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1.
The aim of this study was to establish a normative database, assess precision, and evaluate the ability to identify women
with low bone mass and to discriminate women with fracture from those without for a highly portable, scanning calcaneal ultrasonometer:
the QUS-2. Fourteen hundred and one Caucasian women were recruited for the study. Among them were 794 healthy women 25–84
years of age evenly distributed per 10-year period to establish a normative database. Of these, 171 aged 25–34 years were
defined as the young normal group for the purpose of T-score determination. Precision was assessed within 1 day (short-term) and over a 16-week period (long-term) in 79 women aged
25–84 years. Five hundred twenty-eight women ranging from 50 to 84 years of age with or without prevalent fractures of the
spine, hip or forearm were measured to compare the QUS-2 with bone mineral density (BMD) of the hip and spine. Mean calcaneal
broadband ultrasound attenuation (BUA) was constant in healthy women from 25 to 54 years of age and decreased with increasing
age thereafter. Short-term precision, with and without repositioning of the heel, and long-term precision yielded comparable
results (BUA SDs of 2.1–2.4 dB/MHz, coefficients of variations (CVs) of 2.5–2.9%). Calcaneal BUA was significantly correlated
with BMD of the total hip (TH), femoral neck (FN) and lumbar spine (LS) in 698 women (r= 0.6–0.7, all p<0.0001). A similar relationship was observed for LS BMD compared with either TH or FN BMD (r= 0.7, p<0.0001). Prevalence of osteoporosis in our population (WHO criteria) was 20%, 17%, 21%, and 24% for BUA, BMD of the TH, FN
and LS, respectively. Age-adjusted values for a 1 SD reduction in calcaneal BUA and TH and FN BMD predicted prevalent fractures
of the spine, forearm, and hip with significant (p<0.05) odds ratios of 2.3, 2.0 and 2.1, respectively. Areas under the receiver operating characteristic curves for age-adjusted
bone mass values predicting prevalent fracture were 0.62 for BUA, 0.59 for TH BMD, 0.60 for FN BMD, and 0.57 for LS BMD; all
statistically equivalent. We conclude that the QUS-2 calcaneal ultrasonometer exhibits reproducible clinical performance that
is similar to BMD of the spine and hip in identifying women with low bone mass and discriminating women with fracture from
those without.
Received: 19 July 2000 / Accepted: 6 December 2000 相似文献
2.
Association Between Colles’ Fracture and Low Bone Mass: Age-Based Differences in Postmenopausal Women 总被引:3,自引:0,他引:3
E. Kanterewicz E. Kanterewicz A. Yañez A. Pérez-Pons I. Codony L. Del Rio A. Díez-Pérez 《Osteoporosis international》2002,13(10):824-828
Colles’ fracture (CF) in postmenopausal women has been linked to low bone mass at the lumbar spine and hip. However, the
diverse methodological approaches of previous studies make the results difficult to compare and thus the implications of CF
in osteoporosis daily clinical practice are not clear. We explored the association between CF and low bone mineral density
(BMD) in an incident case-control study in 58 postmenopausal Spanish women aged 45–80 years with recent CF and in 83 population-based
controls of the same age range. The BMD of ultradistal distal forearm, lumbar spine and hip was measured by dual-energy X-ray
absorptiometry (DXA) and WHO criteria were used to define osteoporosis and osteopenia. BMD was significantly lower in cases
for all three areas (p<0.001). Osteoporosis was more prevalent in cases than controls in the wrist (60% vs. 35%, p<0.001), lumbar spine (47% vs. 20%, p<0.005) and hip (19% vs. 6%, p<0.005). After adjusting for age, menopausal status and body mass index, osteoporosis and osteopenia remained significantly
associated with CF only in women aged 65 years or less (ultradistal forearm OR 5.7 (95% CI 1.2–27.2), lumbar spine OR 3.9
(95% CI 1.1–14.3)). We conclude that CF in postmenopausal women aged 65 or less may be used as a sentinel finding to identify
patients with generalized osteoporosis. Additionally, 70% of all CF patients regardless of their age had low bone mass (T-score<−1SD) in any studied site.
