Familial resemblance of bone mineralization, calcium intake, and physical activity in early-adolescent daughters, their mothers, and maternal grandmothers

OBJECTIVE: To describe familial relationships among bone mineral density (BMD), calcium intake, and physical activity in early-adolescent daughters, their premenopausal mothers, and postmenopausal maternal grandmothers. SUBJECTS: Healthy, early-adolescent daughter and premenopausal mother pairs (n=72) were enrolled in the study. In addition, a cohort of 22 postmenopausal maternal grandmothers were measured for comparison of related triads (n=22). DESIGN: Cross-sectional measurements of hip (three sites) and lumbar spine BMD by dual energy x-ray absorptiometry (DXA), body height and weight, menstrual function, current calcium intake, and current and past physical activity patterns were assessed using recalls and questionnaires. STATISTICAL ANALYSIS: Correlational analysis was used to establish relationships between bone characteristics and body size, menstrual function, calcium intake, and physical activity. Multiple regression analyses with backward elimination were used to examine heritability of bone characteristics in daughter-mother and mother-grandmother pairs and daughter-mother-grandmother triads. Quick cluster analysis and cross-tabulation with Pearson's chi(2) were used to evaluate familial patterns for bone characteristics and lifestyle practices. RESULTS: Height, weight, and lumbar spine BMD were significantly correlated within mother-daughter pairs. Current and past calcium intakes were not related within pairs or triads or to BMD in the daughters or the grandmothers. A weak inverse relationship between calcium intake and the hip trochanter and lumbar spine BMD was observed in the mothers (R(2)=-0.25; P=.05). Physical activity, independent of calcium intake, was strong predictor of BMD for daughters and mothers. Among the daughters, the hertiability estimates for trochanter and lumbar spine BMD were 0.56 and 0.70, respectively (P<.01). The heritability estimate for premenopausal mothers were significant for lumbar spine BMD (h(2)=0.66; P<.01). Daughter-mother-grandmother triads with low physical activity had low femoral neck BMD whereas those with high physical activity had high femoral neck BMD (P<.001). APPLICATIONS: Making physical activity a part of the daily routine, in addition to an adequate intake of calcium and bone-related nutrients, is an important goal for maintaining or improving bone health for women of all ages.     

Vitamin D supplementation and bone mineral density in early postmenopausal women

BACKGROUND: Increased vitamin D intake may preserve or increase bone mineral density (BMD) in older persons. OBJECTIVE: A 2-y double-blind study was undertaken to determine whether weekly administration of 10 000 units of vitamin D(2) maintained or increased BMD in younger postmenopausal women more efficiently than did calcium supplements alone. DESIGN: One hundred eighty-seven women who were >or= 1 y postmenopausal were randomly assigned to take either 1000 mg Ca/d after the evening meal or 1000 mg Ca/d plus 10 000 U vitamin D(2)/wk in a double-blind, placebo-controlled format. The BMD of the proximal forearm, lumbar spine, femoral neck, Ward's triangle, and femoral trochanter was measured at 6-mo intervals by osteodensitometry. RESULTS: During the 2-y period, there was no significant difference in the change in BMD at any site between the subjects taking calcium supplements and those taking calcium plus vitamin D(2). Both groups significantly (P < 0.005) gained BMD in Ward's triangle and the femoral trochanter but significantly (P < 0.005) lost bone in the proximal radius. There was no significant change in the lumbar spine or femoral neck BMD. CONCLUSION: In younger postmenopausal women ( age: 56 y) whose average baseline serum 25-hydroxyvitamin D concentration was well within the normal range, the addition of 10 000 U vitamin D(2)/wk to calcium supplementation at 1000 mg/d did not confer benefits on BMD beyond those achieved with calcium supplementation alone.     

