女性骨密度的地区差异及多中心参考数据库对诊断骨质疏松的影响

目的了解我国大陆女性骨密度(bone mineral density,BMD)的地区差异及多中心融合参考数据库对诊断骨质疏松的影响。方法女性参考人群10 343名,年龄范围20～89岁,分别来自长沙、北京、南京、上海、嘉兴、广州和成都地区。除长沙地区1 157名外,其他资料均由通用电气医疗集团(GE Health care)公司提供。受试者均采用GE-Lunar系列DXA骨密度仪测量腰椎和股骨颈BMD。结果 8种不同回归模型分析显示,BMD随年龄变化均采用3次回归模型拟合优度最佳,拟合曲线的决定系数(R~2)为0.149～0.546(P均=0.000)。腰椎BMD随年龄变化的最佳拟合曲线,北京与成都女性之间的差异最大[(12.9±4.9)%],北京与南京女性之间的差异最小[(3.0±3.4)%];各地区女性之间,股骨颈BMD拟合曲线的差异相对较小。与多中心融合BMD参考数据库比较,北京地区数据库对腰椎骨质疏松的检出率显著升高(17.5%vs 12.2%,P=0.028),嘉兴(23.9%vs 30.3%,P=0.001)、长沙(30.4%vs 35.9%,P=0.037)和成都(34.8%vs 41.0%,P=0.032)地区数据库对骨质疏松的检出率显著降低。结论我国大陆女性BMD存在地区差异,特别是腰椎BMD。提示我国需要建立多个区域性BMD参考数据库。     

青年人群骨密度及标准差对骨质疏松检出率的影响研究

目的 探讨青年人腰椎BMD和SD正常参考值影响骨质疏松症(OP)检出率的程度.方法 用GE-Lunar 公司的DXA仪测量骨密度,调查全国6个中心11418例腰椎PA和髋部BMD,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%.从T-score=(受试者BMD-青年人平均BMD)÷青年人骨密度SD值公式中可知,OP检出率与青年人平均BMD呈正比与SD值呈反比.结果 用6个中心及总体各自的青年人平均BMD和SD值为参考标准.对同一人群计算T-score和获得的OP检出率则不相同;发现青年人平均BMD每变化0.01g/cm2,则OP检出率变化1.6%(呈正相关),其SD值每变化0.01 g/cm2,则OP检出率变化4%(呈负相关).结论 青年人平均BMD和SD值不同引起OP检出率也不相同.为了让不同中心的OP检出率有可比性,建议同一个类型的BMD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.     

骨密度拟合参考曲线在骨质疏松诊断中的作用

骨质疏松(OP)是一种以骨量减少和骨组织微结构破坏为特征,继而导致骨脆性增加和骨强度下降及骨折危险性增加的全身性骨骼疾病。测量骨密度(BMD)诊断OP和评价各种疾病状态下的骨量变化及预测发生骨折的风险,已在临床多种学科领域得到广泛应用。BMD是一个非常特殊的定量指标,它不但具有年龄、性别和种族特异性,而且还具有骨骼部位特异性。因此,判别其正常与否,必须采用种族、性别和骨骼部位相匹配的及年龄范围尽可能广泛的BMD拟合参考曲线(也称参考数据库)进行比较和评价。鉴于BMD拟合参考曲线在OP诊断和骨量评价中的重要作用,笔者就…     

双能X线骨密度测定腰椎和股骨颈对诊断骨质疏松检出率的比较

目的探讨双能X线吸收法测量腰椎及股骨颈两个不同部位骨密度对骨质疏松诊断的检出率,寻找灵敏度高、更经济实用的筛查骨质疏松的有效方法方法 2011年1月至2012年12月在我院妇科及老年病科住院的女性患者共732人,分别测量腰椎及股骨颈的骨密度T值,进行SPSS统计研究。结果对同一人群通过股骨颈和腰椎不同部位检测发现骨质疏松的检出率分别为25.4%,32.0%;严重骨质疏松的检出率分别为9.0%,27.9%;两者之间差异有统计学意义(P=0.001),腰椎骨密度测量对骨质疏松诊断检出率明显优于股骨颈。根据4个年龄组的股骨颈和腰椎的骨密度T值比较差异均有统计学意义(P均0.01)。结论采用双能X线骨密度测定对诊断骨质疏松腰椎明显优于股骨颈。     

