早孕期骨密度正常妇女产褥期骨密度分析

目的分析早孕期骨密度正常妇女产褥期骨密度情况,分析产前、产时、产后各种因素对产褥期骨密度的影响。方法对210名在海淀妇幼保健院建档并住院分娩的早孕期桡骨骨密度正常的妇女在产褥期进行超声骨密度测定,分析孕前体重指数、孕期体重增长、分娩方式、胎儿体重、产后出血、产后喂养方式、产后补钙情况、产后户外活动等对产褥期骨密度的影响。结果早孕期骨密度正常的妇女在产褥期骨密度正常者占90.5%,骨量减少占9.5%,骨质疏松0%。210名妇女产褥期骨密度较早孕期减少,差异有统计学意义(P0.05)。产后出血量多于500m L,孕期体重增加超过12.5kg,产后未补钙及产后户外活动少的产妇,产褥期骨密度较低,差异有统计学意义(P0.05)。而孕前体重指数、分娩方式、胎儿体重、产后喂养方式对产褥期骨密度无影响(P0.05)。结论产褥期骨密度较早孕期下降,孕期控制体重增长、产褥期补钙、适当户外活动,可减少骨量流失。     

Bone mineral density in the femoral neck increases after hip resurfacing: a cohort with five-year follow-up

Hip resurfacing is an effective treatment modality for arthritis of the hip in carefully selected patients; however, its use remains controversial due to its higher revision rates compared with conventional total hip replacement surgery. The most frequent reason for revision is femoral neck fracture, and preoperative bone mineral density is an important factor when considering the option of hip resurfacing. Whilst reduction in bone mineral density following total hip replacement is well documented, little is known about the long-term changes in femoral neck bone mineral density after hip resurfacing. We followed 15 patients (ten male and five female) who underwent unilateral hip resurfacing for osteoarthritis with standardised dual energy X-ray absorbiometry scans at two weeks, three months, one year, two years and five years postoperatively to determine changes in the femoral neck bone mineral density. Both males and females initially had decreases in bone mineral density at three months postoperatively, but had gradual mean increases to 119% of their initial measurements by five years. This study demonstrates that femoral neck bone mineral density increases after hip resurfacing and that this increase continues for at least five years.     

Decreased bone mineral density in neurofibromatosis type 1: results from a pediatric cohort

Neurofibromatosis type 1 (NF1) is a common genetic disorder affecting 1 in 3000 live births. It is well documented to be associated with bony deformities and other orthopaedic problems. Based on our observation that NF1 patients undergoing orthopaedic surgery often had osteopenic bone, we performed a study to assess the bone mineral density of a cohort of children with NF1 without orthopaedic defects.Twenty-three patients were recruited from the neurofibromatosis clinic. The bone mineral density of the total body, lumbar spine, and proximal femur was measured using dual-energy x-ray absorptiometry. Quantitative ultrasound was used to measure broadband ultrasonic attenuation at both heels. The group's mean dual-energy x-ray absorptiometry sex- and age-matched Z scores were below normal (-0.8 +/- 1.1, -0.8 +/- 1.2, -0.7 +/- 0.8, -0.6 +/- 1.1, -0.6 +/- 0.9, -0.6 +/- 1.1 for the total body, arms, legs, lumbar spine, and right and left femoral neck, respectively; all P < 0.01). Although some individuals had normal bone mass, 30% had total body Z scores below -1.5. The mean heel broadband ultrasonic attenuation Z score was also lower than normal (-0.8 +/- 0.6; P < 0.001).Children with NF1 have a general tendency toward osteopenia, suggesting an abnormal underlying bone phenotype. This may be relevant when considering operative intervention and, if better understood, may partially explain poor bone healing associated with NF1.     

Bone mineral density measured by dual X-ray absorptiometry in Spanish patients with insulin-dependent diabetes mellitus

Previous studies suggest that low bone mass is a potential complication of insulin-dependent diabetes mellitus. Nevertheless, the factors that influence diabetic osteopenia are not well established. In order to evaluate the prevalence and magnitude of diabetic osteopenia and its association with clinical and metabolic variables, we studied 94 consecutive patients with insulin-dependent diabetes mellitus. Their age ranged from 20 to 56 years and duration of diabetes varied from 1 to 35 years. Bone mineral density (BMD) was measured by dual X-ray absorptiometry at lumbar spine and proximal femur and the values were expressed as z-score. The presence and extent of microvascular complications, degree of metabolic control, and other risk factors for osteoporosis were recorded and some biochemical markers of bone metabolism were assessed. Diabetic patients showed reduced BMD in all sites (lumbar spine: −0.89±1.21; femoral neck: −0.99±1.24; Ward triangle; −1.05±1.24;P<0.0001). Of the 94 patients 19.1% met diagnostic criteria for osteoporosis. BMD correlated with body mass index in all sites and with the duration of disease in Ward's triangle. Presence and extent of diabetic complications were associated with lower BMD, as was smoking. No correlation was found between BMD and biochemical markers. In conclusion, osteopenia is a common complication in patients with insulin-dependent diabetes mellitus. Microvascular complications are a critical point in the progression of diabetic osteopenia. Other risk factors for osteoporosis (nutritional status and smoking) must be taken into account. Preliminary results partially presented at the EASD Meeting in Prague, Czechoslovakia, September 1992     

