护骨素基因T245G多态性与老年人骨密度关系的部位及性别差异

背景:作为骨折发生的重要临床预测因子,骨密度在一定程度上由遗传因素决定.护骨素基因是骨质疏松症发病中的重要候选基因.目的:探讨护骨素基因T245G多态性与骨密度的相关性.方法:选取2008-09/2010-04在北京大学人民医院进行常规查体的老年人281名,其中男182名,女99名.应用PCR-RFLP结合DNA测序检测护骨素基因T245G多态性,使用双能X射线骨密度测量仪测定受试者腰椎、髋部标准位置及前臂的骨密度.同时收集受试者的生化指标及临床观察项目.应用ANOVA方法分析护骨素基因T245G多态性与各检测指标的关系.结果与结论:在老年男性及绝经后女性中,T245G基因T,G等位基因频率分布差异无显著性意义(P > 0.05).在老年男性中,GG和TG基因型具有较高的腰椎骨密度,而TT基因型的腰椎骨密度较低(P < 0.05),Ward's三角区及前臂骨密度在各基因型间差异无显著性意义(P > 0.05).在绝经后女性中,T245G多态性与骨密度无关,说明护骨素基因与老年男性腰椎骨密度有关.     

重组人甲状旁腺激素（1-34）治疗原发性骨质疏松症的疗效评价

目的观察重组人甲状旁腺激素（1-34）[rhPTH（1-34）]治疗骨质疏松症患者骨密度的疗效和安全性。方法采用自身前后对照临床研究,纳入2008年3-5月就诊的原发性骨质疏松症患者共39例,予rhPTH（1-34）20μg1次/d皮下注射,疗程18个月。治疗期间均同时口服钙制剂600mg/d及维生素D3125U/d作为基础治疗。患者治疗前采用双能X线检测腰2～4椎体（L2～4）和股骨颈骨密度（BMD）、肝肾功能、血钙、血磷,治疗后6、12、18个月复查BMD和上述生化指标改变,记录患者不良事件,对患者治疗前后L2～4、股骨颈BMD变化进行对比分析。结果 35例患者完成全疗程治疗,其中男2例,女33例;平均年龄65岁,平均病程6.5年;治疗6、12、18个月时L2～4BMD均较治疗前明显提高（P〈0.01）,而股骨颈BMD在治疗6、12个月时改善不明显（P〉0.05）,18个月时表现出较治疗前明显增加（P〈0.01）;腰椎平均BMD增长率为12.27%,股骨颈BMD增长率为4.11%;治疗期间不良反应少,均不需特殊处理而自行好转。结论 rhPTH（1-34）治疗原发性骨质疏松症安全有效,对改善椎体BMD疗效迅速明显,对改善股骨颈BMD起效慢;适用于绝经后骨质疏松和老年性骨质疏松症患者。     

Reproductive factors affecting the bone mineral density in postmenopausal women

Osteoporosis has been defined as a metabolic bone disease characterized by a loss of bone mineral density (BMD) greater than 2.5 standard deviations below young adult peak bone mass or the presence of fracture. By considering that some factors related to female reproductive system might influence the ultimate risk of osteoporosis, we aimed to investigate if a relationship exists between the present BMD of postmenopausal women with their past and present reproductive characteristics. The present study focused on how BMD could be affected by the following factors in postmenopausal women, such as age at menarche, age at first pregnancy, the number of pregnancies and total breast-feeding time. We reviewed detailed demographic history of 303 postmenopausal women. According to the results of the present study, a negative correlation was found between the number of parities and BMD. The BMD values decreased as the number of pregnancies increased. When the BMD values for lumbar vertebrae 2 and Ward's triangle were investigated, it was observed that a significant difference exists between the women with no child birth and those with more than five parities. There was a significant relationship between age at first pregnancy and BMD values at the lumbar vertebrae 2 and Ward's triangle. Women who had five or more abortions were found to have significantly lower spine BMD values compared to women who had no abortions or women who had one or two abortions. These findings indicate that the increased risk of osteoporosis is associated with the increased number of pregnancies and abortions and higher age at first pregnancy.     

