814例绝经后女性初潮年龄、绝经年龄及月经维持年限与骨质疏松症相关性研究

目的调查了解广州市社区绝经后妇女的生理因素对骨质疏松症的患病率及骨密度(BMD)的影响,为围绝经期女性骨质疏松的预防提供进一步证据。方法采用现场问卷调查了解受试者的基本资料,美国双能X线骨密度仪测量1199例绝经后女性的腰椎正位和左髋部骨密度,以年龄分组进行分析。结果共纳入的814名绝经后妇女当中,腰椎发生骨质疏松症300例,发生率36.9%;髋部发生骨质疏松的312例,发生率38.3%。绝经年限10年内的妇女中,初潮年龄较晚的骨密度越低,发生骨质疏松的风险越高; 55～65岁的绝经后妇女中,绝经年龄较早的骨密度越低,骨质疏松发生的风险越高;月经维持的年限越短,骨密度越低,发生骨质疏松的风险越高。结论广州市社区中绝经后妇女的骨质疏松患病率较高,初潮年龄较晚、绝经年龄较早或月经维持年限较短的妇女骨质疏松的发病率明显升高,建议早筛查、早诊断、早治疗。髋部BMD值是评价骨质疏松症较为敏感的指标,应该首选髋部作为骨密度测量的部位。     

甘肃省20岁～80岁和绝经后女性骨质疏松症患病影响因素分析

目的了解甘肃省20~80岁汉族女性以及绝经女性骨质疏松症患病率,探讨女性骨质疏松症的影响因素。方法2016年7月~8月采用分层整群随机抽样方法在甘肃省兰州市、张掖市、高台县、肃南裕固族自治县选取20~80岁汉族女性进行问卷调查,应用法国Medilink公司生产的Pegasus超声骨密度仪检测跟骨骨强度,采用χ~2检验和非条件logistic回归对骨质疏松症的可能影响因素进行分析。结果甘肃省20~80岁汉族女性骨质疏松症总患病率为15.10%,40~80岁绝经后女性骨质疏松症患病率为25.88%。体重指数越大(OR=0.392,95%CI:0.229-0.672)、从事的职业劳动强度重(OR=0.461,95%CI:0.295-0.721)和体育锻炼频次多(OR=0.565,95%CI:0.407-0.786)有利于降低骨质疏松症发生,有既往骨折史的女性发生骨质疏松症风险高(OR=1.544,95%CI:1.080-2.205)。绝经是骨质疏松症的危险因素(P未绝经组=8.33%vs P绝经组=22.76%,P0.0001;OR=2.633,95%CI:1.655-4.190),其中绝经年限越长骨质疏松症的发生风险越高(OR=2.910,95%CI:1.426-5.939),女性绝经年龄越晚发生骨质疏松症的风险越低(OR=0.354,95%CI:0.172-0.628)。结论针对体重指数低、有既往骨折史、运动少、绝经年龄早和绝经年限长的女性应该格外关注。在膳食上注意补充钙和维生素D,生活上经常锻炼运动。了解骨质疏松症的患病情况及研究其影响因素对成年妇女的健康促进具有重要意义。     

市郊绝经后妇女骨质疏松症知识知晓情况的调查

目的了解市郊绝经后妇女的骨质疏松症知识水平以及影响因素。方法采用一般资料问卷和骨质疏松症相关知识问卷对246名市郊绝经后妇女进行调查。结果市郊绝经后妇女对骨质疏松症相关知识得分（9．47±6．38）分,及格率仅14．63％。65岁以上、文盲及小学文化程度者或不在婚妇女的知识水平显著低于65岁以下、初中文化程度或在婚的绝经后妇女（均P〈0．05）。年龄、文化程度、婚姻是骨质疏松症相关知识得分的影响因素（P〈0.05,P〈0.01）。54．06％的市郊绝经后妇女主要从医护人员处获得知识,且77．24％的市郊妇女最希望与医护人员面对面交谈获取知识。结论市郊绝经后妇女骨质疏松症知识亟需提高,社区压护人琦以及政府应针对市都农村人群的特征．采取有效措施,提高其骨质疏松症知识水平。     

