老年男性2型糖尿病患者各种钙调激素与骨密度改变的关系

目的测定老年男性2型糖尿病患者各种钙调激素及骨密度,探讨老年男性2型糖尿病患者骨质疏松的发病机理,为其防治提供理论依据。方法用双能X线吸收法测定70例老年男性2型糖尿病患者及60例年龄、体重指数相匹配的对照者的腰椎及髋部骨密度,并采用放免法测定血清骨钙索(BGP)、抗酒石酸酸性磷酸酶(TRAP)、甲状旁腺素(PTH)、降钙素(CT)、1,25(OH)2D3、25(OH)D3、尿羟脯氨酸(HOP)等,两组进行比较。结果 老年男性2型糖尿病患者较对照组骨密度显著降低。血BGP、CT、1,25(OH)2D3浓度低于对照组(P<0.05).TRAP、PTH、尿HOP显著高于对照组(P<0.05)。结论老年男性2型糖尿病患者PTH、CT、1,25(OH)2D3等钙调激素分泌及代谢失常,影响骨代谢,出现糖尿病性骨质疏松,表现为骨吸收增加,骨形成减少与缓慢,骨吸收过程大于骨形成。     

正常钙摄入老年男性骨质疏松与钙调节激素相关性的调查与分析

目的：了解正常钙饮食和接受充足阳光照射老年男性骨质疏松的发病情况,对这组老年男性骨质疏松和钙调节激素间的相关性进行调查与分析。方法：95例正常钙饮食和充足光照的老年男性,测定骨密度后,分骨质疏松组和非骨质疏松组,检测钙调节相关激素。用统计学方法对两组进行比较。结果：正常钙饮食和充足光照的老年男性随年龄增加出现骨质疏松,钙调节激素特点为骨质疏松组较非常骨质疏松组,hCT和IGF－1降低,BGP增高,TE2,TTT,hPTH,25-OH-VD无差异。结论：正常钙饮食可抑制骨质疏松组继发的hPTH升高,充足光照可避免25－OH－VD减低,但不可避免地发生hCT,IGF-1,TTT,TE2随年龄增加而降低,故老年男性骨质疏松的发病可能与年龄增加相关激素（TE2,TTT,hCT,IGF-1)的变化密切相关。     

老年男性肥胖与骨密度的关系

目的分析老年男性的腰椎2-4(L2-4)、股骨颈(Neck)、大转子(Troch)和粗隆间(InterT ro)的骨密度(BMD),探讨老年男性肥胖与骨密度的关系。方法以我院273名年龄60~75岁的老年男性为研究对象,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,分析老年男性肥胖与骨密度的关系。结果老年男性各部位的骨密度随年龄的增长而降低,老年男性70~75岁组股骨颈和粗隆间的骨密度均低于60~64岁组(P0.01)。老年男性按不同年龄分组发现,肥胖者不同部位的骨密度均高于对照者(P0.05或P0.01)。结论年龄和体重指数是影响骨密度的重要因素,老年男性肥胖者骨密度较正常体型者高,提示肥胖对骨密度有保护作用。     

中老年人性激素与骨密度关系初步探讨

本文诵过对332例正常中老年人血清性激素放射免疫分析与单光子骨密度的测定旨在探讨中老年人骨矿物质丢失与血清性激素水平的关系。结果表明男性145人中12人(8．3%)血清睾酮含量低于正常标准．这12人骨密度明显低于正常标准，女性187人中75人(40％)血清雌二醇含量低于正常标准，而这75人中49人骨密度明显低于正常。血清睾酮含量低于正常标准之男性全部显示骨密度明显降低(100%)而女性仅49人(65％）显示骨密度明显降低。故可以认为中老年人骨矿物质丢失量与血清性激素含量呈负相关。     

