绝经后妇女年龄、绝经年龄、绝经年限与腰椎和髋部骨密度的关系分析

目的 探讨绝经后妇女年龄、绝经年龄、绝经年限与腰椎和髋部骨密度的关系.方法 调查248名健康的绝经后妇女的年龄、绝经年龄、绝经年限,测量身高、体重、正位腰椎（L2～L4）、髋部骨密度进行分析.结果 随着绝经年限的增长,腰椎和髋部骨密度逐渐降低.单因素相关分析表明年龄、绝经年限与腰椎及髋部各部位骨密度呈显著负相关（P＜0.01）,绝经年龄与腰椎及髋部各部位骨密度无显著相关性（P＞0.05）.调整身高、体重指数后,年龄、绝经年龄与腰椎及髋部骨密度呈显著负相关（P＜0.01）,绝经年龄与腰椎及髋部各部位骨密度无显著相关性（P＞0.05）.多元逐步回归分析显示绝经年限与腰椎、股骨颈及股骨大转子的骨密度呈显著负相关（P＜0.01）,年龄与腰椎、股骨颈及Ward三角区骨密度呈显著负相关（P＜0.05）.结论 年龄、绝经年限与腰椎和髋部骨密度有关.     

绝经后妇女绝经年限、孕次、产次与腰椎骨密度的关系分析

目的 探讨绝经后妇女孕次、产次与腰椎骨密度(BMD)的关系。方法 调查204例健康的绝经后妇女年龄、绝经年限、孕次、产次、测量其身高、体重及正位腰椎BMD,并进行相关分析。结果 随着绝经年限的增加,腰椎各部位BMD逐渐降低。孕1-2次及产1次者的腰椎各部位BMD高于其他,并随着孕次和产次的增加BMD逐渐降低。单因素相关分析显示绝经年限与正位腰椎各部位BMD均呈显著负相关(P<0.01);孕次与第二腰椎(L2)、第三腰椎(L3)、第二腰椎至第四腰椎(L2-L4)呈显著负相关(P<0.05);产次与第二腰椎(L2)、第三腰椎(L3)、第二腰椎至第四腰椎(L2-L4)呈显著负相关(P<0.05)。但调整年龄、体重指数、孕次及产次后,绝经年限与正位腰椎各部位BMD均无显著相关(P>0.05)。调整年龄、体重指数、绝经年限后,孕次、产次与正位腰椎各部位BMD均无显著相关(P>0.05)。多元逐步回归分析显示绝经年限、孕次、产次与正位腰椎各部位BMD仍无显著相关(P>0.05)。结论 绝经后妇女绝经年限、孕次、产次与腰椎BMD的关系有待进一步研究。     

绝经妇女绝经后年限及年龄与骨量丢失率关系

目的探讨绝经后妇女的绝经年限及年龄与骨量丢失率关系。方法1999年5月-2003年4月,对已绝经的1467例妇女进行骨密度测定,并对不同绝经后妇女年龄、绝经年限与骨密度关系进行分析。结果1467例绝经后妇女中,以绝经1-5年期间和40-45岁时各部位骨密度作为基线值比较,绝经已超过35年或年龄大于80岁时各部位骨密度最低。其中按绝经年限腰椎、股骨颈、大转子、华氏三角区在绝经后6-10年间和超过35年时丢失速度最快;按年龄腰椎在56-65岁、股骨颈和华氏三角区在61-65岁、大转子在71-75岁及各部位大于80岁时丢失速度最快。结论绝经后妇女绝经年限及年龄增加,腰椎、股骨颈、粗隆、华氏三角区骨量丢失增加。绝经年限及年龄不同,各部位丢失速度不同。     

绝经后女性的体成分与年龄和绝经的关系及其对不同部位骨密度的影响

目的 调查绝经后女性的体成分与年龄、绝经年龄、绝经年限和腰椎、髋部BMD之间的关系.方法 用双能X线骨密度仪测量919例绝经后女性的体成分、正位腰椎和髋部BMD.结果 下身脂肪量、全身脂肪量和全身瘦组织量与年龄、绝经年龄和绝经年限都相关(P＜0.05～0.01),但只有绝经年限进入体成分的多元逐步回归方程,采用复合或三次回归模型拟合优度最佳.体成分随绝经年限的延长有下降趋势.绝经10年以上女性的下身脂肪量和全身瘦组织量显著减少,分别较绝经年限5年以内女性下降8.6%和3.1%.所有部位的体成分与所测区域的BMD 均呈正相关(P＜0.05～0.01),控制体重变量后,仅有全身脂肪量与腰椎BMD 呈正相关(P＜0.05),而全身瘦组织量与髋部BMD 呈正相关(P＜0.05).多元逐步回归分析发现体成分是影响腰椎和髋部BMD的一个重要因素,但对腰椎BMD影响最大的是全身脂肪量,而对髋部BMD影响最大的是全身瘦组织量.BMD 越低者,全身脂肪量和全身瘦组织量也越低,组间比较有显著性差异.结论 绝经后女性的体成分与年龄、绝经年龄、绝经年限和腰椎、髋部BMD相关,其中,绝经年限对体成分的影响最大,体成分组分对BMD的影响存在部位差异.     