儿童骨质密度不足相关研究概况

伴随诊断和治疗技术的发展,在儿童期发生的骨质密度减低逐渐引起了人们的重视。儿童低骨密度是由多种原因造成的,其中儿童在青春期生长高峰时,钙与维生素D摄入量不足是造成骨量减低的主要原因之一;导致骨量减低的其他临床相关因素还包括：成骨不良、佝偻病、少年类风湿、慢性关节炎,神经肌肉异常相关性骨量降低和特发性骨质疏松等疾病。为能够让临床医师早期认识与处理上述导致儿童期低骨质密度的问题,对儿童骨量降低提供有效的治疗,本文将对正常骨骼矿化过程、骨质密度测量技术,骨质降低的病理生理学机理和治疗方式选择的评估等方面展开综合性论述。     

Bone mineral density in hyperandrogenic amenorrhoea

Summary The authors assessed bone mineral density in antrogenized amenorrheic (group A; n=9_ and androgenized nonamenorrheic patients (group B; n=30) and compared it with controls (n=22). Bone mineral density of group A patients (1.023±0.045 g/cm²) did not differ from controls 1.047±0.83 g/cm²); both groups had significantly lower values than group B women (1.099±0.085 g/cm²). Of the hormonal variables explaining bone mineral density in antrogenized women, only dehydroepiandrosterone sulfate had a significant negative correlation (r=-0.45). In contrast to other forms of amenorrhea, women with hyperantrogenic amenorrhea seem to be spared from osteopenia.     

不同孕期妇女跟骨骨量检测结果分析

目的 探讨不同孕期妇女骨量的变化，指导孕妇合理补钙。方法 采用UBIS5000型超声成像骨量仪，测量300例不同孕期健康妇女跟骨超声振幅衰减（BUA）参数值，并与同年龄组非孕妇女结果进行比较。结果 中，晚期孕妇骨量均值均低于非孕及早孕期妇女，晚孕组与非孕组比较差异有显性（P＜0．05）。结论 孕期妇女存在不同程度骨量减少。骨量测定对孕期保健指导有重要意义。     

Bone mineral density in weight lifters

Summary The effect of intense physical training on the bone mineral content (BMC) and soft tissue composition, and the development of these values after cessation of the active career, was studied in 40 nationally or internationally ranked male weight lifters. Nineteen were active and 21 had retired from competition sports. Fifty-two age- and sexmatched nonweight lifters served as controls. The bone mineral density (BMD) in total body, spine, hip, and proximal tibial metaphysis was measured with a Lunar Dual-energy X-ray absorptiometry (DXA) apparatus and the BMD of the distal forearm was measured with single photon absorptiometry (SPA). Seventeen of the lifters had been measured earlier with SPA in the forearm and 23 in the tibial condyle during their active career in 1975. The BMD was significantly higher in the weight lifters compared with the controls (10% in the total body P<0.001, 12% in the trochanteric region P<0.001, and 13% in the lumbar spine P<0.001). All measured regions except the head showed significant higher bone mass in the weight lifters compared with the controls. In older lifters, the difference from the controls seemed to increase in total body and lumbar vertebrae (BMD), but remained unchanged in the hip. Significant correlation was found between the SPA measurements in 1975 and the corresponding measurements 15 years later in both the forearm (r=0.51, P<0.05 at the 1-cm level and r=0.87, P<0.001 at the 6-cm level) and in the tibial condyle (r=0.61, P<0.01). There was no difference in BMD for any region between active and retired weight lifters that was not explained by difference in age. The weight lifters were on average 5 cm shorter but of the same weight as the controls. In the weight lifters, the body mass index (BMI) was increased as was the lean body mass, but not the fat content.     

