Bone mineral density of the proximal femur and lumbar spine in glucocorticoid-treated asthmatic patients

The importance of the proximal femur as a site of osteoporotic fractures, the development of techniques for bone mineral density (BMD) measurement at this site and the apparent selectivity of the osteopenic effects of glucorticoids have focused attention on the assessment of proximal femoral BMD in steroid-treated subjects. We have, therefore, measured BMD (Lunar DPX) in the lumbar spine and proximal femur of 31 asthmatic patients receiving long-term glucocorticoid therapy (mean ± SEM dose 16 ± 1 mg prednisone/day, mean duration 10 ± 2 years). BMD values expressed as the percentage of normal age- and sex-appropriate mean values, after weight adjustment, were as follows: lumbar spine 80 ± 2%, femoral neck 83 ± 2%, Ward's triangle 78 ± 3% and trochanter 86 ± 2%. All these values were significantly less than control (p<0.0001) and the decrement in BMD was more marked in Ward's triangle than at the other two femoral sites (p<0.05). In all regions BMD was unrelated to dose or duration of steroid treatment. It is concluded that there are reductions in the BMD of the lumbar spine and proximal femur in glucocorticoid-treated asthmatics, probably reflecting the mixed cortical/trabecular makeup of both regions.     

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。     

漯河地区中老年骨质疏松性骨折与股骨近端骨密度相关性研究

目的 调查漯河地区中老年骨密度(BMD)的变化规律和骨折之间的关系。方法 采用法国Medlink公司的的双能X线骨密度仪对漯河地区649名中老年人进行健侧髋部股骨颈、大转子、粗隆间和全髋的骨密度值测量。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~组,其余区域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 中老年人骨近端骨密度值与发生骨质疏松性骨折之间存在密切关系,不容忽视。     

女性类风湿关节炎患者骨密度的研究

目的探讨女性类风湿关节炎(RA)患者骨密度(BMD)的变化和骨质疏松(OP)的发生情况及其与临床指标的相关性.方法采用双能X线骨密度仪,测量了45例女性RA患者和45例女性正常人的前臂、腰椎2～4以及股骨颈、Ward区和大转子的骨矿含量,并同时测定握力、关节功能、X线分期、关节压痛数和肿胀数、日常生活能力评估(以健康评估表HAQ积分表示)和血沉、血清类风湿因子、C反应蛋白、钙、磷、碱性磷酸酶等指标.结果女性RA患者中除股骨Ward区骨量丢失较对照组差异有显著性(P＜0.05)外,其余各测定部位的BMD与对照组间差异无显著性(P＞0.05).45例女性RA患者中发生骨质疏松较非骨质疏松组年龄更大(P＜0.005),关节功能更差(P＜0.01),HAQ积分更高(P＜0.05),握力更低(P＜0.05),CRP更高(P＜0.05).女性RA患者中服用糖皮质激素组与未服用糖皮质激素组间BMD及OP发生情况的差异无显著性(P＞0.05).绝经后女性RA患者的骨量丢失较绝经前明显(P＜0.05);除桡骨远端外,绝经后患者各测定部位BMD均低于绝经前患者(P＜0.05).Logistic Regression分析显示年龄:OR=1.085[(1.019-1.156),P=0.011]和关节功能:OR=4.828[(1.368-17.039),P=0.014]为RA患者骨质疏松发生的相关因素.结论女性RA患者的总体骨量变化与正常人相近,但股骨Ward区的骨量丢失明显高于正常人.其BMD的降低和OP的发生与年龄、绝经和关节炎的严重程度有关.     