绝经后妇女肥胖与骨密度的关系

目的 分析绝经后妇女的腰椎2-4( L2-4)和股骨颈（Neck)、大转子(Troch)、粗隆间（InterTro)的骨密度（BMD),探讨绝经后妇女肥胖与骨密度的关系。方法 以我院269名年龄45 -75岁的绝经后妇女为研究对象,计算体重指数将研究对象分为肥胖组和对照组,采用双能X线骨密度仪检测腰椎、股骨颈、大转子、粗隆间的骨密度,分析绝经后妇女肥胖与骨密度的关 系。结果 肥胖组绝经后妇女不同部位的骨密度均高于对照组(P <0.05或P <0. 01)。绝经后妇女各部位的骨密度随年龄的增长而降低,各年龄组间的骨密度有显著性差异(P <0.05或P <0. 01)。结论 年龄和体重指数是影响骨密度的重要因素,绝经后妇女肥胖者骨密度较正常体型者高,肥胖者可能通过负重等作用,延缓绝经后妇女骨密度的下降。     

血清催产素浓度与绝经后女性骨密度相关性研究

目的探讨催产素与绝经后妇女骨代谢指标以及腰椎和髋部骨密度之间相关性。方法检测185例骨密度正常和132例患骨质疏松症女性的血清催产素、瘦素、雌激素和骨代谢指标浓度。腰椎和股骨颈的BMD通过双能X线吸收法测量。结果患骨质疏松症女性的血清催产素浓度低于骨密度正常的女性(P0.05)。骨质疏松症组中血清催产素浓度与年龄、绝经年限、体质量指数(body mass index,BMI)和血清PINP、BLAP和CTX浓度呈负相关;与瘦素和雌激素具有明显正相关性;在正常骨密度组中,血清催产素浓度和各种指标未发现明显的相关性。调整年龄和BMI后,腰椎和股骨颈骨密度仍然与绝经年限以及血清PINP、BLAP和CTX浓度呈负相关,与雌激素、瘦素和催产素浓度呈正相关。对年龄和BMI进行调整后,进行多元回归分析显示绝经年限、血清催产素、PINP和CTX是腰椎和股骨颈骨密度的显著预测因子。结论绝经后女性患者较高的血清催产素水平与较高的腰椎和股骨颈骨密度有关。     

814例绝经后女性初潮年龄、绝经年龄及月经维持年限与骨质疏松症相关性研究

目的调查了解广州市社区绝经后妇女的生理因素对骨质疏松症的患病率及骨密度(BMD)的影响,为围绝经期女性骨质疏松的预防提供进一步证据。方法采用现场问卷调查了解受试者的基本资料,美国双能X线骨密度仪测量1199例绝经后女性的腰椎正位和左髋部骨密度,以年龄分组进行分析。结果共纳入的814名绝经后妇女当中,腰椎发生骨质疏松症300例,发生率36.9%;髋部发生骨质疏松的312例,发生率38.3%。绝经年限10年内的妇女中,初潮年龄较晚的骨密度越低,发生骨质疏松的风险越高; 55～65岁的绝经后妇女中,绝经年龄较早的骨密度越低,骨质疏松发生的风险越高;月经维持的年限越短,骨密度越低,发生骨质疏松的风险越高。结论广州市社区中绝经后妇女的骨质疏松患病率较高,初潮年龄较晚、绝经年龄较早或月经维持年限较短的妇女骨质疏松的发病率明显升高,建议早筛查、早诊断、早治疗。髋部BMD值是评价骨质疏松症较为敏感的指标,应该首选髋部作为骨密度测量的部位。     