膳食钙、磷以及奶制品对绝经后妇女骨密度的影响

目的探讨膳食中钙、磷以及奶制品的摄入量对骨密度及骨盐含量的影响,为研究骨质疏松的预防提供相关线索和依据。方法在广州市越秀区农林街社区发放传单招募调查对象,并采用自编的结构化标准问卷,对320名广州绝经后妇女的膳食习惯进行调查,并测量其全身、股骨全身、股骨颈、股骨干、大粗隆、Ward’s三角以及腰锥1～4的骨密度和骨量,采用多因素逐步回归分析探讨膳食钙、磷及奶制品对骨盐含量及骨密度的影响。结果 320名调查对象平均57.1岁,平均绝经年限7.3年,平均每天摄入钙、磷及奶制品分别为822 mg、949 mg和126 g,平均全身骨密度为1.054 g/cm2,磷与7个部位的骨密度及骨盐含量呈正相关关系（P〈0.05）。随着磷摄入量增加,全身及腰锥1～4骨密度增加,偏回归系数值分别为0.121和0.184 g.（cm2）-1.g-1.d-1。随着奶制品摄入量增加,股骨全身、股骨干骨密度也相应增加,骨密度偏回归系数值分别为0.686、0.841mg.（cm2）-1.g-1.d-1。钙与全身、股骨全身、股骨颈、大粗隆、股骨干和Ward’s三角的BMC具有正相关性,而在钙与BMD关系中,钙只与股骨全身、大粗隆和股骨干呈正相关性,且每日膳食中每增加100 g钙的摄入量,则股骨全身、大粗隆、股骨干的骨密度相应增加5.3、4.8和7.6 g/cm2。结论增加膳食中钙、磷以及奶制品的摄入量有利于绝经后妇女的骨盐含量及骨密度的提高。     

Dietary iron positively influences bone mineral density in postmenopausal women on hormone replacement therapy

The associations of dietary intakes of iron and calcium on change in bone mineral density (BMD) were examined over 1 y in healthy nonsmoking postmenopausal women (mean age 55.6 +/- 4.6 y) stratified by hormone replacement therapy (HRT) use (HRT, n = 116; no HRT, n = 112). BMD was measured at lumbar spine L(2)-L(4), trochanter, femur neck, Ward's triangle, and total body using dual-energy X-ray absorptiometry at baseline and 1 y. Mean nutrient intakes were assessed using 8-d diet records. All women received 800 mg/d of supplemental elemental calcium. Regression analyses examined the effects of iron and calcium intakes on BMD change adjusting for years past menopause, baseline BMD, weight change, exercise, and energy intake. The interaction of iron with calcium on BMD change was assessed using tertiles of iron and calcium intake and estimated marginal mean change in BMD. Iron was associated (P < or = 0.05) with greater positive BMD change at the trochanter and Ward's triangle in women using HRT. Calcium was associated (P < or = 0.05) with BMD change at the trochanter and femur neck for women not using HRT. In women using HRT in the lowest tertile of calcium intake, change in femur neck BMD increased linearly as iron intake increased. In women not using HRT, BMD increased in the women in the highest tertile of calcium intake. We conclude that HRT use appears to influence the associations of iron and calcium on change in BMD.     

Natural history of bone loss over 6 years among premenopausal and early postmenopausal women

The aims of this prospective cohort study were to determine rates of premenopausal and early postmenopausal bone loss, age at onset of bone loss, and whether rates of bone loss depend on baseline bone mineral density (BMD). The cohort of 614 women aged 24-44 years at baseline from the longitudinal Michigan Bone Health Study was followed for 6 years beginning in 1992-1993. Up to five BMD measurements of the lumbar spine (L(2-4)) and the femoral neck were obtained through 1998-1999 by using dual x-ray absorptiometry and were standardized (as z scores) relative to a young adult, female BMD distribution. Regression models were used to estimate rates of BMD change and to examine BMD as a function of age. At the lumbar spine, the rate of BMD change for premenopausal women varied with time. At the femoral neck, the rate of change was -1.6% (95% confidence interval: -0.9%, -2.3%) of a z score annually (annual loss of 0.3% of baseline BMD (g/cm(2))). Evidence for age at onset of bone loss at the lumbar spine was inconclusive. Bone loss began by the midtwenties at the femoral neck. Additional annual change of -0.7% (95% confidence interval: -0.2%, -1.2%) of a z score was observed at the femoral neck for each unit increase in BMD z score at baseline.     

