老年男性原发性骨质疏松症患者血清性激素的变化

目的探讨血清多种性激素的变化对老年男性原发性骨质疏松的影响。方法182例老年男性患者测定腰椎及髋部骨密度(双能X线骨密度仪)，分为正常、骨量减少与骨质疏松组，40例健康青年男性为对照组。所有受试者用放射免疫法测定血清总睾酮(TT)、雌二醇(E2)、硫酸脱氢表雄酮(DHEAS)、性激素结合球蛋白(SHBG)，用免疫比浊法测定血清白蛋白，并计算游离睾酮(FT)、生物有效性睾酮(Bio-T)、游离雄激素指数(FAI)、游离雌二醇(FE2)及生物有效性雌二醇(Bio-E2)结果老年男性在股骨颈、Ward三角及大转子骨密度明显低于青年男性；随年龄的增长，除SHBG外，其他性激素均有明显下降；老年男性中，Bio—T及FAI在骨质疏松组明显降低，其他激素无明显变化。结论老年男性骨密度降低与增龄引起的性激素下降密切相关，而具有生物活性的睾酮的降低是影响老年男性原发性骨质疏松的重要因素。     

新疆石河子地区汉族中老年人骨质疏松患病率调查

原发性骨质疏松症严重危害着中老年人的身体健康,发病率较高。为了解我区发病情况,本采用单光子骨矿测定仪对本地区584名汉族中老年人行骨矿含量测定。结果显示：男女性40岁以后骨密度(BMD）随年龄增长而逐年下降,骨量与年龄呈负相关。以峰值骨量头减少2．0SD为骨质疏松的诊断标准,50－59年龄段男性患病率为5．7％,女性为33．3％;60－69年龄段男性患病率达25％,女性达78．9％。两性间差异有显性（P＜0．01）;女性发病率为男性2．73倍。研究表明：本地区中老年男女性随年龄增长骨矿丢失明显加速,骨质疏松患病率随之增加,女性发病率明显高于男性。     

用Metriscan骨密度仪研究西藏廊坊正常人群骨密度的变化规律

目的 研究不同海拔、不同种族、不同纬度(地区)正常人群骨量分布差异，确定峰位骨量的年龄段，寻找骨量丢失规律，为临床制定骨质疏松诊断标准提供参考值。方法 选择西藏拉萨11～79岁616名健康藏族男女，河北廊坊地区11～89岁1122名健康汉族男女，以10岁为一年龄段，对男女分别进行分组。用Metriacanm(美国Alara公司提供，其原理是用放射吸收技术评估相对的指骨骨密度)指骨骨密度仪，对非习惯用手的2^nd、3^rd、4^th手指中节进行测量，取结果的平均值。数据结果采用SPSS10．0软件进行统计学分析。结果 峰值骨量藏汉男女都在30～39年龄段。骨量丢失12％以上藏族男性是在70～79年龄段，汉族男性是在80～89年龄段；藏汉女性都在50～59年龄段。藏族女性60～69年龄段骨量丢失已达24．35％，汉族女性70～79年龄段骨量丢失才达23．86％，与汉族相比藏族骨量丢失速率较快；但两地不同年龄段骨量均数比较，男性20～69年龄段两地对比有显著差异，藏族骨密度明显高于汉族；女性11～49年龄段有显著差异，藏族明显高于汉族；其它年龄段虽没有显著性差异，但也是藏族高于汉族。结论 女性在绝经前男性在衰老前廊坊汉族和西藏藏族正常成人骨密度有显著差异；女性在绝经期后，男性在衰老后没有显著差异。其差异原因是地域、海拔不同还是种族差异引起有待于进一步研究。骨量丢失规律符合生理年龄预诊法。     