老年男性骨密度与IGF-1及骨代谢相关激素的关系研究

目的：探讨老年男性骨密度（BMD）与胰岛素样生长因子-1（IGF－1）及骨代谢相关影响激素的关系。方法：采用双能X线骨密度仪测量120例正常老年男性骨密度（BMD）、血IGF－1及生长激素（GH）、雌二醇（E2）、血睾酮（T）、甲状旁腺激素（PTH）等指标，并与青中年男性对照，进行统计分析。结果：老年男性胰素样生长因子－1、雌二醇（E2）及血睾酮（T）呈现随着年龄增长而降低的趋势，并且在骨质疏松组均显低于非骨质疏松组（P＜0．01），IGF－1与骨密度（P＜0．01）、E2（P＜0．005）、T（P＜0．05）呈正相关。结论：IGF－1的增龄性减少同时伴雌激素、雄激素水平的降低可能是老年男性骨质疏松发生的重要机制。     

老年男性血清维生素D水平状况及其与甲状旁腺激素的相关性研究

目的 探讨老年男性血清维生素D水平及其与甲状旁腺素及骨代谢指标的相关性。方法 收集2010年9月至2013 年9月在上海瑞金医院老年病科病房住院及门诊患者895例,平均年龄为76岁。测定其血清25-羟基维生素D[25(OH)D]、血钙（Ca)、血磷(P)、甲状旁腺激素（PTH),1型胶原分子N-端前肽（PINP)及β-1型胶原C端肽（β-CTX)水平。根据血清25 (OH) D水平将患者分为维生素D严重缺乏组（<25 nmol/L)、维生素D缺乏组（25~50 nmol/L)、维生素D不足组（50 ~75 nmol/L)和维生素D充足组（>75 nmol/L)。结果（1)895例老年男性患者年龄60 ~99岁,平均年龄76岁。血清25( OH) D 平均值为(43. 52 ±21. 97) nmol/L。维生素D缺乏者（≤50nmol/L)为592人(67% ),维生素D不足者（50 ~ 75 nmol/L)为223 人(25%)。维生素D缺乏或不足者高达92%,维生素D充足者（>75 nmol/L)仅为80人(8%)。（2)不同年龄段血清25- (OH) D的比较显示,血清25-(OH) D水平随增龄而逐渐降低。60 ~69岁组25-(OH) D值最高,为（46. 27 ± 20. 76) nmol/L,与 其它各组比较差异均有统计学意义(P <0. 05)。相关分析表明,血清25-(OH)D与年龄呈负相关（相关系数r =-0.088,P = 0. 008)。（3)甲状旁腺素（PTH)的平均水平为（55. 74 ±29. 06) pg/mL。相关分析显示,25-(OH)D与PTH、PINP、β-CTX均呈负相关（r值分别为-0.209、-0. 109、-0. 122,P 均 <0.05)。血25-(OH)D 与 Ca 呈正相关（r = 0. 206,P <0.001)。血 25-(OH) D与BMI、P均无相关性（P均>0.05)。结论 老年男性存在严重的维生素D缺乏或不足。血25-(OH) D与PTH、年龄、 PINP、β-CTX均呈负相关。     

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。     

同型半胱氨酸与老年男性骨密度相关性分析

目的 探讨血清总同型半胱氨酸(tHcy)与老年男性骨密度(BMD)的相关性.方法 选择109例年龄≥60岁老年男性为研究对象,采用乳胶增强散射比浊法测定纳入患者的血清总同型半胱氨酸(tHcy),用双能X线测定腰椎前后位总体及股骨总体骨密度(BMD),根据T≤-2.5,-2.5＜T≤-1.0,T＞-1.0分别分为骨质疏松症组、骨量低下组、正常组;评价各组间tHcy的差异,及tHcy与两部位BMD的相关性.结果 ①腰椎前后位总体及股骨总体骨质疏松组、骨量低下组及正常组之间tHcy差异均无显著性(P＞0.05).②tHcy与两部位BMD均无直线相关(r=0.27,P=0.778;r=-0.086,P=0.374).结论 tHcy与两部位BMD无直线相关,tHcy与骨质疏松性骨折间的关系可能独立于BMD和其他潜在的骨折危险因素.     