Received: 3 December 2001 / Accepted: 22 May 2002 相似文献
3.
A. Dey E. V. McCloskey T. Taube R. Cox K. C. Pande R. U. Ashford M. Forster D. de Takats J. A. Kanis 《Osteoporosis international》2000,11(11):953-958
Metacarpal morphometry represents a potentially cheap and widely available non-invasive assessment of skeletal status. In
two cross-sectional studies, we compared the performance characteristics of a semi-automated technique (the Teijin Bonalyzer)
with an in-house manual measurement, and with measures of skeletal strength at other sites. The metacarpal cortical index
(mCI) was measured on hand radiographs of 178 osteoporotic women using both the Teijin Bonalyzer and a digitizing tablet.
Measurements on the latter were consistently lower than with the Bonalyzer except for mCI (0.443 ± 0.080 vs 0.364 ± 0.060,
p<0.001), although correlation coefficients between these two methods were highly significant (r= 0.62–0.83, p<0.001). The reproducibility errors of metacarpal bone mineral density (mBMD) were constant (1.1–1.2%) whilst those for mCI
showed a marked operator-dependency (2.0–7.9%). In 379 elderly community-dwelling women, Bonalyzer mCI and mBMD showed a significant
decline with age (r=−0.30 and −0.27 respectively, p<0.05). Both mCI and mBMD correlated significantly with forearm BMD (r= 0.50 and 0.57 respectively, p<0.001) and hip BMD (r= 0.48 and 0.53 respectively, p<0.001). After adjustment for age and weight, hip BMD demonstrated the best discrimination for prevalent vertebral fractures
as judged by the gradient of risk for a 1 SD decrease in measurement (odds ratio (OR) 2.17, 95% CI 1.56–3.01). Similar but
smaller gradients of risk were shown by Bonalyzer mCI (OR 1.32, 95% CI 1.00–1.75), mBMD (OR 1.35, 95% CI 1.02–1.78) and forearm
BMD (OR 1.39, 95% CI 1.08–1.80). MCI, and in particular mBMD, may be useful assessments of bone mass and fracture risk. In
our study, it is comparable to peripheral assessment of skeletal status by forearm densitometry.
Received: 22 February 2000 / Accepted: 6 June 2000 相似文献
4.
Bone Densitometry: A New, Highly Responsive Region of Interest in the Distal Forearm to Monitor the Effect of Osteoporosis Treatment 总被引:1,自引:0,他引:1
The bisphosphonates have been introduced as alternatives to hormone replacement therapy (HRT) for the treatment and prevention
of postmenopausal osteoporosis. The expected increasing application in at clinical practice demands cost-effective and easily
handled methods to monitor the effect on bone. The weak response at the distal forearm during antiresorptive treatment has
restricted the use of bone densitometry at this region. We describe a new model for bone densitometry at the distal forearm,
by which the response obtained is comparable to the response in other regions where bone densitometry is much more expensive
and technically complicated. By computerized iteration of single X-ray absorptiometry forearm scans we defined a region with
65% trabecular bone. The region was analyzed in randomized, double-masked, placebo- controlled trials: a 2-year trial with
alendronate (n= 69), a 1-year trial with ibandronate (n= 141) and a 2-year trial with HRT (n= 121). Bone mineral density (BMD) at the distal forearm revealed a highly statistically significant dose-related response
and increased 3–5% per year with 2.5 mg ibandronate, 10 mg alendronate or HRT, whereas the decrease in the placebo groups
was 1–3% (p<0.001). The response at the distal forearm was similar to the response at the lumbar spine and hip. In conclusion, trabecular
bone at the distal forearm is as responsive to antiresorptive treatment as trabecular bone in other skeletal regions. Bone
densitometry at the new region of interest in the distal forearm has comparable performance characteristics to more expensive
and technically demanding methods. The method is more accessible clinically and has potential as an alternative for monitoring
bone mass changes during antiresorptive treatment.
Received: 9 February 1998 / Accepted: 30 July 1998 相似文献
5.