老年2型糖尿病患者骨密度变化及影响因素

目的：观察老年2型糖尿病人骨密度变化及影响因素。方法：对94例(其中男性42例．女性52例)及100例健康者检测其馒头餐前后C肽和血糖水平．及用双能X线骨密度仪测定L2-4、Wards区、股骨颈、大转子的骨密度。结果：①糖尿病各组L2-4、Wards、股骨颈、大转子骨密度显著降低。②男性和女性糖尿病患者骨质疏松患病率分别为38％和65．3％，糖尿病患者骨密度与病程、空腹及餐后2h血糖呈负相关．与平均体重指数呈正相关，女性患者骨密度与绝经时间负相关。结论：2型糖尿病人易患骨质疏松，骨密度显著降低。     

Reduced spinal and femoral bone mass and deranged bone mineral metabolism in chronic alcoholics.

Prevalence and factors which may influence the development of osteoporosis have been assessed in 32 chronic alcoholic males by measuring the bone mineral density (BMD) of the lumbar spine and femoral neck by dual photon absorptiometry. Serum bone Gla-protein, as an index of bone formation, 25-hydroxyvitamin D, testosterone and cortisol levels were also measured. Eleven patients (34%) had osteoporosis. In seven the lumbar BMD was below the fracture threshold. Lumbar and femoral neck age-matched BMD were below mean normal values in 20 and in 23 patients, respectively. Moreover, the age-matched BMD was significantly lower in the femoral neck (91.7 +/- 14.4%) than in the lumbar spine (100.1 +/- 17.1%) (P < 0.001). Duration of alcoholism was significantly higher in patients with age-matched BMD below 100% than in those with age-matched BMD above 100%. Bone GLA-protein and 25- hydroxyvitamin D were below normal levels in 67% and 56% of patients, respectively. Serum testosterone was normal in all but two patients, and cortisol was within normal values in all patients tested. In addition a direct correlation was found between the days of abstinence before the study and serum levels of bone GLA-protein (r = 0.64, P < 0.001). In conclusion, chronic alcoholics frequently have bone loss of the lumbar spine and femoral neck related with the duration of alcohol intake. The correlation between bone-GLA protein levels and the days of abstinence suggests that alcohol directly depresses bone formation. Likewise, the low levels of vitamin D also support that this deficiency may contribute to the development of osteopenia in chronic alcoholism.     

Associations between body morphology and bone mineral density in premenopausal women

To investigate whether body morphology, obesity and its long time evolution were associated with lumbar and femoral bone mineral density (BMD) in premenopausal women of the same age. Design: Cross-sectional study. Subjects: 72 healthy premenopausal women born in 1950 (42 years) with a regular physical activity. Measurements: BMD measured by dual-X-ray absorptiometry (DEXA) at lumbar spine and proximal femur; body weight, body mass index (BMI), BMI at 20 years (BMI-20), increase in BMI since age of 20 (BMI->20), body circumferences (breast, waist, hip) and their ratios (WHR, BHR, WBR), smoking and alcohol intake. Results: Lumbar spine BMD did not correlate with any anthropometric measurement. Femoral BMDs correlated positively with weight, BMI, BMI-20, breast, waist, WHR and BHR. The BMI-20 explained the 5% and the current BMI the 13% of variance of total femur BMD. After adjustment for weight or BMI, breast circumference and BHR remained significantly correlated with all femoral BMDs sites except neck. Weight was the best predictor for neck BMD (R² = 0.08; p < 0.02), and BHR for Ward's triangle (R² = 0.12; p < 0.01) and trochanter (R² = 0.10; p < 0.001). Alcohol intake, cigarette smoking, and age of menarche were not related to BMDs. Conclusion: In premenopausal women of the same age, lumbar spine BMD was not associated with any anthropometric measurement. Greater BHR and its long time of evolution may be determinants of greater femoral BMD (trabecular), whereas body weight may be determinant of femoral neck BMD (cortical). Further studies are needed to determine whether large breast to hip ratio may be considered as a protective factor for femoral osteoporosis.     

