2型糖尿病性骨质疏松患者骨小梁分数与骨代谢标志物的相关性分析

目的分析研究2型糖尿病性骨质疏松患者骨小梁分数(trabecular bone score,TBS)与骨代谢标志物的相关性。方法选取115例2型糖尿病患者,根据测定的TBS值水平将这些患者分为骨质疏松组(62例)和非骨质疏松组(53例),比较两组间骨密度(bone mass density,BMD)、TBS值及骨代谢标志物,并对骨质疏松组骨代谢标志物与TBS值进行相关性分析。结果两组间腰椎总BMD及各腰椎(L1-L4) BMD比较差异均无统计学意义(P0.05); TBS值在骨质疏松组明显高于非骨质疏松组,差异有统计学意义(P0.05);骨质疏松组骨钙素(bone gla protein,BGP)、1型胶原羧基端肽β特殊序列(β-Carboxyl terminal peptide,β-CTX)及抗酒石酸酸性磷酸酶5b(tartra-resistant acid phosphatase 5b,TRAP-5b)明显高于非骨质疏松组,比较差异均有统计学意义(P0.05);两组间骨源性碱性磷酸酶(bone alkaline phosphatase,NBAP)、1型前胶原氨基末端前肽(type 1procollagen N-terminal propeptide,P1NP)及25羟维生素D[25-hydroxyvitamin D,25-(OH) VD]比较差异均无统计学意义(P0.05)。经Pearson分析,骨质疏松组的BGP、β-CTX及TRAP-5b与TBS值呈负相关(r值分别为-0.213、-0.247、-0.235,P0.05)。结论 2型糖尿病性骨质疏松患者的骨代谢标志物与TBS值之间具有一定的相关性,TBS联合BGP、β-CTX及TRAP-5b可能有助于2型糖尿病性骨质疏松的早期诊断和治疗监测。     

DEXA在诊断糖尿病骨质疏松中的价值

本文测定１４９例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者腰椎（Ｌ１～Ｌ４）及股骨上端（股骨颈、Ｗａｒｄ三角、股骨粗隆）骨密度，结果显示，不论男女患者＞４０岁以上各年龄组骨密度均低于正常对照组，提示糖尿病患者有骨量减少。腰椎及股骨上端相关分析表明腰椎（Ｌ１～Ｌ４）各椎体之间相关非常显著（Ｐ＜０．００１），提示腰椎各椎体骨密度丢失速度一致；腰椎与股骨颈、Ｗａｒｄ三角、股骨粗隆相关显著（Ｐ＜０．０１），但相对较小，股骨上端Ｗａｒｄ三角区骨密度减低最为显著。因此，股骨上端骨密度检测优于腰椎，一旦Ｗａｒｄ三角区骨密度降低至２．０ＳＤ以下时，即应做出骨质疏松的诊断。     

运用骨小梁分数（TBS)技术评价帕金森病患者骨质量的变化

目的研究帕金森病(PD)患者骨质量、骨量的变化。方法本研究纳入年龄≥40岁的中老年男性和女性共计276人,排除帕金森病外的其他影响骨代谢的继发性疾病及药物,分PD组和健康对照组,PD组共77人,其中男性39人,女性38人,健康对照组共199人,其中男性97人,女性102人。运用双能X线骨密度仪进行股骨颈、总髋部、腰椎BMD测定;运用骨小梁分数(TBS)技术,进行腰椎TBS的测定。分析PD组和健康对照组TBS、BMD的差异。结果 1.男性PD患者的腰椎TBS(1.261±0.074)低于男性对照组的腰椎TBS(1.298±0.073),差异有统计学意义(P=0.008);而男性PD患者的股骨颈BMD、总髋部BMD、腰椎BMD与男性对照组相比均无差异;2.女性PD患者的腰椎TBS(1.223±0.149)亦低于女性对照组的腰椎TBS(1.301±0.110),差异有统计学意义(P0.001);同时,女性PD患者的股骨颈BMD、总髋部BMD、腰椎BMD均低于女性对照组(P值均0.01)。结论 1.无论男性还是女性,PD患者骨质量均明显下降;2.PD患者骨量的变化则存在性别差异,男性PD患者骨量无明显变化,女性PD患者骨量则明显降低。     