济南市1116例中老年人跟骨骨密度分析

目的探讨济南市中老年人骨质疏松的患病情况，为老年病工作者和老年人群的骨保健提供资料。方法对1116例中老年人健康查体者应用单能X线骨密度仪测量的右跟骨骨密度资料进行了回顾性分析，比较了骨密度与年龄和性别的关系。结果①在男性和女性45岁以上的人群中，随着年龄的增大，T值和BMD均逐渐降低，女性的降低幅度明显高于男性（P〈0．05）。②骨量减少和骨质疏松者在60岁以上男性中占60％，75岁以上占70％；骨质疏松患病率男性65岁～69岁组约占5％，70岁～74岁组约占10％，大于75岁组在20％以上。45岁～49岁的女性有30％的骨量减少；骨量减少和骨质疏松在女性50岁～54岁约占45％，55岁～59岁约占80％，60岁～69岁约占90％，70岁以上者高达99％。骨质疏松患病率在女性50岁～54岁近10％，55岁～59岁近30％，60岁～64岁近40％，65岁～69岁50％以上，70岁以上在70％以上。女性的骨质疏松患病率明显高于男性（P〈0．01）。③骨密度测定结果与年龄的相关性分析也显示，T值和BMD与年龄呈显著的负相关（P〈0．05），在女性其相关性更强。④以年龄为自变量，以T值和BMD为应变量，进行曲线拟合也看出，无论在男性还是在女性，T值和BMD随年龄的增大而逐渐变小，在女性曲线更陡。结论在中老年人群，随着年龄的增大，骨密度逐渐降低，骨质疏松的患病率明显增加，尤其在女性更为明显。     

老年男性性激素与骨密度测定

目的　为了解老年男性的骨密度和性激素水平,以探讨性激素在老年男性骨质疏松症发病机理中的作用。方法　６３ 例老年男性分为骨质疏松组与非骨质疏松组,测定骨密度（ＢＭＤ）、血清睾酮（Ｔ）、雌二醇（Ｅ２）、黄体生成素（ＬＨ）、促卵泡刺激素（ＦＳＨ）水平,并与３７ 例青年男性对照。结果　老年男性之ＢＭ Ｄ、Ｔ、Ｅ２ 明显低于青年对照组,而ＬＨ、ＦＳＨ 增高明显。老年男性骨质疏松症的发病率为３９．６８％ 。骨质疏松组与非骨质疏松组比较,Ｔ、Ｅ２ 明显降低,ＬＨ、ＦＳＨ 明显增高,尤以Ｔ 降低明显。结论　由于增龄性激素不足引致骨丢失,雄激素降低可能是老年男性骨质疏松症的主要原因。     

上海市区居民3051例跟骨骨密度的测量

对上海市区居民３０５１人进行了跟骨骨密度测定。其中男１４４４人，女１６０７人，年龄１１～９５岁，按５岁为一年龄组将其分为１７组。结果：跟骨骨峰值出现在２０～２４岁组，女性骨峰值显著小于男性，中年开始出现跟骨骨量丢失，女性的骨丢失速度显著快于男性。女性骨累积丢失量也显著大于男性。女性的跟骨累积丢失量仅次于Ｗａｒｄ三角。跟骨骨密度除了随年龄变化外，也受身高、体重及体重指数的影响。６０岁以上老年女性骨质疏松症的患病率显著高于男性，男、女分别为１３．９％、５８．０％。结论：跟骨骨密度的测量能较好地反映人体骨矿含量的变化规律     

资阳地区定量超声跟骨骨量测定的流调分析

目的调查四川资阳地区健康人群骨密度值及骨质疏松患病率,为骨质疏松的诊断和防治提供科学依据。方法对资阳地区人群亚群抽样1976例,应用日本FURUNO公司生产的超声骨量测定仪CM100测试受试者的右跟骨的超声速度(SOS)值。结果男女骨量峰值(PBM)均出现在20～39岁组,随年龄增加骨量逐渐下降。女性50岁以后骨量丢失明显加快,60～69岁年龄组骨量丢失最快;男性70岁以后骨量丢失明显加快。80岁以前各年龄组女性骨量丢失明显高于男性,80岁以后男性骨量丢失高于女性,但累计骨量丢失女性仍明显高于男性。结论骨量随年龄增长而下降,骨质疏松发病率也随之增加。女性骨量丢失明显高于男性,女性骨质疏松发病率也明显高于男性。     

