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1.
L. M. Salamone T. Whiteside D. Friberg R. S. Epstein L. H. Kuller J. A. Cauley 《Calcified tissue international》1998,63(6):466-470
Cytokines such as interleukin-1 (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor (TNF-α) can influence both bone resorption
and bone formation. The objective of this cross-sectional study was to examine the relationship between cytokine production
by peripheral blood mononuclear cells (PBMC) and bone mineral density (BMD); the annual rate of change in BMD was examined.
Subjects participating in a randomized clinical trial entitled the Women's Healthy Lifestyle Project in Allegheny County,
Pennsylvania were used. They included 50 healthy premenopausal women, aged 45–52 years, who had regular menses within the
past 3 months and were not on replacement estrogens. Dual-energy X-ray absorptiometry measurements at the AP lumbar spine
and femoral neck were made at baseline and at the first annual exam using a Hologic QDR 2000 densitometer. Cytokine production
of IL-1β, IL-6, and TNF-α by PBMC was measured at the annual exam. The median values for stimulated cytokine production by
PBMC were 3.92 ng/ml, 31.3 ng/ml, and 1.05 ng/ml, for IL-1β, IL-6, and TNF-α, respectively. There were modest correlations
between cytokine production and cross-sectional BMD, ranging from r =−0.30 to r =−0.13. Trends of greater spinal bone loss
were observed in women with ``high' (≥75th percentile) cytokine production of stimulated IL-1β and IL-6 (IL-1β: ``high'
=−1.56% ± 0.70 versus ``low' (<75th percentile) =−0.56% ± 0.35, P= 0.21). In contrast, greater annual gains in femoral neck BMD were observed in those with high cytokine production of IL-1β
and IL-6 (IL-1β: high = 3.39% ± 1.16 versus low =−0.85 ± 0.58, P= 0.002). There was no association between stimulated TNF production and annual change in BMD. In this population of healthy
premenopausal women, the relationship between cytokine production by PBMC and the rate of change in BMD was significantly
different for the lumbar spine and femoral neck, possibly reflecting differences in the proportion of trabecular and cortical
bone at these sites.
Received: 5 February 1997 / Accepted: 11 May 1998 相似文献
2.
N. Yoshimura T. Hashimoto K. Sakata S. Morioka T. Kasamatsu C. Cooper 《Calcified tissue international》1999,65(3):198-202
The purpose of this study was to ascertain whether biochemical markers of bone turnover predict bone loss. The survey was
carried out in Taiji, Wakayama Prefecture, Japan. From a list of inhabitants aged 40–79 years, 400 participants (50 men and
50 women in each of four age groups) were selected randomly. Bone mineral density (BMD) was measured, and blood and urine
samples of all participants were examined to obtain values for eight biochemical markers: alkaline phosphatase (ALP), bone
Gla protein (BGP), type I procollagen (carboxyterminal peptide of type I procollagen; PICP), cross-linked carboxyterminal
telopeptide region of type I collagen (ICTP), and urinary excretion of calcium (Ca), phosphate (P), pyridinoline (Pyr), and
deoxypyridinoline (D-Pyr). Each marker was evaluated as a predictor of the rate of bone change in lumbar spine and femoral
neck BMD over a 3-year period. The value of Pyr was significantly related to the change of lumbar spine BMD in men (P= 0.009), and that of BGP was found to be significant in women (P= 0.045). By contrast, none of the bone markers significantly correlated with bone loss at the femoral neck. The coefficient
of determination at the lumbar spine was 5% and 7% at the femoral neck only. We conclude that biochemical markers of bone
turnover cannot predict bone loss rates in middle-aged or elderly Japanese men and women over a 3-year period with sufficient
accuracy for use in clinical decision making.
Received: 26 January 1998 / Accepted: 9 July 1998 相似文献
3.
An Investigation of the Diagnostic Value of Bilateral Femoral Neck Bone Mineral Density Measurements 总被引:1,自引:0,他引:1
G. W. Petley P. A. Taylor A. J. Murrills E. Dennison G. Pearson C. Cooper 《Osteoporosis international》2000,11(8):675-679
This paper describes a study to assess the clinical value of bilateral femoral neck bone mineral density (BMD) measurements.
Although a range of factors will determine clinical decisions, the classification of the site with the lowest T-score is likely to have significant bearing on the management of a patient. While it is common practice to measure BMD at
the lumbar spine and a single neck of femur, knowledge of the BMD of the second femur may also be of diagnostic value. Using
dual-energy X-ray absorptiometry, BMD of the lumbar spine and right and left femoral neck was measured in a group of 2372
white, Caucasian women (mean age ± SD, 56.6 ±13.9 years) routinely referred for bone densitometry. Analysis of the measurements
showed a significant (p= 0.02) but small difference between the mean BMD of the right (0.840 ± 0.152 g/cm2) and left (0.837 ± 0.150 g/cm2) femoral neck. Further investigation of femur scans revealed 79 (3.3%) patients in whom one side was osteoporotic while the
other side and spine were normal or osteopenic using the World Health Organization diagnostic criteria in combination with
manufacturer”s reference data. Patients in whom the femoral neck BMD measurements differed by less than the precision error
of the system were then excluded. This left only 51 (2.2%) patients, that is 29 (1.2%) for right femur and spine scan and
22 (0.9%) for left femur and spine scan, in whom knowledge of both femoral neck BMD measurements could have altered the classification
of the lowest site assessed to osteoporotic. These data suggest that there is only a small benefit from performing bilateral
femoral neck BMD measurements. Since BMD measurements are only one of a range of factors considered as part of a patient”s
management, it is suggested that the extra time, cost and radiation dose associated with measurement of the second femur may
not be justified.