DEXA、QUS在绝经后骨质疏松脊柱骨折诊断中的应用与探讨

目的 探讨对比绝经后骨质疏松患ＤＥＸＡ与ＱＵＳ测量对骨质疏松脊椎骨折的预测能力。方法：应用双能Ｘ线骨密度仪（ＤＥＸＡ,Ｌｕｎａｒ,ＤＰＸ－ＩＱ）和超声骨强度仪（ＱＵＳ,Ｓｕｍｌｉｇｈｔ Ｏｍ－ｎｉｓｅｎｓｅ,Ｒｅｓｅａｒｃｈ）对４９例绝经后骨质疏松脊柱骨折患脊柱、股骨近端和桡骨、戏骨进行测定、比较。结果 ４９例患ＤＥＸＡ腰椎ＢＭＤ－Ｔ值为－２．９９±１．４３,股骨近端ＢＭＤ－Ｔ值为－１．９５     

定量超声在骨质疏松中的应用及评价

定量超声技术具有设备成本及检查费用低、无电离辐射、简便快速、可携带、可反映骨的微结构等优点,在评价松质骨状况和诊断骨质疏松症方面受到国内外医学界的高度重视。但由于骨超声仪器之间差别较大,难以进行有效的质量控制,故定量超声技术在骨质疏松方面的临床应用还存在着一些问题。本文将从技术原理、测量部位、临床价值及质量控制方面对定量超声在骨质疏松中的应用进行综述,为其进一步研究以及在临床上的推广应用奠定基础。     

骨质疏松诊断与骨密度测量

骨质疏松诊断与骨密度测量何耀华邱贵兴骨质疏松是一种严重危害老年人健康的骨代谢性疾病。随着社会人口的老龄化，该病的发生越来越多。它以骨量减少和易发生骨折为特征，给社会、家庭带来危害。早期诊断、治疗骨质疏松对社会将大有裨益［１］。骨密度的测量是评价骨质疏...     

女性类风湿关节炎患者前臂骨密度测定在诊断骨质疏松中的应用价值及影响因素分析

目的探讨绝经后女性类风湿关节炎患者前臂骨密度扫描的分布规律,并通过与椎体、髋部双能X线(DXA)进行对比,确定其在类风湿关节炎(RA)患者骨质疏松诊断中的价值。方法采用DXA法,同时测量200例女性绝经后RA患者非优势侧前臂远端以及腰椎、左髋部骨密度。比较不同扫描部位之间骨密度值的关系,并探讨以诊断中轴骨密度异常的诊断界值,以及可能影响外周骨密度的因素。结果 (1)200例女性绝经RA患者平均年龄(55.9±13.8)岁。根据中轴DXA结果及骨折病史,170例(85.0%)骨密度异常(T值-1.0)。(2)RA患者中轴骨密度异常组前臂远端骨密度(0.33±0.13)g/cm~2,低于正常组(0.44±0.06)g/cm~2,(t=4.29,P0.01)。(3)病程1年以上、抗CCP抗体阳性RA患者前臂骨密度降低。(4)前臂骨密度与中轴骨密度呈正相关。(5)使用前臂骨密度诊断腰椎和左髋骨质疏松的最佳T值分别为-2.65(敏感度为0.702,特异度为0.774)和-2.50(敏感度为0.741,特异度为0.706)。(6)Logistic回归分析显示,年龄(P=0.012)、病程(P=0.011)、以及抗CCP抗体阳性(P=0.05)分别是造成RA患者前臂BMD异常的独立危险因素。结论 RA患者前臂骨密度可以作为筛查女性类风湿关节炎患者中轴骨质疏松的辅助工具,高龄、疾病病程长以及抗CCP抗体阳性患者更容易出现骨密度下降。     