Relationship of extremity muscle torque and bone mineral density in postmenopausal women

The purpose of this study was to examine the correlations between the torque of four extremity muscle groups and the bone mineral density (BMD) of the lumbar spine and hip in postmenopausal women. Fifty-six postmenopausal women (means age = 55.4 years, s = 7.1; means height = 162.6 cm, s = 6.4; means weight = 65.9 kg, s = 9.3) served as subjects. Bone mineral density was measured from the L2-L4 vertebral bodies, greater trochanter, femoral neck, and Ward's triangle using dual-photon absorptiometry. Hip abduction, knee extension, hip flexion, and grip force were assessed using the Spark Muscle Examination and Exercise Dosimeter (MEED) 3000 system. The Pearson product-moment correlations between muscle torque and BMD ranged from .07 to .42. The significant (p less than .05) correlations between torque and BMD (r = .27-.42) occurred in functionally and anatomically related areas. Results of this study demonstrate a statistically significant relationship between torque and BMD in anatomically related areas in postmenopausal women. This relationship, however, is not sufficiently strong to allow for prediction of BMD from the four muscle groups tested in this study. The relationship does suggest that strength may be a factor in the determination of BMD. Maintenance of strength in those muscle groups with anatomical or functional relationships to the hip and lumbar spine may play a role in the prevention and cessation of the osteoporotic changes that occur.     

护骨素基因T245G多态性与老年人骨密度关系的部位及性别差异水

背景：作为骨折发生的重要临床预测因子,骨密度在一定程度上由遗传因素决定。护骨素綦凶是骨质疏松症发病中的晕要候选摹闲。目的：探讨护骨索基因T245G多念性与骨密度的相关性。方法：选取2008-09／2010-04往北京大学人民医院进行常规查体的老年人281名,其中男182名,女99名。应用PCR-RFLP结合DNA测序榆测护骨素基因T245G多态件,使用-烈能X射线骨密度测量仪测定受试者腰椎、髋部标准位置及前臂的。旨密度。同时收集受试者的生化指标及临床观察项目。应用ANOVA方法分析护骨素基因T245G多态性与各检测指标的关系。结果与结论：在老年男性及绝经后女性中,T245G基因T,G等化基凶频率分布差异无显苫性意义（P〉0.05）。在老年男性中,GG和TG基凶型具仃较高的腰椎骨密度,而TT基吲型的腰椎骨密度较低（P〈0.05）,Ward＇S三角区及前臂骨密度在各基因型问差异无显著件意义（P〉0.05）。北绝经后女性中,T245G多念性与骨密度无关,说明护骨索基凶与老年男性腰椎骨密度仃关。     

北京地区汉族妇女绝经前后护骨素基因多态性与骨密度的关系

背景:原发性骨质疏松症是多基因遗传性疾病,但是调节骨量的基因需进一步研究。目的:探讨护骨素基因启动子区基因多态性与中国北京地区绝经前后妇女骨密度之间的关系。设计:前瞻性调查研究。单位:北京协和医院。对象:选择2002-07在北京协和医院健康体检的495名北京地区无亲缘关系的汉族妇女,其中绝经前妇女为306名,年龄20～39岁,绝经后妇女(指自然停经1年以上者)为189名,年龄50～84岁。所有受试对象均对检测项目知情同意。方法:①骨密度测量:应用双能X线骨密度测量方法,观察对象均采取仰卧位,采用骨密度仪测量其后前位第1～4腰椎及股骨近端,包括股骨颈、Ward’s三角和大转子部位的骨密度值。②基因分型:提取两组受试对象外周血DNA,初步确定护骨素基因分型。并取部分PCR产物送上海博亚有限公司测序,验证基因型,观察两组受试对象护骨素基因型的分布频率及其与骨密度的关系,并用Logistic回归作病因学进一步分析观察绝经后妇女护骨素基因多态性与骨质疏松的关系。主要观察指标:①两组受试对象护骨素基因型的分布频率,及其与骨密度的关系。②绝经后妇女护骨素基因多态性与骨质疏松的关系。结果:纳入受试对象495名,全部进入结果分析。①两组受试对象OPG基因型和等位基因分布频率无明显差异,两组总体基因型分布频率依次为163A→G位点,AA型为70.1%,AG型为26.9%,GG型为3.0%;245T→G位点TT型为71.3%,TG型为25.9%,GG型为2.8%。绝经前妇女在163A→G位点,AA组在L2-4、股骨颈、Ward’s三角和大转子的骨密度低于GG AG组,在245T→G位点,TT组与GG TG组相比各部位的骨密度也低,但均无统计学差异(P>0.05)。绝经后妇女163位点AG GG组在L2-4、股骨颈、Ward’s三角和大转子的骨密度均显著低于AA组(P<0.05);245位点TG GG组在股骨颈、Ward’s三角和大转子的骨密度显著低于TT组(P<0.05)。②绝经后妇女163位点AG GG组在L2-4、Ward’s三角是骨质疏松的危险因素(OR=2.045,2.956,P<0.05,95%可信限1.05-6.7),245位点TG GG组在L2-4、Ward’s三角、大转子是骨质疏松的危险因素(OR=2.059,2.859,2.123,P<0.05,95%可信限1.04-6.5)。结论:北京地区绝经后妇女护骨素基因启动子区的163和245位点为变异型G等位基因时,股骨颈、Ward’s三角和大转子的骨密度较低,变异型G等位基因与绝经后妇女骨密度降低相关。     