The Effects of Pregnancy and Lactation on Bone Mineral Density 总被引:8,自引:0,他引:8
We performed a prospective study of bone mineral density (BMD) in 38 women during their first full-term pregnancy until 12
months postpartum. BMD measurements at lumbar spine [L2–L4 (LS)] and forearm [distal 33% (RD) and ultradistal (RUD) region
of the radius] were made within 3 months before conception, after delivery, and at 6 and 12 months postpartum. In mid-pregnancy
the DXA examination was carried out only at the forearm. Patients were grouped according to duration of lactation as group
I, II or III (0–1, 1–6, 6–12 months respectively). During pregnancy there was a significant difference between baseline and
delivery (p< 0.001) in the LS, RUD and RD BMD values. In group I there was no statistically significant difference in LS BMD between
visits following pregnancy. The RUD BMD loss was recovered by 6 months postpartum (PP6). Group II showed continuous bone loss
from delivery until PP6 at LS and RUD. In group III the LS BMD loss continued throughout the lactation period. The RUD BMD
dropped (4.9%) until PP6 then increased by 3.0% as measured at 12 months postpartum (PP12). There was no significant change
in RD BMD in any of three groups during lactation. At LS bone loss between delivery and PP12 correlated well with the duration
of lactation (r=−0.727; p<0.001). We suggest that calcium needed for fetal skeletal growth during pregnancy was gained from maternal trabecular and
cortical sites and that calcium needed for infant growth during lactation was drawn mainly from the maternal trabecular skeleton
in our patients. The effect of pregnancy and lactation on the maternal bone mass was spontaneously compensated after weaning.
Received: 13 July 2000 / Accepted: 19 April 2001 相似文献
6.
In women with postmenopausal osteoporosis (PMO), response to therapy with bisphosphonates is conventionally monitored using
central-site (hip and spine) bone mineral density (BMD), but more convenient alternatives are desirable. During a randomized
parallel-group study of the efficacy of once-weekly (80 mg vs 160 mg) oral alendronate in the treatment of PMO, 81 women (mean
age 70.2 years ± 4.6 SD) had BMD measurements of total hip (TH) and lumbar spine (LS) (L1–L4, Hologic); and of the middle
phalanx of the middle digit of the non-dominant hand (accuDXA) at baseline and after 6 and 12 months of therapy with alendronate.
At the same timepoints, subjects also had measurements of speed of sound (SOS) through bone at four sites (distal 1/3 radius,
proximal phalanx of the third finger, midshaft of the tibia and fifth metatarsal) using the Sunlight Omnisense Ultrasound
Bone Sonometer. Data from both patient groups were pooled for this analysis. Mean TH BMD at baseline was 0.705 g/cm2± 0.093 (SD) and increased by 1.7%± 2.3% and 2.5%± 2.3% at 6 and 12 months respectively (p= 0.09 and p<0.0001). Mean LS BMD at baseline was 0.718 ± 0.076 g/cm2 and increased by 3.9%± 3.6% and 6.1%± 3.5 % at 6 and 12 months respectively (both p<0.0001). There was no statistically significant change from baseline in mean BMD by accuDXA at either 6 or 12 months. The
only statistically significant changes in SOS were at the radius (decrease in SOS at 12 months, p = 0.04) and tibia (increase at 6 months, p<0.01, but no change between baseline and 12 months). Baseline correlation coefficients between accuDXA and LS and TH DXA
were 0.22 (p= 0.05) and 0.27 (p= 0.02) respectively. Correlation coefficients between SOS and LS DXA ranged from 0.05 to 0.22; and between SOS and TH DXA
ranged from –0.08 to 0.10 (all p= NS). These data suggest that the response to alendronate therapy over this time period cannot be measured by accuDXA or
Sunlight SOS at the sites studied.
Received: 26 June 2001 / Accepted: 27 September 2001 相似文献
7.
