intake was quantified using dietetic scales, measuring cups, and spoons based on 7 days of diet records. Urine samples were collected the morning of testing after an overnight fast. Venous blood samples for the hematological and biochemical studies were also obtained in the fasting state.

Results

In the group of women with Ca intake < 800 mg / d we found a significant and negative relationship between Ad-SoS with age (?? = ?4.020, F = 23.327) and selenium intake (?? = ?0.419, F = 10.067), as well as a positive relationship with Ca intake (?? = 0.104 and F = 7.084) (p <0.0001 in all). In the group of women with Ca intake > 800 mg / d, age has a significant and negative relationship (?? = ?4.829 and F = 106.745), whereas folic acid intake has a significant and positive relationship (?? = 0.047 and F = 5.858) (p <0.0001 in both).

Conclusion

Elevated selenium intake negatively affects bone mass measurements in postmenopausal women over the age of 51 but only if calcium intake is also less than 800 mg / day. When calcium intake is greater than 800 mg/day, selenium did not appear to affect bone mass.