慢性肾衰竭患者的甲状旁腺激素升高与心脏损害关系的探讨

为了研究甲状旁腺激素 (ＰＴＨ)对慢性肾衰竭患者心脏损害的作用 ,我们用放射免疫分析法测定全段ＰＴＨ(ｉＰＴＨ) ,兹将 38例分析结果报道如下。资料与方法1　对象　选择 1999年 2月～ 2 0 0 0年 10月我科的慢性肾衰竭住院患者 38例 ,既往无高血压、心脏瓣膜病及心力衰竭病史 ,近半年来未用过钙剂及维生素Ｄ制剂 ,除外原发性甲状旁腺功能亢进。并依其ｉＰＴＨ值是否增高分为ＳＨＰＴ(ＰＴＨ增高为继发性甲状旁腺功能亢进组 )和ＮＳＨ ＰＴ组 (ＰＴＨ正常为非继发性甲状旁腺功能亢进组 )。 2 0例我院心内科门诊高血压患者 ,经检查排除其他器…     

性激素及甲状旁腺激素与老年男性骨转换生化指标的相关性分析

目的:探讨老年男性血清性激素及甲状旁腺激素与骨转换生化指标的相关性。方法:收集2011年5~6月在我院常规年度体检年龄≥60岁的老年男性465例,年龄60~93岁。测定血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、睾酮(T)、性激素结合球蛋白(SHBG);血清甲状旁腺激素(PTH)、25-羟化维生素D3(25(OH)D3);骨转换生化指标(I型胶原羧基末端肽:CTX;骨钙素:OC;Ⅰ型前胶原氨基末端前肽:PINP);并计算游离睾酮(FT)、生物可利用睾酮(BT)、睾酮分泌指数(TSI)和游离睾酮指数(FTI);分析各指标与老年男性骨转换生化指标的相关性。结果:老年男性血清FSH、LH、SHBG水平随年龄增加而升高,而FT、BT、TSI、FTI、PTH及CTX、OC和PINP随增龄呈下降趋势,80岁以后下降较为显著(P0.05)。PTH与CTX、OC和PINP均呈正相关(r=0.227,0.269,0.162;P0.01),校正年龄因素后,相关性仍然存在;SHBG与OC负相关(r=-0.100,P0.05)。各骨转换指标随PTH四分位水平升高而增加,第一分位与第四分位之间均存在显著差异(P0.01)。多元逐步回归结果显示,年龄与CTX、OC和PINP负相关(β=-0.126,-0.141,-0.122;P0.05),PTH与CTX、OC和PINP正相关(β=0.196,0.279,0.189;P0.001),SHBG与OC负相关(β=-0.100,P0.05)。结论:增龄是老年男性骨转换减低的根本原因,血清PTH和SHBG水平与骨转换生化指标相关。     

Vitamin D, parathyroid hormone levels and bone mineral density in community-dwelling older women: The Rancho Bernardo Study

Vitamin D (25(OH)D) increases the efficiency of intestinal calcium absorption. Low levels of serum calcium stimulate the secretion of parathyroid hormone (PTH), which maintains serum calcium levels at the expense of increased bone turnover, bone loss and increased risk of fractures. We studied the association between 25(OH)D and PTH levels, and their associations with bone mineral density (BMD), bone loss, and prevalence of hip fractures in 615 community-dwelling postmenopausal aged 50–97 years. Mean level of 25(OH)D and PTH were 102.0 nmol/l±35.0 nmol/l and 49.4 ng/l±23.2 nmol/l, respectively; 49% of women were current hormone therapy users. The overall prevalence of vitamin D insufficiency (25(OH)D<50 nmol/l) was 2%, and prevalence of high PTH levels (>65 ng/l) was 17.4%. In multiple linear regression analyses hip BMD was negatively and independently associated with PTH levels ( p =0.04), and positively and independently associated with 25(OH)D levels ( p =0.03). There were only 23 women (3.7%) who experienced a hip fracture. In age-adjusted analyses there were no significant differences of 25(OH)D and PTH levels by hip fracture status. Across the entire range of values, the overall correlation between 25(OH)D and PTH was moderate ( r =–0.20). However, after the threshold vitamin D level of 120 nmol/l, all PTH values were below 65 ng/l. Further studies are necessary to identify the optimal vitamin D levels necessary to prevent secondary hyperparathyroidism.     

