南京地区成年女性衰老过程中各部位骨密度的变化

目的 探讨南京地区成年女性骨质疏松的患病情况,及衰老过程中各部位骨密度的变化。方法 对南京地区成年女性,20-29岁,共计388人,均排除继发性骨质疏松症,运用双能X线骨密度仪,对所有患者进行腰椎及髋部骨密度测定。结果 1.南京地区成年女性,骨量正常者占33.5%,骨量低下者占48.5%,骨质疏松者占18%;其中绝经前成年女性骨量正常者占52.7%,骨量低下者占47.3%,无骨质疏松患者;绝经后女性骨量正常者占12%,骨量低下者占49.7%,骨质疏松患者占38.3%;2. 20~39岁年轻女性,随年龄增加,各部位骨密度均无明显下降;但自40岁开始至49岁,股骨颈骨密度首先开始下降,而此时腰椎及总髋部骨密度无明显变化;到50岁开始,各部位骨密度均明显下降;其中50~69岁时,腰椎骨密度T值与股骨颈骨密度T值之间的差异消失,但均低于总髋部骨密度T值。结论 1.南京地区年轻女性骨量低下者患病率较高,随年龄增加,绝经后女性骨量低下者进一步增多,且骨质疏松患病率高达38.3%;2.在女性50岁前,股骨颈骨密度下降最早,诊断骨质疏松最敏感,而50岁后,腰椎骨密度与股骨颈骨密度均明显下降,诊断骨质疏松同样敏感。     

中国女性的年龄相关骨密度、骨丢失率、骨质疏松发生率及参考数据库——多中心合作项目

目的 本研究采用多中心合作调查了中国女性的年龄相关骨密度(BMD)、骨丢失率和骨质疏松发生率.调查结果被用来建立一个BMD参考数据库.用以诊断中国女性的骨质疏松.方法 采用双能X线吸收骨密度测量仪(DXA)测量了北京、上海、广州、成都、南京和嘉兴地区20～89岁女性的腰椎(L1～L4)(n=8 142)和髋部(n=7 290)的BMD值.不同部位骨骼BMD随年龄的变化用三次回归模型拟合来描述.结果 股骨颈和全股骨的BMD峰值出现在30～34岁,脊柱和股骨粗隆部的峰值出现在40～44岁.年轻成人的(YA)的BMD值(均值和标准差(SD)用20～39岁年龄段的平均BMD进行计算)在后前位脊柱、股骨颈、股骨粗隆和全股骨分别为1.116±0.12 g/cm2、0.927±0.12 g/cm2、0.756±0.11 g/cm2和0.963±0.13 g/cm2.85岁老年女性脊柱的BMD减少了32%,股骨减少了30%～35%.骨质疏松的定义是BMD值与本研究组中确立的年轻成人BMD值相比≤-2.5个标准差,在50岁及以上的女性,发生率分别为脊柱28%、股骨任何部位15%、脊柱或者股骨为31%.结论 本研究为中国女性骨质疏松的预防和治疗提供了重要数据,并且建立了一个可供全中国范围内女性骨质疏松诊断使用的可靠的参考数据库.     

定量CT研究成年女性腰椎骨密度与椎旁体质成分的相关性

目的探讨不同年龄段成年女性腰椎骨密度(bone mineral density,BMD)与腰3椎体(L3)层面体质成分的相关性。方法将496名成年女性按年龄分为青年组(≤44岁)、中年组(45～59岁)、老年组(≥60岁),计算体质量指数(body mass index,BMI),采用定量CT(quantitative computed tomography,QCT)测量L1～3椎体BMD及L3椎体中心层面周围各体质成分含量,包括BMI、椎体周围脂肪含量(FM)、瘦组织含量(LM)、脂肪与瘦组织比值(F/L)、骨量与瘦组织比值(B/L)、腹部总脂肪(TAT)、内脏脂肪(VAT)、皮下脂肪(SAT)。依据BMD分为骨量正常组(≥120 mg/cm~3)、骨量减少组(80～120 mg/cm~3)和骨质疏松(≤80 mg/cm~3,OP)组。通过单因素方差分析不同年龄组BMI、BMD及各体质成分的组间差异。利用线性相关分析BMD与各体质成分的相关性。结果研究对象平均年龄(50.9±12.5)岁(25～82岁)。BMI、BMD、LM、SAT值在老年组低于中、青年组,组间差异有统计学意义(P0.01),FM在老年组高于中、青年组(P0.01)。VAT随年龄增加逐渐减低,组间差异无统计学意义(P=0.955)。BMD与年龄、FM呈负相关,与BMI、LM、SAT呈正相关,与VAT呈较弱正相关。在不同BMD组中,BMI、LM、SAT在骨质疏松组中最低,组间差异有统计学意义(P0.01),FM在骨质疏松组中最高(P0.01),而VAT在不同BMD组间差异无统计学意义(P=0.701)。结论女性腰椎周围肌肉含量、脂肪浸润程度、腹部皮下及内脏脂肪与腰椎BMD存在相关性,其中BMI、LM、SAT与BMD呈正相关,而FM与BMD呈负相关。     

