Comparison of quantitative ultrasound of the phalanges with conventional bone densitometry in healthy postmenopausal women

The objective of this study was to evaluate the utility of the quantitative ultrasound (QUS) technique for the identification of subjects with spine fracture or low bone mineral density (BMD) previously determined by dual energy X-ray absorptiometry (DEXA). QUS of the phalanges in 1,350 postmenopausal women (60–83 years old) was compared with DEXA measurements of four skeletal sites (lumbar spine, total hip, femoral neck, and distal radius) of the same subjects. The contribution of body mass index (BMI) was also assessed. Amplitude dependent speed of sound (AD-SoS), ultrasound bone profile index (UBPI), and BMD of all anatomical regions, except for the spine, decreased significantly with increasing age quartiles. QUS parameters correlated weakly but significantly with BMD ( r =0.21–0.31, p <0.01). After adjustment for BMI, the association between QUS parameters and BMD remained unchanged. UBPI was found to be independent of BMI. All techniques and all sites were able to significantly discriminate fractured from non-fractured subjects by receiver operating characteristic (ROC) analysis (area under the curve [AUC]0.60, p <0.0001). AD-SoS and UBPI showed similar fracture discrimination ability of spine, distal radius and total body BMD in terms of odds ratios, but BMD of the total hip and femoral neck showed the best performance in discriminating fractured from non-fractured subjects. In conclusion, QUS assessment of the phalanges correlates moderately with BMD of all skeletal sites and is able to effectively discriminate fractured from non-fractured subjects.The authors wrote this article on behalf of the PERF study group     

Osteoporosis case finding in the general practice: phalangeal radiographic absorptiometry with and without risk factors for osteoporosis to select postmenopausal women eligible for lumbar spine and hip densitometry

Mass screening for osteoporosis using DXA measurements at the spine and hip is presently not recommended by health authorities. Instead, risk factor questionnaires and peripheral bone measurements may facilitate the selection of women eligible for axial bone densitometry. The aim of this study was to validate a case finding strategy for postmenopausal women who would benefit most from subsequent DXA measurement by using phalangeal radiographic absorptiometry (RA) alone or in combination with risk factors in a general practice setting. The sensitivity and specificity of this strategy in detecting osteoporosis (T-score 2.5 SD at the spine and/or the hip) were compared with those of the current reimbursement criteria for DXA measurements in Switzerland. Four hundred and twenty-three postmenopausal women with one or more risk factors for osteoporosis were recruited by 90 primary care physicians who also performed the phalangeal RA measurements. All women underwent subsequent DXA measurement of the spine and the hip at the Osteoporosis Policlinic of the University Hospital of Berne. They were allocated to one of two groups depending on whether they matched with the Swiss reimbursement conditions for DXA measurement or not. Logistic regression models were used to predict the likelihood of osteoporosis versus no osteoporosis and to derive ROC curves for the various strategies. Differences in the areas under the ROC curves (AUC) were tested for significance. In women lacking reimbursement criteria, RA achieved a significantly larger AUC (0.81; 95% CI 0.72–0.89) than the risk factors associated with patients age, height and weight (0.71; 95% C.I. 0.62–0.80). Furthermore, in this study, RA provided a better sensitivity and specificity in identifying women with underlying osteoporosis than the currently accepted criteria for reimbursement of DXA measurement. In the Swiss environment, RA is a valid case finding tool for patients with risk factors for osteoporosis, especially for those who do not qualify for DXA reimbursement.     

绝经后妇女骨量减低筛查及早期干预研究

目的 观察在骨量减低阶段进行干预对骨质疏松的发生及骨折的预防作用,探寻最佳的骨质疏松健康管理原则,从而为更早期防治骨质疏松提供理论依据。方法 到本医院行双光能X线骨密 度仪(DEXA NORLAND)测定的骨量减低绝经后的妇女273例,分为干预组与对照组,研究时间为1 年。所有数据均用SPSS统计软件进行分析,结果用x±s表示,组间比较采用t检验,P<0. 05显示差异具有统计学意义。结果 骨量减低阶段进行干预对骨质疏松的发生及骨折的预防作用显著,探寻出最佳的骨质疏松健康管理原则。结论 在骨量减低期间即进行生活方式及药物干预,观察不同干预方式对骨密度、骨代谢指标的影响程度,通过不同方式干预,骨量减低的绝经后妇女转归情况及对骨质疏松性骨折的预防,为更早期防治骨质疏松提供理论依据。     