Effects of parathyroid hormone alone or in combination with antiresorptive therapy on bone mineral density and fracture risk – a meta-analysis

Aim The effects of parathyroid hormone (PTH) alone or in combination with antiresorptive therapy on changes in bone mineral density (BMD) and fracture risk were studied. Materials and methods Randomised placebo controlled trials were retrieved from the PubMed, Web of Science or Embase databases. Results PTH alone or in combination with antiresorptive drugs reduced vertebral [relative risk (RR)=0.36, 95% confidence interval (CI): 0.28–0.47, 2p<0.01] and non-vertebral (RR=0.62, 95% CI: 0.48–0.82, 2p<0.01) fracture risk and increased spine BMD by 6.6% (95% CI: 5.2–8.1%, 2p<0.01) and hip BMD non-significantly by 1.0% (95% CI: −0.1 to 2.1%, 2p=0.08) during 11–36 months of follow-up (13 trials). The gain in spine and hip BMD tended to increase with the length of the PTH treatment. No significant effect of study duration on fracture risk could be demonstrated. The major adverse events were hypercalcaemia, nausea and discomfort at the injection sites. Only limited data are currently available on fracture risk reduction with PTH plus antiresorptive therapies. Conclusion Although the number of studies on non-vertebral fractures is limited, our pooled analysis revealed that PTH alone or in combination with antiresorptive drugs would appear to be able to reduce the risk of vertebral and non-vertebral fractures and to increase spine and perhaps hip BMD. However, these analyses were based on cross-sectional data – i.e. based on indirect comparisons – and further studies with a direct comparison of study duration are necessary. No studies comparing PTH, PTH plus antiresorptive drugs and antiresorptive drug versus placebo in a factorial design are available; consequently, we were unable to draw any conclusions on the superiority of PTH plus antiresorptive drug versus antiresorptive drug or PTH alone with respect to BMD or fractures.     

Relationship between bone mineral density and dietary intakes in the elderly

Dietary protein and/or calorie insufficiencies represent an important problem in elderly patients. The biological and clinical implications, and particularly the influence on bone mass of undernutrition in the elderly, have not been completely defined, although several studies have demonstrated a high prevalence of dietary insufficiencies in patients with a recent fracture of the proximal femur. In the present study the relationship between dietary intakes, physical performance and bone mineral density (BMD) was examined in hospitalized elderly patients. The study comprised 74 patients (48 women, mean age 82 years; and 26 men, mean age 80 years) who were hospitalized for various medical indications. They were divided into two groups according to their dietary protein intakes, evaluated during the first 28 days in hospital while on a regular diet. The first group consisted of 26 patients (14 women and 12 men) whose protein intake was equal to or greater than 1 g per kilogram of ideal body weight. The second group consisted of 48 patients (34 women and 14 men) who consumed less than 1 g of protein per kilogram of ideal body weight. The two groups differed also in their energy, carbohydrate, lipid and calcium intakes. Patients in the group with the higher protein intake displayed higher BMD at the level of the femoral neck as measured by dual-photon absorptiometry. The men in this group also had higher lumbar spine BMD. After 4 weeks in hospital the women with a higher protein intake had significantly enhanced bicipital and quadricipital muscle strength and better performance as indicated by the increased capacity to climb stairs. These results indicate that lower dietary intakes in hospitalized elderly patients without fractures are associated with lower physical performance and lower femoral neck BMD. Thus, the role of dietary factors, including protein, in the risk of proximal femoral fractures deserves further investigation.     