绝经后女性血清硒水平与骨质疏松骨密度和骨代谢指标相关性研究

目的探索血清硒水平与绝经后妇女骨代谢指标以及腰椎和髋部骨密度之间相关性。方法检测156例正常骨密度和162例骨质疏松症的血清硒、25-羟基维生素D、PTH、骨钙素、PINP、CTX和NTX/Cr等指标水平。腰椎和股骨颈的BMD通过双能X线吸收法测量。探索了血清硒水平与骨密度的关系。结果骨质疏松症女性的血清硒水平低于正常骨密度的女性(P0.05)。在骨质疏松症妇女中,血清硒水平与年龄、绝经年限、BMI、PTH、骨钙素、PINP、CTX和NTX/Cr水平呈负相关,与25-羟基维生素D水平呈正相关。在正常骨密度组,血清硒水平与这些参数均未发现明显的相关性。调整年龄和BMI后,腰椎和股骨颈骨密度与血清硒及25-羟基维生素D水平呈显著正相关,与绝经年限、PTH、骨钙素、PINP、CTX和NTX/Cr呈负相关。对年龄和BMI进行调整后,进行多元回归分析以确定BMD的预测因子,血清硒和PINP、CTX是腰椎和股骨颈骨密度的显著预测因子。结论绝经后女性患者血清硒水平降低与腰椎和股骨颈骨密度降低密切有关。     

北京市中老年女性月经及身体成分与骨密度的相关性研究

目的调查北京市中老年女性年龄、月经和身体成分特征,分析其与骨密度的关系以及对骨密度的影响。方法招募45～80岁女性384名,调查受试者月经状况,包括初潮年龄、绝经年龄和绝经年限;测试受试者腰椎、左股骨颈、左髋以及全身骨密度,并测试全身脂肪和肌肉含量,由此计算脂肪含量指数(fat mass index,FMI)、肌肉含量指数(lean mass index,LMI)和四肢骨骼质量指数(appendicular skeletal muscle mass index,ASMI)。采用Pearson相关和多元逐步回归模型分析各因素与骨密度的关系。结果相关性结果显示,年龄、绝经年限、初潮年龄与骨密度呈显著负相关,绝经年龄、LMI、FMI和ASMI与骨密度呈显著正相关。多元逐步回归分析结果显示,绝经年限与各部位骨密度均呈显著负相关,ASMI与各部位骨密度均呈显著正相关,FMI仅与全髋和全身骨密度具有显著相关性,初潮年龄和绝经年龄仅与腰椎和全身骨密度具有显著相关性。结论绝经年限是中老年女性骨密度的独立危险因素,而ASMI则为独立保护因素,绝经年龄、初潮年龄以及FMI对中老年女性骨密度的影响存在部位差异性。     

绝经后妇女椎体骨折与骨密度的对照研究

目的探讨绝经后妇女骨质疏松性椎体骨折与骨密度的关系。方法随机选择椎体骨折的绝经后妇女120例为骨折组，无椎体骨折的120例绝经后妇女为对照组。两组的年龄、身高、体重等差异无显著性，均行胸腰椎正侧位X线摄片。用双能X线吸收仪（DXA）测量腰椎（L2-4）前后位及髋部骨密度（BMD）和T值。结果骨折组腰椎及髋部BMD和T值均低于对照组（P≤0．05）。结论腰椎BMD降低与绝经后妇女的骨质疏松性椎体骨折相关，髋部骨密度值的降低在一定程度上也能提示骨折的危险性。绝经后骨质疏松妇女应重视BMD变化，预防椎体骨折的发生。     

The impact of reproductive and menstrual history on bone mineral density in Chinese women.

Low bone mineral density (BMD) is an important risk factor for osteoporotic fractures. The impact of gynecological history on BMD is of great concern, but the results are largely inconsistent. In this study, we investigated the association of gynecological history with BMD in 214 postmenopausal women (60.4 +/- 5.7 yr), as well as with peak bone density (PBD) in 428 premenopausal women (30.8 +/- 5.3 yr) from Shanghai City in China. BMD was measured at lumbar spine (L1-4) and total hip by dual energy X-ray absorptiometry. Raw BMD values were adjusted by age, age2, height, and weight. In the postmenopausal group, more parity had significantly detrimental effects on BMD at both the spine and hip (p < 0.01). The age of the first delivery, the duration of lactation, and the age at menarche did not show significant impacts on BMD (p > 0.05). More years since menopause only had marginally significant decreasing effects at the spine (p = 0.09), but not at the hip (p > 0.10). In the premenopausal group, none of the three reproductive factors had significant impact on PBD (p > 0.05); the age of menarche inversely affected PBD at both the spine (p < 0.01) and hip (p < 0.05). Our results suggest that some gynecological events might influence BMD variation in healthy Chinese women.     