颈动脉内膜中层厚度和绝经后妇女骨密度相关性研究

目的探讨绝经后骨质疏松症患者颈动脉内膜中层厚度(CIMT)的差异及CIMT和斑块增大的风险。方法进行横断面研究,包括60位绝经后骨质疏松症妇女和60位非骨质疏松症绝经后妇女。CIMT采用B型超声测量。结果绝经后骨质疏松症妇女与无骨质疏松症妇女的平均CIMT差异无统计学意义(P 0.05)。骨质疏松症组CIMT升高的风险与非骨质疏松症组相似。骨质疏松症妇女斑块出现的风险是正常人的三倍。然而,调整了易使妇女患有心血管疾病的年龄和基础疾病后,两组之间斑块的存在并无显着差异(校正比值比=0.85;95%可信区间0.10～6.464)。结论绝经后妇女与无骨质疏松症患者的平均CIMT无差异。绝经后骨质疏松症女性的CIMT升高风险与无骨质疏松症的绝经后妇女相当。两组之间斑块的存在没有显着差异。     

甘肃省20-80岁和绝经后女性骨质疏松症患病影响因素分析

目的 了解甘肃省20-80岁汉族女性以及绝经女性骨质疏松症患病率,探讨女性骨质疏松症的影响因素。 方法 2016年7-8月采用分层整群随机抽样方法在甘肃省兰州市、张掖市、高台县、肃南裕固族自治县选取20-80岁汉族女性进行问卷调查,应用法国Medilink公司生产的Pegasus超声骨密度仪检测跟骨骨强度,采用?2检验和非条件logistic回归对骨质疏松症的可能影响因素进行分析。 结果 甘肃省20-80岁汉族女性骨质疏松症总患病率为15.10%,40-80岁绝经后女性骨质疏松症患病率为25.88%。体重指数越大(OR=0.392,95%CI: 0.229-0.672)、从事的职业劳动强度重(OR=0.461,95%CI: 0.295-0.721)和体育锻炼频次多(OR=0.565,95%CI: 0.407-0.786)有利于降低骨质疏松症发生,有既往骨折史的女性发生骨质疏松症风险高(OR=1.544, 95%CI: 1.080-2.205)。绝经是骨质疏松症的危险因素(P未绝经组=8.33% vs P绝经组=22.76%,P?0.0001;OR=2.633,95%CI: 1.655-4.190),其中绝经年限越长骨质疏松症的发生风险越高(OR=2.910,95%CI: 1.426-5.939),女性绝经年龄越晚发生骨质疏松症的风险越低(OR=0.354,95%CI: 0.172-0.628)。 结论 针对体重指数低、有既往骨折史、运动少、绝经年龄早和绝经年限长的女性应该格外关注。在膳食上注意补充钙和维生素D,生活上经常锻炼运动。了解骨质疏松症的患病情况及研究其影响因素对成年妇女的健康促进具有重要意义。     

昆明地区绝经后妇女腰椎QCT测量分析

目的通过对昆明地区绝经后妇女腰椎定量CT(QCT)测定值进行分析,以探讨昆明地区绝经后妇女骨密度(BMD)变化的规律,不同年龄段骨质疏松症(OP)的检出率。方法以出生并生活在昆明市区的50～79岁、绝经1年以上的社区女性208例为研究对象,用定量CT法测量其腰1至腰5的骨密度(BMD)。结果绝经1年以上的妇女BMD均值均进入骨质疏松期,随着年龄的增加其BMD均值逐渐降低,且昆明地区绝经后妇女各年龄段的BMD均值均较北方同年龄段人稍低,绝经后妇女骨量减少和骨质疏松症的发生率均随年龄的增加而明显增高(P0.01),其中50～59岁年龄段上升速度较快,60岁以后上升速度明显趋缓。结论 QCT诊断绝经后妇女骨质疏松具有较高的敏感性、准确性及可重复性,昆明地区绝经后妇女骨密度均值稍低于北方同年龄组,骨质疏松的程度稍重一些,昆明地区绝经后妇女骨量减少和骨质疏松症的发生率均随年龄的增加而明显增高,明显增高年龄段主要在55～59岁。     