绝经妇女MTHFR基因多态性与骨密度关系的meta分析

目的:采用meta分析方法研究绝经后妇女亚甲基四氢叶酸还原酶(MTHFR)C677T基因多态性与骨密度的关系。方法:通过多种数据库检索国内外已发表绝经妇女MTHFR基因多态性和骨密度关系的相关文章进行资料分析。结果:5篇文献符合meta分析纳入标准,均报道了绝经妇女MTHFR基因多态性与股骨颈和椎骨骨密度的关系。分析结果表明,TT基因型与CC/CT基因型妇女相比,具有更低的股骨颈密度,合并效应尺度(WMD)为-0.01g/cm2(95%CI:-0.01～0.01,P<0.001);而TT基因型与CC/CT基因型妇女椎骨骨密度无差异,其WMD为-0.01mg/cm2(95%CI:-0.04～0.01,P=0.32)。结论:绝经妇女MTHFRC677T基因多态性与股骨颈骨密度相关,TT基因型女性具有较低的骨密度,TT基因型可作为预测绝经妇女骨质疏松症的风险因子。     

阿法骨化醇对绝经后妇女骨密度及骨转换标志物的影响

目的探讨阿法骨化醇对绝经后妇女骨密度及骨转换标志物的影响。方法选择2009年9月至2011年12月在本院更年期门诊经骨密度（BDM）测量诊断为骨量减少或骨质疏松症,年龄在55～75岁之间的67例绝经后女性为观察对象,随机分为试验组36例,对照组31例。试验组口服氨基酸螯合钙1 000mg/d,阿法骨化醇0.25μg/次,一天两次;对照组口服氨基酸螯合钙1 000mg/d。两组均连续服药48周。两组治疗前、后采用双能X线吸收法测定股骨颈、大粗隆、Ward三角区及腰椎L2-4骨密度;同时采用酶联免疫法检测血清骨碱性磷酸酶（BALP）、抗酒石酸酸性磷酸酶（TRACP）、25羟维生素D3[25-（OH）D3]结果治疗前试验组与对照组间股骨颈、大粗隆、Ward三角区及L2-4骨密度差异均无统计学意义（P〉0.05）。试验组各部位BMD治疗后均有显著增加（P〈0.05）,而对照组治疗前后仅L2-4有显著增加（P〈0.05）。治疗后试验组与对照组各部位BMD差异均有统计学意义（P〈0.05）。血清BALP、TRACP及25-（OH）D3水平治疗前试验组与对照组间比较,差异均无统计学意义（P〉0.05）,治疗后组间比较差异均有统计学意义（P〈0.05）。试验组治疗前血清BALP、TRACP及25-（OH）D3水平分别为（26.52±6.07）μg/L、（2.84±0.97）U/L、（53.91±19.04）nmol/L,治疗后分别为（21.85±5.96）μg/L、（2.37±0.88）U/L、（57.87±19.24）nmol/L,BALP、TRACP均呈显著降低,25-（OH）D3有显著升高（P〈0.05）;对照组治疗前后各骨代谢指标改变差异无统计学意义（P〉0.05）。结论阿法骨化醇可用于绝经后骨质疏松症的治疗,可增加骨密度、降低骨转换,对治疗骨质疏松症有理论依据和临床意义。     

Bone loss at the proximal femur and reduced lean mass following liver transplantation: a longitudinal study.