2型糖尿病患者绝经期骨密度与甲状旁腺素、雌激素相关性研究

目的 观察2型糖尿病妇女绝经期骨密度与甲状旁腺素、雌激素相关性研究.方法 测定绝经期2型糖尿病妇女伴骨质疏松（A）组及绝经期2型糖尿病妇女无骨质疏松（B）组的左侧髋部股骨颈、大转子、华氏三角区、及腰椎L2～L4正侧位的骨密度和血清中骨代谢指标,如：骨钙素、碱性磷酸酶、钙、磷、甲状旁腺素、雌二醇、Ⅰ型胶原羧基末端终肽（β-CTx）的浓度,对骨密度与多个变量之间的关系进行相关分析,并对（A）组血清中的甲状旁腺素、雌二醇、骨钙素、β-CTx与不同部位的骨密度之间的关系进行多元逐步回归分析.结果绝经期2型糖尿病妇女（B）组的腰椎、大转子、华氏三角区、股骨颈等骨密度指标明显低于对照组（A）（P＜0.05）;2型糖尿病绝经期妇女血清中雌二醇水平与腰椎L2～L4骨密度呈正相关（P＜0.032）;甲状旁腺素水平与股骨颈骨密度呈负相关（P＜0.034）.结论 绝经期2型糖尿病患者甲状旁腺素和雌激素水平与骨密度密切相关,分别可以用于预测骨质疏松发生的不同部位.     

Correlation of vitamin D,bone mineral density and parathyroid hormone levels in adults with low bone density

Background:

Bone mineral densiy (BMD) is known to be affected by serum 25-hydroxyvitamin D (25(OH) D) levels, intact parathyroid hormone (iPTH) levels. Indian data pertinent to above observation is scant. Our study aimed to investigate the relationships between serum 25-hydroxyvitamin D (25(OH) D) levels, intact parathyroid hormone (iPTH) levels and bone mineral density (BMD) in a cohort of Indian patients.

Materials and Methods:

Adults with or without fragility fractures with low BMD at the hip or lumbar spine were evaluated clinically along with laboratory investigations. T-scores of the hip and spine were derived from BMD-DEXA (dual-energy X-ray absorptiometry). Multivariate regression models were used to investigate the relationships between serum 25(OH) D, iPTH and BMD.

Results:

Total of 102 patients (male:female = 38:64) with a mean age of 62.5 ± 6.4 years were included in the study. Forty-four patients had osteopenia. Osteoporosis was present in 58 patients. The mean values for serum 25(OH) D and iPTH levels were 21.3 ± 0.5 ng/ml and 53.1 ± 22.3 pg/ml, respectively. In 84.3% of patients, serum 25(OH) D levels were below 30 ng/ml (Normal = 30-74 ng/ml), confirming vitamin D deficiency. There was no association between 25(OH) D levels and BMD at the hip or lumbar spine (P = 0.473 and 0.353, respectively). Both at the hip and lumbar spine; iPTH levels, male gender, body mass index (BMI) and age were found to be significant predictors of BMD. Patients with higher BMI had significantly lower BMD and T-score. At levels <30 ng/ml, 25(OH) D was negatively associated with iPTH (P = 0.041).

Conclusion:

Among our cohort of patients with low BMD, no direct relationship between serum 25(OH) D levels and BMD was observed. However, a negative correlation between iPTH and 25(OH) D at serum 25(OH) D concentrations <30 ng/ml. Serum iPTH levels showed a significant negative association with BMD at the hip and lumbar spine. Our findings underscore the critical role of parathyroid hormone in bone metabolism and health.     