Received: 28 October 1999 / Accepted: 2 February 2000 相似文献
4.
S. L. Hui L. Zhou R. Evans C. W. Slemenda M. Peacock C. M. Weaver C. McClintock C. C. Johnston Jr 《Osteoporosis international》1999,9(3):200-205
This study characterizes the rates of growth and loss of bone mass as a function of age in white females. It combines longitudinal
data from several studies of bone mass on healthy white female subjects ranging from age 6 to 90 years. Rates of change in
bone area, bone mineral content (BMC) and bone mineral density (BMD) are estimated separately for the spine and the femoral
neck of each individual using linear regression. The individual rates of change are then fitted as a nonparametric function
of age using weighted moving averages, resulting in a curve of age-specific mean change as a function of age. When the curves
of BMD were compared between the hip and the femoral neck, the cessation of bone growth and the onset of bone loss were found
to occur at an earlier age at the hip than at the spine. No significant differences in the ages of maximum rates of growth
or maximum loss were found between the two skeletal sites. This information will be useful for designing interventions to
promote bone growth or retard bone loss.
Received: 2 December 1997 / Accepted: 22 May 1998 相似文献
5.
Allogeneic Bone Marrow Transplantation is Associated with a Preferential Femoral Neck Bone Loss 总被引:1,自引:0,他引:1
N. Buchs C. Helg C. Collao B. Chapuis D. Slosman J.-P. Bonjour R. Rizzoli 《Osteoporosis international》2001,12(10):880-886
Osteoporosis is a major complication of organ transplantation. Little is known about the risk of developing osteoporosis
in bone marrow transplant (BMT) recipients. We studied early and late changes in bone mineral density (BMD), as well as biochemical
markers of bone remodeling, in patients at the time of allogeneic BMT (alloBMT) and up to 13 years thereafter. In a cross-sectional
study, 102 patients (40 women, 62 men, mean age ± SEM, 38.9 ± 1.6 years) were segregated into a first group (A, n= 48) and evaluated before or during the first weeks (mean ± SD 0.3 ± 0.1 month, range –0.5 to 3 months) following alloBMT,
and a second group (B, n= 54) studied 60.1 ± 5.6 months (range 6–156 months) following alloBMT. Lumbar spine (LS) BMD was similar in groups A and
B and was within normal limits. In contrast, femoral neck (FN) Z- and T-scores were significantly decreased in group B compared with group A (–0.68 ± 0.14 vs –0.03 ± 0.14 SD and –0.84 ± 0.14 vs
–0.22 ± 0.14 SD, respectively; p≤0.002). Osteopenia (T-score between –1 and –2.5 SD) was present in 35% of group A and 43% of group B patients (NS). Osteoporosis (T-score <–2.5 SD) was detected in 7% of group B patients, but in none of those in group A (p= 0.05). In a longitudinal study, 56 subjects were evaluated at the time of alloBMT, and 33 and 23 were studied 6 or 12 months
later, respectively (13 women, 20 men, 37.5 ± 1.6 years). All were treated with supplements of calcium and vitamin D. Amenorrheic
women received hormone replacement therapy (HRT). Three-monthly pamidronate infusions were given to 15 men and 10 non-amenorrheic
women who were osteopenic/osteoporotic or had elevated baseline bone turnover markers. Mean baseline LS and FN Z- and T-scores were within normal range. Six months after BMT, FN BMD decreased by 4.2 ± 0.7% (p<0.001), and whole body BMD and bone mineral content by 1.5 ± 0.4% and 3.1 ± 0.6%, respectively (p≤0.0001). Twelve months after the graft, there was no further significant bone loss and only FN BMD decrease remained significantly
different compared with baseline (–5.6 ± 1.1%, p≤0.0001). These results indicate that the risk of decreased BMD is higher for the femoral neck than the lumbar spine and whole
body levels in patients with allogeneic bone marrow transplantation, and that bone loss occurs mainly during the first 6 months
after the graft.
Received: 9 February 2001 / Accepted: 23 May 2001 相似文献
6.