股骨颈aBMD和vBMD与骨面积的关系及对诊断骨质疏松的影响

目的 探讨股骨颈的面积骨密度(aBMD)和体积骨密度(vBMD)与骨面积(BA)之间的关系及其对诊断骨质疏松(OP)的影响.方法 采用QDR-4500A型扇形柬双能X线吸收法骨密度仪,测星5585例年龄5～96岁的女性髋部(股骨近端)股骨颈的BA、骨矿含量(BMC)、aBMD和vBMD.结果 股骨颈aBMD和vBMD的峰值BMD(x±s)分别为0.8098±0.1017 g/cm2和0.1747±0.0244 g/cm3,BMC与BA呈显著正相关(r=0.350,P=0.000),aBMD与BA相关无显著性(r=-0.022,P=0.104),vBMD与BA呈显著负相关(r=-0.381,P=0.000).年龄≥40岁(平均52.7±9.58岁)的受试者(n=4012)股骨颈BA按四分位数分成Q1、Q2、Q3和Q4组,各组之间的BMC呈显著性梯次增加,vBMD呈显著性梯次减少,各组之间的aBMD无显著性差异.采用aBMD诊断时,四个组的OP检出率分别为Q1=8.59%、Q2=7.67%、Q3=8.86%和Q4=9.07%,各组之间的差异无显著性意义;采用vBMD诊断OP时,四个组的OP检出率分别为Q1=1.90%、Q2=4.88%、Q3=6.87%和Q4=13.4%,呈显著性梯次增加.在年龄≥40岁的全体受试者,aBMD的OP检出率(8.55%)显著高于vBMD(6.80%),两者的诊断齐同率为67.1%.结论 该研究揭示股骨颈aBMD与骨骼大小不相关,vBMD与骨骼大小呈负相关.aBMD的OP检出率显著高于vBMD.     

女性腰椎投影骨面积对骨密度及骨质疏松诊断的影响

目的观察健康女性腰椎投影骨面积(projective bone area,BA)对面积骨密度(areal bonemineral density,aBMD)和骨质疏松(osteoporosis,OP)诊断的影响。方法 1.成都地区健康女性824例,年龄20～80岁,用GE LUNAR公司生产的EXPERT-XL双能X线骨密度仪,测定腰椎正位1-4投射骨面积(BA)、骨矿物含量(bone mineral content,BMC)、面积骨密度(aBMD)。按照WHO推荐的诊断标准:aBMD低于峰值骨2.5个标准差为OP。2.按年龄分为20～39岁、40～59岁、60～80岁3个年龄组。各年龄组按BA大小分成大(large BA group,LBAG)、中(intermediate BA group,IBAG)、小(small BA group,SBAG)3组。3.统计学处理:用SPSS13.0统计软件,BA与BMC和aBMD的相关性用pearson相关分析;不同年龄组不同BA组腰椎BMC、aBMD比较用方差分析,OP检出率差异比较用卡方检验。结果 1.BA与BMC(r=0.768P0.01)和aBMD呈正相关(r=0.171P0.01);2.20～39岁、40～59岁、60～80岁不同BA组BMC、BMD比较均为:LBAGIBAGSBAG,差异有统计学意义(P0.05)。3.20～39岁不同BA组均无OP检出;40～59岁LBAG、IBAG、SBAG组OP检出率分别为:5.0%、13.5%、18.9%,BA越大,OP检出率越低,差异有统计学意义(P0.05);60～80岁LBAG、IBAG、SBAG组OP检出率分别为:45.2%、55.8%、64.3%,BA越大,OP检出率越低,差异有统计学意义(P0.05)。结论成都地区健康女性腰椎BA大者aBMD、BMC较高,OP检出率较低;反之腰椎BA小者,aBMD、BMC较低,OP检出率高。女性40岁后应注意骨质疏松防治。     