Early postmenopausal diminution of forearm and spinal bone mineral density: A cross-sectional study

Diminution of bone mineral density (BMD) in the spine and forearm was studied cross-sectionally in 363 women who were 6 months to 10 years postmenopausal. BMD was determined by dual-energy X-ray absorptiometry (DXA) (Hologic QDR-2000) in the lumbar spine, in both the supine lateral (LAT) and anteroposterior (AP) projections, and in the distal third of the forearm. The postmenopausal diminution of BMD was best described by an exponential fit. The initial rate of postmenopausal diminution of BMD was highest in the most trabecular sites (LAT>AP> forearm), but 10-year diminution was similar at all sites (12%–13%, corresponding to about 1.0–1.5 SD), and extrapolation suggested reverse order of the rates of diminution thereafter (forearm>AP>LAT). When bone mineral content of the entire L3 vertebra (tBMC) was measured in vivo, AP tBMC could account for only 67% of the variation in LAT tBMC, compared withr ²=0.997 in vitro. This observation suggests an accuracy problem in vivo in one of the spine measurement methods. We conclude that the initial rate of BMD diminution after the menopause seems to be highest in the spine, especially when measured laterally, but that this rate levels off within the first decade. The lower precision error of a forearm measurement (0.8% v 1.6 for AP and 3.1 for LAT) therefore implies that this method may require a shorter observation period than spine measurements for the detection of bone loss 5–10 years after menopause. Long-term longitudinal spine and forearm measurements are, however, needed to confirm these conclusions.     

The relationship between bone mineral density and ultrasound in postmenopausal and osteoporotic women

The aim of this cross-sectional study was to use a novel method of data analysis to demonstrate that patients with osteoporosis have significantly lower ultrasound results in the heel after correcting for the effect of bone mineral density (BMD) measured in the spine or hip. Three groups of patients were studied: healthy early postmenopausal women, within 3 years of the menopause (n=104, 50%), healthy late postmenopausal women, more than 10 years from the menopause (n=75, 36%), and a group of women with osteoporosis as defined by WHO criteria (n=30, 14%). Broadband ultrasound attenuation (BUA), speed of sound (SOS) and Stiffness were measured using a Lunar Achilles heel machine, and BMD of the lumbar spine and left hip was measured using dual-energy X-ray absorptiometry (DXA). SOS, BUA and Stiffness were regressed against lumbar spine BMD and femoral BMD for all three groups combined. The correlation coefficients were in the range 0.52–0.58, in agreement with previously published work. Using a calculated ratio R, analysis of variance demonstrated that the ratio was significantly higher in the osteoporotic group compared with the other two groups. This implied that heel ultrasound values are proportionately lower in the osteoporotic group compared with the other two groups for an equivalent value of lumbar spine and femoral neck BMD. We conclude that postmenopausal bone loss is not associated with different ultasound values once lumbar spine or femoral neck BMD is taken into account. Ultrasound does not give additional information about patterns of bone loss in postmenopausal patients but is important in those patients with osteoporosis and fractures.     

绝经后妇女桡骨远端骨折术后桡骨短缩与骨密度的相关性研究

目的分析绝经后妇女的骨密度与桡骨远端骨折术后出现桡骨短缩的相关性。方法回顾性分析自2012-01—2014-06行手术治疗的252例绝经妇女桡骨远端骨折,术后均达到解剖复位或基本达到解剖复位,获得1年完整随访。将术后3个月桡骨短缩距离4 mm的患者纳入观察组,其余的按年龄、骨折类型及绝经时间进行1∶1个体匹配,纳入与观察组同样数量的病例进入对照组(术后3个月桡骨短缩距离4 mm)。术前、术后3个月及术后6个月用双能X线骨密度仪对2组健侧桡骨进行骨密度测量。结果观察组骨密度值:术前(0.69±0.14)g/cm2,术后3个月(0.67±0.12)g/cm~2,术后6个月(0.62±0.10)g/cm~2。对照组骨密度值:术前(0.79±0.15)g/cm~2,术后3个月(0.76±0.13)g/cm~2,术后6个月(0.71±0.10)g/cm~2。2组骨密度值随时间增加而降低,且观察组术前(F=7.588,P=0.008)、术后3个月(F=8.520,P=0.005)、术后6个月(F=11.203,P=0.001)骨密度值均低于对照组,差异有统计学意义(P0.05)。结论对于桡骨远端骨折患者术后出现桡骨短缩的原因,骨密度降低是一个不容忽略的重要因素,在术后应重视对低骨密度的患者采取相应措施。     