MTHFR基因多态性与蒙古族绝经后妇女骨质疏松的相关性研究

目的探讨本地区蒙古族绝经后妇女亚甲基四氢叶酸还原酶(methylenetetrahydrofolate reductase,MTHFR)基因的多态性位点C677T、A1298C基因多态性与内蒙古地区蒙古族绝经后女性骨质疏松症(osteoporosis,OP)遗传易感性的关系。方法收集150例门诊及住院(确诊为骨质疏松)蒙古族绝经后妇女为观察组,对照组来自门诊按年龄配比的骨含量正常的蒙古族绝经后妇女145例,均以双能X线骨密度仪测定腰椎和髋部骨密度,以T值≤-2.5诊断为骨质疏松,-2.5≤T≤-1.0为骨含量减少,T值-1.0为骨含量正常,并进行MTHFR C677T及A1298C基因多态性检测。结果骨质疏松组MTHFR基因受体C677T基因型CC、CT、TT频率分别为29.3%、44.0%和27.7%,对照组基因型CC、CT、TT频率分别为42.8%、44.8%和12.4%,两组差异有统计学意义(P=0.017)。骨质疏松症组中的T等位基因频率为48.7%,显著高于对照组(34.8%,P=0.005),提示T等位基因是骨质疏松发生的危险因素(OR=1.77,95%CI=1.18~2.64,P=0.001)。与CC基因型相比,TT基因型携带者的骨质疏松发生风险增加至3.15倍(95%CI=1.45~6.86,P=0.004),该作用在年龄≥60岁及体重指数偏高的女性中表现更明显。而MTHFR A1298C的多态性位点对绝经后骨质疏松的发生没有显著影响(P=0.513)。结论 MTHFR C677T基因变异与蒙古族绝经后妇女骨质疏松易感性明显相关,MTHFR A1298C的多态性位点与蒙古族绝经后妇女骨质疏松的发生没有明显相关性。     

甘肃省藏族与汉族妇女绝经前和绝经后骨强度变化对 比分析

目的探讨甘肃省藏族和汉族妇女绝经前和绝经后骨强度变化。方法采用GE EXPRESSⅡ超声骨密度测量仪对109例年龄40~52岁绝经前和100例年龄53~60岁绝经后藏族妇女与55例年龄40~52岁绝经前和72例年龄53~60岁绝经后汉族妇女进行骨强度对比分析。测量右脚跟骨的骨强度、骨质情况,通过计算T值和Z值,评估藏族和汉族妇女绝经前和绝经后骨强度变化和骨折风险。结果 1.藏族和汉族妇女绝经前骨强度指数明显均高于绝经后藏族和汉族妇女;藏族妇女和汉族妇女两者之间对比无差别(t=7.408,P=0.000;t=4.903,P=0.000)。2.藏族和汉族妇女绝经后骨质少孔和骨质疏松检出率明显高于绝经前藏族和汉族妇女;藏族和汉族妇女两者之间对比无差别(χ2=7.928,P=0.000;χ2=7.723,P=0.021)。结论 1.绝经后藏族和汉族妇女骨质流失较严重,应及时补充雌激素和钙剂,预防骨质疏松的发生。2.由于少数民族与汉族长期居住在一起,生活和饮食习惯逐渐相近及地理环境相同,使得绝经前和绝经后藏族妇女与绝经前和绝经后汉族妇女骨强度变化、骨质少孔及骨质疏松检出率无明显差别。     

绝经后非糖尿病妇女骨质疏松症影响因素的Logistic回归和ROC曲线分析

目的观察绝经后非糖尿病妇女骨质疏松症的影响因素,探讨影响骨质疏松的关键因素。方法选取北京市海淀区社区共343名48~86岁的中老年绝经后非糖尿病妇女,开展相关问卷调查,并对其进行骨密度测定。结果343名绝经后非糖尿病妇女骨质疏松症患病率为42.6%;单因素Logistic分析显示年龄、年龄、文化程度、产次、体质指数(Body Mass Index,BMI)、血清碱性磷酸酶(Alkaline Lipase,ALP)是骨质疏松的可能影响因素(P0.05)。多因素Logistic分析显示高龄、高ALP是中老年绝经后妇女骨质疏松发病的可能影响因素,高BMI是其的可能保护因素。ROC曲线分析表明联合BMI、ALP、年龄的曲线下面积(Area Under the Curve,AUC)为0.761,敏感性68.71%,特异性72.08%,最佳诊断临界值为0.437。结论绝经后非糖尿病妇女骨质疏松症患病率较高,年龄、ALP、BMI为影响骨质疏松的关键因素。     