N. B. Watts D. K. Jenkins J. M. Visor D. C. Casal P. Geusens 《Osteoporosis international》2001,12(4):279-288
Alendronate therapy in osteoporotic women decreases bone turnover and increases bone mineral density (BMD). Optimal patient
management should include verification that each patient is responding to therapy. Markers of bone turnover and BMD have both
been proposed for this purpose. We have investigated changes resulting from alendronate therapy with an enzyme immunoassay
for bone alkaline phosphatase (BAP) and compared it with total alkaline phosphatase (TAP) and BMD of the lumbar spine, hip,
and total body. Subjects were drawn from a multicenter randomized, placebo-controlled trial of alendronate in postmenopausal
women with osteoporosis. BAP and TAP levels were measured at baseline and following 3, 6 and 12 months of therapy with either
placebo (n= 180) or alendronate 10 mg/day (n= 134). All subjects also received 500 mg/day supplemental calcium. BMD was measured at baseline and following 3, 6, 12, 18,
24 and 36 months of therapy. To compare BAP, TAP and BMD at each site for identifying women that experienced a skeletal effect
of alendronate, we calculated least significant change (LSC) values from the long-term intraindividual variability in each
placebo-treated woman. Median levels of BAP decreased by 34%, 44% and 43% at 3, 6 and 12 months, respectively, in alendronate-treated
women (p<0.0001 compared with baseline and with placebo). These changes were significantly greater (p<0.0001) than changes observed for TAP. Following 6 months of alendronate therapy, 90% of the women had experienced a decrease
in BAP exceeding the LSC compared with only 71% for TAP. The greatest number of women similarly identified with BMD at any
site (i.e. a gain in BMD exceeding the LSC) was 81% for spinal BMD at 36 months. All other sites were less than 70% at 36
months. Short-term changes in BAP and TAP were modestly associated with subsequent changes in BMD at all sites (Spearman’s
rho −0.22 to −0.52, p<0.05). Compared with TAP and BMD, BAP testing rapidly and sensitively identified skeletal effects of alendronate thus enabling
appropriate drug monitoring of osteoporotic women. Though BAP and TAP changes were modestly predictive of BMD changes, the
value of the bone marker tests is their ability to detect rapidly a skeletal effect of therapy.
Received: 19 May 2000 / Accepted: 31 October 2000 相似文献
7.
J. Leppälä P. Kannus S. Niemi H. Sievänen I. Vuori M. Järvinen 《Osteoporosis international》1999,10(4):337-342
High peak bone mass and density in early adulthood is an important protective factor against osteoporotic fractures in later
life, but it is not known whether injuries to growing bones adversely affect the attainment of peak bone mass and density.
The purpose of this study was therefore to examine with dual-energy X-ray absorptiometry the areal bone mineral density (BMD)
of the injured and uninjured extremity (the femoral neck, trochanter area of the femur, distal femur, patella, proximal tibia
and distal tibia), lumbar spine and distal radius of young adults with a history of an early-life femoral shaft fracture and
to find out whether the fracture had affected the attainment of peak bone density of these patients. Thus, the BMD and clinical
status of 41 patients (28 men, 13 women) who had sustained a femoral shaft fracture in childhood or adolescence (between 7
and 15 years of age, average 13 years before the study) were examined. The fracture had led to a statistically significant
difference in BMD between the injured and uninjured side distal to the fracture site (men/women: distal femur, −3.7%/−3.9%;
patella, −3.1%/−5.9%; proximal tibia, −2.0%/−4.6%; distal tibia, −3.4%/−5.2%), whereas the proximal femur did not show such
differences. The male patients’ spinal BMD was significantly lower (−7.9%) than that in their age-, height- and weight-matched
healthy controls. The female patients’ spinal BMD tended to be fairly comparable (−1.6%) to that of the controls (NS). In
summary, this study indicates that early-life femoral shaft fracture results in a moderate (−2% to −6%) long-term side-to-side
BMD difference distal to the fracture site. Patients’ spinal BMD values also tend to be lower than that of controls. Thus,
a femoral shaft fracture sustained in childhood or adolescence seems to disturb somewhat the attainment of peak bone density,
the important predictor of osteoporotic fractures in later life.
Received: 23 December 1998 / Accepted: 1 April 1999 相似文献
8.
Low bone density as assessed by calcaneal ultrasound has been associated with mortality in elderly men and women. We examined
the relationship between bone density measured at the hip and all cause and cardiovascular mortality in elderly men. Men aged
65–76 years from the general community were recruited from general practices in Cambridge between 1991 and 1995. At baseline
survey, data collection included health questionnaires, measures of anthropometry and cardiovascular risk factors, as well
as bone mineral density (BMD) measured using dual energy X-ray absorptiometry. All men have been followed up for vital status
up to December 1999. BMD was significantly inversely related to mortality from all causes and cardiovascular disease, with
decreasing rates with increasing bone density quartile, and an approximate halving of risk between the bottom and top quartile
(p <0.002, test for trend all causes and p <0.025, test for trend for cardiovascular deaths). In multivariate analyses using the Cox proportional hazards model, an
increase of 1 standard deviation (0.144 g/cm2) in total hip bone density was significantly associated with an age-adjusted 0.77 relative risk (95% CI 0.66–0.91) for all-cause
mortality and 0.76 relative risk (95% CI 0.62–0.93) for cardiovascular disease mortality. The association remained significant
after adjusting for age, body mass index, cigarette smoking status, serum cholesterol, systolic blood pressure, past history
of heart attack, stroke or cancer and other lifestyle factors which included use of alcohol, physical activity and general
health status. Low bone density at the hip is thus a strong and independent predictor of all-cause and cardiovascular mortality
in older men.