Physical training preserves bone mineral density in postmenopausal women with forearm fractures and low bone mineral density

Summary One hundred and twelve postmenopausal women with low bone mineral density (BMD) and forearm fractures were randomized to physical training or control group. After one year the total hip BMD was significantly higher in the women in the physical training group. The results indicate a positive effect of physical training on BMD in postmenopausal women with low BMD. Introduction The fivefold increase in hip fracture incidence since 1950 in Sweden may partially be due to an increasingly sedentary lifestyle. Our hypothesis was that physical training can prevent bone loss in postmenopausal women. Methods One hundred and twelve postmenopausal women 45 to 65 years with forearm fractures and T-scores from −1.0 to −3.0 were randomized to either a physical training or control group. Training included three fast 30-minute walks and two sessions of one-hour training per week. Bone mineral density (BMD) was measured in the hip and the lumbar spine at baseline and after one year. Results A per protocol analysis was performed, including 48 subjects in the training group and 44 subjects in the control group. The total hip BMD increased in the training group +0.005 g/cm2 (±0.018), +0.58%, while it decreased −0.003 g/cm2 (±0.019), −0.36%, (p = 0.041) in the control group. No significant effects of physical training were seen in the lumbar spine. A sensitivity intention to treat analysis, including all randomized subjects, showed no significant effect of physical training on BMD at any site. Conclusions The results indicate a small but positive effect of physical exercise on hip BMD in postmenopausal women with low BMD.     

Axial BMD, change in BMD and bone turnover do not predict breast cancer incidence in early postmenopausal women

Previous studies have indicated a relationship between bone mineral density and the incidence of breast cancer in middle-aged and elderly women, with women with higher BMD being at significant increased risk. We investigated whether there was such a relationship in younger women who were perimenopausal or in their early postmenopausal years. As part of a population-screening program for osteoporosis, 5,119 women aged between 45 and 54 years were scanned between 1990–1994 at the Osteoporosis Research Unit. In 1997–2001, 3,884 returned for follow-up scans and questionnaires, and 3,144 returned a postal questionnaire in 2002. All cases of incident breast cancer were noted. One hundred sixty-six women indicated that they had suffered from breast cancer, of which 87 were incident cases (59 had prevalent breast cancer at baseline and 20 had benign or unconfirmed diagnosis and were excluded because of the use of agents that may interfere with BMD, e.g., tamoxifen). We compared therefore the incident breast cancer group (BC group; n =87) with a control group (C group; n =3,013). There were no significant differences using a t -test between the BC group and C group for baseline DXA of the spine or femoral neck. Further changes in BMD over a mean period of 6.9 years demonstrated no significant hazard ratio for the lumbar spine or femoral neck. No relationship was seen between the bone turnover markers pyridinoline/creatinine or deoxypyridinoline/creatinine assessed at their second study visit and incidence of breast cancer. In conclusion, in perimenopausal or early postmenopausal women there is no relationship between the incidence of breast cancer and BMD, change in BMD or bone turnover.     

Computed radiographic absorptiometry and morphometry in the assessment of postmenopausal bone loss