E. Lespessailles E. Lespessailles S. Poupon R. Niamane S. Loiseau-Peres S. Loiseau-Peres G. Derommelaere R. Harba D. Courteix C. L. Benhamou C. L. Benhamou 《Osteoporosis international》2002,13(5):366-372
An analysis of trabecular bone texture based on fractal mathematics, when applied to trabecular bone images on plain radiographs,
can be considered as a reflection of trabecular bone microarchitecture. It has been shown to be able to distinguish postmenopausal
osteoporosis cases from controls. This cross-sectional study was carried out to investigate the influence of age, time since
menopause and hormone replacement therapy (HRT) on the fractal dimension of trabecular bone texture at the calcaneus in a
sample of 537 healthy women. Fractal analysis of texture was performed on calcaneus radiographs and the result expressed as
the Hmean parameter (H = 2–fractal dimension). Total hip, femoral neck and lumbar spine bone mineral density (BMD) was measured
by dual-energy X-ray absorptiometry. There was a statistically significant Hmean parameter decrease with age (p<0.0001) but the degree of correlation was low (r=–0.2) compared with the correlation between age and BMD (r=–0.36 to –0.61 according to the BMD site). We found a weak but statistically significant correlation between time since menopause
and Hmean (r=–0.14, p= 0.03) in the 241 postmenopausal women included in the study. Hmean was significantly lower in a group of postmenopausal
women without HRT (n= 110) compared with a group of age-matched postmenopausal women with HRT (n = 110): respectively 0.683 ± 0.043 and 0.695 ± 0.038 (p= 0.03). In conclusion, this study suggests that there is a menopause- and age-related decrease in the Hmean parameter and
that HRT interferes with the results of the fractal analysis of trabecular bone texture on calcaneus radiographs.
Received: 2 March 2001 / Accepted: 2 October 2001 相似文献
8.
Quantitative Ultrasound Measurements of the Tibia and Calcaneus in Comparison with DXA Measurements at Various Skeletal Sites 总被引:2,自引:0,他引:2
The performance of quantitative ultrasound (QUS) measurements of the tibia and calcaneus was studied in 109 elderly people
(age range 65–87 years). Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured at the calcaneus and
SOS was assessed at the tibia. Short-term precision of tibial QUS was studied in 16 volunteers. The coefficient of variation
(CV) was 0.4% and the standardized CV (sCV) was 4.4%. We compared the calcaneal and tibial QUS measurements with bone mineral
density (BMD) measurements of the lumbar spine, femoral neck, trochanter and total body assessed by dual-energy X-ray absorptiometry
(DXA). Calcaneal QUS correlated better with BMD at various skeletal sites than tibial QUS. Calcaneal BUA showed higher correlations
with BMD values of the lumbar spine, femoral neck, trochanter and total body than calcaneal and tibial SOS (r= 0.48–0.64, r= 0.30–0.47, r= 0.35–0.47, respectively; p<0.001). Body weight modified the relationships between calcaneal and tibial QUS and BMD measurements of the hip. Higher body
weight was associated with higher BMD values at the femoral neck and trochanter for the same calcaneal and tibial QUS values.
After adjustments for body weight correlations of tibial and calcaneal QUS with BMD improved and were very similar. This suggests
that correction for body weight is important and could add to the predictive value of QUS measurements.
Received: 16 July 1997 / Accepted: 8 July 1998 相似文献
9.
Bisphosphonates such as etidronate and alendronate are widely accepted as effective agents for the treatment of osteoporosis.