Received: 16 August 2000 / Accepted: 27 October 2000 相似文献
9.
C. Gómez Acotto A. M. Schott D. Hans H. Niepomniszcze C. A. Mautalen P. J. Meunier 《Osteoporosis international》1998,8(5):455-459
The objective of our study was to compare bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) and
quantitative ultrasound (QUS) parameters in women with hyperthyroidism and controls. In this cross-sectional study, QUS parameters
and BMD values observed in untreated hyperthyroid patients were compared with data obtained from age-matched controls. Twenty-four
women with Graves' disease were studied. Eight patients were postmenopausal. All patients had evidence of thyrotoxicosis as
indicated by a raised total serum thyroxine and a suppressed serum thyroid stimulating hormone. BMD of the hip, lumbar spine
and whole body, and body composition, were measured by DXA. Ultrasound evaluation on the os calcis was performed with an Achilles
device. All measurements were performed before antithyroid therapy. The QUS parameters of BUA, SOS and Stiffness were significantly
lower in hyperthyroid patients than in controls. Similar results were observed for the BMD of lumbar spine, femoral neck and
total skeleton. Lean tissue and fat mass were also significantly decreased in hyperthyroid patients. In conclusion, these
findings suggest that hyperthyroidism affects cortical and trabecular bone equally, as well as bone quality. QUS measurements
may be helpful for assessing, using a simple and non-irradiating method, the bone effects of thyrotoxicosis.
Received: 9 June 1997 / Accepted: 27 October 1997 相似文献
10.
Age-Related Bone Mineral Density, Accumulated Bone Loss Rate and Prevalence of Osteoporosis at Multiple Skeletal Sites in Chinese Women 总被引:18,自引:0,他引:18
Er-Yuan Liao Xian-Ping Wu Xiao-Ge Deng Gan Huang Xu-Ping Zhu Zhao-Feng Long Wen-Bo Wang Wei-Li Tang Hong Zhang 《Osteoporosis international》2002,13(8):669-676
We investigated the age-related bone mineral density (BMD), accumulated bone loss rate (ABLR) and the prevalence of osteoporosis
at different skeletal sites in Chinese women. BMD was measured at the anteroposterior (AP) spine, supine lateral spine (areal
BMD at the midarea [mLat] and the whole region [Lat], volumetric BMD at the middle region [MVD] and total region [TVD]), hip
(femoral neck [FN], trochanter [Troc] and Ward’s triangle [Ward’s]) and forearm (radius + ulna ultradistal [RUUD], 1/3 region
[RU1/3] and total region [RUT]) using a dual-energy X-ray absorptiometry (DXA) fan-beam bone densitometer (Hologic QDR 4500A)
in 2702 females aged from 5 to 96 years old. Data were analyzed by eight different regression models. We found that the cubic
regression model was the best for describing age-related changes in BMD. The coefficients of determination (R
2) of the fitting curve were 0.398 to 0.612 (p= 0.000). The data were then analyzed by 5-year age groups. This showed that the earliest peak BMD was at the age of 20–24
years at Troc and Ward’s, and the latest at the age of 40–44 years at RU1/3 and RUT of the distal forearm. Compared with BMD,
the ABLRs were highest at Ward’s (−66.2%) and the lowest at RU1/3 of the distal forearm (−31.3%) in subjects over 80 years
old. The prevalence of osteoporosis at at least one site in these women was 0.5 ± 0.4% in those 30–39, 4.6 ± 4.4% in those
40–49, 23.9 ± 13.3% in those 50–59, 56.3 ± 20.3% in those 60–69, 71.8 ± 16.7% in those 70–79 and 83.2 ± 12.1% those over 80
years of age, respectively. The prevalence of osteoporosis in these women was 8.6–11.1% at the age of 40–49 and 36.5–40.6%
at the age of 50–59 at the lateral spine regions (mLat, Lat, MVD and TVD), and 0.5–3.7% at the age of 40–49 and and 3.9–21.7%
at the age of 50–59 years at the other skeletal sites (AP, FN, Troc, Ward’s, RUUD, RU1/3 and RUT). Significant differences
were found in the prevalence of osteoporosis between the lateral spine regions and other skeletal sites (p<0.001) at the age of 40–59 years. In summary, we demonstrated significant age-related differences in peak BMD, ABLR and osteoporosis
prevalence among various skeletal sites. Our data suggest that the supine lateral spine is the most sensitive site for the
diagnosis of osteoporosis, especially in the early menopausal period, although the prevalence of osteoporosis varied with
age and with different sites measured.