The longevity of recipients of liver transplant may be compromised by spinal osteoporosis and vertebral fractures. However, femoral neck fractures are associated with a higher morbidity and mortality than spine fractures. As there is little information on bone loss at this clinically important site of fracture, the aim of this study was to determine whether accelerated bone loss occurs at the proximal femur following transplantation. Bone mineral density and body composition were measured at the femoral neck, lumbar spine and total body, using dual x-ray absorptiometry in 22 men and 19 women, age 46 +/- 1.4 y (mean +/- SEM) before and at a mean of 19 mo after surgery (range 3-44). Results were expressed in absolute terms (g/cm2) and as a z score. Before transplantation, z scores for bone mineral density were reduced at the femoral neck (-0.47 +/- 0.21 SD), trochanter (-0.56 +/- 0.19 SD), Ward's triangle (-0.35 +/- 0.14 SD), lumbar spine (-0.76 +/- 0.13 SD), and total body (-0.78 +/- 0.15 SD) (all P < 0.01 to < 0.001). Following transplantation, bone mineral density decreased by 8.0 +/- 1.7% at the femoral neck (P < or = 0.01) and by 2.0 +/- 1.2% at the lumbar spine (P < or = 0.05). Total weight increased by 12.2 +/- 2.3%, lean mass decreased by 5.7 +/- 1.4%, while fat mass increased from 24.1 +/- 2.0% to 35.1 +/- 1.8% (all P < or = 0.001). Patients with end-stage liver disease have reduced bone mineral density. Liver transplantation is associated with a rapid decrease in bone mineral density at the proximal femur, further increasing fracture risk and a reduction in lean (muscle) mass, which may also predispose to falls. Prophylactic therapy to prevent further bone loss should be considered in patients after liver transplantation.     

甲状旁腺激素基因多态性与钙摄入量对青春期女童骨量增长的交互作用

目的:探讨甲状旁腺激素(PTH)基因多态性与钙摄入量对青春期女童骨量增长的交互作用。方法:选择228名9～11.5岁未月经初潮的健康女童进行2年追踪,用双能X线骨密度仪(DEXA)检测对象追踪前后全身、左侧近端股骨(包括股骨颈、大转子、粗隆间和华氏三角区)、L1～L4腰椎骨矿含量和骨密度,采用PCR-RFLP技术检测PTH基因BstBⅠ位点多态性。结果:BB基因型女童L1～L4腰椎骨矿含量增长率、左侧近端股骨、粗隆间和L1-L4腰椎骨密度增长率均高于含b等位基因女童(P=0.022～0.047)。BB基因型女童在高钙摄入(>950mg/d)时,粗隆间骨矿含量(ITBMC)增长率较中等和低钙摄入时分别高29.4%和35.0%,股骨颈骨密度(FNBMD)增长率分别高66.7%和46.2%。而含b等位基因女童的ITBMC和FNBMD增长率在不同钙摄入量之间没有显著性差异。结论:PTH基因BstBⅠ多态性与钙摄入量对青春期女童骨量增长存在交互作用,BB基因型女童高钙摄入可促进其骨量增长。     

Effects of body mass index on bone mineral density in men

INTRODUCTION: A strong positive association between body mass index and bone mineral density is well defined in postmenopausal osteoporosis, but not in men. AIMS: The primary goal of the current research was to investigate this association in case of men. METHODS: According to WHO criteria (T-score below -1.0 at all measure site) seventy-two (mean age 55.7 +/- 0.99, range 38-78 yr normal density) healthy male with normal density were recruited. Exclusion criteria were the absence of any risk factors or signs of metabolic disease. Bone mineral measurements at the lumbar spine (L2-4) and femoral neck were performed by the dual-energy X-ray absorptiometry (DEXA, Lunar DPX-L, USA), bone mineral content of the non-dominant radius was measured with single photon absorptiometry (SPA, NK-364, Hungary). Participants were divided into three groups according to body mass index normal weight (18.5-24.9 kg/m2), moderate overweight (25-29.9 kg/m2) and obese subjects (> 30 kg/m2). RESULTS: Femur neck density was significantly lower in the normal weight than in the overweight counterparts (0.969 +/- 0.03 vs 1.062 +/- 0.02 p = 0.01). There was a strong positive association between BMI and femur neck BMD (r = 0.412 p < 0.001). Body mass was an independent predictor of femur neck bone mineral density (regression coefficients 0.382, p = 0.001). There was not correlation at the lumbar spine and the radius sites. CONCLUSION: Bone density at femur neck sites is lower in the normal weight men than in obese subjects, therefore the risk factors for proximal femur osteoporosis are higher in these cases. Prevention strategy is needed for men in the lowest quintile of body mass to prevent further decrease in BMD and reduce the risk of hip fracture.     