股骨颈骨折合并抑郁老年男性骨密度和骨代谢变化

目的分析老年男性股骨颈骨折合并抑郁患者骨密度和骨代谢生化指标变化,探讨抑郁对骨质疏松骨代谢的影响。 方法选取于北京医院骨科2017年1月至2019年1月住院的老年男性股骨颈骨折患者102例。排除病理性骨折、认知功能障碍等患者。依据老年抑郁量表(GDS)将老年男性股骨颈骨折患者分为抑郁组和对照组。通过测定并比较两组患者的骨密度(BMD)、血清碱性磷酸酶(ALP)、血钙、血磷、25-羟基-维生素D[25(OH)D]、骨钙素(OC)、Ⅰ型原胶原氨基端前肽(P1NP)、血清Ⅰ型胶原羧基末端肽交联β特殊序列(β-CTX)水平,分析抑郁严重程度(GDS评分)与骨密度及骨代谢生化指标的相关性。分类变量的比较采用卡方检验,连续变量的比较采用t检验,两组连续性变量的相关性应用Pearson相关分析。 结果抑郁组患者BMD明显低于对照组(腰椎t ＝5.964、髋部t ＝2.845,P <0.05)。与对照组相比,抑郁组血清25(OH)D水平下降(t ＝3.077,P <0.05),抑郁组血清OC水平低于对照组(t ＝2.013,P <0.05),而血清β-CTX水平高于对照组(t ＝2.938,P <0.05),P1NP水平与对照组差异无统计学意义(t ＝0.684,P >0.05)。抑郁严重程度(GDS评分)与BMD(r＝-0.456,P <0.05)、25(OH)D(r＝-0.546,P <0.05)、OC(r＝-0.215,P <0.05)呈负相关,与P1NP(r＝-0.115,P>0.05)相关性不显著,与β-CTX(r＝0.372,P<0.05)呈正相关。 结论抑郁症患者的骨形成标志物水平降低和骨吸收标志物水平升高,抑郁症是低骨密度和骨折的危险因素。应重视老年抑郁症患者骨代谢指标和25(OH)D的检测,及时进行维生素D的补充和有效的抗骨吸收药物治疗。     

强直性脊柱炎患者的骨密度变化

目的 评价强直性脊柱炎患者的骨密度变化，探讨其骨代谢改变的病因和发病机理。方法 采用前瞻性健康对照研究方法，对67例强直性脊柱炎患者以双能X线吸收法测定腰椎、股骨颈、股骨粗隆和Ward三角区骨密度，同时检测骨钙素、降钙素、血钙及炎症急时相反应指标，并与健康对照组进行比较。结果 强直性脊柱炎骨密度与对照组比较：股骨颈、股骨粗隆和Ward三角区骨密度显著降低，早期患者的腰椎骨密度显著降低；血清骨钙素水平较对照组显著降低；骨密度指标与炎症急时相反应指标呈负相关。结论 强直性脊柱炎患者的骨密度降低，其原因应是免疫炎症反应、运动受限等多种因素作用的结果。     

Bone mineral density, bone turnover markers and fractures in patients with indolent systemic mastocytosis

Objective

We systematically assessed bone mineral density (BMD), bone turnover markers (BTM), and fractures in a large cohort of patients with Indolent Systemic Mastocytosis (ISM).

Methods

Eighty-two patients (mean age 48 years, 37 women) with ISM were studied. BMD was measured by dual X-ray absorptiometry at the lumbar spine and proximal hip. The serum markers of bone turnover included bone-specific alkaline phosphatase, C-telopeptides of type I collagen, and serum osteocalcin. Previous clinical fractures were registered and spine X-ray was obtained from all patients.

Results

Three women were excluded for concomitant diseases associated to osteoporosis. Osteoporosis according with the WHO classification (T-score < − 2.5) was found in 16 patients (20.0%) (7 females and 9 men). Mastocytosis-related low BMD (Z-score at either the spine or the hip < − 2) was found in 3 women (9%) and 13 men (28%). The BMD was generally lower at the spine than at the hip. No significant correlation was observed between serum tryptase levels and T or Z-score BMD. One or more moderate or severe vertebral fractures were found in 17 patients (12 men); in 11 of them Z-score values were > − 2 or not valuable at the spine. No significant difference was found in the prevalence of mastocytosis-related low BMD and/or vertebral fractures between patients with or without skin involvement. Two patients had radiographic and densitometric osteosclerosis-like characteristics. In osteoporotic patients higher, normal or lower serum BTM were found, without correlations with serum tryptase levels, while in patients with osteosclerosis both BTM and serum tryptase values were particularly increased.

Conclusions

Vertebral osteoporosis and fractures are frequent in patients with ISM. Spine X-ray and densitometric examination are warranted in all patients, also without skin involvement and particularly in males; Z-score other than T-score BMD must be evaluated. Patients with idiopathic osteoporosis should be evaluated for mast cell disease. Both high than low BTM can be observed in patients with osteoporosis while osteosclerosis is characterized by high bone turnover and serum tryptase levels.     