Received: 20 November 2001 / Accepted: 13 February 2002 相似文献
11.
M. M. Boomsma C. A. Stegeman A. B. Kramer M. Karsijns D. A. Piers J. W. Cohen Tervaert 《Osteoporosis international》2002,13(1):74-82
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a relapsing-remitting disease, which is treated with
corticosteroids (CS) in combination with cyclophosphamide. One of the major side-effects of this treatment is osteoporosis,
which may result in the increased occurrence of fractures. In the present study we measured the prevalence of reduced bone
mineral density (BMD) in a cross-sectional cohort of patients and correlated BMD findings with cumulative doses of CS and/or
cyclophosphamide. BMD was measured by dual-energy X-ray absorptiometry (DXA) of the lumbar spine, radius and proximal femur
between January 1998 and December 1999. Cumulative doses of CS and cyclophosphamide were calculated by chart review. Ninety-nine
consecutive patients (48 men, 51 women) aged 55 ± 16 years (mean ± SD) were studied 50 months (median; range 0–400 months)
after a diagnosis of ANCA-associated vasculitis had been made. Sixty-nine patients were treated with 10.7 g (median cumulative
dose; range 0.4–67.2g) of CS, and 88 patients were treated with 34.1 g (median cumulative dose; range 0.8–324.3g) of cyclophosphamide.
Fifty-seven percent of the patients had osteopenia (T-score: –1 to –2.5 SD), and 21% had osteoporosis (T-score: <−2.5 SD) at least at one site. Thirty-four of 37 (92%) postmenopausal women, 9 of 14 (64%) premenopausal women, and
34 of 48 (71%) men had either osteopenia or osteoporosis. The mean age- and sex-adjusted BMD (Z-score) of the proximal femur in men was found to be significantly lower than zero. Cumulative dose of CS therapy showed an
inverse relation with Z-scores at the lumbar spine (p= 0.035) and proximal femur (p = 0.011). Cumulative dose of cyclophosphamide was not correlated with Z-scores. Osteopenia and osteoporosis are thus frequently observed in patients with ANCA-associated vasculities. However, only
in men is the mean Z-score significantly lower than zero. Cumulative dose of CS therapy is significantly associated with bone loss at the spine
and femur.
Received: 26 March 2001 / Accepted: 1 August 2001 相似文献
12.
R. G. Crilly R. J. Sebaldt A. B. Hodsman J. D. Adachi J. P. Brown C. H. Goldsmith D. A. Hanley W. O. Olszynski L.-G. Ste-Marie G. F. Stephenson 《Osteoporosis international》2000,11(7):607-614
We investigated whether an increase in lumbar spine bone mineral density (LS BMD) at 6 months or at 12 months could predict
the response to intermittent cyclical therapy (ICT) with etidronate, defined in one of two ways: (i) an increase in LS BMD
at 24 months (improvement) or (ii) an increase in LS BMD ≥0.028 g/cm2 (significant improvement). The latter is a precision term calculated from test–retest values for LS BMD in osteoporotic patients.
Two hundred and forty-seven patients (32 men; 5 premenopausal and 210 postmenopausal women) were followed for 24 months by
dual-energy X-ray absorptiometry (DXA) and were not taking estrogen, calcitonin or fluoride during treatment with ICT-etidronate.
One hundred and fifty patients had a LS BMD measurement after 6 months of treatment with ICT-etidronate and 205 patients had
one at 12 months. Baseline characteristics (mean;SD) were as follows: age, 66;11 years; years since menopause, 21;10; number
of vertebral fractures at baseline, 0.87;1.26; LS BMD T-score, −2.8;1.2. After 24 months of treatment with ICT-etidronate, 81% of the patients had an improvement, and 55% had a
significant improvement at the LS. Only 6% significantly lost bone (loss of 0.028 g/cm2 or more). The mean percent change from baseline in LS BMD was 5.1% (95% confidence interval 4.2% to 6.0%). The results for
men and postmenopausal women were similar to those for the entire group. Accuracy and sensitivity were marginally, but not
significantly, higher when response was predicted using 12 month versus 6 month LS BMD measurements. The positive predictive
values of improvement at 6 or 12 months were 89% and 90% respectively for improvement at 24 months, and 66% and 68% for significant
improvement at 24 months. Identification of nonresponders was less successful and similar at 6 months and 12 months. Forty
percent and 39% of the patients, who had no improvement at 6 or 12 months respectively, also had no improvement at 24 months,
i.e., were true negatives, while 77% and 71% had no significant improvement at 24 months. The results may reflect slow response
in a small subgroup of patients rather than nonresponse; however, no response at 1 year might identify patients whose rate
of response is sufficiently slow that alternative therapy is justified. These data demonstrate a good response rate to ICT-etidronate
and may help reduce the need for follow-up BMD measurements in those who show an early improvement.
Received: 12 November 1999 / Accepted: 3 January 2000 相似文献
13.