青春期女性骨密度与月经状况的关系

目的 了解昆明12～14岁女性骨密度水平并就影响因素进行分析.方法 利用双能X线骨密度测定仪测量昆明市某中学98名12～14岁青少年腰椎及髋部骨密度(Bone Mineral Density,BMD), 采用问卷调查形式了解与骨密度相关因素.结果 女生腰椎、股骨颈、大转子骨密度明显高于男生(P<0.05);月经初潮年龄早的女生骨密度较高(P<0.05).结论 青春期(12～14岁)阶段女生骨密度较同年龄段男生高,该年龄段女生骨密度与月经初潮年龄有关.     

上海市女性骨量变化与骨质疏松检出率

目的 在了解上海市女性骨密度(BMD)变化规律基础上,探讨使用不同年龄段峰值BMD作为诊断标准时,比较骨质疏松检出率的差异.方法 采用Hologic QDR-2000双能X线吸收仪测量3 390例20～84岁女性腰椎1-4(L1-4)后前位和左侧股骨近端(Total、Neck、Troch和Inter)BMD值,确定峰值BMD出现的年龄段,在此基础上统计分析骨质疏松检出率.结果 以5岁年龄段分组分析显示:L1-4峰值BMD出现在30～34岁年龄段,为0.989g/cm2,股骨近端各部位峰值BMD均出现在20～24岁年龄段,分别为0.878 g/cm2、0.806 g/cm2、0.655 g/cm2和1.019 g/cm2;以上述峰值BMD作为标准时,2 317例50～84岁妇女L1-4、Total、Neck、Troch和Inter骨质疏松检出率分别为42.2%、15.1%、13.4%、9.4%和13.1%.而以20～39岁年龄段BMD作为峰值分析显示:L1-4、Total、Neck、Troch和Inter均值BMD分别为0.962 g/cm2、0.844 g/cm2、0.776 g/cm2、0.626 g/cm2和0.984 g/cm2;2 317例50～84岁妇女L1-4、Total、Neck、Troch和Inter骨质疏松检出率分别为29.3%、18.3%、14.9%、16.0%和16.1%.以5岁年龄段分组与以20～39岁年龄段BMD作为峰值比较,骨质疏松检出率在L1-4、Total、Troch、Inter部位差异均有统计学意义,而Neck部位差异无统计学意义.结论 以不同年龄段BMD作为峰值时,骨质疏松检出率存在差异,临床以BMD来诊断骨质疏松时,应关注该问题.     

绝经后妇女膝关节骨性关节炎骨密度的临床研究

目的 通过测量膝关节骨性关节炎患者桡骨远端和跟骨骨密度,探讨膝关节骨性关节炎患者骨密度的特征及膝关节骨性关节炎与骨质疏松症的关系.方法 对100例绝经后妇女膝关节骨性关节炎患者分别测量桡骨远端和跟骨的骨密度.所有患者均按kellgren分级标准对膝关节进行评分.结果 绝经后妇女膝关节骨性关节炎患者桡骨远端和跟骨的骨密度值随kellgren分级级数的增高差异无显著性.以低于同性别同部位峰值骨量的2.0 SD为骨质疏松诊断标准,桡骨远端和跟骨符合骨质疏松症诊断率分别为51%和46%.桡骨远端骨密度与体重指数的相关系数为0.3630(P<0.01).结论 绝经后妇女膝关节骨性关节炎患者伴发骨质疏松症的比例较高,且随年龄增高有不断增高的趋势.膝关节骨性关节炎患者的骨密度与体重指数呈正相关.     