骨密度与体积骨密度诊断腰椎、股骨颈骨质疏松效果比较研究

目的通过流行病学调查比较面积骨密度(areal bone mineral density,aBMD)和体积骨密度(volumetric BMD,vBMD)对骨质疏松的检出率,从而探索出针对大骨骼和小骨骼人群骨质疏松诊断的校正诊断方法。方法采用GE-Lunar DPX双能X线吸收法骨密度测量仪测量腰椎和股骨颈骨密度,将仪器给的投影面积(cm~2)通过正方体数学模式(腰椎)和圆柱体数学模式(股骨颈)分别获得骨体积和vBMD(vBMD=骨矿物含量/骨体积),按世界卫生组织推荐20～39岁的aBMD和vBMD的标准差生成的T值定义正常、骨量减低和骨质疏松,骨质疏松诊断用世界卫生组织确立的T值诊断法。结果腰椎和股骨颈vBMD诊断骨质疏松症避免了aBMD引起的小骨误诊两部位分别为16%和11.6%,大骨漏诊在两部位分别为7%和18%。腰椎骨体积每小于均值10 cm~3,其aBMD的误诊率为1%;每大于均值10 cm~3,漏诊率为0.44%。股骨颈骨体积每小于均值1.0 cm~3,aBMD的误诊率为2.6%;每大于均值1.0 cm~3,漏诊率为4%。结论诊断骨质疏松用vBMD可以避免aBMD引起的大骨漏诊和小骨误诊的弊病。     

Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study

The measurement of BMD by dual‐energy X‐ray absorptiometry (DXA) is the “gold standard” for diagnosing osteoporosis but does not directly reflect deterioration in bone microarchitecture. The trabecular bone score (TBS), a novel gray‐level texture measurement that can be extracted from DXA images, correlates with 3D parameters of bone microarchitecture. Our aim was to evaluate the ability of lumbar spine TBS to predict future clinical osteoporotic fractures. A total of 29,407 women 50 years of age or older at the time of baseline hip and spine DXA were identified from a database containing all clinical results for the Province of Manitoba, Canada. Health service records were assessed for the incidence of nontraumatic osteoporotic fracture codes subsequent to BMD testing (mean follow‐up 4.7 years). Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Osteoporotic fractures were identified in 1668 (5.7%) women, including 439 (1.5%) spine and 293 (1.0%) hip fractures. Significantly lower spine TBS and BMD were identified in women with major osteoporotic, spine, and hip fractures (all p < 0.0001). Spine TBS and BMD predicted fractures equally well, and the combination was superior to either measurement alone (p < 0.001). Spine TBS predicts osteoporotic fractures and provides information that is independent of spine and hip BMD. Combining the TBS trabecular texture index with BMD incrementally improves fracture prediction in postmenopausal women. © 2011 American Society for Bone and Mineral Research     

TBS as a Tool to Differentiate the Impact of Antiresorptives onCortical and Trabecular Bone in Children With OsteogenesisImperfecta

Introduction/Background: Osteogenesis imperfecta is a hereditary connective tissue disorder, resulting in low bone mass and high bone fragility. Dual-energy X-ray absorptiometry (DXA) and in adulthood also the trabecular bone score (TBS) are well established to assess bone health and fracture risk. The purpose of this investigation was to assess the usefulness of TBS in respect to different treatment regimes in children with osteogenesis imperfecta. Changes of areal bone mineral density (aBMD) and TBS using DXA scans of children treated with antiresorptive therapies were evaluated. Methodology: DXA scans (aBMD, TBS) of 8 children with OI were evaluated. The scans were taken during a 1 yr period of treatment with bisphosphonates and during 1 yr pilot trial using denosumab. Changes of aBMD and TBS during both treatment regimens were compared. Results: During bisphosphonate treatment aBMD increased about 6.2%, while TBS increased about 2.1%. The difference between aBMD and TBS before and after bisphosphonate treatment was not significant (p?=?0.25). During denosumab treatment aBMD increased around 25.1%, while TBS increased 6.7%. The change of aBMD was significant (p?=?0.007), as was the difference between aBMD and TBS (p < 0.001). Conclusions: Denosumab had a significant effect on both aBMD and TBS but was significantly more pronounced in aBMD. These results suggest a stronger effect of denosumab on cortical bone and the growth plate in comparison to bisphosphonates. Beside the lack of paediatric reference data and the small sample size, the results suggest TBS to be a useful tool for monitoring skeletal changes during development, growth, and antiresorptive therapy in children with OI.     