Preferential low bone mineral density of the femoral neck in patients with a recent fracture of the proximal femur

Bone mass is an important determinant of resistance to fractures. Whether bone mineral density (BMD) in subjects with a fracture of the proximal femur (hip fracture) is different from that of age-matched controls is still debated. We measured BMD of the femoral neck (FN) on the opposite side to the fracture, as well as femoral shaft (FS) and lumbar spine (LS) BMD by dual-photon absorptiometry in 68 patients (57 women and 11 men, mean age 78.8±1.0) 12.4±0.8 days after hip fracture following a moderate trauma. These values were compared with BMD of 93 non-fractured elderly control subjects (82 women and 11 men), measured during the same period. As compared with the controls, FN BMD was significantly lower in fractured women (0.592±0.013 v. 0.728±0.014 g/cm²,P<0.001) and in fractured men (0.697±0.029 v. 0.840±0.052,P<0.05). Expressed as standard deviations above or below the mean BMD of age and sex-matched normal subjects (Z-score), the difference in FN BMD between fractured women and controls was highly significant (–0.6±0.1 v. +0.1±0.1,P<0.001). As compared with mean BMD of young normal subjects, BMD was decreased by 36.9±1.4 and 22.4±1.5% (P<0.001) in fractured and control women, respectively. There was no significant difference between FN BMD of 33 women with cervical and 24 with trochanteric hip fractures (0.603±0.017 v. 0.577±0.020). FN BMD was lower than 0.705 g/cm² in 90% of fractured women. The prevalence of fracture increased with decreasing FN BMD, reaching 100% with values below 0.500 g/cm². FS and LS BMD were significantly lower in women with hip fracture than in controls (1.388±0.036 v. 1.580±0.030,P<0.001, for FS, and 0.886±0.027 v. 0.985±0.023,P<0.01, for LS), but these differences were not significant when expressed as a Z-score. In men with a recent hip fracture, FS BMD was significantly lower than in controls (1.729±0.096 v. 2.069±0.062,P<0.01), but the difference at the LS level did not reach statistical significance. These results indicate that both women and men with a recent hip fracture had decreased bone mineral density of the femoral neck, femoral shaft and lumbar spine. However, the difference appeared to be of higher magnitude for the femoral neck suggesting a preferential bone loss at this site.     

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。     

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。     

Reduced bone perfusion in proximal femur of subjects with decreased bone mineral density preferentially affects the femoral neck

Using dynamic contrast enhanced MR imaging, this study investigated perfusion of the proximal femur in subjects with normal BMD, low bone mass and osteoporosis. Study cohort comprised healthy elderly Hong Kong Chinese volunteers consisting of 107 males (74.4 ± 4.2 years, mean ± SD) and 135 females (73.9 ± 4.3 years). Right proximal femur BMD measurement by DXA and MR perfusion imaging (maximum enhancement, E^max and enhancement slope, E^slope) of the femoral head, neck, and proximal shaft were carried out within a one month interval. Normal BMD, low bone mass and osteoporotic subjects accounted for 46.7%, 44.9%, and 8.4% of males; and 32.6%, 43.7%, and 23.7% of females. Perfusion indices showed that femoral head perfusion was less perfused compared to the femoral shaft (E^max and E^slope indices of head region = 28% of shaft region). Compared with normal BMD subjects, E^max of femoral head, neck, and proximal femur shaft were reduced by 15 ± 5% (mean ± standard error); 40 ± 4%; 15 ± 5% respectively for low bone mass subjects, and 36 ± 4%; 50 ± 6%; 47 ± 6% respectively for osteoporotic subjects. E^slope of femoral head, neck, and proximal femur shaft were reduced by 17 ± 7%; 41 ± 5%; 4 ± 7% for low bone mass subjects and 50 ± 5%, 62 ± 5%, 34 ± 8% for osteoporotic subjects. In low bone mass and osteoporotic subjects there was a tendency for perfusion in the femoral neck to reduce to a greater degree relative to that in the femoral head and shaft.     

Bone mineral density and prevalent vertebral fractures in men and women

To test the hypothesis that the association between bone mineral density (BMD) and estimated volumetric BMD and prevalent vertebral fractures differs in men and women, we studied 317 Caucasian men and 2,067 Caucasian women (average age 73 years). A total of 43 (14%) men and 386 (19%) women had a vertebral fracture identified on lateral spine radiographs using vertebral morphometry. Hip and spine areal BMD was about 1/3 standard deviation lower among men and women with a vertebral fracture. A 0.10 g/cm² decrease in areal BMD was associated with 30–40% increased odds of having a fracture in men and 60–70% increased likelihood in women. Low bone mineral apparent density (BMAD) was also associated with 40–50% increased odds of a vertebral fracture in both genders. The probability of a man having a fracture was observed at higher absolute areal BMD values than observed for women (P=values for interaction of BMD × gender: trochanter, P=0.05; femoral neck, P=0.10; total hip, P=0.09). In contrast, the probability of fracture was similar in men and women across the range of estimated volumetric BMD (BMAD). In conclusion, low BMD and low BMAD are associated with increased odds of vertebral fracture in both men and women. Measures of bone mass that partially correct for gender differences in bone size may yield universal estimates of fracture risk. Prospective studies are needed to confirm this observation.     