宁波男性骨密度和骨质疏松影响因素的研究

目的评价宁波市男性健康人群的骨量和骨质疏松(OP)的发病情况。方法794名健康男性采用Sunlight的超声骨密度测定胫骨的超声速度值(SOS)。并按年龄、民族、生活习惯进行分组,以10岁为1个年龄组,生活习惯包括吸烟、酗酒、户外活动(大于1h/d)和喝咖啡者。结果宁波市男性骨SOS峰值年龄在30～39岁,60岁以后OP患病率23.4%,过量吸烟、饮酒和喝咖啡者骨SOS值低于同年龄组,户外活动者(如爬山、慢跑)平均日照不少于1h/d,骨质情况优于同年龄组其他人,骨质疏松患病率也较低,本市的不同民族男性各年龄段的骨质差异无显著性。结论宁波市健康男性骨质状况良好,但生活不良嗜好是本地区影响骨密度的重要因子,应当提倡良好的生活习惯。     

体积骨密度的估算方法及其对诊断骨质疏松的意义

骨密度（BMD）有面积骨密度（aBMD）和体积骨密度（vBMD）两种表达方式,它们在临床实验研究中被广泛采用。本文综述了vBMD的估算方法、aBMD和vBMD存在的性别差异和种族差异,以及aBMD和vBMD对诊断骨质疏松的影响。     

用骨质疏松骨折的骨密度变化来探讨骨质疏松诊断标准

目的 用脊椎压缩性骨折及髋骨骨折人群骨矿含量(BMC)、骨密度(BMD)的改变来探讨国人骨质疏松诊断标准。方法 对成都地区≥20岁健康人群共1460人采用：DEXA测量L2-4和股骨上端Neck、Ward’s、Troch的BMC、BMD和BMC／体重(W)；对≥50岁摄T5—L4侧位片。用本次流调获得的骨峰值(PBM)，分别减2．0SD和2．5SD作为骨质疏松(OP)的诊断标准，对脊椎压缩性骨折、髋骨骨折人群的BMC、BMD和BMC／W骨质疏松检出率进行分析，并对L1-L4骨质增生骨密度进行修正。结果 脊椎压缩性骨折人群的：BMD、BMC、BMC／W在PBM减去2．0SD，OP的检出率L2—4BMD女性为89％，男性为60％。修正骨质增生后女性为93％，男性为74％。两组均明显高于女性BMC(72％)、BMC／W(70％)及男性BMC(56％)、BMC／W(40％，)和减去2．5SD为标准的各指标检出率。用PBM-2．0SD对髋骨骨折人群OP检出率在NeckBMD女性为89％，男性为100％，两组均高于BMC、BMC／W及Ward’s、Troch和减去2．5SD各指标检出率。结论 我国骨质疏松诊断标准应为骨峰值L2—4：BMD-2．0SD，当其腰椎有明显骨质增生时可给予适当修正。     

大鼠骨密度测定方法及其在骨质疏松模型建立中的应用

精确定量测定骨密度是分析骨代谢改变的重要内容。本文应用（１２５）ＩＳＰＡ大鼠骨密度仪和双能Ｘ线骨密度仪，对由维甲酸和卵巢切除两种方法诱发的大鼠骨质疏松模型进行股骨和全身骨密度测定，结果为前者模型的骨密度较对照分别降低６．７％和４．８％，后者模型的骨密度较对照分别降低７．６％和８．３％，降低均有显著意义。由此表明，大鼠骨密度测定在骨质疏松模型建立中是十分有用的指标之一。     