Bone mineral density in diabetes mellitus

In the present study bone mineral content (BMC) was measured at 1/3 and 1/10 the length of the radius from the distal end in 100 adult diabetic subjects (55 females, 45 males, 54 insulin-dependent [IDD], 46 non-insulin-dependent [NIDD]), using single photon absorptiometry. Each individual BMC value in the diabetics was first compared to normal BMC values for age obtained in our laboratory from 500 non-diabetic subjects. BMC in the diabetics was within the normal range (M +/- 2 SD) with respect to sex and age. Data from IDD and NIDD males, under and over 50 years of age, and of IDD and NIDD females, pre- and postmenopausal, were compared with the respective control group data after matching each diabetic subject to a non-diabetic one of identical age and menstrual history and of comparable body mass index. In each group BMC in the diabetic subjects was found not to be statistically different from BMC in the control ones. Correlation analysis was carried out between BMC and endocrine or metabolic parameters obtained in 52 of the diabetic patients. BMC in diabetic subjects was not correlated with plasma levels of hormones (thyroid hormones, cortisol, 17-beta-estradiol, testosterone), Ca, P or alkaline phosphatase activity. It was inversely correlated with urinary Ca and P in NIDD women and with urinary Ca in NIDD men. No relationship was found between BMC and the metabolic control of diabetes (evaluated by basal glycemia, 2h-post-prandial glycemia and glycosylated hemoglobin).     

Bone mineral density in adolescents: Higher values in a rural area—a population-based study of 246 subjects in southern Sweden

We performed, in a cross-sectional study, dual energy X-ray absorptiometry (DXA) among 15-16-year-old boys (n 58) and girls (n 44) living in an urban area and among boys (n 82) and girls (n 66) of the same age from a rural area. We measured bone mineral density (BMD) of the total body, the lumbar spine and the hip. In the rural population, we found significantly higher BMD levels in the lumbar spine (14% for the boys and 12% for the girls) and the total body (6.9% for the boys and 3.4% for the girls). We detected no significant differences in the hip BMD.

Adolescents in rural areas seem to develop a higher peak bone mass and thereby presumably have a lower risk of developing fragility fractures.     

Bone mineral density in diabetic children and adolescents: a follow-up study

OBJECTIVE: To establish whether T1DM can affect bone mineral density (BMD) in children and adolescents. RESEARCH DESIGN AND METHODS: We performed a cross-sectional and longitudinal study of 57 diabetic children and adolescents and 57 normal controls. Total body and lumbar BMD and bone mineral content (BMC) were assessed by DXA (Lunar DPX) and volumetric transformation was calculated using the Katzman formula for total body BMD (BMAD) and using the Kroger formula for Lumbar BMD (L2L4BMDvol). BMC, BMAD, BMDspine, and L2L4BMDvol were adjusted for confounding factors such as age, gender, BMI, height, weight, and pubertal stage. RESULTS: BMDspine in the control group increased by 0.006 (g/cm(2))/year; while in the 39 diabetic patients longitudinally studied, it dropped by 0.006 (g/cm(2))/year during a follow-up period of 51 +/- 27 months. The average time spent weekly doing physical activity resulted in T1DM group directly correlated to BCM (P < 0.001) and inversely correlated with BMDspine (P < 0.05) and L2L4BMDvol (P < 0.01). L2L4BMDvol resulted significantly correlated with previous BMD spine (R = 0.63; P < 0.0001) and BMC evaluation (R = 0.42; P < 0.01) but not with BMAD. A second lumbar DXA evaluation performed in 38 patients after 1.00 +/- 0.16 years confirmed a small but significant decrease of 1.6% per year in L2L4BMDvol. The percentage of variation of L2L4BMDvol between the two evaluations was not correlated with the level of metabolic control, insulin requirement, and duration of the disease. Patients with complications showed similar L2L4BMDvol to patients without complications. CONCLUSIONS: Diabetic children and adolescents show a slight negative pattern of spine mineralization, which does not depend on metabolic control and microvascular complications.     

骨折病人的骨密度检测

目的 观察骨折病人骨折治疗前后的骨密度变化.方法对202例男性骨折病人和96例女性骨折病人在骨折后1w、1个月、3个月、6个月时进行数字X线骨密度测量(XBM),观察骨密度值的变化.结果 男、女骨折病人骨折后1个月时与骨折时比较,男:降低4.84%;配对t检验:t=6.134,P<0.001;女:降低5.71%;t=4.734,P<0.001;3个月时与骨折时比较,男:降低1.41%;配对t检验:t= 1.288,P>0.05;女:降低2.10%;t=1571,P>0.05;6个月时与骨折时比较,男:降低0.26%;配对t检验:t= 0.009,P>0.05;女:降低0.60%;t=0.288,P>0.05.结论 男、女骨折病人骨折后1个月时有非常显著的骨密度降低,3个月时骨密度有明显恢复,较骨折时已无显著性降低;6个月时基本恢复到接近正常水平,与骨折时比较没有显著性差异.     

Bone mineral density deficiency in children.