However, some physicians find the choice of which one to use in different patients, and the comparative magnitude of response,
unclear. Fifty postmenopausal women with osteoporosis [group 1: 27 women who had received 3 years of previous cyclical etidronate
treatment, mean age 70.5 years, bone mineral density (BMD) mean T-score lumbar spine (LS) −3.58 and femoral neck (FN) −2.51; group 2: 23 women who had not previously received cyclical etidronate
treatment, mean age 73.7 years, BMD mean T-score LS −3.65 and FN −2.96] were treated with 10 mg alendronate daily, to determine whether pretreatment with etidronate
affected the response to alendronate, and whether patients who did not respond to etidronate, responded to alendronate. There
was a significant increase in LS BMD after 2 years of treatment with alendronate compared with baseline (group 1: 7.84%, p<0.001; group 2: 6.69%, p<0.001), but there was no statistical difference between the groups. In the group 1 patients there was a significant difference
between the initial response (at the LS BMD) to 2 years of cyclical etidronate (1.86%) and later response to 2 years of alendronate
(7.84%) (p<0.0001). The 10 patients who did not respond at the LS to etidronate alone, showed a significantly better response (mean
BMD change +6.3%) when subsequently treated with alendronate (a net difference of 9.3%, p = 0.002). In 15 patients who did not respond at the FN to etidronate alone, the mean response to alendronate was +0.96% (a
difference of 7%, p = 0.004). This study shows that pretreatment with 3 years of cyclical etidronate is not detrimental to the subsequent LS
BMD response to alendronate. There is evidence that alendronate produced a greater bone density response than etidronate,
and patients who did not respond to etidronate with an increase in LS bone density, subsequently did so following alendronate.
Received: 22 June 1999 / Accepted: 18 January 2000 相似文献
10.
Digital X-ray radiogrammetry (DXR) is a technique that uses automated image analysis of standard hand radiographs to estimate
bone mineral density (DXR-BMD). Previous studies have shown that DXR-BMD measurements have high precision, are strongly correlated
with forearm BMD and are lower in individuals with prevalent fractures. To determine whether DXR-BMD measurements predict
wrist, hip and vertebral fracture risk we conducted a case–cohort study within a prospective study of 9704 community-dwelling
elderly women (the Study of Osteoporotic Fractures). We compared DXR-BMD, and BMD of the radius (proximal and distal), calcaneus,
femoral neck and posteroanterior lumbar spine in women who subsequently suffered a wrist (n= 192), hip (n= 195), or vertebral fracture (n= 193) with randomly selected controls from the same cohort (n= 392–398). DXR-BMD was estimated from hand radiographs acquired at the baseline visit. The radiographs were digitized and
the Pronosco X-posure System was used to compute DXR-BMD from the second through fourth metacarpals. Wrist fractures were
confirmed by radiographic reports and hip fractures were confirmed by radiographs. Vertebral fractures were defined using
morphometric analysis of lateral spine radiographs acquired at baseline and an average of 3.7 years later. Age-adjusted odds
ratio (OR, vertebral fracture) or relative hazard (RH, wrist and hip fracture) for a 1 SD decrease in BMD were computed. All
BMD measurements were similar for prediction of wrist (RH = 1.5–2.1) and vertebral fracture (OR = 1.8–2.5). Femoral neck BMD
best predicted hip fracture (RH = 3.0), while the relative hazards for all other BMD measurements were similar (RH = 1.5–1.9).
These prospective data indicate that DXR-BMD performs as well as other peripheral BMD measurements for prediction of wrist,
hip and vertebral fractures. Therefore, DXR-BMD may be useful for prediction of fracture risk in clinical settings where hip
BMD is not available.
Received: 27 April 2001 / Accepted: 10 October 2001 相似文献
11.
G. Martínez Díaz-Guerra F. Hawkins A. Rapado M. A. Ruiz Díaz M. Díaz-Curiel 《Osteoporosis international》2001,12(3):178-184
Osteoporosis in men is a significant health problem, and factors associated with bone mass are being investigated. Although
osteoporosis is a typical feature of hypogonadism, the influence of testosterone levels and other hormonal factors on bone
mass of eugonadal males is unknown. Our aim was to identify several anthropometric and hormonal predictors that could be responsible
for the variability in bone mineral density (BMD) in healthy men. One hundred elderly men (age 68 ± 7 years) were investigated
in this cross-sectional study. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral
sites (femoral neck, Ward’s triangle, trochanter, intertrochanter and total femur). Anthropometric measures were obtained
including: weight, height, body mass index (BMI), waist–hip ratio and testicular volume. Hormonal data measures were total,
free and bioavailable testosterone, dihidrotestosterone, estradiol, sex hormone binding globulin (SHBG), insulin-like growth
factor I (IGF-I), intact parathyroid hormone (iPTH) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3). One subject was excluded because primary hypogonadism was found. SHBG levels were increased in 53.5% of men, and 8% showed
a mild increase in iPTH levels. Twenty-eight subjects had densitometric criteria of osteoporosis (T-score ≤−2.5). All BMD sites were positively correlated with body weight (r= 0.29–0.48, p<0.001) and BMI (r= 0.24–0.47, p<0.001). A negative correlation between SHBG levels and intertrochanter (IT) and total femur (TL) BMD was found (r=−0.24 and r=−0.22, p<0.05). After adjusting for age and BMI, SHBG and IGF-I levels were negatively correlated (r=−0.33, p<0.001). In multiple linear regression analysis independent predictors of bone mass were body weight, SHBG and iPTH levels.