The best method for the diagnosis of osteoporosis and assessment of fracture risk is currently considered to be bone densitometry. The most commonly used dual-energy X-ray absorptiometry (DXA) methods may sometimes not predict bone mass accurately in every skeletal site, are expensive and not widely available. The recent development of computed analysis of a plain radiograph of the hand might provide a practical, inexpensive and rapid method for evaluation of bone mineral status. In this study we evaluated 20 healthy premenopausal and 660 postmenopausal women. In 36 of these subjects a second evaluation was carried out after 2 years of therapy with calcium supplements. The internal and external diameters of the second metacarpal and the metacarpal and ultradistal radial bone density were evaluated using a technical device developed in our laboratory and marketed by NIM, Verona, Italy (Osteoradiometer). The radio-graphic images, captured by a video camera, were digitized and studied by computed analysis. In 150 subjects bone density at the level of the lumbar spine, femur, and ultradistal and proximal radius was also measured by DXA techniques. Both external (D) and internal (d) diameters increase significantly with age and years since menopause (YSM), whereas metacarpal index (D–d/D) and metacarpal and ultradistal radial bone density decrease significantly with age and YSM. The ratio between metacarpal bone mineral content and the cortical area (volumetric metacarpal bone density) did not change with age. Significant correlations were found between radiometric findings and DXA measurements. The best correlation coefficients were between bone density measured at the level of the ultradistal radius by DXA and radiographic absorptiometry. In the 2-year follow-up study, a 4.9% and 6.2% decline in radial metacarpal bone density respectively were observed, but the difference was statistically significant only for the latter. In conclusion, computed radiogrammetry is closely correlated with all DXA measurements and may be useful in screening of large populations, providing a simple, inexpensive and sufficiently precise method for evaluation of bone mineral status. Further studies are warranted for assessing the accuracy of radiogrammetry for longitudinal investigations and its capacity to predict fracture risk.     

Effects of cyclical etidronate therapy on bone loss in early postmenopausal women who are not undergoing hormonal replacement therapy

This study was carried out to investigate the effectiveness and tolerability of cyclical etidronate therapy in the prevention of bone loss occurring in early postmenopausal women who are not undergoing hormone replacement therapy (HRT). A total of 109 Caucasian women aged 45–60 years were treated with etidronate 400 mg/day or placebo for 14 days followed by calcium supplementation 500 mg/day for 77 days. Ninety-one women completed the 2 years of the study. After 2 years, the estimated difference between the two groups as regards lumbar spine bone mineral density (BMD) was 2.53% (SEM 1.07%;p=0.01); BMD of the hip and wrist were not significantly different between treatment groups. A clear reduction in bone turnover was obtained as evidenced by a significant decrease in serum alkaline phosphatase level and in urinary N-telopeptide/creatinine ratio in the etidronate group; the difference between the two groups was –12%±3.2% for serum alkaline phosphatase level (p=0.019) and –22.9%+13.7% for the urinary N-telopeptide/creatinine ratio (p=0.047). There was no statistically significant difference between the two groups in terms of the serum osteocalcin levels and urinary hydroxyproline/creatinine and calcium/creatinine ratios. Etidronate was generally well tolerated and its adverse event profile was similar to that of placebo. The results of this study indicate that cyclic etidronate therapy can prevent trabecular bone loss, with no deleterious effect on cortical bone, in the first 5 years of menopause and that it has a very high safety margin.     

Weight,body composition,and bone density in postmenopausal women

Associations of body weight and body composition with bone mineral density (BMD) were examined in 261 postmenopausal women. BMD, body fat, and body nonfat soft tissue (NFST) were measured by dual-energy X-ray absorptiometry (DXA). A height-independent BMD variable (HIBMD) was calculated to correct for differences among individuals in bone thickness, a dimension that is ignored by DXA scanners. HIBMD was calculated as BMD divided by height at the spine and femoral neck, and BMD divided by the square root of height at the total body. Weight, fat, and nonfat soft tissue were all positively correlated with both BMD and HIBMD, but the magnitudes of regression and correlation coefficients were lower when HIBMD was the dependent variable. The weight-independent associations of body composition with HIBMD were examined by including weight and % NFST together in linear models. In these analyses, weight was positively associated with HIBMD at all three skeletal sites (r=0.22–0.26, P<0.05), % NFST was not associated with HIBMD at the spine or femoral neck (r=0.01–0.02), and there was only a weak inverse correlation of % NFST with total body BMD (r=-0.12, P<0.05). These findings are consistent with those of previous studies demonstrating positive associations between body weight and BMD. In addition, they demonstrate that once bone thickness and body weight are taken into account, body composition appears to have little if any independent effect on bone density at the skeletal sites measured. This finding is consistent with the hypothesis that the protective effect of body weight is brought about predominantly through its mechanical force on the skeleton.     