绝经后妇女血清基质金属蛋白酶-9和基质金属蛋白酶抑制因子-1与骨密度的关系

目的 探讨绝经后妇女血清基质金属蛋白酶-9(MMP-9)和基质金属蛋白酶抑制因子-1(TIMP-1)与骨密度(BMD)之间的关系.通过观察绝经后妇女不同骨密度条件下MMP-19、TIMP-1浓度的变化,探讨两者在骨质疏松症(OP)中的作用,为临床OP诊断与干预治疗提供依据.方法 选择绝经后妇女80例.采用Challenge双能x线骨密度仪(DXA)测量腰椎(L2-L4)侧位和左侧髋部(股骨颈、大转子、Ward三角区)6个骨骼区域的骨密度(BMD).分为正常对照组(骨密度正常组,21例)、低骨量组(20例)、骨质疏松组(23例)和严重骨质疏松组(骨质疏松骨折组,16例),对各组进行身高、体重等常规检查并用酶联免疫吸附试验(ELISA法)测定各组血清MMP-9和TIMP-1的浓度.结果 绝经后女性血清MMP-9水平随骨密度的降低呈现升高趋势.以骨质疏松骨折组为著;低骨量组、骨质疏松组TIMP-1水平与对照组比较没有统计学意义;正常对照组、低骨量组、骨质疏松组MMP-9与TIMP-1的比率依次升高,致使MMP-9与TIMP-1的比率失调.结论 绝经后妇女血清MMP-9水平升高及MMP-9与,TIMP-1的比率失调可能为绝经后骨质疏松症发生的重要影响因素.     

青岛地区成年男性多骨骼部位骨密度数据库的建立

目的确立青岛地区正常成年男性骨密度（BMD）的正常参考范围,探讨青岛地区正常成年男性的骨密度随年龄变化的规律。方法用Challenge双能X线骨密度仪测量692例25-83岁男性参考人群腰椎（L2-L4）正位和左侧髋部（股骨颈、大转子、Ward三角区）6个骨骼区域的BMD。用8种回归模型拟合健康成年男性人群BMD随年龄的变化趋势,找出最佳拟合的方程建立数据库。结果①6个骨骼区域峰值骨密度（PBMD）在30-34岁。②各骨骼区域在达到PBMD之后,均呈现随年龄增高BMD逐渐降低的趋势。③用三次回归模型拟合程度优于其他回归模型,拟合曲线的决定系数（R2）最大。结论：青岛地区正常成年男性的BMD呈现PBMD后随增龄而逐渐下降,但下降趋势较平缓。三次回归是建立BMD正常参考数据库的最佳模型。     

中国长沙地区女性多骨骼部位骨密度参考值横断面调查

目的 横断面调查中国长沙地区女性多骨骼部位骨密度（BMD）随年龄的变化，建立诊断骨质疏松症（OP）参考数据库。方法 用DXA QDR－4500A型扇形束骨密度仪测定2702例5－96岁女性腰椎前后位（AP）和仰卧侧位、髋部及前臂38个不同区域的BMD。结果 按每5岁年龄分组分析的结果显示，38个不同骨骼区域的峰值BMD分别出现在20－24岁至40－44岁之间，其中髋部（股骨颈除外）最早（20－24岁），前臂（超远端除外）最晚（40－44岁）。结论 不同骨骼区域峰值BMD出现的年龄各异。     

女性不同骨骼部位骨密度峰值和参考图的建立方法

目的建立女性不同骨骼部位骨密度(BMD)参考图和确定峰值BMD(PBMD). 方法 用DXA QDR 4500A型扇形束骨密度仪测量3378例5～96岁女性腰椎前后位(AP)和仰卧侧位、髋部和前臂的BMD,用8种回归模型拟合BMD随年龄的变化,找出最佳拟合模型方程建立参考图和确定PBMD.结果三次回归模型拟合程度最佳,即方程的决定系数(R2)最大.我们应用拟合曲线建立了BMD参考图,拟合曲线方程计算各骨骼部位最高的BMD(A方法)和BMD最高的5岁年龄组(B方法)及年龄横断面(C方法)计算PBMD,发现在大多数骨骼部位,三种方法计算的PBMD的差异有显著性.结论此研究建立了女性不同骨骼部位BMD参考图.应用拟合曲线方程计算PBMD(A方法)可获得符合骨骼部位特异性的真正的PBMD,不同方法计算PBMD将对PBMD和诊断骨质疏松产生严重影响.     

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     

Normative bone mineral density data at multiple skeletal sites in Indian subjects

Summary

Age-related change in bone mineral density (BMD) varied according to skeletal site in Indian subjects. A larger proportion of subjects was classified as osteoporotic and osteopenic using the Caucasian database than newly derived peak BMD values at most skeletal sites. Results establish useful normative data for reliable interpretations of individual dual-energy X-ray absorptiometry (DEXA) values

Introduction

Osteoporosis is believed to occur at a relatively younger age in the Indian population. With increasing knowledge on significant differences in BMD between various racial groups, there is increased emphasis for the use of population-specific reference database.

Methods

BMD at multiple skeletal sites was measured using DEXA (Prodigy, Lunar) in 615 Indian women (20–86 years) and 489 Indian men (20–83 years). Best-fit models were drawn for each skeletal site. Osteopenia and osteoporosis diagnosis rates were calculated using Caucasian and derived Indian peak BMD values.