中老年女性骨关节炎患者骨密度的特点

目的　通过测量骨关节炎患者腰椎和髋部骨密度 ,探讨骨关节炎患者骨密度的特点及骨关节炎与骨质疏松症的关系。方法　本组研究对象均为中老年女性膝关节骨关节炎患者 ,其中 5 9例测量了腰椎和髋部骨密度 ,12例仅测量了腰椎骨密度。所有患者均按Kellgren分级标准对膝关节进行了评分。结果　绝经后妇女膝关节X线评分随Kellgren分级级数的增高患者腰椎骨密度均值逐渐增高 ,4级骨关节炎患者腰椎骨密度均值明显高于 2级患者 (P <0 0 5 ) ,而髋部骨密度均值随Kellgren分级级数的增高差异无显著性。如以低于同性别同部位峰值骨量的 2 0SD为骨质疏松诊断标准 ,腰椎和髋部符合骨质疏松症诊断的分别为 4 3 7%和 77%。在控制年龄和骨关节炎的影响后 ,股骨颈骨密度与体重指数的偏相关系数为 0 4 0 7(P <0 0 1)。结论　中老年女性骨关节炎患者中同时患有骨质疏松症的比例较高 ,同髋部骨密度测量相比 ,腰椎骨密度测量受骨关节炎影响较大。     

The relationship between osteoarthritis of the hands,bone mineral density,and osteoporotic fractures in elderly women

To study the relationship between osteoarthritis (OA) and osteoporosis (OP), radiographic osteoarthritis lesions of the hands (HOA) were quantified in 300 healthy women, aged 75 years or more, as a subgroup of a cohort originally recruited for a multi-centre study of risk factors for femoral neck fracture. The HOA combined score (i.e. the sum of the grades of joint-space narrowing, osteophytes, erosions and joint misalignment), the osteophytosis score and the joint-space narrowing score were calculated on a radiograph of both hands. Bone mineral density (BMD) was measured using dual-energy X-ray absortiometry (Lunar DPX) at the femoral neck, Ward's triangle and the total body. BMDs of the total spine, lumbar spine, and the upper and lower limbs were derived from the regional analyses of the total body measurement. Correlations between bone mass, HOA scores and other variables were explored by multiple linear regression and stepwise logistic regression analysis. The HOA combined score was positively correlated with increasing age but not with body mass index. In the multiple regression analyses the HOA combined score positively correlated with BMD at all sites, except the femoral neck and Ward's triangle; the osteophytosis score correlated with BMD at all sites; and no correlation was found between BMD and the joint-space narrowing score. According to stepwise logistic regression and after adjustment of BMD for age, women with an HOA combined score higher than 20 had signficantly higher BMD values at all skeletal sites. Sixty-nine women (23%) reported a history of osteoporotic fracture; among them, 20 (6.6%) reported a history of vertebral fracture. The OA score of both subgroups was significantly lower than that of women with no history of fracture. These data suggest that in elderly women the severity of HOA is positively correlated with bone mass and that women with a high score of HOA more rarely report a history of osteoporotic fracture.     

Bone density and fragility fractures in patients with developmental disabilities

Summary  We investigated prior fractures, osteoporosis risk factors, and bone mineral density (BMD) in 107 institutionalized adults with developmental disabilities. We found a very high prevalence of BMD in the osteoporotic range and a significant correlation between lower BMD and prior fragility fractures. Introduction  The purpose of this study was to investigate factors contributing to osteoporosis and fragility fractures among developmentally disabled adults. Methods  Adults from a residential center participated in a prospective study in which bone mineral density (BMD) at the forearm and heel were measured with a portable X-ray densitometer. Prior fragility fractures were identified from chart review. Results  Among 107 participants, 84 (78.5%) had a measurement within the osteoporotic range. The heel was more severely abnormal (mean T-score −3.1 ± 1.5) than the forearm (−1.6 ± 1.3, p < .0.0001). Radiographically confirmed prior fragility fractures (17 [16.3%]) were associated with lower heel (p = 0.0155) and forearm (p = 0.0172) T-scores. In multiple regression analysis, there were independent associations between forearm BMD and prior fragility fractures (p = 0.0126) and between heel BMD and prior fragility fractures (p = 0.0291). The odds ratio for prior fracture increased by 2.02 (95% CI 1.12–3.64) for each standard deviation (SD) decrease in heel T-score and by 2.39 (95% CI 1.08–5.32) for each SD decrease in forearm T-score. Conclusions  We found a very high prevalence of osteoporotic BMD measurements in institutionalized adults with developmental disabilities. Lower heel and forearm BMD measurements were significantly and independently associated with prior fragility fractures in this population.     