西藏拉萨地区藏族正常人群骨矿含量分布研究

目的 为了解正常藏族人群骨量分布，确定峰值骨量的年龄段，寻找骨丢失规律，为骨质疏松骨密度诊断标准提供参考依据。方法 选择5∽89岁健康藏族男女681人，20岁以前以5岁为一年龄段，其它以10岁为一年龄段，对男女分别进行分组。用DTX-200(美国OSTEOMETER公司提供)双能X线密度仪，对非优势手臂的远端进行测量，取结果的平均值，数据输入SPSS软件数据库进行统计分析。结果 峰值骨量男女都在30∽39年龄段，以后随年龄增加骨量逐渐减少。男性在60∽69年龄段骨量丢失达17．61％，70∽79年龄段骨量丢失达23．90％；女性在50．59年龄段13．91％。女性60∽69年龄段骨量丢失已达26．48％。结论 应依据不同地区正常人群骨量分布，建立诊断标准，用骨量丢失百分率诊断骨质疏松具有普遍意义。     

2型糖尿病患者骨密度变化及血清IGF-1水平

目的 观察2型糖尿病患者不同性别、不同年龄阶段以及肥胖与非肥胖状态下IGF-1血清浓度及前臂骨密度水平。方法2型糖尿病100人,根据年龄、体重分别进行分组。ELISA法测定血清IGF-1浓度,双能X线骨密度检测仪(DEXA)测量前臂超远端(尺桡骨远端1/10交界处)及中远端(尺桡骨远端1/3交界处)骨密度(BMD)、骨矿含量(BMC)及T积分。结果 骨质疏松症的患病率为14％(<50岁组)到73％(>70岁组),总患病率为33％(超远端)和27％(中远端)。其中女性患病率为47.7％和22.7％,男性为21.4％和30.4％。BMD、BMC、IGF-1血清水平随增龄逐渐低降,50岁以后女性BMD、BMC较男性显著下降。肥胖者的:BMD、BMC较非肥胖者高,非肥胖女性骨质疏松症的患病率升高。IGF-1在男性与女性之间及肥胖与非肥胖者之间均无差异。结论 2型糖尿病非肥胖者的骨密度低于肥胖者,女性低于男性,非肥胖女性易在前臂超远端发生骨质疏松症。:IGF-1不受性别和体重的影响,随增龄逐渐减少。     

用MetriScan?骨密度仪测量西双版纳、西藏、内蒙古地区健康人群骨密度的情况调查分析

目的应用放射吸收法测量云南西双版纳、西藏和内蒙古三个少数民族地区，对傣族、藏族和蒙古族健康人群的骨量分布差异和峰值骨量进行调查分析，为临床诊断骨质疏松提供参考。方法选择云南西双版纳傣族健康男女1126名，年龄20～79岁。西藏藏族健康男女1531名，年龄20～79岁。内蒙东乌旗蒙古族健康男女901名，年龄20～79岁。以10岁为一年龄段进行分组。用美国Alara公司提供的Metriscan^TM指骨骨密度仪，进行骨密度测量。数据采用SPSS软件包进行统计学分析。结果西双版纳傣族男女、西藏藏族男女和内蒙古东乌旗蒙古族女性的峰值骨年龄段均在30—39岁，蒙古族男性峰值骨年龄段在4｜D～49岁。傣族和藏族男性骨量丢失12％以上在60—69岁年龄段，蒙古族男性70～79年龄段骨量丢失11．04％。傣族女性50～59岁年龄段骨量丢失达20．80％，藏族女性为13．67％。蒙古族女性丢失12％以上在60-69岁年龄段。三个民族不同年龄段骨密度值比较，男性除藏族和蒙古族20—39岁年龄段没有差异外，其余各年龄段均有显著性差异。女性除傣族和藏族20-29岁年龄段没有差异外，其余各年龄段均有显著性差异。结论健康成人傣族男性与藏族和蒙古族健康成人男性相比骨密度有显著差异，藏族和蒙古族男性40岁以后骨密度均值有显著性差异。傣族女性与蒙古族女性各年龄段骨密度均有显著性差异，傣族与藏族女性30岁后骨密度有显著性差异。其差异是种族、地域，还是生活习性引起有待进一步研究。     