Serum albumin has been found to be positively correlated with bone mass in small studies of ambulatory men or women with
diagnosed osteoporosis. In this study the relation between serum albumin and bone mineral density (BMD) was examined in 1593
white, community-dwelling men and women aged 50–95 years. BMD was determined using single-photon absorptiometry (SPA) at the
ultradistal radius and the midshaft radius, and using dual-energy X-ray absorptiometry (DXA) at the hip and spine. Albumin
was measured from a fasting blood sample using the Technicon SMA 12 autoanalyzer. Mean albumin levels in both men and women
decreased significantly with increasing age. All but four values were within the normal range (3.5–5.0 g/dl). BMD decreased
with increasing age at all sites. In both sexes there was weak positive correlation between serum albumin and BMD in the unadjusted
model (Pearson's rvalues <0.3, p values <0.005). After age adjustment, however, the relationship was no longer significant (Pearson's r values <0.05, p values >0.18). Men and women were divided into three sex-specific categories – osteoporotic, osteopenic and normal – based
on World Health Organization criteria in relation to young adult means (normal, BMD > –1 SD; osteopenia, BMD between –1 SD
and –2.5 SD; osteoporosis, BMD <–2.5 SD). Mean albumin values did not differ significantly across the three BMD categories
in men or women. BMD levels stratified for albumin levels and calcium supplement status (a marker for osteoporosis awareness)
also did not differ. Albumin levels were also not associated with a history of low-trauma fractures. In summary, there was
no age-independent association between serum albumin within the normal range and low BMD or fractures in community-dwelling
healthy older adults. We conclude that previously reported associations most likely reflect inadequate adjustment for the
age-related decrease in albumin levels and the selection of very frail osteoporotic subjects.
Received: 7 October 1997 / Revised: 21 January 1998 相似文献
14.
Treatment of Postmenopausal Women with Osteoporosis or Low Bone Density with Raloxifene 总被引:3,自引:0,他引:3
P. J. Meunier E. Vignot P. Garnero E. Confavreux E. Paris S. Liu-Leage S. Sarkar T. Liu M. Wong M. W. Draper 《Osteoporosis international》1999,10(4):330-336
Raloxifene, a selective estrogen receptor modulator (SERM), has been shown to improved bone mineral density (BMD) and serum
lipid profiles in healthy postmenopausal women. The objective of this study was to examine the effects of raloxifene on BMD,
biochemical markers of bone metabolism and serum lipids in postmenopausal women with low bone density or osteoporosis. This
Phase II, multicenter, 24-month, double-masked study assessed the efficacy and safety of raloxifene in 129 postmenopausal
women (mean age ± SD: 60.2 ± 6.7 years) with osteoporosis or low bone density (baseline mean lumbar spine BMD T-score: −2.8). Women were randomly assigned to one of three treatment groups: placebo, 60 mg/day raloxifene-HCl (RLX 60) or
150 mg/day raloxifene-HCl (RLX 150) and concomitantly received 1000 mg/day calcium and 300 U/day vitamin D3. At 24 months, BMD was significantly increased in the lumbar spine (+3.2%), femoral neck (+2.1%), trochanter (+2.7%) and
total hip (+1.6%) in the RLX 60 group compared with the placebo group (p<0.05). The RLX 150 group had increases in BMD similar to those observed with RLX 60. A greater percentage of raloxifene-treated
patients, compared with those receiving placebo, had increased BMD (p<0.05). Serum bone-specific alkaline phosphatase activity, serum osteocalcin, and urinary type I collagen:creatinine ratio
were significantly decreased in the RLX-treated groups, compared with the placebo group (p<0.01). RLX 60 treatment significantly decreased serum levels of triglycerides, and total- and LDL-cholesterol levels (p<0.01). The rates of patient discontinuation and adverse events were not significantly different among groups. In this study,
raloxifene increased bone density, decreased bone turnover, and improved the serum lipid profile with minimal adverse events,
and may be a safe and effective treatment for postmenopausal women with osteoporosis or low bone density.
Received: 26 December 1998 / Accepted: 31 March 1999 相似文献
15.
Non-association of Estrogen Receptor Genotypes with Bone Mineral Density and Bone Turnover in Korean Pre-, Peri-, and Postmenopausal Women 总被引:19,自引:0,他引:19
K. Han J. Choi I. Moon H. Yoon I. Han H. Min Y. Kim Y. Choi 《Osteoporosis international》1999,9(4):290-295
Estrogen is known to play a critical role in both skeletal maturity and the rate of bone loss. This suggests the possibility
that the estrogen receptor (ER) gene is one of the candidate genes that determines peak bone density and/or bone turnover
rate. We investigated two established restriction fragment length polymorphisms (RFLPs) in intron 1 at the ER gene, represented
as PvuII and XbaI. In 598 healthy Korean women aged 20–74 years, we examined the association of these ER genotypes with bone mineral density
(BMD) and bone turnover status. The distribution of the PvuII and XbaI RFLPs was as follows: pp 205 (34.3%), Pp 308 (51.5%), PP 85 (14.2%) and xx 384 (64.2%), Xx 180 (30.1%), XX 34 (5.7%), respectively (where capital letters signify the absence of, and lower-case letters signify the presence of, the
restriction site of each RFLP). No significant genotypic differences were found in BMD and bone markers. We grouped the subjects
into three categories according to their menstrual status: 104 premenopausal women with regular menstruation, 182 perimenopausal
women who had amenorrhea of not less than 3 months and not more than 12 months’ duration, and 312 postmenopausal women whose
last menstruation was at least 12 months previously. No significant genotypic difference in either BMD or bone markers was
found in any of these three groups. Furthermore we categorized women in peri- and postmenopause into a high loser group and
a normal loser group according to the level of bone resorption markers. There was no difference in genotypic proportions between
the high and normal loser groups. Our data suggest that these ER polymorphisms are not associated with BMD or bone turnover
in Korean women.
