骨密度与股骨颈抗骨折能力对骨质疏松诊断价值的比较研究

目的 探索骨密度及股骨颈抗骨折能力两种骨质疏松的诊断方法在临床上应用中各自的特点。方法 用双能X线骨密度仪(DEXA)及神经-肌肉-关节-骨骼综合测量分析系统(MES)分别对118例绝经后妇女进行测量，比较两者的结果，探讨两者的差异的原因。结果 118例绝经后妇女中被DEXA诊断为骨质疏松者48人，患病率为40．67％。有24例被MES诊断为骨质疏松，患病率为20．34％。结论 研究提示DXEA测定骨密度(BMD)的方法更容易发现在正常体重者中的骨质疏松患者，而MES测定股骨颈抗骨折能力指标(FS)的方法在超体重和肥胖者中的骨质疏松诊断中占有优势。FS和BMD结合应用于骨质疏松诊断克服了骨密度(BMD)由于体重影响造成的漏诊和误诊现象。即在正常体重的患者进行诊断时选择BMD，而对于超体重和肥胖者使用FS指标则更为合理。     

绝经后骨质疏松症患者骨密度及骨代谢参数的调查研究

目的 了解E2和IL－6在骨质疏松症发病中的作用。方法 选择绝经后妇女120例，绝经后有骨质疏松60例（OP组），绝经后无骨质疏松60例（NOP组），另外选择绝经前妇女60例为对照组。对180名妇女雌二醇（E2）、骨密度（BMD）、白细胞介素－6（IL－6）、血清总碱性磷酸酶（ALP）、骨钙素（BGP）、尿羟脯氨酸肌酐比值（尿Hoc/Cr)、尿钙肌酐比值（尿Ca/Cr)等指标进行了测定。结果 绝经后妇女骨形成指标BGP及ALT明显高于对照组妇女，其中ALP在OP组和NOP组间有差异，而BGP在OP组和NOP组间无差异；绝经后妇女骨吸收指标尿HOP／Cr及尿Ca/Cr明显高于对照组妇女，OP组尿HOP／Cr及尿Ca/Cr又明显高于NOP组；绝经后妇女的血清E2的含量明显低于对照组（绝经前妇女），OP组又明显低于NOP组；绝经后妇女血清IL－6的含量明显高于对照组妇女，而OP组又明显高于NOP组。结论 本研究证明E2、IL－6与骨质疏松关系密切，雌激素水平的下降，IL－6分泌增多，是导致骨吸收加速的重要原因之一。     

Changes in bone mineral density in transient osteoporosis of the hip

Transient osteoporosis of the hip is a disorder characterised by pain, and associated with temporary osteopaenia. Although osteopaenia is the essence of the condition, data do not exist about the local bone density of the femoral neck if no medication is administered. We describe three patients who were treated with limitation of weight-bearing only. Repeated bone mineral density measurements were obtained, and that at the femoral neck was lowest two months after the onset of the condition. The mean reduction in bone mineral density when compared with an age-matched control group was 13% (3% to 24%). Spontaneous recovery was observed in all patients.     

骨质疏松患者下颌骨随访的初步研究

目的初步研究下颌体、下颌支做为骨密度随访指标的临床意义。方法采用美国Norland XR-800双能X线骨密度仪,通过重复四次测定30例正常志愿者下颌骨骨密度,计算下颌体、下颌支重复性试验精确度变异系数百分比;通过测定30例正常志愿者及45例骨质疏松或骨量减少患者左股骨近端、正位腰椎、下颌骨骨密度,观察其骨密度的差异;通过测定20例用药患者6个月内左股骨近端、正位腰椎、下颌骨骨密度,随访观察股骨颈、Ward区、L2-4、下颌体、下颌支骨密度(BMD)随时间的变化规律及临床特点。结果 130例正常志愿者下颌体的重复性为2.08%,下颌支的重复性为2.75%,略高于Ward区的重复性变异系数2.27%。245例骨质疏松或骨量减少患者下颌体、下颌支BMD显著降低,与正常志愿者相比,差异有统计学意义(P0.05)。320例随访用药患者下颌骨BMD变化先于其它部位出现,下颌支BMD四周即可发生变化,早于下颌体。结论下颌骨骨密度变化敏感性高,非常适合做为骨质疏松患者的临床随访指标,优于其他部位的骨密度测量。     

Comparative effects of teriparatide and ibandronate on spine bone mineral density (BMD) and microarchitecture (TBS) in postmenopausal women with osteoporosis: a 2-year open-label study

Summary

Treatment effects over 2 years of teriparatide vs. ibandronate in postmenopausal women with osteoporosis were compared using lumbar spine bone mineral density (BMD) and trabecular bone score (TBS). Teriparatide induced larger increases in BMD and TBS compared to ibandronate, suggesting a more pronounced effect on bone microarchitecture of the bone anabolic drug.