Heel ultrasound in women after long-term ERT compared with bone densities in the forearm,spine and hip

To compare heel ultrasound values with bone densitites at different measurement sites as determined by single photon absorptiometry (SPA) and dual-energy X-ray absorptiometry (DXA) in long-term users of estrogen replacement therapy (ERT), we analyzed data from 30 users of estradiol implants (mean duration of treatment 16 years) and 32 non-users, comprising 28 complete age-matched pairs. The precision errors in vivo of ultrasound measurements were 0.18%, 1.3% and 1.5% for speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness index, respectively. In the controls, ultrasound parameters correlated well with values from SPA and DXA measurements (r=0.51–0.63,p<0.004). In long-term users of ERT, however, measurements with ultrasound did not correlate with DXA in the spine and hip (r=0.01–0.31, NS) but correlated well with SPA in the forearm (r=0.47–0.66,p<0.009). Implant users, compared with non-users, had small and just significantly different values when measured by ultrasound (at most 12%,p=0.03–0.04) but significantly higher bone mineral densities (18%–25%,p=0.0001–0.01) in the forearm, spine and hip when measured by SPA or DXA. Data indicated that a substantial proportion of long-term users of estrogen may be non-responders concerning the effect of estrogen on bone qualities expressed in heel ultrasound values. In a multivariate regression analysis the effect of increasing age and increasing treatment duration were both negative for the ultrasound parameters. This is in contrast to our previous finding for bone density parameters in which the negative effect of increasing age was more than compensated by the positive effect of increasing treatment duration. Heel ultrasound correlated poorly with DXA measurement of axial bone density in long-term estrogen users. It has been stated that ultrasound measurements of bone status represent architecture and structure independently of bone mass. If so, then longterm ERT seems, in a substantial proportion of women, to preserve the bone mass and density better than the structure of the bone. Thus, the present study demonstrates a situation where ultrasound determinations can not simply be extrapolated to reflect the mineral density of the central skeleton.     

Leisure physical activity is associated with quantitative ultrasound measurements independently of bone mineral density in postmenopausal women

The purpose of this study was to assess the magnitude of the relationship between leisure physical activity and bone status as measured either by an Achilles^TM ultrasound bone densitometer (QUS) or dual-energy X-ray absorptiometry (DXA) in postmenopausal women. We studied 1162 French Canadian postmenopausal women, aged 33–84 years (mean age 58 years), for QUS parameters [broadband ultrasound attenuation (BUA), speed of sound (SOS), and stiffness index (SI)] measured at the right calcaneus, and bone mineral density (BMD) measured at the lumbar spine and femoral neck. Multivariate regression analyses revealed that leisure physical activity level was an independent predictor of the heel QUS parameters and of femoral neck BMD. No such association was observed for BMD of the lumbar spine. Heel QUS parameters (BUA, SOS, SI) and femoral neck BMD adjusted for interfering covariables showed a statistically significant difference between sedentary (less than three sessions/month) and active women (three or more sessions/week) (P 0.001). Furthermore, after adjusting each heel QUS parameters for the mean lumbar spine BMD value, the association observed between leisure physical activity and QUS remained significant. These results suggest that regular leisure physical activity could influence QUS parameters, independently of BMD, and that quantitative ultrasound could be a suitable outcome measure in exercise studies in postmenopausal women.     

喝牛奶与绝经后妇女骨密度关系的临床研究

目的 探讨喝牛奶与绝经后妇女骨密度的相关性。方法 随机选择1478例福州汉族绝经后妇女,喝牛奶组795例,不喝牛奶组683例,双能X线骨密度仪测定腰椎、股骨颈、大转子和Ward区骨密度,SPSS 18.0统计软件分析喝牛奶与不同部位骨密度的关系。结果 ①喝牛奶组与不喝牛奶组两组比较,结果为年龄、体重、质量指数有差异。②腰椎骨密度与年龄、体重指数、喝牛奶、体重进行逐步回归分析（y=0.843-0.003×年龄-0.010×BMI+0.006×体重+0.016×喝牛奶,β=0.392,回归系数t检验P=0.000）,体重对腰椎骨密度影响较大。③体重、体重指数、年龄为协变量,喝牛奶为变量,行协方差分析,喝牛奶组腰椎BMD（0.754±0.138g/cm2）明显高于不喝牛奶组（0.742±0.113g/cm2）,统计学有显著性差异(F=5.935,P=0.015),股骨颈骨密度无差异。④喝牛奶组骨质疏松患病率为69.18%,不喝牛奶组患病率为71.16%,两者比较无差异（P=0.42）。结论 喝牛奶可维持绝经后女性腰椎高骨密度,这类人群适量饮用牛奶,一定程度上,具有预防骨质疏松的作用。     