女性腰椎投影骨面积对骨密度及骨质疏松诊断的影响

目的观察健康女性腰椎投影骨面积(projective bone area,BA)对面积骨密度(areal bonemineral density,aBMD)和骨质疏松(osteoporosis,OP)诊断的影响。方法 1.成都地区健康女性824例,年龄20～80岁,用GE LUNAR公司生产的EXPERT-XL双能X线骨密度仪,测定腰椎正位1-4投射骨面积(BA)、骨矿物含量(bone mineral content,BMC)、面积骨密度(aBMD)。按照WHO推荐的诊断标准:aBMD低于峰值骨2.5个标准差为OP。2.按年龄分为20～39岁、40～59岁、60～80岁3个年龄组。各年龄组按BA大小分成大(large BA group,LBAG)、中(intermediate BA group,IBAG)、小(small BA group,SBAG)3组。3.统计学处理:用SPSS13.0统计软件,BA与BMC和aBMD的相关性用pearson相关分析;不同年龄组不同BA组腰椎BMC、aBMD比较用方差分析,OP检出率差异比较用卡方检验。结果 1.BA与BMC(r=0.768P0.01)和aBMD呈正相关(r=0.171P0.01);2.20～39岁、40～59岁、60～80岁不同BA组BMC、BMD比较均为:LBAGIBAGSBAG,差异有统计学意义(P0.05)。3.20～39岁不同BA组均无OP检出;40～59岁LBAG、IBAG、SBAG组OP检出率分别为:5.0%、13.5%、18.9%,BA越大,OP检出率越低,差异有统计学意义(P0.05);60～80岁LBAG、IBAG、SBAG组OP检出率分别为:45.2%、55.8%、64.3%,BA越大,OP检出率越低,差异有统计学意义(P0.05)。结论成都地区健康女性腰椎BA大者aBMD、BMC较高,OP检出率较低;反之腰椎BA小者,aBMD、BMC较低,OP检出率高。女性40岁后应注意骨质疏松防治。     

骨质疏松性骨折与骨密度关系的研究进展

骨质疏松症是老年人的常见病和多发病,其最大的危害是导致骨折的发生。随着老年人口的增加,骨质疏松性骨折的发病率也显著增高,这已经引起了医学研究者的普遍关注。近年来对运用骨密度检测来预测骨质疏松性骨折的研究很多,但是还没有形成一个定论,故对运用骨密度检测来预测骨质疏松性骨折的研究现状作一简单综述。     

Effects of the sample size of reference population on determining BMD reference curve and peak BMD and diagnosing osteoporosis

Summary Establishing reference databases generally requires a large sample size to achieve reliable results. Our study revealed that the varying sample size from hundreds to thousands of individuals has no decisive effect on the bone mineral density (BMD) reference curve, peak BMD, and diagnosing osteoporosis. It provides a reference point for determining the sample size while establishing local BMD reference databases. Introduction This study attempts to determine a suitable sample size for establishing bone mineral density (BMD) reference databases in a local laboratory. Methods The total reference population consisted of 3,662 Chinese females aged 6–85 years. BMDs were measured with a dual-energy X-ray absorptiometry densitometer. The subjects were randomly divided into four different sample groups, that is, total number (Tn) = 3,662, 1/2n = 1,831, 1/4n = 916, and 1/8n = 458. We used the best regression model to determine BMD reference curve and peak BMD. Results There was no significant difference in the full curves between the four sample groups at each skeletal site, although some discrepancy at the end of the curves was observed at the spine. Peak BMDs were very similar in the four sample groups. According to the Chinese diagnostic criteria (BMD >25% below the peak BMD as osteoporosis), no difference was observed in the osteoporosis detection rate using the reference values determined by the four different sample groups. Conclusions Varying the sample size from hundreds to thousands has no decisive effect on establishing BMD reference curve and determining peak BMD. It should be practical for determining the reference population while establishing local BMD databases.     