Introduction

The trabecular bone score (TBS) is an index of bone microarchitecture, independent of bone mineral density (BMD), calculated from anteroposterior spine dual X-ray absorptiometry (DXA) scans. The potential role of TBS for monitoring treatment response with bone-active substances is not established. The aim of this study was to compare the effects of recombinant human 1–34 parathyroid hormone (teriparatide) and the bisphosphonate ibandronate (IBN), on lumbar spine (LS) BMD and TBS in postmenopausal women with osteoporosis.

Methods

Two patient groups with matched age, body mass index (BMI), and baseline LS BMD, treated with either daily subcutaneous teriparatide (N?=?65) or quarterly intravenous IBN (N?=?122) during 2 years and with available LS BMD measurements at baseline and 2 years after treatment initiation were compared.

Results

Baseline characteristics (overall mean ± SD) were similar between groups in terms of age 67.9?±?7.4 years, body mass index 23.8?±?3.8 kg/m², BMD L1–L4 0.741?±?0.100 g/cm², and TBS 1.208?±?0.100. Over 24 months, teriparatide induced a significantly larger increase in LS BMD and TBS than IBN (+7.6 %?±?6.3 vs. +2.9 %?±?3.3 and +4.3 %?±?6.6 vs. +0.3 %?±?4.1, respectively; P?<?0.0001 for both). LS BMD and TBS were only weakly correlated at baseline (r ²?=?0.04) with no correlation between the changes in BMD and TBS over 24 months.

Conclusions

In postmenopausal women with osteoporosis, a 2-year treatment with teriparatide led to a significantly larger increase in LS BMD and TBS than IBN, suggesting that teriparatide had more pronounced effects on bone microarchitecture than IBN.     

确定骨密度检测首次检查年龄与复查时间的研究

目的 研究上海及周边地区骨密度检测首次检查年龄与复查时间.方法 2008年12月至2009年4月对上海及其周边地区1871例用双能X线吸收法检查者数据,并分成健康组A组与对照组B组进行分析.结果 两组腰椎曲线均低于左髋部曲线.男性30～39岁,女性40～49岁达到骨峰值.A组的检查者当腰椎T值的均值低于峰值1个标准差的时候男性是在40岁前后,女性在47岁前后.骨密度数据从"正常范围"转入"低骨量".骨密度检查价格相对便宜,辐射小,最小有意义变化值在BMD变化5%左右.结论 健康男性初查在40岁前后,40～54岁时5年检查1次,55～64岁3年检查1次,女性初查在47岁前后,47～54岁1年半检查1次,55岁～74岁3年检查1次.对照组按照临床要求决定复查时间.     

Timing of low bone mineral density and predictors of bone mineral density trajectory in children on long-term warfarin: a longitudinal study

Summary

We studied bone mineral density (BMD) of children exposed to long-term warfarin. BMD Z-scores?≤??2.0 were estimated to occur in less than one fifth of the patients after 10 years of warfarin exposure, and BMI and growth hormone deficiency predicted BMD changes over time. These predictors can help identify high-risk patients.

Introduction

Children with chronic diseases are at increased risk of developing thrombosis, which may require long-term warfarin therapy. Warfarin could further jeopardize the bone health of a population already at risk for bone fragility. Our objective was to investigate the occurrence and timing of low bone mineral density (BMD) and the predictors that influence BMD trajectory in children receiving warfarin for >1 year.

Methods

We analyzed the results of an institutional protocol that includes dual-energy X-ray absorptiometry, with or without spinal X-rays and laboratory biomarkers, as required.