Osteopenia in juvenile diabetes

Summary The bone mineral status of fifty-one children with diabetes mellitus was studied by single photon absorptiometry. The mean bone mineral content was 13% below values predicted by age, sex, height, and weight. Those children whose diabetes was one year or less in duration were as osteopenic as those whose diabetes was of longer duration. The demineralized children received a higher daily insulin dose than the others. No association was noted between the degree of skeletal demineralization and sex, statural growth, renal function, and serum calcium and phosphorus. No significant changes in bone mineral content were noted longitudinally.     

Osteopenia in juvenile diabetes

The bone mineral status of fifty-one children with diabetes mellitus was studied by single photon absorptiometry. The mean bone mineral content was 13% below values predicted by age, sex, height, and weight. Those children whose diabetes was one year or less in duration were as osteopenic as those whose diabetes was of longer duration. The demineralized children received a higher daily insulin dose than others. No association was noted between the degree of skeletal demineralization and sex, statural growth, renal function, and serum calcium and phosphorus. No significant changes in bone mineral content were noted longitudinally.     

Bone Mineral Density and Androgen Levels in Elderly Males

To clarify the relationship of sex male hormones and bone in men, we studied in 140 healthy elderly men (aged 55–90 years) the relation between serum levels of androgens and related sex hormones, bone mineral density (BMD) at different sites, and other parameters related to bone metabolism. Our results show a slight decrease of serum-free testosterone with age, with an increase of follicle stimulating hormone (FSH) and luteinizing hormone (LH) in a third of the elderly subjects studied. BMD decreased significantly with age in all regions studied, except in the lumbar spine. We found a positive correlation between body mass index (BMI) and BMD at the lumbar spine and femoral neck (P < 0.001). No relationship was found (uni- and multivariate regression analysis) between serum androgens or sex hormone-binding globulin (SHBG) and BMD. We found a positive correlation of vitamin D binding protein (DBP) and osteocalcin with lumbar spine BMD and with BMI, DBP, IGF-1, and PTH with femoral neck BMD. In conclusion, there is a slight decline in free testosterone and BMD in the healthy elderly males. However, sex male hormones are not correlated to the decrease in hip BMD. Other age-related factors must be associated with bone loss in elderly males. Received: 29 April 1997 / Accepted: 9 November 1997     

Bone metabolism in thyroidectomized patients--evaluation of bone mineral content by quantitative CT

The bone mineral content in the patients who had undergone operation for thyroid carcinoma was measured by quantitative CT. Thirty-eight cases were enrolled as the subjects. All cases were papillary adenocarcinoma of the thyroid. The totally thyroidectomized group consisted of 3 males and 14 females, and the non-totally thyroidectomized group (post-lobectomy) 3 males and 18 females. Thirty-eight healthy males and females were assigned to the control group. For evaluation of bone mineral content, quantitative CT was used and bone mineral content in the patient's lumbar vertebrae was measured. Concurrently, bone metabolic parameter in serum was determined. No significant difference was observed in the mean bone mineral content among the above three groups. To make correction by sex and age, BMC-index was defined as the value that the bone mineral content in each case was divided by the standard mean by the same age and sex. No significant difference was observed in BMC-index among the above three groups. No significant correlation was observed in serum calcitonin level with the bone mineral content and BMC-index. It suggests that no influence is exerted on bone metabolism if serum calcitonin is maintained in the physiological level.     