太原市健康人腰椎骨密度研究

我院从１９９５～１９９８年,通过健康检查对１５５１名太原地区健康人群进行腰椎骨密度（ＢＭＤ）研究,其中男性５１７人,女性１０３４人,在不同年龄段中发现骨矿峰值在３０～３９岁,两性一致,男性保持２０年,女性１０年后骨矿含量随年龄增加而减少。女性６０岁以后ＢＭＤ降低２１．６６％,而男性仅３．５４％,其中Ｌ１降低达１８．８７％,Ｌ２与Ｌ２－４降低的幅度,女性一致,男性则有显著差异。本研究认为Ｌ２－４男性     

Bone mineral density in healthy Kuwaiti women

Objective This study aimed to measure bone mineral density (BMD) of the lumber spine and femur regions in healthy adult Kuwaiti women, and to evaluate the influence of body size on BMD results. Methods Bone mass measurement was performed by dual-energy X-ray absorptiometry at the lumbar spine (L2-L4) and femur (four regions) of healthy ambulatory Kuwaiti females aged between 20 and 80 years. Body size measurements and a detailed questionnaire on past medical and gynecologic history, as well as lifestyle factors, were administered to all subjects. After excluding those with apparent or suggested abnormalities affecting bone mass, only 805 women from 4,887 were included and served as the target subjects. Results The spine BMD values for Kuwaiti women up to 69 years old were lower than their US counterparts; the peak value was established in the fifth decade. Femur neck BMD was relatively stable up to menopause. Spine osteoporosis was prevalent among 10% of the subjects, compared with 4% in the femoral neck. Regression analysis revealed that each kilogram of body weight has a change of 0.3% in premenopausal women and 0.5–0.6% in the older group. In multiple regressions that included the three factors (height, weight and age), the effect of age superseded that of weight in the older group of women, where there was a detrimental annual effect on spine and femur (neck and total hip) BMD by 0.9%, while each kilogram of body weight had a constructive effect by 0.4 and 0.3%. In the premenopausal women, the positive effect of 1 kg of body weight was equivalent to about 1 year of aging in the trochanter region and half a year in the total hip region. Conclusion The BMD value of healthy Kuwaiti women tend to be lower than the US reference at the lumber spine in all age groups but showed higher values for femur neck only in the age group of late 30s through 60 years. Weight has a stronger effect on BMD than does the height. The prevalence of osteoporosis in the lumber spine was more than double that in the femur neck in postmenopausal women.     

股骨颈骨密度和股骨颈轴长与老年 髋部骨折的关系

目的 探讨股骨颈骨密度、股骨颈轴长与髋部骨折的关系，了解股骨颈骨密度、股骨颈轴长预测骨折的能力。方法 通过双能Ｘ线吸收骨密度测量仪测量髋部骨折组患者和同龄男女非骨折对照组的股骨颈轴长、股骨颈骨密度，分析比较两种测量指标预测股骨颈骨折的敏感性。结果 不同性别骨折组患者的股骨颈骨密度均明显低一南年龄、同性别对照组，差异有非常显著性意义（Ｐ〈０．０１），而骨折组与非骨折组男女股骨颈轴和莘差异无显著性意义     

骨密度对骨质疏松性骨折的判断价值

目的研究骨密度对骨质疏松性骨折的判断价值。方法共3组研究对象,398例骨质疏松不伴有骨折的研究对象(A组),胸腰椎骨折患者(B组),骨密度正常的正常组进行研究。研究骨密度的一般情况、不同T值在各组的分配情况,骨质疏松性骨折与骨密度(BMD)的相关性。结果腰椎L2-L4、L2-L4和股颈的BMD值之间,T值人数分配之间,正常组、A组以及B组的差别具有统计学意义(P<0.05)。腰椎L1-L4、L2-L4和股颈的BMD以及总BMD的测定值均与骨质疏松性骨折相关。结论我们认为:本地区所收治的骨质疏松性骨折患者,全部应诊断判定为骨质疏松症。