渐进抗阻训练结合阿仑膦酸钠提高绝经后骨质疏松症患者腰椎骨密度的初步研究

目的观察渐进抗阻训练结合阿仑膦酸钠疗法对提高绝经后骨质疏松症患者腰椎骨密度的效果。方法20例绝经后骨质疏松症患者随机分为A、B两组,各10例,A组接受渐进抗阻训练结合阿仑膦酸钠治疗,B组仅接受阿仑膦酸钠治疗,疗程均为3个月。治疗前后用双能X线吸收仪分别测量腰椎骨密度。结果治疗前,两组患者的骨密度差异无显著性意义;治疗3个月后,A组患者的腰椎骨密度提高(4.520±0.68)%,B组提高(0.100±0.01)%,两组间的差异有非常显著性意义(P<0.01)。结论渐进抗阻训练结合阿仑膦酸钠疗法可提高绝经后骨质疏松症患者腰椎的骨密度,效果明显优于单纯服用阿仑膦酸钠。     

Double photon absorptiometry in renal osteodystrophy

Bone mineral content (BMC) of the lumbar spine (L2-L4), femoral neck, Ward's triangle and the trochanteric region was measured in 52 consecutive patients on maintenance haemodialysis. In the whole group the median BMC value as percentage of sex- and age-matched normal means was significantly decreased only in Ward's triangle (91.7%; p less than 0.02). In patients with chronic interstitial nephritis there was a significant decrease in bone density in Ward's triangle and the trochanteric region (p less than 0.02). There was no correlation between BMC and time on dialysis or intact parathormone. BMC value did not predict the type of renal osteodystrophy, according to Delling. 17 patients underwent a second investigation after one year. There was a slight fall in mean BMC of the lumbar spine (-0.9%) and Ward's triangle (-1.1%). The fall in mean BMC of the trochanteric region was pronounced (-3.2%). We believe that the observed low demineralisation, which was more pronounced in patients with interstitial nephritis, may be attributable to early and carefully monitored therapy with vitamin D metabolites.     

Relationship between trunk muscle torque and bone mineral content of the lumbar spine and hip in healthy postmenopausal women

The purpose of the study was to determine the relationship between trunk muscle strength and bone mineral density (BMD). Fifty-six postmenopausal women, aged 38 to 73 years, were examined. The BMD of lumbar vertebrae L2-4, the femoral neck, the Ward's triangle, and the greater trochanter was measured with dual-photon absorptiometry. Isometric and isokinetic torque and work measurements obtained on a trunk testing unit were used to assess trunk flexor and extensor strength. Correlation analysis demonstrated a statistically significant relationship between most trunk torque and work measurements and BMD. The trunk extensors generally provided higher correlations with BMD than did the trunk flexors, and the isokinetic extension torque values demonstrated higher correlations than the isometric extension values in every case. Linear backward-regression models, based on the subjects' weight and trunk flexor and extensor torque and work measurements, demonstrated multiple-correlation coefficients of .67, .58, .43, and .65 in predicting the BMD of the L2-4 region, femoral neck, Ward's triangle, and greater trochanter region, respectively. Estrogen therapy status did not affect the linear regression models. These data suggest a positive relationship in postmenopausal women between flexor and extensor torque values and BMD at the lower lumbar spine and proximal femur.     