2型糖尿病患者微血管病变与骨密度相关性研究

目的探讨2型糖尿病患者微血管病变与骨密度的相关性。方法本横断面研究共纳入2 170例2型糖尿病患者(包括1 188名绝经后女性和982名50岁男性)。根据24 h尿蛋白水平对这些受试者进行分组:一组(30 mg)、二组(30～299mg)和三组(300 mg)。通过双能X射线吸收测定法评估其腰椎、髋部和股骨颈的骨密度。视网膜病的眼底照相和24 h尿蛋白作为2型糖尿病中微血管病的标志物。比较受试者的特征和骨密度。多变量分析用于研究骨密度与微血管病之间的关联。结果第三组在两种性别中具有最低的骨密度水平。在调整年龄、体重指数、高血压、高脂血症、糖尿病状态、肝功能、肾功能、性激素和25(OH)维生素D后,多变量分析显示,微血管病变与女性骨密度呈负相关(腰椎:r=-0. 522,P0. 001;髋关节:r=-0. 301,P=0. 010;股骨颈:r=-0. 314,P=0. 009),男性未发现相关性。结论绝经后女性2型糖尿病患者的微血管病变与骨密度之间呈负相关。     

Spinal bone mass after long-term treatment with L-Thyroxine in postmenopausal women with thyroid cancer and chronic lymphocytic thyroiditis

This study investigated the effect of long-term treatment upon bone density with L-Thyroxine in postmenopausal women compared with untreated postmenopausal women with climacteric symptoms. We measured spinal bone density in three groups (n=84) of postmenopausal women: (A) those treated with TSH-suppressive dosis of L-Thyroxine for a medium of 5 years after removal of thyroid cancer; (B) those on L-Thyroxine treatment for a median of 9 years after being diagnosed with chronic lynfocitic thyroiditis (CLT); and (C) those with no thyroid disease or other known pathology and without any treatment. There were no differences in dietary calcium intake and daily activity between untreated and L-Thyroxine-treated women. Measurements of bone mineral density were performed at spine level L1–L4 using a dual X-ray densitometer and serum thyroid-stimulating hormone (TSH), thyroid hormones, and bone markers (serum osteocalcin, procollagen I, urinary calcium), and PTH levels were assayed and found to be within normal ranges. Women receiving L-Thyroxine after thyroid cancer had slightly higher FT4 levels compared with women who had CLT and lower TSH levels, with serum T4 and T3 levels normal and similar in both groups. No significant differences were found in spinal bone density after L-Thyroxine treatment between Groups A and B and compared with Group C. Bone loss according to 2 SD below reference standards (age and sex matched) was found in the 12.9% of L-Thyroxine-treated patients versus 22.6% of untreated women. No correlation was found between bone loss and thyroid hormone levels and duration of treatment. Our data suggest that long-term L-Thyroxine therapy in postmenopausal women maintaining near physiological levels of thyroid hormones is not associated with significant axial bone loss, therefore other factors should be considered when this occurs.     

影响经皮椎体后凸成形术椎体高度恢复的相关因素分析

目的:探讨影响经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折椎体高度恢复的相关因素。方法:对2007年1月～2008年10月于我院因骨质疏松性椎体压缩骨折行单节段经皮椎体后凸成形术的43例患者进行回顾性分析。分别记录患者的年龄、性别、病程、有无外伤史、术前椎体压缩程度、术前矢状面Cobb角、骨折类型、骨密度、手术入路途径、骨水泥剂量及有无侧凸畸形等相关因素,观察患者术后压缩椎体高度恢复情况,应用双变量回归分析及t检验行单因素分析,应用多元线性回归分析行多因素分析,研究各因素与经皮椎体后凸成形术椎体高度恢复情况的相互关系。结果:术后椎体高度恢复率为(39±17)%。单因素分析结果显示患者的病程、术前椎体压缩程度、骨折类型、骨密度及有无腰椎侧凸与术后椎体高度恢复情况有一定的相关性(P0.05),而患者的年龄、性别、术前矢状面Cobb角、骨水泥剂量及手术途径与术后椎体高度恢复情况无相关性(P0.05)。多因素分析结果显示患者术前椎体压缩程度、骨密度及骨折类型是影响术后椎体高度恢复情况的主要因素,其标准化偏回归系数分别为-0.622、-0.283、0.131。结论:患者术前椎体压缩程度、骨密度及骨折类型是影响经皮椎体后凸成形术椎体高度恢复的主要因素,观察患者的这些指标有助于预测经皮椎体后凸成形术椎体高度恢复情况。     