Results

Low BMD (age, sex, race, and height-for-age-Z-score adjusted BMD Z-score?≤??2.0) was detected in 13 % (9/70) of the patients at some point during their follow-up; these patients were more likely to have complex underlying medical conditions and low body mass index (BMI) percentile. BMD Z-scores remained within normal range in 87 % of children. Survival analysis showed that the estimated 10-year abnormal BMD-free rate for the entire group was 81 % (95 % confidence interval [CI] 69 to 93 %). Trajectory analysis revealed that BMI percentiles at baseline and growth hormone deficiency (GHD) were associated with lower BMD Z-scores at the first assessment, whereas baseline BMI percentile was the only predictor of BMD Z-score over time.

Conclusions

Our findings identified BMI and GHD as risk factors influencing BMD in children exposed to long-term warfarin, creating an opportunity for early detection and intervention in these patients.

     

影响绝经后女性糖尿病患者骨密度的相关因素研究

目的　探讨影响绝经后女性糖尿病骨密度的相关因素 ,防止骨质疏松的发生发展。方法　按WHO标准选取 80例绝经后女性糖尿病患者 ,按年龄分 40～ 49岁 ,50～ 59岁 ,60～ 69岁 ,≥ 70岁 4个组 ,另外选取同龄健康绝经后女性 60名 ,按上述标准分组作对照。应用双能X线骨密度仪检测受试者右前臂桡骨远端 1 /3点处和第 2～ 4腰椎骨密度 (BMD)。采用放射免疫方法测定雌二醇(E2 )、睾酮 (T)、黄体生成素 (LH)、卵泡刺激素 (FSH)、游离甲状腺激素 (FT3、FT4 ) ,并同时检测空腹血糖(FPG)和糖基化血红蛋白 (HbA1c)、血钙、血磷和碱性磷酸酶 (ALP) ,然后进行统计学处理。结果　①绝经后女性E2 、T随年龄增加而降低 ,LH和FSH升高。糖尿病患者的这种变化更为明显。②绝经后女性糖尿病患者甲状腺功能 (T3,T4 )随年龄增加而减低 ,与BMD(L2 4 )呈正相关 (r=0 550 ,r=0 41 6 ,P<0 0 1 )。③绝经后女性糖尿病患者L2 4 骨密度与血糖水平和糖基化血红蛋白浓度呈负相关 ,(r =-0 467,r=- 0 40 2 ,P <0 0 1 )。结论　绝经后的女性糖尿病患者骨密度降低与年龄、性激素水平、甲状腺功能 ,尤其是血糖控制的程度密切相关     

健康中青年男性体检者骨密度现状研究

目的 研究上海及周边地区健康中青年男性骨密度现状.方法 2007年4月至8月对上海及周边地区来我院健康体检的304名中青年男性进行双能x线骨密度仪检测,对其结果尤其是中青年的骨密度测定结果进行分析研究.结果 体检健康男性腰椎骨密度峰值出现在60～69岁(0.992±0.121 g/cm2),其余各部分骨密度峰值均出现在20～29岁[总髋骨(0.979±0.149)g/cm2、股骨颈(0.890±0.172)g/cm2、大转子(0.712±0.123)g/cm2、Ward氏区(0.742±0.159)g/cm2];参照世界卫生组织的骨质疏松诊断标准,该研究发现30～39岁骨质疏松患病率为11.27%,40～49岁为7.34%,50～59岁为17.65%.参照最新文献报道的三组(上海、长沙、香港)国内男性骨密度峰值分别得出的骨质疏松和骨量减少比例仍然较高,即使在骨量减少最少的一组数据(上海)中,其所占比例也分别高达26.67%(20～29岁),21.13%(30～39岁),22.02%(40～49岁)和25.88%(50～59岁).结论 本研究对象为上海及周边地区男性公司职员或私营企业主,其各年龄段骨质疏松患病率均高于国内其他各地的报道,而且30～39岁和40～49岁年龄组都有半数骨密度不正常.吸烟、饮酒、疲劳熬夜等不良生活习惯对现代中青年人骨密度的严重影响不容忽视.     

Reduction of bone mineral density in rheumatoid arthritis: A longitudinal study

In the last decade, more accurate quantitative methods to assess bone mass in vivo have become available. We have applied these techniques to assess periodic changes of bone loss in rheumatoid arthritis (RA) patients. In this longitudinal study, 132 female RA patients were divided into two groups. The first group of 90 patients were postmenopausal, with a mean age of 60.2 years (PM group), whereas the second group of 42 patients were premenopausal, with a mean age of 42.7 years (M group). The clinical courses of these patients were followed for an average of 3 years. Bone mineral density (BMD) in the lumbar spine (L2–L4), and the femoral neck were measured by dual-energy X-ray absorptiometry (DXA), and second metacarpal bone mineral density was measured by using densitometric techniques periodically. Reduction of BMD in the lumbar spine was significant in both groups (P<0.01–0.05), but there was no statistical difference between the two groups. The BMD of the femoral neck had a tendency to decrease but this was not significant. The predictors for periodic bone loss in the PM group were aging and nutritional factors, whereas for the M group they were indices of rheumatoid arthritis disease activity.     