血清S1P与绝经后2型糖尿病患者骨密度和骨代谢指标之间的相关性研究

目的探讨血清1-磷酸鞘氨醇(S1P)与绝经后2型糖尿病患者骨密度(bone mineral density,BMD)和骨代谢指标之间的相关性。方法选取2018年2月至2019年12月期间在海口市妇幼保健院就诊的绝经后2型糖尿病女性,收集患者一般临床资料和获取其血液标本,检测生化指标、S1P和髋部、腰椎骨密度。结果最终选取130名血糖控制较好的绝经后2型糖尿病女性参与本研究,年龄为(59.3±8.9)岁,血糖为(8.75±1.5)mmol/L;S1P平均浓度为(6.46±0.78)μmol/L。相关分析表明S1P与腰椎(L1~4)、全髋和股骨颈BMD呈显著负相关(P均<0.05)。多步逐步回归分析表明,血清S1P和Ⅰ型胶原交联C末端肽(β-CTX)与腰椎(L1~4)、全髋和股骨颈BMD密切相关;而血清S1P和β-CTX是各部位BMD独立危险因素。结论1-磷酸鞘氨醇与绝经后2型糖尿病女性骨密度和β-CTX水平密切相关。     

Changes in Bone Mineral Density with Age in Men and Women: A Longitudinal Study

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     

Bone mass and mineral metabolism in HIV+ postmenopausal women

The objective of this cross-sectional study was to estimate the prevalence of and risk factors for osteoporosis in HIV+ postmenopausal women. Bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA) and biochemical indices of mineral metabolism were measured in 31 Hispanic and African American HIV+ postmenopausal women. BMD was compared with 186 historical controls, matched for age, ethnicity and postmenopausal status. Mean BMD was significantly lower at the lumbar spine and total hip in the HIV+ group, as compared with controls. Prevalence of osteoporosis was higher in the HIV+ group than controls at the lumbar spine (42% vs 23%, p =0.03) and total hip (10% vs 1%, p =0.003). Among HIV+ women, time since menopause and weight were significant predictors of BMD, while duration or class of antiretroviral therapy (ART), AIDS diagnosis, nadir CD4, steroid use, and vitamin D deficiency were not. Prevalence of osteoporosis is substantially higher in HIV+ Hispanic and African-American postmenopausal women than in controls. Established osteoporosis risk factors were more important in predicting BMD than factors associated with HIV infection and ART. Long-term management of the growing female HIV population should include the evaluation for and management of osteoporosis.     

The effect of age and menopause on bone mineral density of the proximal femur

Although the menopause has been associated with increased bone loss at several skeletal sites, it has not previously been noted in the hip, yet estrogen therapy has been reported to reduce the incidence of hip fractures. We investigated the effect of age and menopause on bone loss in the proximal femur by measuring bone mineral density (BMD) of the femoral neck, Ward's triangle, and trochanter by dual-photon absorptiometry in 263 normal women aged 20-84. Multiple regression analyses revealed a significant decrease in BMD of the femoral neck and Ward's triangle with age in both pre- and postmenopausal women (p less than 0.001). In the trochanter the decrease with age was significant only in postmenopausal women (p less than 0.001). Further analysis revealed that BMD decreased faster at all sites in the early postmenopausal years. During the first 6 years postmenopause, the decrease in BMD of the femoral neck and trochanter was 3-10 times higher than the change in the decade prior to menopause. About 20% of the lifetime femoral neck loss and 30% of the trochanteric loss occurred in the early postmenopausal period. It is concluded that both age and menopause are major determinants of BMD in the proximal femur. These findings could explain why estrogen therapy has been reported to prevent hip fracture. The rapid early postmenopausal loss in BMD of the proximal femur demonstrates the importance of starting estrogen replacement therapy immediately after menopause for maximum effect.     

Bone mineral density in old age: the influence of age at menarche and menopause

Being aware that age at menarche, age at menopause, and length of fertile period influence bone mineral density (BMD) in the early postmenopausal period, we have failed to find any earlier studies where such an influence on the axial skeleton has been studied in old age when the incidence of hip fracture starts to increase. A large cohort of women, all 75 years old (n = 1044) participated in the Malmö Osteoporosis Prospective Risk Assessment (OPRA) Study. The BMD of the lumbar spine and femoral neck was assessed by a dual-energy X-ray absorptiometry (DXA) technique. Age at menarche and at menopause was recalled with a questionnaire. Also, data on estrogen medication was collected. We found that, after excluding ever-users of potent estrogens (n = 49), there was a small but significant correlation of early menarcheal age with high BMD of the lumbar spine (r = –0.08; P = 0.017) and femoral neck (r = –0.10; P = 0.002) at age 75. Excluding the extremes (5% of the women) with very early or very late menarche, age at menarche no longer influenced the BMD in old age (r = –0.06; P = 0.113). Age at menopause had no influence on the BMD of the lumbar spine (r = 0.04; P = 0.246) or femoral neck (r = 0.00; P = 0.985), at age 75. The length of the fertile period did not influence BMD in old age. The influence of menarcheal or menopausal age on BMD at age 75 was not substantially altered after including body mass index (BMI) in a multiple regression model. Age at menarche or menopause seems to be of limited or no importance as a risk factor for osteoporosis when subjects are age 75 or older.