Parathyroid hormone treatment can reverse corticosteroid-induced osteoporosis. Results of a randomized controlled clinical trial.

Corticosteroid-induced osteoporosis is the most common secondary cause of osteoporosis. We conducted a 12-mo, randomized clinical trial of human parathyroid hormone 1-34 (hPTH 1-34) in postmenopausal women (mean age was 63 yr) with osteoporosis who were taking corticosteroids and hormone replacement therapy. Response to the treatment was assessed with bone mineral density (BMD) measurements of the lumbar spine by quantitative computed tomography (QCT); BMD measurements of the lumbar spine, hip, and forearm by dual-energy x-ray absorptiometry (DXA); and biochemical markers of bone turnover. The mean (+/-SE) changes in BMD of the lumbar spine by QCT and DXA in the PTH group were 35+/-5.5% and 11+/-1.4%, respectively, compared with a relatively small change of 1.7+/-1.8% and 0+/-0.9% in the estrogen-only group. The differences in mean percentage between the groups at 1 yr were 33.5% for the lumbar spine by QCT (P < 0.001) and 9.8% for the lumbar spine by DXA (P < 0.001). The changes in the hip and forearm were not significantly different between or within the groups. During the first 3 mo of PTH treatment, markers of bone formation increased to nearly 150%, whereas markers of bone resorption increased only 100%, suggesting an early uncoupling of bone turnover in favor of formation. These results suggest that parathyroid hormone dramatically increases bone mass in the central skeleton of postmenopausal women with corticosteroid- induced osteoporosis who are taking hormone replacement.     

绝经后妇女骨质疏松危险因素的临床分析

目的：分析妇女绝经后骨质疏松的相关因素。方法：用双能X线骨密度仪测量78名绝经扫无骨折妇女（A组）、34例绝经后骨折妇女（B组）、20名围绝经期妇女（C组）和52名青年健康妇女（D组）的骨密度,并对临床资料作分析对比。结果：A、B两组各部位的骨密度值和骨质疏松发病率的均低于C、D两组（P＜0．05）,B组各部位的骨密度值（除第一腰椎外）均低于A组（P＜0．05）,C组的第一腰椎、第二腰椎、沃德三角（Ward triangle）和全身骨密度值显著低于D组（P＜0．05）,绝经后妇女的骨密度值与其年龄、绝经所限和孕、产次呈显著负相关（P＜0．01）,与体重和体重指数呈显著性正相关（P＜0．01）。结论：妇女在绝经后骨密度显著降低,年龄越大、绝经年限越长和孕、产次越多,其骨密度越低,而体重和体重指数越大,其骨密度越高。     

Once-monthly ibandronate for postmenopausal osteoporosis: review of a new dosing regimen