骨质疏松患者腰椎、髋部骨密度对比性研究

目的探讨骨质疏松患者在应用双能X线骨密度检测仪检测不同部位骨密度时应检测的部位。方法选取2013年1 月至2013年4月在我院行双能X线骨密度检测、符合骨质疏松诊断的患者共310例,比较腰椎、右髋、左髋骨密度低于M~2SD 的百分率差异和左右髋部的骨密度（BMD)值。结果腰椎骨密度检测结果低于M~2SD有223例,占71. 93%,左髋骨密度检 测结果低于M~2SD有190例,占61. 29%,右髋骨密度检测结果低于M~2SD有204例,占65. 08%,左髋、右髋骨密度（BMD)比 较F =0. 313,P =0. 576,两组无差异。结论双能X线吸收测定法是骨密度检查的“金标准”,技术员应检测腰椎、左髋及右 髋三个部位,检测报告三个部位的骨密度均值,并以三个部位中的最低T值作为诊断依据。尽可能避免骨质疏松的漏诊。     

118例甲亢患者骨密度及骨代谢指标的研究

目的：为探讨甲亢患者骨密度与骨代谢指标的改变。方法：本文测定了１１８例甲亢患者腰椎（Ｌ２～４）及股骨上端（Ｎｅｃｋ、Ｗａｒｄ三角、Ｔｒｏｃｈ）骨密度、血清骨钙素（ＢＧＰ）、甲状旁腺素中间片段（ＰＴＨ－ｍ）及尿脱氧吡啶啉（Ｄｐｄ）。结果：甲亢患者骨密度低于正常对照组，ｔ检验具显著差异（ｐ＜０．０１）、血清ＢＧＰ及Ｄｐｄ高于正常对照组，ｔ检验具显著差异（ｐ＜０．０１），与骨密度呈负相关ｒ＝－０．２１３５、－０．２０５０（ｐ＜０．０５）；而ＰＴＨ－ｍ低于正常对照组，与骨密度无相关性ｒ＝０．０８３０（ｐ＞０．０５）。结论：甲亢为高转换型骨质疏松，ＢＧＰ、Ｄｐｄ可作为骨形成及骨吸收的敏感指标     

Peptide YY (PYY) levels and bone mineral density (BMD) in women with anorexia nervosa

INTRODUCTION: Anorexia nervosa (AN) is a psychiatric illness that results in significant bone loss. Studies examining the neuroendocrine dysregulation that occurs in AN may increase understanding of endocrine systems that regulate bone mass. Peptide YY (PYY) is an anorexigenic peptide derived primarily from the intestine, with actions mediated via activation of Y receptors. We have previously shown that PYY levels are elevated in adolescents with AN. Y2 receptor knockout mice have increased bone mineral density (BMD) and thus PYY may play a role in regulating bone mass. We hypothesized that PYY levels would be inversely associated with BMD in women with AN. METHODS: This was a cross-sectional study performed in a General Clinical Research Center of 12 adult women with AN, (mean+/-SEM) mean age 30.9+/-1.8 years, BMI 17.1+/-0.4 kg/m2, and % ideal body weight 77.5+/-1.7%. PYY concentrations were measured hourly from 20:00 h to 08:00 h. BMD was measured using dual X-ray absorptiometry (DXA). RESULTS: In women with AN, mean overnight PYY levels strongly inversely correlated with BMD at the PA spine (r=-0.77, p=0.003), lateral spine (r=-0.82, p=0.002), total hip (r=-0.75, p=0.005), femoral neck (r=-0.72, p=0.009), total radius (r=-0.72, p=0.009) and 1/3 distal radius (r=-0.81, p=0.002). Body mass index was inversely correlated with PYY level (r=-0.64, p=0.03). Multivariate stepwise regression analysis was performed to determine the contribution of age, duration of AN, BMI, fat-free mass, and PYY to BMD. For PA and lateral spine, PYY was the primary determinant of BMD, accounting for 59% and 67% of the variability, respectively. Fat-free mass and duration of anorexia nervosa were the primary determinants of BMD at other skeletal sites. CONCLUSIONS: In women with anorexia nervosa, an elevated PYY level is strongly associated with diminished BMD, particularly at the spine. Therefore further investigation of the hypothesis that PYY may contribute to the prevalent bone pathology in this disorder is merited.     