Usefulness of Trabecular Bone Score (TBS) to Identify Bone Fragility in Patients with Primary Hyperparathyroidism

Background: Patients with primary hyperparathyroidism usually show decreased bone strength that are often not well diagnosed by conventional Dual-energy X-ray absorptiometry (DXA). Trabecular Bone Score (TBS) is a new technique for assessing bone microarchitecture indirectly. This cross-sectional study evaluates the usefulness of TBS in patients with primary hyperparathyroidism in clinical practice. Methodology: Bone mineral density (BMD) by DXA and TBS values by TBS InSight® software were determined in 72 patients with primary hyperparathyroidism to analyze its relationship with fragility fractures. A receiver operating curve was performed to evaluate the usefulness of TBS as predictor of fragility fractures. FRAX index with and without adjustment by TBS was calculated. Additionally, longitudinal data of a subgroup of patients according to the therapeutic management were also evaluated. Results: A total of 51.4% of the patients showed degraded microarchitecture while only 37.5% of them were diagnosed of osteoporosis by DXA. No significant correlation was found between TBS values and BMD parameters. However, TBS values were lower in osteoporotic patients compared to those classified as normal by BMD (1.16 ± 0.12vs 1.26 ± 0.17; p?=?0.043) and in patients with fragility fractures compared to nonfractured patients (1.19 ± 0.03vs 1.24 ± 0.02, p < 0.001). The area under the curve for TBS performed better than the combination of femoral, hip and spine-BMD for prevalent fractures (0.714vs 0.679). TBS-adjusted FRAX was higher than nonadjusted model for both major osteoporotic and hip fracture (4.5% vs 3%; 0.9% vs 0.7%; p < 0.001). At follow-up, an improvement in TBS values was observed in treated patients (medical or surgical) vs nontreated close to significance (1.27 ± 0.10vs 1.24 ± 0.11, p?=?0.074). Conclusions: TBS could be a useful tool to identify increased fracture risk in patients with primary hyperparathyroidism underdiagnosed by BMD. Moreover, FRAX adjusted by TBS could be a more robust tool for predicting the risk of osteoporotic fracture to help in therapeutic decisions in this population.     

腰椎侧位骨密度测量在骨质疏松症诊断中的应用

目的　为了探讨腰椎前后位、腰椎侧位测量图象的分析方法 ,以便寻找更敏感的测量部位 ,为本地区骨质疏松症的研究提供有益的参考数据。方法　本研究应用法国DMS公司生产的Challanger双能X线骨密度仪 ,对大连地区 80 1名正常人的腰椎骨密度进行了测定。在图象分析上我们探讨了腰椎侧位图象的分析方法 ,即在ROI(regionsofinterest)的划定上 ,采用了腰椎侧位全椎体和腰椎侧位中间区两种划定方法 ,侧位中间区ROI大小规定为椎体扫描图象长宽各 1 /2所围的区域。结果　男性腰椎骨峰值年龄在 2 0～ 2 9岁 ;女性腰椎骨峰值年龄在 30～ 39。无论男性还是女性 ,腰椎骨量随年龄增长而丢失增加 ,腰椎各部位骨量累计丢失率顺序为 :腰椎侧位中间区 >腰椎侧位全椎体>腰椎前后位 ,腰椎侧位中间区最敏感。结论　男性腰椎各部位骨峰值年龄在 2 0～ 2 9岁 ;女性腰椎部位骨峰值年龄在 30～ 39。腰椎侧位BMD能更敏感地反映腰椎松质骨骨量的变化 ,以侧位中间区最敏感 ,侧位测量优于前后位测量     