Received: 16 March 1998 / Accepted: 17 August 1998 相似文献
16.
J. M. Pouillès F. A. Tremollières S. Martinez M. Delsol C. Ribot 《Osteoporosis international》2001,12(1):71-76
The aim of this study was to evaluate the ability of peripheral dual-energy X-ray absorptiometry (pDXA) measurement of the forearm to predict low axial bone mineral density (BMD) as defined according to the WHO classification. Two hundred and thirty-four healthy women aged 45-60 years were investigated. BMD was measured at the proximal and distal radius + ulna by pDXA and at the lumbar spine and femoral neck by DXA. There was a significant but moderate correlation between peripheral and axial BMD measurements, with r values ranging from 0.4 to 0.6 (SEE: 13.5-17%). The cutoff values for the proximal and distal radius BMD that allow the identification with 95% sensitivity of postmenopausal women with either a lumbar spine or femoral neck T-score < -1, corresponded to a T-score of +0.5 (proximal radius) and +1 (distal radius). More than 90% of the whole population had a peripheral T-score below these thresholds. Using an axial T-score < or = -2.5 as the definition of abnormality reduced to 48% (proximal radius) to 66% (distal radius) the number of women who would have required DXA axial measurements (i.e., with a pDXA T-score below the cutoff value of -0.7). Of the 33 women (14%) with a proximal radius T-score < or = -2.5 (osteoporosis), only 1 had a lumbar spine and femoral neck T-score > or = -1 (normal). Conversely, of the 50% (proximal radius) to 65% (distal radius) of the women with normal forearm measurement, 5% (proximal radius) to 9% (distal radius) were found to be osteoporotic and an additional 57% (proximal radius) to 59% (distal radius) could be classified as osteopenic (T-score between -1 and -2.5) at either the lumbar spine or femoral neck. In conclusion, use of pDXA forearm measurement as a prescreening tool in early postmenopausal women should allow the direct identification of about 50% of the women with no axial osteoporosis. However, this study highlights the difficulties in using a unique T-score that could be applied to different sites to diagnose osteoporosis. 相似文献
17.
K. L. Cobb J. L. Kelsey S. Sidney B. Ettinger C. E. Lewis 《Osteoporosis international》2002,13(11):893-900
To examine whether exposure to oral contraceptives (OCs) is associated with bone mineral density (BMD) in young women, we
studied, cross-sectionally and longitudinally, 216 white and 260 black women enrolled in the Coronary Artery Risk Development
in Young Adults (CARDIA) study. Spine, hip and whole body BMDs were measured by dual-energy X-ray absorptiometry (DXA) when
the women were aged 25–37 years, and whole body BMD was remeasured in 369 of the women 3 years later. A comprehensive history
of OC use, including dose of ethinyl estradiol (estrogen) and duration of use, was determined from an interviewer-administered
questionnaire. After adjustment for other relevant variables, we found that cumulative estrogen from OCs (mg) explained 4.0%
of the variation in spine BMD (p = 0.024) among white women, but did not explain any of the variance in BMD in black women. Cumulative OC estrogen was associated
with a decreased risk for low bone density (lowest quartile) at the spine, hip and whole body in white women. The odds ratios
(95% CIs) comparing women in the highest quartile of cumulative OC estrogen with those in the lowest quartile were, at the
spine: 0.08 (0.02, 0.46); at the hip: 0.23 (0.06, 0.87); and at the whole body: 0.37 (0.11, 1.26). OC exposure was not related
to low bone density in black women. OCs did not predict longitudinal changes in whole body BMD in either race. These results
suggest that exposure to the estrogen from OCs during the premenopausal years may have a small beneficial effect on the skeleton
in white women. Benefit is proportional to the cumulative estrogen exposure, suggesting that previous cross-sectional studies
that considered OC use as a dichotomous variable may have lacked the power to detect an association.
Received: 22 January 2002 / Accepted: 25 April 2002
Correspondence and offprint requests to: Kristin L. Cobb, Division of Epidemiology, HRP Redwood Building, Stanford University, Stanford, CA 94305, USA. Tel: +1 (650)
498 6784. Fax: +1 (650) 725 6951. e-mail: kcobb@stanford.edu 相似文献
18.