BACKGROUND: Ibandronate, a nitrogen-containing bisphosphonate, was approved by the US Food and Drug Administration (FDA) in May 2003 as a daily oral regimen for the treatment and prevention of post-menopausal osteoporosis. In March 2005, the FDA approved once-monthly dosing with ibandronate for the same indications. OBJECTIVE: The purpose of this article was to review the efficacy and tolerability of ibandronate 150 mg once monthly in the treatment and prevention of post-menopausal osteoporosis. METHODS: A search of MEDLINE (1966-September 2005) and International Pharmaceutical Abstracts (1971-September 2005) for articles relating to the efficacy and tolerability of once-monthly ibandronate in the treatment of postmenopausal osteoporosis was conducted using the terms ibandronate and ibandronic acid. Additional searches were conducted to identify publications relevant to compliance and pharmacoeconomic considerations using the terms bispbospbonate, compliance, cost, and pharmacoeconomics. The reference lists of identified articles and presentations from recent scientific meetings also were reviewed. Selected safety information from the manufacturer was incorporated. RESULTS: Ibandronate 2.5 mg/d and intermittent ibandronate (20 mg QOD for 12 doses every 3 months) have been shown to effectively reduce the incidence of vertebral fractures; after 3 years of therapy in a placebo-controlled clinical trial, the relative risk reductions for new vertebral fractures with daily and intermittent ibandronate were 62% and 50%, respectively (both, P<0.001 vs placebo). Once-monthly ibandronate has been evaluated in 2 clinical trials: a Phase I dose-ranging trial in 144 healthy postmenopausal women and a Phase III noninferiority trial in 1609 women with postmenopausal osteoporosis who were randomized to receive ibandronate 2.5 mg/d or 1 of 3 monthly ibandronate regimens: 50/50 mg (50 mg given on 2 consecutive days) once monthly; 100 mg once monthly; and 150 mg once monthly. The primary end point of the Phase III trial was the change from baseline in lumbar spine bone mineral density (BMD). After 1 year of therapy, patients who received ibandronate 150 mg once monthly had a significantly greater increase from baseline in lumbar spine BMD compared with those who received ibandronate 2.5 mg/d (4.9% vs 3.9%, respectively; P=0.002). The overall adverse-event profile was similar between the daily and monthly regimens. Drug-related adverse events were reported in 32.4% of patients receiving ibandronate 2.5 mg/d and 36.9% of patients receiving ibandronate 150 mg monthly. Upper gastrointestinal adverse events occurred in a respective 22.8% and 22.5% of the 2 groups. After 1 year of therapy, patients receiving ibandronate 150 mg monthly reported more flulike symptoms (8.3%) compared with those receiving ibandronate 2.5 mg/d (2.8%). In a crossover study comparing preference for and convenience of monthly ibandronate and weekly alendronate in 342 ambulatory women with postmenopausal osteoporosis, significantly more patients preferred the monthly ibandronate regimen to the weekly alendronate regimen (71.4% vs 28.5%, respectively; P<0.001). CONCLUSION: Once-monthly ibandronate is an effective and well-tolerated treatment option for postmenopausal osteoporosis.     

Effects of lumbar disc surgery on bone mineral density in women with lumbar disc disease

This prospective study evaluated 60 reproductive-age and postmenopausal women with lumbar disc disease to demonstrate the short-term effects of lumbar disc surgery on bone mineral density (BMD). Lumbar BMD was measured preoperatively and 3 months postoperatively by dual-energy X-ray absorptiometry (DEXA). Surgery was performed at only one level (L3-L4) and consisted of partial hemilaminectomy, discectomy, and, if necessary, partial facetectomy. Before surgery, 50% of the patients had osteopenia, and 31.7% had osteoporosis. After surgery, BMD decreased 5.5% in L3 vertebrae (P=.07), 14% in L4 vertebrae (P=.003), and 4.6% in L1-L4 (P=.039). Six of 11 patients with normal BMD before surgery became osteopenic postoperatively; 9 of 30 women with osteopenia fulfilled criteria for osteoporosis after surgery. Reproductive-age and postmenopausal women undergoing surgery for lumbar disc disease are at risk of bone loss and should be spared an extensive procedure, which can further increase the amount of bone lost. All women for whom a surgical intervention is planned should be evaluated by DEXA preoperatively and postoperatively.     