长春市16019例汉族人群骨密度调查及骨质疏松发病率分析

目的 调查长春市16019例汉族人群骨密度,分析本地区峰值骨量及骨密度变化的人群规律.方法 采用美国Osteometer Medi Tech公司生产的DTX-200型骨密度仪,检测受试者非受力侧前臂桡尺骨远端三分之一处骨密度(BMD).将16019例检测结果按不同性别每5岁为一年龄组,应用SPSS 13.0软件统计分析骨密度均值、T评分及骨量丢失百分率.结果 长春市男、女性人群骨密度峰值分别为0.625±0.109、0.506±0.058,其峰值年龄为30～39岁年龄段,40岁以后开始缓慢下降,50～59岁年龄段男性骨质疏松发病率为7.7%,女性为6.97%;60～69岁年龄段男性骨质疏松发病率为18.13%,女性为35.97%;70～79岁年龄段男性骨质疏松发病率为36.41%,女性为59.55%,80岁以上男性骨质疏松发病率为57.53%,女性为75.56%.结论 不同年龄及同年龄组两性之间比较骨密度测定值差异显著(P<0.01).50岁以后各年龄段女性骨质疏松发病率明显高于男性(P<0.01).本研究报告的骨密度峰值高于日本、丹麦同类型骨密度仪检测结果;与北京地区骨密度检测结果相近.与西双版纳傣族、西藏、甘肃东乡族比较,差异显著(P<0.01).     

Comparison of the radiographic vertebral trabecular pattern with the vertebral fracture prevalence and spinal bone density

Spinal bone densitometry allows accurate and precise measurement of the severity of bone loss. Where densitometry is not yet available medical practitioners have to continue to rely on clinical radiography. Since the grey levels of the radiographic image are highly inaccurate we studied the radiographic vertebral trabecular pattern for its suitability as a semiquantitative assessment of vertebral bone loss. We defined four vertebral trabecular pattern indices (VTPI 4=normal, VTPI 1=severe bone loss) and tested these for correlations with the prevalence of vertebral fractures, and with spinal and hip bone mineral density measured by dual-energy X-ray absorptiometry (DXA). We found negative correlations between VTPI and the percentage of patients with vertebral fractures (p=0.0001), between VTPI and the number of vertebral fractures per patient (r=0.606,p=0.001) and between VTPI and the severity of vertebral fractures, and a positive correlation between VTPI and spinal (r ²=0.556,p=0.0001) and hip DXA values (r ²=0.315,p=0.0001). We conclude that the vertebral trabecular pattern index can be used to assess the severity of spinal bone loss when a bone densitometer is not available.     

Factors associated with trabecular bone score in postmenopausal women with type 2 diabetes and normal bone mineral density

BACKGROUNDOsteoporosis and type 2 diabetes (T2D) have been recognized as a widespread comorbidity leading to excess mortality and an enormous healthcare burden. In T2D, bone mineral density (BMD) may underestimate the risk of low-energy fractures as bone quality is reduced. It was hypothesized that a decrease in the trabecular bone score (TBS), a parameter assessing bone microarchitecture, may be an early marker of impaired bone health in women with T2D.AIMTo identify clinical and body composition parameters that affect TBS in postmenopausal women with T2D and normal BMD.METHODSA non-interventional cross-sectional comparative study was conducted. Potentially eligible subjects were screened at tertiary referral center. Postmenopausal women with T2D, aged 50-75 years, with no established risk factors for secondary osteoporosis, were included. BMD, TBS and body composition parameters were assessed by dual-energy X-ray absorptiometry. In women with normal BMD, a wide range of anthropometric, general and diabetes-related clinical and laboratory parameters were evaluated as risk factors for TBS decrease using univariate and multivariate regression analysis and analysis of receiver operating characteristic (ROC) curves.RESULTSThree hundred twelve women were initially screened, 176 of them met the inclusion criteria and underwent dual X-ray absorptiometry. Those with reduced BMD were subsequently excluded; 96 women with normal BMD were included in final analysis. Among them, 43 women (44.8%) showed decreased TBS values (≤ 1.31). Women with TBS ≤ 1.31 were taller and had a lower body mass index (BMI) when compared to those with normal TBS (Р = 0.008 and P = 0.007 respectively). No significant differences in HbA1c, renal function, calcium, phosphorus, alkaline phosphatase, PTH and 25(ОН)D levels were found. In a model of multivariate linear regression analysis, TBS was positively associated with gynoid fat mass, whereas the height and androgen fat mass were associated negatively (all P < 0.001). In a multiple logistic regression, TBS ≤ 1.31 was associated with lower gynoid fat mass (adjusted odd ratio [OR], 0.9, 95% confidence interval [CI], 0.85-0.94, P < 0.001), higher android fat mass (adjusted OR, 1.13, 95%CI, 1.03-1.24, P = 0.008) and height (adjusted OR, 1.13, 95%CI, 1.05-1.20, P < 0.001). In ROC-curve analysis, height ≥ 162.5 cm (P = 0.04), body mass index ≤ 33.85 kg/m² (P = 0.002), gynoid fat mass ≤ 5.41 kg (P = 0.03) and android/gynoid fat mass ratio ≥ 1.145 (P < 0.001) were identified as the risk factors for TBS reduction.CONCLUSIONIn postmenopausal women with T2D and normal BMD, greater height and central adiposity are associated with impaired bone microarchitecture.     