Results

Age-related change in BMD varied with skeletal site in both sexes. Peak BMD in women was observed between 31 and 40 years of age at the hip, spine, and radius 33% and between 20 and 30 years at the ultradistal radius. Peak BMD in men was attained between 20 and 30 years at the hip and radius 33% and between 31 and 40 years at the spine and ultradistal radius. A larger proportion of Indian subjects was classified as osteoporotic and osteopenic based on the Caucasian database than newly derived Indian peak BMD values at all skeletal sites except radius 33% and femoral neck in females above 40 years of age.

Conclusion

Results establish useful normative data for the Indian population for reliable interpretations of individual DEXA values.     

Association between HIV infection and bone mineral density in climacteric women

Summary

A cross-sectional study was conducted with the purpose of evaluating bone mineral density in HIV seropositive and seronegative climacteric women. HIV infection was negatively associated with bone mineral density in the lumbar spine

Purpose

To assess bone mineral density (BMD) and its associated factors in HIV seropositive and seronegative climacteric women

Methods

A cross-sectional study with 537 women (273 HIV seropositive and 264 HIV seronegative) aged between 40 and 60 years old receiving follow-up care at two hospitals in Brazil. A questionnaire on clinical and sociodemographic characteristics was completed. Laboratory tests were performed, and BMD was measured at the lumbar spine and hip. Statistical analysis was carried out by Yates and Pearson chi-squared tests, Mann–Whitney test, and multiple linear regression.

Results

The mean age was 47.7 years in HIV-seropositive women, and 75 % had nadir CD4 above 200, and 77.8 % had viral load below the detection limit. The mean age in the HIV-seronegative women was 49.8 years. The prevalence of low spinal BMD was 14.6 % in the HIV-seropositive and 4.6 % in the HIV-seronegative women (p?<?0.01). The prevalence of low BMD at the femoral neck was 5.6 % in HIV-seropositive and 3.3 % in the HIV-seronegative women (p?=?0.38). Multiple analyses showed that the factors associated with lower BMD at the spine were being postmenopausal and being HIV-seropositive. Being overweight was associated with a higher BMD. At the femoral neck, factors associated with lower BMD were being postmenopausal and being white. Being overweight and having a greater number of pregnancies were associated with higher BMD

Conclusions

HIV-seropositive women on long-term antiretroviral treatment and in good immunological conditions exhibited low BMD in the spine (L1–L4). However, BMD in the femoral neck was similar to non-infected women.

     

绝经后妇女血肌肉生长抑制素与骨密度的关系

目的探讨绝经后妇女血肌肉生长抑制素与体成份、血脂及骨密度的关系。方法纳入175名年龄在51~75岁的绝经后妇女,用双能X线吸收仪测量其骨密度(bone mineral density,BMD)及体成分。酶联免疫吸附法测定其血清肌肉生长抑制素、25羟维生素D3、甲状旁腺激素(parathyroid hormone,PTH)、骨碱性磷酸酶(bone alkaline phosphatase,BAP)、I型胶原C末端肽(type I collagen C terminal peptide,CTX)。结果与骨质疏松者相比,无骨质疏松的妇女体重指数、肥体重及瘦体重更高(P0.01)。骨质疏松妇女年龄显著大于无骨质疏松妇女(P0.01)。经年龄校正后,两组之间血BAP、CTX、25羟维生素D3、PTH、血脂成分及肌肉生长抑制素差异无统计学意义。所有测定部位BMD均与绝经年龄、肥体重及瘦体重成正比,与年龄、血BAP成反比。肌肉生长抑制素与血甘油三酯成负相关(β=-0.203,P=0.007),与体成分及所有部位骨密度无相关。结论研究数据表明血肌肉生长抑制素浓度与肌肉量及骨量无相关,需进一步研究阐明肌肉生长抑制素在调节骨代谢中的作用。     

绝经后妇女肥胖与骨密度的关系

目的 分析绝经后妇女的腰椎2-4( L2-4)和股骨颈（Neck)、大转子(Troch)、粗隆间（InterTro)的骨密度（BMD),探讨绝经后妇女肥胖与骨密度的关系。方法 以我院269名年龄45 -75岁的绝经后妇女为研究对象,计算体重指数将研究对象分为肥胖组和对照组,采用双能X线骨密度仪检测腰椎、股骨颈、大转子、粗隆间的骨密度,分析绝经后妇女肥胖与骨密度的关 系。结果 肥胖组绝经后妇女不同部位的骨密度均高于对照组(P <0.05或P <0. 01)。绝经后妇女各部位的骨密度随年龄的增长而降低,各年龄组间的骨密度有显著性差异(P <0.05或P <0. 01)。结论 年龄和体重指数是影响骨密度的重要因素,绝经后妇女肥胖者骨密度较正常体型者高,肥胖者可能通过负重等作用,延缓绝经后妇女骨密度的下降。