The effect of a one-year alendronate therapy on postmenopausal osteoporosis. (Results in Hungary of an international multicenter clinical study)

The FOSIT (Fosamax International Trial) was a placebo-controlled, double blind trial, to determine the effects of daily oral dose of 10 mg alendronate-sodium (Fosamax) or placebo, for one year in postmenopausal osteoporotic women. It was an international, multicenter study; the 153 centers distributed over 34 countries. The number of patients was 1908. Authors report the data of the only Hungarian study site, Debrecen. Twenty women [age (mean +/- SD) 62 +/- 8 years with bone mineral density--BMD--< or = 0.98 g/cm2 at the lumbar spine by LUNAR DPX densitometer] were enrolled into the study and randomly assigned to oral alendronate 10 mg daily or placebo (10 patients in each group). Patients in both groups received 500 mg of calcium. Bone density measurements were performed by dual x-ray absorptiometry (DXA) at months 0, 3, 6, and 12 at the lumbar spine and at the femoral neck. Biochemical indices of bone turnover [bone specific alkaline phosphatase (bAP) and urinary N-telopeptide/creatinine ratio (NTx/crea] were also measured every three months. Percent change of the BMD measurements from baseline at one-year in the alendronate group was +6% and in the placebo group -0.7% on the lumbar spine (p < 0.001). Alendronate treatment increased the bone mineral density in the femoral neck, the trochanter, the Ward's triangle and the total hip by +3.2, +1.6, +3.5, +2.2% respectively, meanwhile the changes in the placebo group were -1.2%; -0.7%; -0.9%; -0.8%, respectively, the difference was not significant. Urinary NTx/crea decreased by 70.6% in the alendronate group and by 9.4% in the placebo group, while bAP decreased by 47.4% in the alendronate group and 15.2% in the placebo group (p < 0.001). In conclusion, after one year of treatment with alendronate induced increase of bone mineral density at the lumbar spine and decreased the bone turnover as compared to the placebo group.     

Tea drinking and bone mineral density in older women

BACKGROUND: High caffeine intake is reportedly a risk factor for reduced bone mineral density (BMD) in women. Most studies, however, are from populations in which coffee drinking predominates and is the major caffeine source. Tea contains caffeine but also has other nutrients, such as flavonoids, that may influence bone mass in different ways. OBJECTIVE: We examined the relation between tea drinking and BMD in older women in Britain, where tea drinking is common. METHODS: We measured BMD at the lumbar spine, femoral neck, greater trochanter, and Ward's triangle in 1256 free-living women aged 65-76 y in Cambridge, United Kingdom. Tea drinking was assessed by self-completed questionnaire and women were categorized as tea drinkers or non-tea drinkers. RESULTS: There were 1134 tea drinkers (90.3%) and 122 non-tea drinkers (9.7%). Compared with non-tea drinkers, tea drinkers had significantly greater ( approximately 5%) mean BMD measurements, adjusted for age and body mass index, at the lumbar spine (0.033 g/cm(2); P = 0.03), greater trochanter (0.028 g/cm(2); P = 0.004), and Ward's triangle (0.025 g/cm(2); P = 0.02). Differences at the femoral neck (0.013 g/cm(2)) were not significant. These findings were independent of smoking status, use of hormone replacement therapy, coffee drinking, and whether milk was added to tea. CONCLUSIONS: Older women who drank tea had higher BMD measurements than did those who did not drink tea. Nutrients found in tea, such as flavonoids, may influence BMD. Tea drinking may protect against osteoporosis in older women.     