Establishment of BMD reference databases for the diagnosis and evaluation of osteoporosis in central southern Chinese men

Osteoporosis in men is an increasingly important public health problem. This study was designed to establish bone mineral density (BMD) reference databases for central southern Chinese men at multiple skeletal sites. We recruited 2433 native Chinese males for BMD assessment. Of these, 1537 were healthy volunteers (age range, 15–85 years), and 896 were suspected to have osteoporosis. BMD values were measured at the posteroanterior (PA) and lateral spine, hip, and distal forearm using a Delphi A absorptiometer. The quadratic regression model provided the best fit for age-related changes in BMD in the spine and hip. The cubic regression model was the best for describing age-related BMD changes in the distal forearm. Peak BMD in the lumbar spine, femoral neck, and total hip occurred at 15–19 years. Peak BMD at the distal forearm occurred at 40–44 years. The prevalence of primary osteoporosis in subjects ranging from 50–85 years was 4.3%–27.7% at various skeletal sites. Compared to the databases established here, the Hologic databases led to significantly higher osteoporosis detection rates. The BMD reference databases established for central southern Chinese men provide the most reliable diagnostic standards for osteoporosis detection in men of central south China.     

Establishment of BMD reference plots and determination of peak BMD at multiple skeletal regions in mainland Chinese women and the diagnosis of osteoporosis

Osteoporosis is a major public health problem, particularly in women. Bone mineral density (BMD) reference plot is a basic, and the peak BMD (PBMD) an important, parameter in the diagnosis of osteoporosis. In order to establish reference plots of BMD at multiple skeletal sites in Chinese women and improve the diagnostic accuracy for osteoporosis, we measured BMDs at several skeletal regions in 3,378 Chinese women, aged 5–96 years, using a dual-energy X-ray absorptiometry fan-beam bone densitometer. After determining that the cubic regression model best fit all skeletal regions, we utilized the curve-fitting to establish BMD reference plots and utilized the curve-fitting equation to calculate the highest BMDs at all skeletal regions using three different methods of calculation—actual PBMD (method A), PBMD of each 5-year age group (method B), and a cross-section of age (method C). When the three methods were compared, we found significant differences among them at the majority of skeletal regions studied. When we utilized these three methods to determine the prevalence of osteoporosis in 2,120 women aged 40 years and older, except for the Wards triangle, we observed significant differences among them at all skeletal regions. In the present study, we established new BMD reference plots at multiple skeletal regions for women of mainland China. Our findings also indicate that curve-fitting equations can be employed to calculate actual PBMDs specific to individual regions, and that the use of different methods to calculate PBMD may have a significant impact on both PBMD and the diagnosis of osteoporosis. Therefore, we suggest that a standardized method be established to calculate site-specific PBMDs based on the peak values of best-fit reference curves in appropriate age groups.     

不同峰值骨量对诊断青岛地区成年女性骨质疏松敏感性的比较

目的 比较青岛地区正常汉族成年女性峰值骨密度(PBMD)数据库与骨密度仪自身所应用数据库差异,以及对骨质疏松症(OP)诊断的影响.方法 应用法国DMS公司CHALLENGER型双能X线骨密度仪(DXA)对青岛地区汉族人868例25～83岁女性居民进行腰椎(L_2-L_4)部位和左侧髋部(股骨颈、大转子、Wards三角区)6个骨骼区域的BMD.统计分析获得本地区正常汉族人女性骨密度(BMD)数据库,将其PBMD及标准差与法国CHALLENGER型DXA骨密度仪所应用数据库的PBMD及标准差进行比较分析,并分别用两组数据库对191例脆性骨折患者进行诊断,观察两者诊断阳性率的差异.结果 青岛地区汉族人群6个骨骼区域BMD随年龄变化,不同部位骨峰值出现的时间不同,腰椎在25～29岁,髋部在40～44岁,其骨密度峰值骨量高于法国DMS公司CHALLENGER型DXA的峰值骨量,两个数据库的标准差无明显差异.应用本地区正常汉族人女性BMD数据库可提高对脆性骨折患者骨质疏松的诊断率约50%.结论 通过建立青岛地区汉族人群女性的骨密度数据库,确立青岛地区PBMD标准,与仪器PBMD比较显著提高了本地区汉族人群女性的骨质疏松症诊断准确率.     