S. M. Hamburg D. A. Piers A. P. van den Berg M. J. H. Slooff E. B. Haagsma 《Osteoporosis international》2000,11(7):600-606
Hepatic osteodystrophy is a complication of chronic liver disease and bone mass is known to decline further in the first
year after liver transplantation. The present study focused on bone mineral density (BMD) between 1 and 15 years after liver
transplantation under a prednisolone- and azathioprine-based immunosuppressive regimen. Three groups of adult patients were
studied: group 1, 45 patients with a follow-up of 5–9 years after transplantation, had BMD measurements done at 1, 2 and 5
years after transplantation; group 2, 17 patients with a follow-up of 10–14 years, had BMD measurements done at 5 and 10 years;
group 3, 4 patients with a follow-up of more than 15 years, had BMD measurements done at 10 and 15 years. BMD of lumbar spine
(L1–L4) and proximal femur was measured using dual-energy X-ray absorptiometry, and at the same time radiographs of the spine
and hips were made. Spinal BMD increased significantly, during the second post-transplant year; subsequently no significant
changes were seen. Proximal femur BMD decreased slightly, but significantly during the second year, and remained stable afterwards.
About one-third of patients had a BMD below the fracture threshold (= 0.798 g/cm2 for the lumbar spine and 0.675 g/cm2 for the hip) during the follow-up. In 5 of the 66 patients studied, new vertebral fractures occurred. No fractures or avascular
necrosis of the hips were seen. Furthermore, after transplantation lower Z-scores of the hip were found in patients with pre-transplant cholestatic liver diseases, and lower Z-scores of the lumbar spine were found in men compared with women. Long-term follow-up of BMD up to 15 years after transplantation
revealed an improvement mainly in the second postoperative year with no deterioration afterwards. Nevertheless a substantial
number of patients (around one-third) kept a BMD below the fracture threshold, and new fractures may occasionally occur. The
overall outcome appeared somewhat less favorable in men and patients transplanted for cholestatic liver diseases.
Received: 15 July 1999 / Accepted: 11 January 2000 相似文献
19.
Bone mineral density (BMD) has been shown to be different in different ethnic groups. When lifestyle and diet evolve, there
is a possibility of a change in the normal reference BMD values within an ethnic group over a period of time. As the osteoporotic
risk uses the T-score as the bench mark, it is pertinent to evaluate whether such changes do occur. Two measurements, 5 years apart, of the
BMD of the spine and the hip were made in a cohort of Chinese women in Hong Kong. A kernel function smoothing method, a nonparametric
statistical method, was employed to present the BMD data. The greatest rate of bone loss was found to occur between 50 and
59 years of age, but this rate of loss was reduced from age 60 onwards. The BMD values obtained in these two measurements
were different from the previous studies in the same population and were found to be higher at the lumbar spine and neck of
femur in women over 65 years of age. Even within the cohort, there seemed to be a reduction in the BMD values of the hip in
a span of 5 years, although the differences were statistically insignificant. These studies suggest that BMD values could
change in a population for a variety of possible reasons. Hence, the reference BMD values might need to be evaluated at regular
intervals for the T-score to be meaningful.
Received: 26 April 2000 / Accepted: 8 February 2001 相似文献
20.
Bone Mineral Density in French Canadian Women 总被引:3,自引:0,他引:3
C. Blanchet S. Dodin M. Dumont Y. Giguère L. Turcot-Lemay J. Beauchamp D. Prud'homme 《Osteoporosis international》1998,8(3):268-273
This cross-sectional study investigated bone mineral density (BMD) at the lumbar spine (L2–4) and femoral neck in French
Canadian women residing in the Quebec city area. Data collection was initiated in 1988 and completed in 1994. A total of 747
French Canadian Caucasian women (16–79 years of age) with no metabolic bone disease were evaluated. BMD measurements were
obtained using dual-photon absorptiometry (DPA) or dual-energy X-ray absorptiometry (DXA). Anthropometric measures such as
weight, height and body mass index (BMI) were recorded. Medical files provided information on demographic characteristics,
hormonal profile and lifestyle habits. Results show a curvilinear trend of BMD with aging. Furthermore, the peak BMD at the
lumbar spine (L2–4) was reached at 29 years followed by a stable phase until 35 years, after which BMD started to decrease.
The pattern of bone evolution at the femoral neck was different, peak BMD being achieved earlier, at 21 years, while after
age 26 years a significant decrease was already observed. Women older than 60 years showed the lowest BMD. Regression analysis
showed that age, weight and height are determinants of BMD at the lumbar spine and explained 33.9% of inter-individual variation.
At the femoral neck, 29.1% of variation was explained by age and height only. In conclusion, our data suggest that French
Canadian women have a different pattern of bone loss at the femoral neck compared with the lumbar spine, according to their
mean BMD values.
Received: 21 July 1997 / Accepted: 15 October 1997 相似文献