市郊绝经后妇女骨质疏松症知识知晓情况的调查

目的了解市郊绝经后妇女的骨质疏松症知识水平以及影响因素。方法采用一般资料问卷和骨质疏松症相关知识问卷对246名市郊绝经后妇女进行调查。结果市郊绝经后妇女对骨质疏松症相关知识得分(9.47±6.38)分,及格率仅14.63%。65岁以上、文盲及小学文化程度者或不在婚妇女的知识水平显著低于65岁以下、初中文化程度或在婚的绝经后妇女(均P0.05)。年龄、文化程度、婚姻是骨质疏松症相关知识得分的影响因素(P0.05,P0.01)。54.06%的市郊绝经后妇女主要从医护人员处获得知识,且77.24%的市郊妇女最希望与医护人员面对面交谈获取知识。结论市郊绝经后妇女骨质疏松症知识亟需提高,社区医护人员以及政府应针对市郊农村人群的特征,采取有效措施,提高其骨质疏松症知识水平。     

北京地区3859名体检人群骨密度调查及骨量异常患病率分析

目的调查北京地区健康体检人群骨密度的情况以及骨量减少和骨质疏松的患病率,为骨质疏松症的防治提供参考。方法选择2017年1月至2018年12月在中日友好医院健康体检中心进行健康体检的人群,排除继发性骨质疏松症及其他影响骨代谢的因素,共3859名。其中男性2067名,女性1792名。年龄20~83岁,平均年龄(51.29±11.18)岁,按性别及年龄每10年一组。采用美国GE公司的LUNAR Prodigy双能X线骨密度仪测量受试者腰椎1~4正位及股骨颈和全髋的骨密度。分析各组不同部位骨密度情况及骨量异常(包括骨量减少和骨质疏松)的患病率。采用SPSS 22.0统计软件进行分析,以P<0.05为差异有统计学意义。结果①男性腰椎1~4骨密度峰值在20~29岁,股骨颈和全髋骨密度峰值在30~39岁。女性各部位骨密度峰值均在30~39岁。②随年龄增长,男性和女性骨量异常患病率均呈上升趋势,50岁以上女性骨量异常患病率显著上升,明显高于同年龄组男性。③30~59岁男性和女性腰椎骨量异常患病率均明显高于髋部;70岁以上男性和60岁以上女性髋部骨量异常患病率明显高于腰椎。结论中老年人群尤其是绝经后女性是骨质疏松症的高危人群;老年人群的骨质疏松筛查可以考虑选择髋部骨密度为主。     

Predictive value of low BMD for 1-year fracture outcomes is similar for postmenopausal women ages 50-64 and 65 and Older: results from the National Osteoporosis Risk Assessment (NORA).