骨康冲剂对骨质疏松症BMD、BGP、PYD、E2、T的干预

目的 运用补肾健脾活血的代表方剂-骨康冲剂治疗原发性骨质疏松的疗效观察证明补肾健脾活血法的临床意义.方法 原发性骨质疏松症80例,随机分为骨康冲剂治疗组、强骨胶囊对照组对照观察.结果 骨康冲剂治疗组总有效率达96%,显效率达72%.治疗后比治疗前骨密度提高了,临床症状有明显改善、肾虚积分均有明显下降、但两组无明显差异,血清骨钙素（BGP）显著上升,尿吡啶酚（PYD）显著下降.以上指标两组均无差异.结论 骨康冲剂具有促进骨形成,抑制骨吸收的作用.对防治骨质疏松症有效,并说明补肾健脾活血法对防治骨质疏松症有实用价值.     

老年骨质疏松症诊断标准探讨

本文对老年骨质疏松症骨密度（ＢＭＤ）诊断标准进行深入探讨。以美国Ｌｕｎａｒ公司ＤＰＸ－Ｌ型双能Ｘ线ＢＭＤ测定仪，随机对北京市６０～９４岁７３４名老年人进行ＢＭＤ测定，并分别以同性别、同部位峰值减低２．０及２．５ＳＤ作为骨质疏松症诊断标准进行分析比较。结果：以减低２．５ＳＤ较减低２．５ＳＤ所得骨质疏松症患病率高１倍左右，如以Ｗａｒｄ’ｓ三角为例，男性６０～６９、７０～７９及８０岁以上组，以减低２．０ＳＤ为诊断标准，其患病率各为２５．５％、４７．６％及４８．２％；若以减低２．５ＳＤ为诊断标准其患病率则下降为１０．６％、１９．０％及２３．２％，两者相差１倍以上。结论：若以减低２．５ＳＤ为诊断标准很可能造成一部分骨质疏松症患者被误诊、漏诊。鉴于国人ＢＭＤ峰值较白人低０．５ＳＤ左右，应以峰值减低２．０ＳＤ作为诊断骨质疏松症的标准为宜。     

Establishment and evaluation of bone mineral density reference databases appropriate for diagnosis and evaluation of osteoporosis in Chinese women

 This study was designed to establish Bone Mineral Density (BMD) Reference Databases for multiple skeletal sites appropriate for the diagnosis and evaluation of osteoporosis (OP) in Chinese women. We recruited 2702 healthy Chinese women, 5–96 years of age, for BMD assessment. BMD values at multiple skeletal sites including anteroposterior (AP) and lateral (Lat) lumbar spine, hip, and forearm were measured by dual-energy X-ray absorptiometry (DXA) using a QDR 4500A device; results were analyzed according to age group using eight regression models. BMD Reference Databases (CWD) were established according to the best regression equation and compared with Hologic reference databases for “Oriental Women” (OWD). Results indicated that the cubic regression model was superior to the quadratic, linear, logarithmic, and exponential regression models, etc. for our purpose, with a determinate coefficient (R ²) of 0.363–0.650 (P = 0.000). We included 1636 female patients, aged 35–86 years, in our tests. In comparison with Hologic Reference Databases, the mean detection rate of OP in the newly established BMD Reference Databases for Chinese Women (CWD) was 16.0% ± 2.68% lower (range, 13.7%–20.5%) at the AP spine, 16.8% ± 11.0% lower (range, 3.5%–32.8%) at the Lat spine (except for L4), 18.7% ± 4.6% lower (range, 12.6%–24.2%) at the hip, and 14.3% ± 6.9% higher (range, 4.7%–24.3%) at the forearm. The difference in detection rates for OP was significant between the two reference databases (P = 0.000), which was consistent with the differences in peak BMD values and the biological variability between them. Based upon our data, we confirmed that the Hologic BMD Reference Databases for Oriental Women (OWD) were not suitable for the diagnosis of OP in Chinese women; the BMD Reference Databases for Chinese Women (CWD) established in this study would provide reliable diagnostic standards for detection of OP in the women of South China. Received: July 9, 2002 / Accepted: December 5, 2002 Offprint requests to: X.-P. Wu     