With the development of improved diagnostic and treatment options, reduced bone mineral density in children is receiving increased attention. The etiology of osteopenia in healthy children is multifactorial and incompletely understood, but poor calcium intake during the adolescent growth spurt may be an important (and potentially reversible) factor. Other clinically relevant causes of reduced bone mineral density in children include osteogenesis imperfecta, rickets, juvenile rheumatoid and other chronic arthritides, osteopenia associated with neuromuscular disorders, and idiopathic osteoporosis. To provide effective treatment, it is important to understand the process of normal skeletal mineralization, the techniques of bone mineral density measurement, the pathophysiology of osteopenia, and the evaluation and treatment options for the general pediatric population as well as for patients with specific pediatric disorders.     

Bone mineral density in women with sarcoidosis

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Almost any organs of the body, but mostly the lungs, are involved. Bone mineral density (BMD) can be affected directly or indirectly in chronic granulomatous systemic diseases such as sarcoidosis. The aim of our study was to evaluate BMD in premenopausal and postmenopausal sarcoidosis patients with or without prednisone treatment and to compare their BMD values with those of a control group having the same menopausal status. Thirty-five premenopausal women (18 untreated, 8 treated, and 9 controls) and 21 postmenopausal women (5 untreated, 5 treated, and 11 controls) were included in the study. All of the patients had a histologically proven diagnosis and were being followed-up at the Sarcoidosis Outpatient Clinic of our unit. BMD of the lumbar (L) spine and femoral neck was measured by dual-energy absorptiometry (DEXA). The subgroups of premenopausals and postmenopausals were compared separately. Comparison among the groups was performed by using analysis of variance. Age, duration of the disease, and body mass index were comparable in treated, untreated, and control subgroups of the pre- and postmenopausal groups, and the subgroups of postmenopausals had comparable durations since menopause. For premenopausals, BMD values at L1–4 were not significantly different among the subgroups (0.920 ± 0.08g/cm², 0.801 ± 0.09g/cm², and 0.910 ± 0.05g/cm², for untreated, treated, and controls, respectively). However, the BMD value at the femoral neck in treated patients (0.921 ± 0.1g/cm²) was significantly lower than the values in untreated patients (1.080 ± 0.2g/cm²; P 0.01) and in controls (1.028 ± 0.17g/cm²; P 0.05). For postmenopausals, the BMD value at L1–4 in controls (1.019 ± 0.07g/cm²) was significantly higher than the values in untreated patients (0.783 ± 0.01g/cm²) and in treated patients (0.751 ± 0.08g/cm²; P 0.001 for both). The BMD value at the femoral neck in controls (0.890 ± 0.1g/cm²) was higher than the values in untreated patients (0.745 ± 0.08g/cm²) and treated patients (0.747 ± 0.1g/cm²), but the difference was not statistically significant (P = 0.06). We concluded that sarcoidosis patients, especially postmenopausal patients with corticosteroid treatment, may have an increased risk of bone mineral loss. Large-scale studies are warranted in order to delineate the exact roles of the disease itself, menopausal status, and corticosteroid treatment in this bone mineral loss.     

Bone mineral density in pediatric transplant recipients

BACKGROUND: Reduced bone mass and fragility fractures are known complications after transplantation in adults. Far less is known about the skeletal effects of transplantation in children and adolescents. METHODS: This cross-sectional study examined the skeletal status of children (ages 9-18 years) who were at least 1 year post-cardiac (n=13), post-renal (n=8), or post-bone marrow (BMT; n=15) transplantation. Bone mass at total hip, femoral neck, spine (L2-4), and whole body (WB) was determined by dual energy x-ray absorptiometry and compared with age, sex, and ethnic-specific reference data. Standard deviations (z-scores) were calculated for both areal bone mineral density (BMD) and estimated volumetric bone density (bone mineral apparent density [BMAD]). RESULTS: Cardiac transplant patients had significantly lower BMD z-scores compared with the reference population at all skeletal sites. BMT recipients had significantly reduced BMD z-scores at total hip, spine, and WB. Kidney transplant patients had a significantly reduced WB BMD z-score only. Spine BMAD z-scores remained significantly reduced in cardiac and BMT subjects. Three of 36 patients had radiographic evidence of spinal fracture after transplantation. No correlation between steroid dosage and any measure of bone mass was observed. CONCLUSIONS: Cardiac and BMT recipients had reduced BMD at multiple skeletal sites, and renal transplant recipients had reduced WB BMD for age. Deficits in spine bone density persisted after correcting for small bone size using BMAD. Low bone density and the occurrence of vertebral fractures indicate that cardiac, renal, and bone marrow transplantation in children is associated with reduced bone health.