甲状旁腺素和维生素D受体基因多态对糖尿病患者骨密度的影响

目的探讨甲状旁腺素(PTH)基因多态性与中国北方汉族人糖尿病患者骨密度的关系,联合分析维生素D受体(VDR)基因和PTH基因多态性与骨密度的相关性。方法选自青岛市内分泌糖尿病医院1998年1月~2002年1月住院的糖尿病患者,运用聚合酶链反应限制性片段长度多态性(PCR-RFLP)技术检测了1型糖尿病(T1DM)组54例,2型糖尿病(T2DM)组104例,健康对照(CON)组102例,260例中国北方汉族人PTH基因多态性;采用双能X线吸收法骨密度仪(DEXA)测量骨密度。结果校正年龄和BMI后,1型糖尿病组腰椎、股骨颈骨密度低于对照组(P0.05);2型糖尿病组与对照组相比,骨密度差异无显著性(P0.05);甲状旁腺素(BSTB1位点)基因型和等位基因分布频率在1型糖尿病组、2型糖尿病组与对照组间差异无显著性(P0.05);在对照组及2型糖尿病组,BB基因型者腰椎(L2-4)和股骨颈部位骨密度显著高于Bb/bb基因型(P0.05);在1型糖尿病组,BB基因型仅腰椎L2-4部位骨密度高于Bb/bb基因型(P0.05);联合VDR基因多态(Apa I酶切位点)分析结果表明,Bbaa基因型在腰椎和股骨颈骨密度低于其他基因型(P0.05)。结论糖尿病患者PTH基因多态性(BSTB1位点)可能是预测骨量减少、骨质疏松易感性的遗传标志。联合VDR基因多态(Apa I酶切位点)有助于识别糖尿病患者发生骨质疏松的高危人群。     

Serum 25-hydroxyvitamin D, parathyroid hormone, and bone mineral density in men: the Rancho Bernardo study

Introduction This study examined the distribution and determinants of serum 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) and their associations with bone mineral density (BMD) at the hip and spine in 414 older men (mean age 74 years) living in southern California.Methods At a clinic visit (1997–2000), demographic and lifestyle information, fracture history, and medication use were recorded; venous blood for serum 25OHD and PTH was obtained; and BMD was measured at the hip and spine.Results Only one man had vitamin D deficiency (25OHD <20 nmol/l), but 15.5% of the men had high parathyroid levels (PTH ≥65 pg/ml). The mean 25OHD and PTH levels were 109.0 nmol/l and 50.3 pg/ml, respectively. Overall, 21.5% used calcium and 9.7% used vitamin D supplements. Serum 25OHD decreased with age and was lowest in the winter; levels were higher in supplement users (vitamin D and/or calcium; p<0.01). Serum PTH did not vary by age or season, and it was lower in supplement users (p<0.01). After excluding 12 men who were outliers for serum 25OHD and PTH, there was no significant correlation between serum 25OHD and PTH (r=−0.05, p=0.3). In multiple adjusted models, serum 25OHD was positively associated with BMD at the hip (p=0.01) and spine (p=0.001). Serum PTH was moderately and inversely associated with BMD at the hip (p=0.04) but not at the spine (p=0.77).Conclusion We conclude that serum 25OHD is associated with bone health in older, community-dwelling men.     

济南市城区健康老年男性骨密度分析

目的 探讨济南城区健康老年男性骨密度的变化规律,为防治男性骨质疏松提供依据。方法 于2010年,随机抽取本院所管辖的3个社区,再随机抽取963名健康成年男性作为研究对象,年龄40～90岁,平均年龄（61.3 ± 13.6）岁。采用双能X线骨密度测量仪（GE Lunar DPX-NT, USA）检测腰椎1至4联合值、股骨颈、全股骨、挠骨远端和挠尺骨全部的骨密度。 结果 (1) 40岁以后腰椎、股骨及前臂骨密度缓慢下降,70至74岁,股骨颈及挠骨远端骨密度明显降低,与65至69岁比较,差异有显著性 (P< 0.05)。(2) 股骨颈、股骨全部、挠骨远端、挠尺骨全部骨密度累积丢失率为18.71%、14.80%、20.95%、25.68%。(3) 70至79岁骨质疏松和骨量减少的发生率为29.1%和45.3%,80至90岁为50.0%和32.4%。结论 男性在70至74岁骨丢失加速,70岁以后骨质疏松发生率明显上升。