跑步运动配合银杏叶提取物摄入对去卵巢肥胖骨质疏松大鼠骨密度、血脂和抗氧化能力影响研究

目的探讨跑步运动配合银杏叶提取物摄入对骨密度、骨代谢、血脂和抗氧化能力的影响效果。方法利用80只雌性SD大鼠,随机分为去卵巢高脂组和对照组,去卵巢高脂组进行卵巢切除手术,对照组进行假手术,术后去卵巢高脂组进行高脂饲料喂食,对照组进行正常喂食,共进行6周;将接受切除卵巢手术和高脂喂食的的大鼠又随机分为模型组(M组)、银杏叶组(G组)、运动组(R组)、银杏叶+运动组(GE组),接受假手术和正常喂食的大鼠,为假手术组(S组)。进行12周干预,干预结束后,将大鼠置入代谢笼,采集尿样,后进行大鼠的腹腔静脉取血,对大鼠进行骨扫描、血液生化指标检查、骨代谢标志物检查。结果体重方面,在干预后3、6、9、12周M组大鼠体重显著高于S组,P0.05,R组、G组、GR组大鼠体重有逐渐上升趋势,但是在3、6、9、12周均显著低于M组,P0.05。骨密度和骨代谢方面,M组大鼠BMD、血清雌二醇水平显著低于R组、G组GR组、S组大鼠,P0.05。M组大鼠MDA水平显著高于S组、R组、G组和GR组,P0.05;M组大鼠血清OC、ALP、尿液DPD/Cre、Ca/Cre、P/Cre显著高于S组、R组、G组和GR组,P0.05。抗氧化方面,M组大鼠CAT、GSH-PX水平显著低于S组、R组、G组和GR组,P0.05;血脂方面,M组大鼠血液TG、TC水平显著高于S组、R组、G组和GR组,P0.05。结论去卵巢肥胖骨质疏松大鼠利用跑步运动配合摄入银杏叶提取物或单纯摄入银杏叶提取物进行中长期干预治疗能够增加骨密度和雌激素水平,降低骨吸收和骨转换率、降低体重和血脂水平、增加抗氧化能力。     

广州地区骨质疏松症合并髋部骨折骨密度阈值的研讨

目的 了解广州地区骨质疏松髋部骨折的骨密度阈值为预防髋部骨折提供有用的数据和措施。方法 调查和分析133例年龄在65岁以上，受伤后两周内入院治疗的男女性不同类型的髋部骨折患者的骨密度情况，分析及提出髋部骨折的骨密度阈值。结果 无论何种类型的股骨颈骨折男性的骨密度均比女性高，差异有显著性，虽然男性股骨颈骨折平均BMD≥-2.31SD；但其中73％病例有1个部位骨密度≤-2.5SD。女性股骨颈骨折和男，女性粗隆间骨折髋部骨量损失相近似，都明显低于男性股骨颈骨折。结论 股骨颈骨折的类型以及粗隆间骨折Garden分型与骨量无关；外伤后女性发生股骨颈骨折或粗隆间骨折与骨量无关。男性发生粗隆间骨折与骨量丢失更多有关。男女性骨质疏松髋部骨折都可以用骨密度减低2．5SD作为骨折的阈值。