The best predictive model accounted for 24–40% of the observed variability of BMD. However, most of the BMD variability was
explained by body weight. In conclusion, in our study body weight, SHBG and iPTH levels were predictors of BMD in healthy
elderly men.
Received: 9 June 2000 / Accepted: 27 September 2000 相似文献
12.
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
13.
Estimation of Bone Mineral Density by Digital X-ray Radiogrammetry: Theoretical Background and Clinical Testing 总被引:9,自引:0,他引:9
A. Rosholm L. Hyldstrup L. Bæksgaard M. Grunkin H. H. Thodberg 《Osteoporosis international》2001,12(11):961-969
A new automated radiogrammetric method to estimate bone mineral density (BMD) from a single radiograph of the hand and forearm
is described. Five regions of interest in radius, ulna and the three middle metacarpal bones are identified and approximately
1800 geometrical measurements from these bones are used to obtain a BMD estimate of the distal forearm, referred to as BMDDXR (from digital X-ray radiogrammetry, DXR). The measured dimensions for each bone are the cortical thickness and the outer
width, in combination with an estimate of the cortical porosity. The short-term in vivo precision of BMDDXR was observed to be 0.60% in a clinical study of 24 women and the in vitro variation over 12 different radiological clinics
was found to be 1% of the young normal BMDDXR level. In a cohort of 416 women BMDDXR was found to be closely correlated with BMD at the distal forearm measured by dual-energy X-ray absoptiometry (r= 0.86, p<0.0001) and also with BMD at the spine, total hip and femoral neck (r= 0.62, 0.69 and 0.73, respectively, p<0.0001 for all). The annual decline was estimated from the cohort to be 1.05% in the age group 55–65 years. Relative to this
age-related loss, the reported short-term precision allows for monitoring intervals of 1.0 years and 1.6 years in order to
detect expected age-related changes with a confidence of 80% and 95%, respectively. It is concluded that the DXR method offers
a BMD estimate with a good correlation with distal forearm BMD, a low variation between geographical sites and a precision
that potentially allows for relatively short observation intervals.
Received: 8 November 2000 / Accepted: 14 June 2001 相似文献
14.
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
15.
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
16.
The aim of this study was to determine possible associations between bone mineral density (BMD), 25-hydroxyvitamin D (25(OH)D)
and intact parathyroid hormone (PTH). In a retrospective study we examined the case notes of free-living postmenopausal women
living in our city (34° S). We also report a low prevalence of vitamin D deficiency (25(OH)D <25 nmol/l, 5.6%) and of secondary
hyperparathyroidism (intact PTH >65 pg/ml, 7.5%). Age was correlated with BMD at the lumbar spine (r=−0.25, p = 0.00038) and femoral neck (r=−0.252, p = 0.0003). Body mass index (BMI) was correlated with BMD at the femoral neck (r= 0.177, p = 0.021) but not at the lumbar spine. 25(OH)D was positively correlated with BMD at the femoral neck (r = 0.149, p=0.036) but not at the lumbar spine. PTH was positively correlated with age (r= 0.279, p = 0.012) and negatively correlated with 25(OH)D (r=−0.322, p = 0.0036). PTH was also negatively correlated with BMD at the lumbar spine (r=−0.258, p=0.02) and the femoral neck (r=−0.282, p = 0.011). Forward stepwise multiple regression showed that BMI, age and 25(OH)D made significant contributions to BMD at
the femoral neck. PTH also showed a significant contribution to BMD at both sites. In conclusion, weak correlations found
between PTH and 25(OH)D and BMD suggest these biochemical variables, among other factors, contribute to lumbar spine and femoral
neck BMD.