原发性骨质疏松症患者骨密度和骨代谢指标的对比研究

目的探讨骨密度（BMD）和骨代谢指标在原发性骨质疏松症的诊治过程中的临床意义.方法采用XR-36型双能X线骨密度仪和放射免疫方法,对252例中老年志愿者不同部位的BMD及血清骨钙素（BGP）、Ⅰ型前胶原氨基端前肽、Ⅰ型胶原交联羧基末端肽的含量进行测定.结果①无论是对照组还是骨质疏松组（OP）,老年男性BMD均明显高于老年女性BMD,其差异具有非常显著性（P＜0.01）;②OP组的BGP值明显低于对照组,其差异具有显著性（P＜0.05）;OP组的血清Ⅰ型前胶原氨基端前肽（PINP）值均明显低于对照组,而血清Ⅰ型胶原交联羧基末端肽（ICTP）值均明显高于对照组,其差异具有显著性（P＜0.05）.结论联合检测BGP、HNP和ICTP水平可直接反映骨胶原合成和降解状态,对于判断老年OP的进程以及指导OP的用药有着重要的意义.     

保定地区2020例健康体检骨密度分析

目的:骨质疏松(osteoporosis,OP)是常见病、多发病,其对机体的危害正逐渐被人们认识和关注.该研究对保定地区20-60岁在职人员进行的骨密度检测,以了解在职人员的不同年龄人群骨密度的变化,分析该地区在职人员不同年龄骨密度变化情况.方法:采用X线放射吸收法对2020例各年龄段男女非常用手2、3、4指的中节指骨检测骨密度.结论:OP不仅常见于老年人,在各个年龄阶段均可发病.科学合理的工作和生活可以促进改善人体骨骼系统的代谢和功能,增加骨密度.     

护骨素与女性年龄和骨密度的关系

目的 探讨血清护骨素(Osteoprotegrin,OPG)与女性年龄和骨密度(BMD)之间的关系.方法 用ELISA测定672名20～80岁女性志愿者的OPG,用DXA测定腰椎正位总体和股骨颈的BMD.根据年龄段、是否绝经分组.结果 ①OPG在30～39岁年龄段最低(2.80±1.37)pmol/L,与40～69岁的各组比较有统计学意义(P均＜0.05).②40～59岁人群中,绝经后组的OPG(5.70±3.14)pmol/L比绝经前组(3.45±2.01)pmol/L高(P均=0.000).③年龄与OPG和腰椎及股骨颈的BMD相关(r值分别为0.130,P均＜0.01);OPG与腰椎和股骨颈的BMD呈负相关(r=-0.183和-0.108,P＜0.01).结论 sOPG能较敏感地反映妇女随年龄及绝经变化的骨转换状况;且生化指标的变化先于骨密度的变化,可辅助用于预测骨丢失.     

血清Chemerin水平与骨质疏松症患者骨密度的相关性研究

目的评估骨质疏松症患者和健康对照者血清chemerin水平,探讨血清chemerin水平与骨密度(bone mineral density,BMD)的关系。方法选取2017年1月至2018年2月在西宁市第二人民医院门诊就医的200名参与者,进行年龄和性别匹配的病例对照研究。Pearson相关性检验用于调查血清chemerin水平与BMD之间的关系。结果分为骨质疏松组100例,对照组100例。骨质疏松组患者血清chemerin水平[(87. 65±5. 57) ng/m L]显著高于对照组[(70. 09±5. 16) ng/m L],差异有统计学意义(P0. 01)。两组股骨骨密度与chemerin呈负相关(骨质疏松组:r=-0. 394,P0. 01;对照组:r=-0. 679,P0. 01);两组腰椎骨密度与chemerin也呈负相关(骨质疏松组:r=-0. 305,P0. 01;对照组r=-0. 361,P0. 01)。结论骨质疏松症患者血清chemerin水平升高,与BMD呈负相关。需进一步研究chemerin在骨质疏松症病理生理中的作用。