Mothers and daughters: intergenerational patterns of reproduction

BACKGROUND: The objective of this study was to assess intergenerational mother-daughter patterns of reproduction. METHODS: In 1966, 12 055 pregnant women in Northern Finland, representing 96% of all births in the region, responded to a questionnaire in mid-gestation. In 1997-98, the 31-year-old daughters born from those pregnancies were sent a questionnaire and 4523 (80%) responded. Reproduction was compared between all mother-daughter pairs (n=4523) and separately for the pairs (n=489) of similar age (mothers 30-32 years). RESULTS: The menarcheal ages of the mothers and their daughters correlated slightly (Spearman correlation coefficient 0.206). The probability of the daughter to be multiparous was higher if her mother was multiparous at the time of the daughter's birth than if she was not. No association in the rate of spontaneous abortions was found. The first pregnancy of the daughters born from unwanted pregnancies was more often unwanted than the first pregnancy of the wanted daughters, after adjusting for parity (P=0.004). The analysis of the age-matched mother-daughter pairs gave similar results. CONCLUSION: A positive association between mothers and daughters in menarcheal age, parity and desirability of pregnancy was found.     

Nutrition, mild hyperparathyroidism, and bone mineral density in young Japanese women

BACKGROUND: The adverse effects of poor nutrition on the bones of young Asian women have not been fully elucidated. OBJECTIVE: The purpose of this study was to investigate possible associations of vitamin D nutrition, calcium intake, and other nutrients with bone metabolism and bone mass in young Japanese women. DESIGN: The subjects were 108 female college students aged 19-25 y. Dietary nutrients were measured by using the duplicate sampling method on 3 weekdays. Serum 25-hydroxyvitamin D [25(OH)D], intact parathyroid hormone, and bone turnover markers were also measured. Bone mineral density (BMD) of the spine and femur was measured by dual-energy X-ray absorptiometry. RESULTS: The proportions of the subjects with low 25(OH)D (< 30 nmol/L) and high intact parathyroid hormone (> or = 6.9 pmol/L) concentrations were 32.4% and 15.7%, respectively. Serum 25(OH)D concentrations (P = 0.0265) and calcium intake (P = 0.0103) were inversely associated with serum intact parathyroid hormone. In addition to weight and physical activity, the presence of mild hyperparathyroidism was associated with a low BMD of the lumbar spine (P = 0.0062) and the femoral neck (P = 0.0250), and a low calcium intake was associated with a low BMD of the femoral neck (P = 0.0044). CONCLUSIONS: Low calcium intake (based on low BMD of the femoral neck only) and mild hyperparathyroidism (based on low BMD of both the femoral neck and lumbar spine), partly explained by low vitamin D nutrition and a low calcium intake, are important predictors of low BMD in young Japanese women. Effects of poor nutrition and mild hyperparathyroidism on bone peak bone mass in young women should be further investigated in longitudinal studies.     

Follow-up study of bone mineral density in postmenopausal patients with primary biliary cirrhosis

Osteopenia is a common complication in primary biliary cirrhosis (PBC). In this follow-up study the authors investigated the metabolic bone disease in postmenopausal PBC patients. 17 Ca and vitamin D supplemented, postmenopausal female patients with PBC (stage II-IV, age: 41-84, mean: 52, each AMA M2 positive, without ascites) were followed-up for an average of 6.3 years. Bone mineral density (BMD) was measured yearly by dual energy x-ray absorptiometry (XR26, Norland) in lumbar spine (L2-4), femoral neck (FN), and radius BMC by single photon absorptiometry. Urinary pyridinoline/creatinine (Pyr/c) and deoxypyridinoline/creatinine ratio (D-Pyr/c) by HPLC, 25-OH-D3 level and standard liver function tests were monitored in all patients. At the beginning the BMD was decreased in 7 out of 17 patients (T-score < -2.5). The mean BMD was 0.885 SD +/- 0.26 g/cm2 in L2-4, 0.725 +/- 0.16 g/cm2 in FN and the BMC 0.703 +/- 0.14 g/cm in the radius. During follow-up the rate of annual bone loss was increased in patients with osteoporosis at the start of this study. There was a correlation between the urinary Pyr/c and D-pyr/c values and the annual rate of bone loss in patients with PBC (r: -0.79; p < 0.01). In patients with severe osteoporosis at the time of the diagnosis of PBC a more pronounced progression of bone loss was observed during the follow-up period.     