The relationship of low bone mass and fracture in younger postmenopausal women has not been extensively studied. In a large cohort of postmenopausal women > or =50 years of age, we found the relationship of BMD measured at peripheral sites and subsequent 1-year fracture risk to be similar between women <65 and those > or =65 years of age. INTRODUCTION: Low bone mass and fractures are prevalent in older postmenopausal women. However, the frequency of low bone mass and fracture in younger postmenopausal women has not been studied extensively. There are very limited data regarding the association between BMD measurements and fractures in postmenopausal women who are between the ages of 50 and 64. MATERIALS AND METHODS: In the National Osteoporosis Risk Assessment (NORA) we studied the frequency of low bone mass and its association with fracture in women 50-64 years of age in comparison with women > or =65 of age. NORA enrolled 200,160 postmenopausal women > or =50 years of age who had no prior diagnosis of osteoporosis. Baseline BMD was measured at the heel, forearm, or finger. A 1-year follow-up survey requesting incident fractures since baseline was completed by 163,935 women, 87,594 (53%) of whom were 50-64 years of age. The association between BMD and fracture was assessed using logistic regression, adjusted for important covariates. RESULTS: Thirty-one percent of women 50-64 years of age had low bone mass (T scores < or = -1.0) compared to 62% of women > or =65 years of age. During the first year of follow-up, 2440 women reported fractures of wrist/forearm, rib, spine, or hip, including 440 hip fractures. Nine hundred four women 50-64 years of age reported fractures, including 86 hip fractures, accounting for 37% of fractures and 20% of hip fractures reported in the entire NORA cohort. Relative risk for osteoporotic fracture was 1.5 for each SD decrease in BMD for both the younger and older groups of women. CONCLUSION: Low BMD in younger postmenopausal women 50-64 years of age showed a 1-year relative risk of fracture similar to that found in women > or =65 years of age.     

Higher sea fish intake is associated with greater bone mass and lower osteoporosis risk in postmenopausal Chinese women

Summary  

We examined the cross-sectional association of the intakes of different types of fishes with bone mass and osteoporosis risk in postmenopausal Chinese women. We found that higher intake of sea fish is independently associated with greater bone mass and lower osteoporosis risk among postmenopausal Chinese women.     

High serum sclerostin predicts the occurrence of osteoporotic fractures in postmenopausal women: The center of excellence for osteoporosis research study

Sclerostin regulates bone formation by inhibiting Wnt pathway signaling. Low circulating sclerostin levels cause high bone mass. We hypothesized that postmenopausal women with increased sclerostin levels have a greater risk for osteoporosis‐related fractures. We examined the association between circulating sclerostin together with bone turnover markers and osteoporosis‐related fracture risk in 707 postmenopausal women, in a population‐based study with a mean follow‐up period of 5.2 ± 1.3 years. Multivariate Cox proportional hazards regression models were used to analyze fracture risk, adjusted for age, body mass index, and other confounding risk factors. High sclerostin levels were strongly associated with increased fracture risk. After adjustment for age and other confounders, the relative fracture risk was more than sevenfold among postmenopausal women for each 1‐SD increment increase in sclerostin level. Women in the highest quartile of sclerostin levels had about a 15‐fold increase in fracture risk. Results were similar when we compared sclerostin at the 1‐year visit to an average of two to three annual measurements. Fracture risk attributable to sclerostin levels was 56.6% in the highest quartile. Only high levels of bone resorption markers (plasma cross‐linked C‐terminal telopeptide of type 1 collagen [p‐CTx], urinary CTx [u‐CTx], and urinary N‐telopeptide of type 1 collagen [u‐NTx]) were predictive of osteoporosis‐related fractures but at much lower hazard ratio (HR) values than that of serum sclerostin. Associations between sclerostin levels and fracture risk were independent of bone mineral density and other confounding risk factors. High sclerostin levels are a strong and independent risk factor for osteoporosis‐related fractures among postmenopausal women. © 2012 American Society for Bone and Mineral Research.     

Spine and femur density and broadband ultrasound attenuation of the calcaneus in normal Spanish women

Summary Bone density of the spine and femoral neck and broadband ultrasound attenuation of the calcaneus were measured in 111 normal Spanish women between the ages of 30 and 70 years. The cross-sectional study showed that spine and hip density decreased by 36 and 29%, respectively, and the ultrasound attenuation value decreased by 32% between 30 and 70 years of age. The rate of bone loss at the three sites was significant in women over age 50 and in postmenopausal women. These normative data will be helpful in assessing bone mass in Spanish women suspected of having osteoporosis.     