Mean wall thickness and formation periods of trabecular bone packets in idiopathic osteoporosis

Summary The mean wall thickness (MWT) and duration of formation periods (sigma_f) of trabecular bone packets have been measured in iliac crest biopsies following double tetracycline labeling from 9 women having primary osteoporosis, with vertebral crush fractures and reduced trabecular bone volume (TBV), and 9 age- and sex-matched controls. The MWT of the osteoporotic biopsies was significantly less than that of the controls and was negatively correlated with age in the latter. There was also a positive correlation between MWT and TBV in the controls but not in the osteoporotics. Sigma_f, in days, showed a tendency to decline with age in the control biopsies and was further decreased in the osteoporotic patients. These results suggest that a major contribution to the negative skeletal balance existing in both primary osteoporosis and physiological osteopenia is a decrease in bone formation, caused by a reduction in the life span of the osteoblastic population at the basic multicellular unit (BMU) level.     

女性年龄相关的腰椎骨量与骨骼大小的关系及对诊断骨质疏松的影响

目的探讨腰椎骨量(面积骨密度和体积骨密度)与年龄和骨骼骨面积(BA)大小之间的关系,及腰椎骨骼大小对评价骨量和诊断骨质疏松(OP)的影响。方法采用QDR-4500A型扇形束双能X线吸收法骨密度仪,测量5585例年龄5～96岁的女性正位腰椎BA、骨矿含量(BMC)、面积骨密度(aBMD)及估算体积骨密度(vBMD)。结果腰椎aBMD和vBMD的峰值BMD(x珋±s)分别为0.9884±0.1064g/cm2和0.1310±0.0128g/cm3。在所有年龄阶段aBMD随年龄的变化率显著大于vBMD。腰椎BA与BMC、aBMD和vBMD均呈显著正相关,其中BA与BMC的相关系数最大(r=0.706,P=0.000),与aBMD的相关系数次之(r=0.394,P=0.000),与vBMD的相关系数最小(r=0.141,P=0.000)。年龄≥40岁(平均52.7±9.58岁)的受试者(n=4012)腰椎BA按四分位数分成Q1、Q2、Q3和Q4组,4个组之间的BA、BMC和aBMD的平均值均有显著性差异。采用aBMD诊断OP,4个组的OP检出率分别为Q1=33.6%、Q2=17.9%、Q3=13.3%和Q4=8.39%,呈显著性梯次降低;与总体组比较,Q1组的患病风险增加126%,Q2、Q3和Q4组的患病风险分别降低3%、31%和59%。采用vBMD诊断OP,4个组的OP检出率分别为Q1=27.4%、Q2=18.3%、Q3=15.9%和Q4=14.0%,其梯次差异显著低于aBMD;与总体组比较,Q1组的患病风险增加62%,Q2、Q3和Q4组的患病风险分别降低4%、19%和30%。Q1组aBMD的OP检出率显著高于vBMD,Q4组aBMD的OP检出率显著低于vBMD。在椎体最小的Q1组,aBMD(OR=2.26)的患病风险比vBMD(OR=1.62)大约高64%,在椎体最大的Q4组,aBMD(OR=0.41)的患病风险比vBMD(OR=0.70)大约低29%。结论该研究揭示腰椎vBMD并不能完全消除骨骼大小对评价骨量和诊断OP的影响。在腰椎椎体较小的受试者,aBMD诊断OP的敏感性高于vBMD;在椎体较大的受试者,vBMD诊断OP的敏感性则高于aBMD。