Assessment of the bone status of Nigerian women by ultrasound and biochemical markers

Ultrasound analysis of the calcaneus and serum markers of bone turnover were used to examine the bone status of healthy Nigerian women who reside in an area of the world where dietary calcium intake is generally low and estrogen replacement therapy is not widely available. A total of 218 women (108 premenopausal and 110 postmenopausal) between the ages of 16 and 95 years were enrolled in the study. Broadband ultrasound attenuation (BUA) and speed of sound velocity (SOS) were measured and used to calculate the stiffness index (SI) of the calcaneus. In this cross-sectional study, the Nigerian women exhibited a marked age-dependent decline in SI that was defined by the regression equation SI=105.9–6.62E-3×Age². SI was significantly correlated with age (r=−0.41,P<0.001) and with serum NTx concentrations (r=−0.26,P<0.001), but not with serum levels of bone specific alkaline phosphatase (BSAP). Years since menopause was also significantly correlated with SI (r=0.40,P<0.001). A significant increase in serum NTx concentration occurred at least a decade before a significant decline in SI was evident. In the total study group, 24% of the women had T-scores indicative of osteopenia and 9% had T-scores indicative of osteoporosis, based on US reference data. Although the reported current incidence of fracture is low in women in sub-Saharan West Africa, these data show that after menopause Nigerian women have a decline in bone quality and increase in bone turnover similar to North American Caucasian women.     

Effect of cyclical therapy with phosphorus and etidronate on axial bone mineral density in postmenopausal osteoporotic women

Forty seven women with postmenopausal osteoporosis and at least one but no more than four vertebral compression fractures received sequential and cyclical therapy with phosphorus and etidronate (p/etid). During the same 2-year period of observation, three other groups of patients received either sodium fluoride (n=12), estrogen replacement therapy (n=12), or vitamin D and calcium (Ca⁺⁺) alone (n=15).Axial bone mineral density (BMD) was measured by means of dual-photon absorptiometry. Lateral thoracic and lumbar spine radiographs were taken to assess fractures. Bone mineral density increased from baseline during p/etid therapy: Mean 15.7±1.6% (SD) (P<0.001). During the same time, the patients in the sodium fluoride group showed a comparable increase in their BMD from baseline: mean 15.7±1.1% (P<0.001). During the first year of therapy, patients in the estrogen replacement group had an increase in their BMD from baseline: mean: 4.6%±1.1% (P<0.05). No change in BMD was seen in the control group that received vitamin D and Ca⁺⁺ alone.No patient who received p/etid, sodium fluoride, or estrogen replacement therapy had any new vertebral compression fractures or height loss, whereas in the control group that received vitamin D and Ca⁺⁺ alone 6 out of 15 had height loss and at least one new vertebral fracture (P<0.01).p/etid therapy increases BMD in women with postmenopausal osteoporosis comparable to sodium fluoride but without side effects or toxicity and stabilizes vertebral compression fractures.     

绝经后妇女骨质疏松性椎体骨折与腰椎骨密度的关系

目的探讨绝经后妇女骨质疏松性椎体骨折与腰椎骨密度的关系。方法选择骨质疏松性椎体骨折的绝经后妇女23例为骨折组,无椎体骨折的25例绝经后骨质疏松妇女为对照组。两组的年龄、绝经年限、身高、体重、体重指数差异无显著性,均行胸腰椎正侧位X线摄片。用双能X线吸收仪（DXA）测量的腰椎（L2-4）前后位骨密度（BMD）、骨矿含量（BMC）和T值。结果骨折组BMD、BMC和T值均低于对照组（P〈0.01）。结论腰椎BMD降低与绝经后妇女的骨质疏松性椎体骨折相关。绝经后骨质疏松妇女应重视BMD变化,预防椎体骨折的发生。     