吸入糖皮质激素对女性哮喘患者骨密度和骨代谢的影响

背景吸入性糖皮质激素是治疗哮喘的一线药物.但长期吸入大剂量糖皮质激素是否有引起骨质丢失的危险尚不能排除,尤其对女性哮喘患者.目的了解国内女性哮喘患者长期吸入糖皮质激素是否会对骨密度和骨代谢产生影响.设计以患者为观察对象,配对比较分析.对象纳入40例女性哮喘患者为1998-02/2002-02在南京医科大学第一附属医院呼吸科门诊就诊者.均无长期全身使用激素史,且对实验目的知情同意.其中吸入糖皮质激素组(吸入组)20例每日坚持吸入激素≥5个月(年龄18～63岁,绝经5例),对照组20例(年龄18～60岁,绝经5例)采用常规平喘解痉药物治疗.对照组按年龄、性别和绝经情况与吸入组配对,平均人).方法采用双能X线骨密度仪测定患者L2-4椎体、股骨颈、股骨转子、股骨三角及股骨总量的骨密度,以绝对值和T评分(即与同性别成年人骨峰值相比的标准差)表示.同时与其同年龄、性别相应正常数据相比较,确定骨密度在这些部位的相对值.同时用放射免疫分析法等测定这些患者的血骨钙素以及碱性磷酸酶等指标,进行对比分析.主要观察指标①两组患者骨密度比较.②两组血骨钙素以及碱性磷酸酶等指标比较.③吸入组日均吸入激素剂量和吸入激素的累积量与骨密度的相关性.结果两组患者L2-4椎体、股骨颈、股骨转子、股骨三角及股骨总量的骨密度值及T评分差异不明显(P＞0.05).吸入组20例患者的上述5个部位骨密度值与其相应日均吸入糖皮质激素剂量之间无明显相关性(r=-0.325～-0.110 2,P＞0.05);L2-4椎体、股骨颈和股骨三角的骨密度值与吸入糖皮质激素累积量之间呈显著负相关(r=-0.495,-0.517,-0.531,P＜0.05).吸入组患者上述5个部位骨密度的T评分与其吸入糖皮质激素累积量无明显相关性(r=0.443～0.295,P＞0.05).吸入组股骨三角处的绝对骨密度值与其年龄呈显著负相关(r=-0.506,P＜0.05),而对照组5个部位绝对骨密度值与其年龄之间无明显相关性(r=-0.079～0.326,P＞0.05).两组血清骨钙素及其他生化指标差异不明显(P＞0.05).结论长期吸入糖皮质激素控制哮喘,对女性哮喘患者的骨密度和骨代谢一般不会产生明显影响,但长期吸入激素的女性哮喘患者随着吸入激素累积量的增加和或年龄的增长,引起骨质丢失的危险可能会增高.     

Normative data of bone mineral density in an unselected adult Austrian population

BACKGROUND: There is increasing evidence that correct interpretation of bone mineral density (BMD) measurements by dual energy X-ray absorptiometry (DEXA) requires a population-specific reference range. We therefore collected data on age-related BMD in a random sample of the normal adult Austrian population to establish an appropriate normative database. METHODS: We measured BMD by DEXA at five different skeletal sites in 1089 subjects, i.e. 654 females and 435 males, aged between 21-76 years, who had been recruited by 17 centres across Austria. RESULTS: Age-related bone loss was observed until age 65 years with significant changes at the lumbar spine (r = -0.23), total hip (r = -0.07), trochanter (r = -0.10), femoral neck (r = -0.30) and Ward's triangle (r = -0.40) in the women but only at the femoral neck (r = -0.23) and at Ward's triangle (r = -0.40) in the men. When we calculated T scores from the BMD data of the young normal adult study population and used the T score set points according to the WHO classification of osteopenia and osteoporosis, we found that, depending on the skeletal site measured, 7.6-27.4% of the women and 16-41% of the men in our study group had low bone mass, whereas 0.6-2.7% of the female and 0.2-1.0% of the male study population were osteoporotic. However, osteoporosis was indicated in 4-9-fold more females and 5-15-fold more males when we based our estimates on the normative data provided by the manufacturers of the DEXA systems. CONCLUSION: Our data underscore the importance of using a population-specific reference range for DEXA measurements to avoid overdiagnosis of osteoporosis.     

绝经后骨质疏松症患者强化护理的效果观察

目的探讨强化护理对绝经后骨质疏松症（PMO）患者骨密度和骨代谢的影响。方法55例PMO患者随机分为强化护理组（n=24）和对照组（n=21）。两组每天服用元素钙600mg，强化护理组并接受健康教育和户外运动指导。对照组由家人自由安排护理。结果干预1年后，强化护理组髋部骨密度明显增加，而对照组骨密度无明显改变，组间差异有统计学意义（P〈0．05）；强化护理组骨形成和骨吸收指标明显下降（P〈0．05），而对照组骨代谢指标无显著变化。结论强化护理可有效增加PMO患者髋部的骨密度，抑制骨代谢，有助于PMO的治疗。     

Effect of miglustat on bone disease in adults with type 1 Gaucher disease: a pooled analysis of three multinational, open-label studies