Received: 19 February 2000 / Accepted: 20 June 2000 相似文献
17.
M. Sundberg P. Gärdsell O. Johnell E. Ornstein I. Sernbo 《Osteoporosis international》1998,8(5):410-417
We performed ultrasound measurements (QUS) of the calcaneus in a population-based setting on 280 healthy children, aged 11–16
years, from a small urban area in southern Sweden. The results are compared with dual-energy X-ray absorptiometry (DXA) measurements
in the total body, the lumbar spine and the hip, as well as single-energy X-ray absorptiometry (SXA) of the forearm. Normative
data and correlations between the three different techniques were determined. We found significant correlations between QUS
and age (r= 0.34–0.54), height (r= 0.13–0.56) and weight (r= 0.30–0.60), and between QUS and bone mineral density (BMD) measurements (r= 0.44–0.70). Boys increased all their bone mineral variables with age, whereas girls showed a decreasing trend from age 15
years. QUS had a significantly higher increase in standardized value with age than Ward's triangle BMD, but a significantly
lower increase in standardized value with age than distal radius (cortical site) BMD. At other BMD sites we did not find any
significant differences compared with QUS regarding changes with age. The measurements obtained by QUS, DXA and SXA, respectively,
were divided into quartiles. Of all subjects in the lowest quartile for QUS measurements, only 34–50% were also in the lowest
quartiles for DXA and SXA measurements. In conclusion, QUS measurements of the calcaneus in children show similar results
as for adult regarding the correlation with DXA and SXA; they also have a significant correlation with anthropometric data.
QUS did not identify the same individuals with low bone mass as the X-ray techniques.
Received: 23 June 1997 / Accepted: 21 January 1998 相似文献
18.
Bone Density in an Immigrant Population from Southeast Asia 总被引:9,自引:0,他引:9
M. A. Marquez L. J. Melton III J. M. Muhs C. S. Crowson A. Tosomeen M. K. O’Connor W. M. O’Fallon B. L. Riggs 《Osteoporosis international》2001,12(7):595-604
The epidemiology of bone loss in populations of Asian heritage is still poorly known. This study compared the skeletal status
of a convenience sample of 396 Southeast Asian immigrants (172 Vietnamese, 171 Cambodians and 53 Laotians) residing in Rochester,
Minnesota in 1997 with 684 white subjects previously recruited from an age-stratified random sample of community residents.
Areal bone mineral density (BMD, g/cm2) and volumetric bone mineral apparent density (BMAD, g/cm3) were determined for lumbar spine and proximal femur using the Hologic QDR 2000 instrument for the white population and the
QDR 4500 for Southeast Asian subjects; the machines were cross-calibrated from data on 20 volunteers. Lumbar spine BMD was
7% higher in white than Southeast Asian women ( p < 0.001), and similar results were observed for the femoral neck; lumbar spine BMD was 12% higher in white than nonwhite
men ( p < 0.001). Race-specific discrepancies were reduced by calculating BMAD: for premenopausal women, lumbar spine and femoral
neck differences between whites and Southeast Asians were eliminated; for postmenopausal women the lumbar spine differences
persisted ( p < 0.0001), while femoral neck BMAD was actually higher for Southeast Asians. There were no race-specific differences in femoral
neck BMAD among men of any age ( p= 0.312), but lumbar spine BMAD was less for younger ( p= 0.042) but not older ( p= 0.693) Southeast Asian men. There were differences among the Southeast Asian subgroups, but no clear pattern emerged. Predictors
of lumbar spine BMAD in Southeast Asian women were age ( p < 0.001), weight ( p= 0.015) and gravidity ( p= 0.037). Even after adjusting for bone size using BMAD, 32% and 9% of Southeast Asian women and men, respectively, would
be considered to have osteoporosis at the femoral neck and 25% and 4%, respectively, at the lumbar spine. These findings indicate
a need for culturally sensitive educational interventions for Southeast Asians and for physicians to pursue diagnosis and
treatment to prevent osteoporosis-related disabilities in this population.