Homocysteine and fracture risk in postmenopausal women: the OFELY study

Summary Homocysteine has recently been described as an independent risk factor for osteoporotic fractures in the elderly. We prospectively followed 671 postmenopausal women belonging to the OFELY study, mean age 62 years, during a mean follow-up of 10 years. After adjustment for age, there was no significant relation between the plasma level of homocysteine and the subsequent risk of fracture. Introduction Plasma homocysteine increases with age. Recent studies have described homocysteine as an independent risk factor for osteoporotic fractures in elderly. We investigated the role of plasma homocysteine in the subsequent risk of fractures in healthy ambulatory postmenopausal women. Methods Homocysteine was measured at baseline in 671 postmenopausal women from the OFELY cohort (mean age 62.2 ± 9 years). Incident clinical fractures were recorded during annual follow-up and vertebral fractures were evaluated with radiographs every four years. A cox proportional hazards model based on time to first fracture was used to calculate hazard ratios for quartiles of homocysteine values. Results Mean homocysteine was 10.6 ± 3.4 μmol/l, increasing with age. After adjustment for age, homocysteine was significantly associated with physical activity, calcium intake, serum albumin and serum creatinine but not with bone turnover markers and bone mineral density. During a mean follow-up of 10 years, 183 fractures occurred among 134 women. After adjustment for age, the overall relative risk of fracture for each 1 SD increment of homocysteine was 1.03 (95%CI 0.87–1.31). Fracture risk was higher in women with homocysteine in the highest quartile without adjustment but no longer after adjustment for age. Conclusions Homocysteine is not an independent risk factor of osteoporotic fractures in healthy postmenopausal women from the OFELY cohort with a broad age range.     

绝经后女性非酒精性脂肪性肝病与骨密度的相关性研究

目的研究乌鲁木齐市绝经后女性非酒精性脂肪性肝病与骨密度的关系。方法根据非酒精性脂肪性肝病(NAFLD)诊断标准,将我院住院的66例绝经后中老年女性分为NAFLD组和正常对照组,NAFLD组34例,正常对照组32例。对所有研究对象的肝/脾CT比值、骨密度(BMD)、身高、体重和血液生化学指标进行数据收集及统计学处理。结果 (1)NAFLD组的体质指数(BMI)、谷酰转肽酶(GGT)、甘油三酯(TG)和空腹血糖(FBG)高于对照组,低密度脂蛋白(LDL)低于对照组(P0.05)。(2)NAFLD组的腰椎及髋部各部位BMD均低于对照组,但差异不具有统计学意义(P0.05)。(3)NAFLD组的肝/脾CT比值与大转子和全髋BMD呈正相关;谷丙转氨酶(ALT)、谷草转氨酶(AST)与股骨颈、Ward三角和全髋BMD呈正相关;FBG与股骨颈和Ward三角BMD呈正相关(P0.05)。对照组的LDL、脂蛋白a[LP(a)]与髋部BMD关系密切:LDL与股骨颈和Wards三角BMD呈正相关,LP(a)与髋部各部位BMD呈显著负相关(P0.05)。结论 (1)肝脂肪变可能会导致患NAFLD绝经后女性的髋部BMD减低,高血糖可能对患NAFLD的绝经后女性髋部BMD具有保护作用。(2)LP(a)可能是无NAFLD绝经后女性髋部发生BMD减低的危险因素。(3)NAFLD可能会使绝经后女性体内ALT、AST、LDL、LP(a)及血糖对髋部BMD的影响作用发生改变。     

Effects of age and menopause on bone density of entire skeleton in healthy and osteoporotic women

We studied 885 women to evaluate the effects of age and menopause on bone mineral density (BMD) in both healthy and postmenopausal osteoporotic subjects. The study cohort consisted of 161 healthy premenopausal women (age range 25–54 years), 357 healthy postmenopausal women (35–85 years) and 367 osteoporotic women (41–87 years). Total body and regional (spine, trunk, pelvis, arms, legs) BMD were measured with a dual-energy X-ray (DXA) device (Lunar DPX). Premenopausal BMD values remained essentially unchanged until the first half of the fourth decade, when they decreased. BMD values in both healthy postmenopausal and osteoporotic women were significantly lower than premenopausal values, and continued to decrease statistically after the onset of menopause. The highestZ-score (0.96±0.92) was found for total body BMD. HigherT-score values were found in osteoporotic than in normal postmenopausal women. In both healthy and osteoporotic postmenopausal women the best fits for BMD changes in total body, spine, trunk, arms and legs were obtained with the natural logarithm of years since menopause; only the pelvis BMD decreased linearly. Multiple regression analysis indicated that postmenopausal BMD changes in both normal and osteoporotic women were linked chiefly to body weight and years since the onset of menopause.