Vitamin D(3) and vitamin K(1) supplementation of Dutch postmenopausal women with normal and low bone mineral densities: effects on serum 25-hydroxyvitamin D and carboxylated osteocalcin

OBJECTIVE: Improvement of vitamin D and K status of about 60 -y-old postmenopausal Dutch women. DESIGN: In a randomized study postmenopausal women with normal (T-score >-1; n=96) and low (T-score< or =-1; n=45) bone mineral density (BMD) of the lumbar spine, were supplemented with 350-400 IU vitamin D(3), 80 microg vitamins K(1) vitamins K(1)+D(3), or placebo for 1 y. Serum 25-hydroxyvitamin D [25(OH)D] and percentage carboxylated osteocalcin (%carbOC) were measured at baseline and after 3, 6 and 12 months. RESULTS: Baseline %carbOC of the entire study population was positively correlated with BMD of the lumbar spine and femoral neck. Correspondingly, women with low BMD had lower %carbOC at baseline than women with normal BMD but this difference disappeared after 1 y of supplementation with vitamin K(1) ((mean+/-s.d.) 68+/-11% (95% CI, 64. 5-71.2%) vs 72+/-6% (95% CI, 70.1-72.9%), respectively). One year of supplementation with vitamin D(3) showed maximum increases in 25(OH)D of 33+/-29% (95% CI, 24.8-41.8%) and 68+/-58% (95% CI, 50.1-84.6%) in women with normal and low BMD, respectively. During winter, however, a 29% decline in maximum 25(OH)D levels was not prevented in women with low BMD. CONCLUSION: Daily supplementation of Dutch postmenopausal women with >400 IU vitamin D(3) is indicated to prevent a winter decline in 25(OH)D and to control serum parathyroid hormone levels. Daily supplementation with 80 microg vitamin K(1) seems to be necessary to reach premenopausal %carbOC levels. A stimulatory effect of calcium and/or vitamin D on %carbOC cannot be excluded. European Journal of Clinical Nutrition (2000) 54, 626-631.     

绝经后妇女体力活动水平与骨密度的关系

目的检验绝经后妇女体力活动(PA)总量及不同强度PA与骨密度(BMD)和骨盐含量(BMC)的关联。方法从广州市社区招募315名50～70岁停经妇女。通过面对面访问调查其日常PA情况及一般情况和膳食情况等相关协变量。采用双能X-光骨密度仪检测全身、腰椎(L1-L4)及左侧股骨(总股骨、股骨颈、大粗隆、股骨干和Wards区)的BMD和BMC。结果以PA能量代谢当量(MET值)进行三等分位法分组,协方差分析结果显示总体上各部位BMD和BMC随PA总量增加而呈增高的趋势。PA总量低、中、高水平组全身BMD的均值(SE)分别为(1.045±0.008),(1.043±0.008),(1.068±0.008)g/cm2,高PA组显著高于低和中PA组(P=0.049和0.028)。其他部位BMD在三组间无统计学差异意义(P>0.05)。高PA组总股骨、股骨颈、股骨干和Wards区的BMC显著高于低PA组(P=0.004～0.042)。不同强度PA对BMD影响不同,低强度PA越少、中等强度PA越多以及适量的高强度PA均增加BMD。结论较高的PA水平,尤其是增加中等强度和适量的高强度PA更有利于绝经后妇女的骨质健康。