Received: 12 October 2000 / Accepted: 15 February 2001 相似文献
19.
We performed a prospective study to evaluate the normal changes in bone mineral density (BMD) in the forearm, hip, spine
and total body, and to study the agreement between changes in BMD estimated from cross-sectional data and the actual longitudinal
changes. Six hundred and twenty subjects (398 women, 222 men; age 20–89 years) without diseases or medication known to affect
bone metabolism undertook baseline evaluations, and 525 (336 women, 189 men) completed the study. BMD was measured twice 2
years apart by dual-energy X-ray absorptiometry. From cross-sectional evaluations the only premenopausal bone loss (<0.003
g/cm2/year) was found in the hip. In women after menopause and in men an age-related bone loss (0.002–0.006 g/cm2/year) was found at all sites. The data from the longitudinal evaluation showed a small bone loss in women before menopause
at the hip and lumbar spine (<0.4%/year (<0.004 g/cm2/year)); this bone loss nearly tripled in the early postmenopausal years (<10 years since menopause), and thereafter decreased
to the premenopausal rate for the hip, and to zero for the lumbar spine. The most pronounced bone loss after menopause occurred
in the forearm (1.2 %/year (0.006 g/cm2/year)), and it remained constant throughout life. In men there was a small longitudinal bone loss in the hip throughout life,
and a small bone loss in the distal forearm after the age of 50 years. In all groups, except for the early postmenopausal
women, we found a small increase in total body BMD with age. When comparing the changes in BMD estimated from cross-sectional
data with the longitudinal changes, only the hip and forearm generally displayed agreement, whereas the changes in the total
body and spine generally were incongruous. In conclusion, the hip and forearm appear to be the sites with the best agreement
between the cross-sectional estimated and the longitudinal age-related changes in BMD.
Received: 22 August 2000 / Accepted: 22 June 2001 相似文献
20.
In Vivo MRI Measurements of Bone Quality in the Calcaneus: A Comparison with DXA and Ultrasound 总被引:5,自引:0,他引:5
Magnetic resonance imaging (MRI) has shown promise in the assessment of bone architecture. The precision and feasibility
of MRI measurements in osteoporosis in vivo have been assessed in this study. T2′ was calculated from measurements of T2 and
T2* in the calcaneus of 32 postmenopausal women using a gradient-echo sequence PRIME (Partially Refocused Interleaved Multiple
Echo). This sequence allows the measurement of T2 and T2* in one acquisition. In vivo measurements of bone mineral density
(BMD) by dual-energy X-ray absorptiometry (DXA) were made in the calcaneus, spine and femoral neck. The ultrasound parameters
broadband ultrasound attenuation (BUA) and speed of sound (SOS) were also measured in the calcaneus. These three techniques
have not previously been compared in the same study population. The precision of the MRI technique was poor relative to the
DXA and ultrasound techniques, with a CV of 6.9%± 4.4% for T2′ and 5.5%± 3.6% for T2*. Approximately 4% of this is due to
system error as determined by phantom measurements. The postmenopausal women were classified as having low BMD if they had
a lumbar spine (L2–4) BMD of less than 0.96 g/cm2 (more than 2 standard deviations below normal peak bone mass). Calcaneal T2′ was significantly correlated with calcaneal
BMD (r = –0.79, p <0.0001), BUA (r = –0.59, p = 0.0004) and SOS (r = –0.58, p = 0.0006). T2′ was significantly different in postmenopausal women with normal BMD and those with low BMD (p <0.01). However, the difference was of only borderline significance (p <0.06) after adjustment for age and years since menopause.
Received: 8 July 1997 / Accepted: 29 April 1998 相似文献