性激素在老年男性骨质疏松发病及治疗中作用的研究进展

骨质疏松（osteoporosis，OP）与年龄增长密切相关，在老年人群中患病率显著高于中青年人群，严重危害老年人群的健康。性激素在男性骨骼代谢中发挥重要作用，其中，雌激素和雄激素都能够促进骨形成，对抗骨量丢失，而孕激素则可能对男性骨量的维持起到负性调节作用。老年男性体内雌激素、雄激素的缺乏与其骨密度降低、OP患病率增加都有着密切的关系，性激素及其受体调节剂为OP的治疗提供了新的思路。雌激素是目前女性绝经后骨质疏松（postmenopausal osteoporosis，PMOP）治疗的常用药物，并不被推荐用于治疗男性OP；雄激素替代治疗可使老年男性骨密度得到增加，但在前列腺和心血管安全性上存疑，因而并不推荐常规使用；选择性雌激素受体调节剂（selective estrogen receptor modulator，SERM）能提升血清睾酮水平，有助于增加腰椎和髋关节骨密度，降低骨折风险，但尚未被正式批准用于治疗男性OP，其疗效及安全性有待更多的临床试验来验证；选择性雄激素受体调节剂（selective androgen receptor modulator，SARM）应用于OP的相关研究尚处于起步阶段，目前仅在动物模型中被证实能够增加雄性大鼠的骨骼强度。本文就性激素在老年男性OP发病及治疗中的作用进行回顾和总结，以期为临床医师的工作提供一定参考。     

Reduced levels of serum IGF-1 is related to the presence of osteoporotic fractures in male idiopathic osteoporosis

IntroductionThe pathophysiology of male idiopathic osteoporosis (MIO) remains unknown. The aim of this study was to evaluate the involvement of IGF-1 in MIO, and to explore the relationships between bone mineral density and serum levels of IGF-1 and sex hormones.MethodsInclusion criteria were osteoporosis (T-score < ?2.5 SD) and/or an osteoporotic fracture. The osteoporotic patients were included after an exhaustive work-up to exclude the principal causes of secondary osteoporosis. Serum levels of IGF-1, estradiol, testosterone, SHBG, markers of bone turnover, and bone mineral density were compared between 79 MIO and 26 healthy subjects.ResultsA significant reduction in serum IGF-1 was found in MIO patients (p = 0.0189). This remained significant after adjustment for body mass index (BMI). A negative correlation was found between SHBG and serum IGF-1 (r = ?0.231, p = 0.048). SHBG levels were higher in osteoporotic patients (p = 0.001). The Free Testosterone Index (FTI, total testosterone/SHBG) (p = 0.002) was also lower in MIO patients. After adjustment for FTI and BMI, a significant association was observed between IGF-1 level and the presence of an osteoporotic fracture, indicating an independent effect of IGF-1 level on fracture risk. The odds ratio (OR) for fracture for each SD decrease in IGF1 level was 1.8 [CI: 1.09–2.96] (p = 0.021).ConclusionOur study indicates a decrease in serum IGF-1 levels in MIO. This could be either the cause or the consequence of a disturbance in sex hormone metabolism with increased SHBG serum levels.     

The mineral content in adult radius and ulna in southwestern area of Guang-xi]

We investigate the BMD of ulna and radius of 2690 persons in southwestern areas of Guang-xi. The results show that the bone mineral content in male is higher than that in female and it is higher in middle-aged person than in the elderly. It is at 32-33 years old that the BMD reaches the peak, then decreases after 35 years old with 5-7 percent and/10 percent loss of the bone mass in male and female per 10 years, respectively. The losing rate of bone mass in female after 50 years old is faster than that in male. In addition, we compared the BMD in workers of different professions at the same age, and found that the heavier the labour intensity, the higher the bone mineral content and the BMD is higher in workers doing outdoor works. The bone mineral content in miners who work in the mine for a long time is lowered. This presentenship that there is a close relationship between the bone mineral content and age, sex, sunshine exposure and intensity of labour.