The late effect of subtotal thyroidectomy and radioactive iodine therapy on calcitonin secretion and bone mineral density in women treated for Graves' disease

This study was designed to evaluate the effect of subtotal thyroidectomy and/or radioactive iodine therapy on plasma immunocalcitonin (iCT) levels and bone densities in patients treated for Graves' disease. Forty-eight women whose ages ranged from 29 to 79 years (mean, 55 years) were evaluated. All were at least 10 years beyond treatment. Fourteen patients had undergone subtotal thyroidectomy, 22 had received radioactive iodine therapy, and 12 had received both. Serum calcitonin levels were measured with the patient fasting and at 30 minutes and 2 hours after the ingestion of 15 mg of calcium in orange juice. Single photon absorptiometry was used to measure bone mineral density of the middle and distal radius. The mean fasting plasma levels of iCT for patients undergoing subtotal thyroidectomy was 27 +/- 2 mumol/L; women treated with radioactive iodine, 26 +/- 2; women undergoing subtotal thyroidectomy followed by radioactive iodine, 24 +/- 2, and for normal control women, 48.5 +/- 4.7. The mean stimulated iCT level of each of the patient groups was significantly lower than that of the normal controls (p = 0.01). There were no significant differences among the groups. Although there was an increased loss of bone mineral density in postmenopausal patients, with age and race as covariates, the bone densities of the distal radius in women undergoing subtotal thyroidectomy and/or receiving radioactive iodine were not significantly lower than those of normal control subjects (p greater than 0.05). These findings are consistent with other observations that patients treated by thyroidectomy and/or radioactive iodine for Graves' disease have lower basal levels of calcitonin and decreased calcitonin response to a provocative stimulus. Whether this loss of calcitonin reserve is a significant factor in development of postmenopausal osteoporosis remains unanswered.     

绝经后女性股骨近端骨密度与骨质疏松性骨折相关性研究

目的：研究绝经后女性股骨近端骨密度的变化规律与骨质疏松症、骨质疏松性骨折间的关系。方法采用法国Medlink公司Osteocore 3型双能X线骨密度仪,对本地区417例绝经后女性股骨颈、大转子、粗隆间、全髋进行骨密度测定。结果骨折组各年龄段、各部位的BMD均比非骨折组低（ P＜0．05）。随着年龄的增长,股骨近端骨量逐渐丢失,除了45～50组,其余各年龄段骨折组的患病率明显高于非骨折组（ P＜0．05）,骨密度值越低,骨折危险性越大。结论绝经后女性股骨近端骨密度与发生骨质疏松性骨折的风险呈明显负相关性,应该注意预防。     

Prevalence of Postmenopausal Osteoporosis in Italy and Validation of Decision Rules for Referring Women for Bone Densitometry

We report the prevalence of osteoporosis, osteopenia, and fractures in a cohort of Italian women randomly recruited among the general population and validate the use of clinical guidelines in referring women for bone density testing. We enrolled in the study 995 healthy women (age range 45–92 years). A bone density test at the lumbar spine and femur was performed and a questionnaire on osteoporosis risk factors completed for all patients. The prevalence of osteoporosis was 33.67 %, that of osteopenia was 46.63, and 19.7 % were normal at bone density testing. Osteoporotic women were generally older and thinner, with a shorter period of estrogen exposure. The prevalence of fractures was 21.9 %, and fractured women had a lower bone density, were older, and had a longer postmenopausal period. Clinical guidelines for referring women for bone density testing performed poorly (the best performance was 68 %). This is the first study providing data on the prevalence of osteoporosis/osteopenia and of fractures in a cohort of healthy postmenopausal women. Known risk factors influence bone density and risk of fractures. The role of screening in detecting women with postmenopausal osteoporosis is far from optimal.     

上海市区居民3051例跟骨骨密度的测量

对上海市区居民３０５１人进行了跟骨骨密度测定。其中男１４４４人，女１６０７人，年龄１１～９５岁，按５岁为一年龄组将其分为１７组。结果：跟骨骨峰值出现在２０～２４岁组，女性骨峰值显著小于男性，中年开始出现跟骨骨量丢失，女性的骨丢失速度显著快于男性。女性骨累积丢失量也显著大于男性。女性的跟骨累积丢失量仅次于Ｗａｒｄ三角。跟骨骨密度除了随年龄变化外，也受身高、体重及体重指数的影响。６０岁以上老年女性骨质疏松症的患病率显著高于男性，男、女分别为１３．９％、５８．０％。结论：跟骨骨密度的测量能较好地反映人体骨矿含量的变化规律