BACKGROUND: Bone manifestations are a source of disability among patients with Gaucher disease (GD) and a focus of disease management. The effect of enzyme replacement therapy (ERT) on GD bone disease can be limited and may take up to 8 years to become manifest. Miglustat, a glucosylceramide synthase inhibitor, may have a positive influence on GD bone disease. OBJECTIVES: The aim of this analysis was to evaluate the effects of miglustat on bone manifestations and bone mineral density (BMD) in patients with type 1 GD. METHODS: This was a pooled analysis of data collected prospectively over an observation period of 2 years from patients who participated in 3 multinational, open-label clinical trials evaluating the efficacy and tolerability of miglustat 100 mg TID (the currently approved therapeutic dose). Bone manifestations were assessed qualitatively and in relation to treatment and spleen status. The effects of miglustat on BMD were assessed by dual-energy x-ray absorptiometry at the lumbar spine and/or femoral neck. Bone response was defined as a positive change in BMD, based on the change in BMD Z-score from baseline to months 6, 12, and 24. Changes in BMD were also analyzed according to spleen status and baseline severity of osteopenia. RESULTS: The analysis involved 72 patients, including 41 (57%) who had received previous ERT and 20 (28%) who had undergone splenectomy. Patients' mean (SD) age was 41.2 (13.1) years. The most frequent bone-related manifestations at study entry were osteoporosis (43/63 [68%] patients) and bone pain (41/65 [63%] patients). At 2 years, 54/65 (83%) patients reported no bone pain. The reductions in bone pain were comparable among all subgroups, including high-risk patients (ie, splenectomized). No new cases of bone crisis, avascular necrosis, or pathologic fractures were reported. BMD Z-scores were improved from baseline at both the lumbar spine and femoral neck at each time point (months 6, 12, and 24) (P < 0.001). As early as 6 months after the initiation of miglustat monotherapy, significant increases from baseline in the BMD Z-score were observed at both the lumbar spine (mean, 0.15; P = 0.022) and femoral neck (0.23; P < 0.001); the increases remained significant at 12 months (0.19 [P = 0.012] and 0.21 [P = 0.017], respectively) and 24 months (0.21 [P = 0.015] and 0.18 [P = 0.039]). Significant increases in BMD Z-scores were observed at the femoral neck in splenectomized patients (P < 0.001) and at both sites in osteoporotic patients (lumbar spine: P < 0.001; femoral neck: P = 0.006). CONCLUSION: This pooled analysis of 3 open-label studies of miglustat 100 mg TID suggests that miglustat monotherapy may reduce the incidence of bone pain and improve BMD in patients with type 1 GD, including those with a history of splenectomy and/or osteoporosis.     

Quantitative bone ultrasound at phalanges and calcaneus in osteoporotic postmenopausal women: influence of age and measurement site

Phalangeal and calcaneal quantitative ultrasound (QUS) measurements were tested in a postmenopausal osteoporotic population of a wide age range to assess their ability to identify subjects with vertebral fractures in a population of postmenopausal women with osteoporosis. A group of 127 osteoporotic women aged from 50 to 85 y, who had been postmenopausal for at least 5 y, were enrolled. All subjects underwent phalangeal and calcaneal QUS measurements, femoral neck and lumbar spine dual energy X-ray absorptiometry (DXA) measurements and lateral thoracic and lumbar spine radiography. Osteoporosis was defined on the basis of femoral neck or lumbar spine bone mineral density (BMD) T-score lower than -2.5 SD or of the presence of one or more vertebral atraumatic fractures, independently of BMD values. Fifty-two women had one or more vertebral fractures, while the remaining 75 had no evidence of previous fracture. Both QUS techniques were able to discriminate between fractured and nonfractured subjects in the whole group (p < 0.05). When patients aged <70 y (n = 43) and patients aged > or = 70 y (n = 84) were considered separately, phalangeal QUS and lumbar spine BMD were able to discriminate vertebral fractures in the younger group (p < 0.05), whereas calcaneal QUS was able to discriminate vertebral fractures in the older one (p < 0.05). The results of this study raise an issue of the optimal use of different QUS techniques and different skeletal sites in the management of osteoporosis in early or late postmenopausal life.     

Bone mineral density measured by dual-energy X-ray absorptiometry in normal men

A cross-sectional study of 222 healthy Finnish men aged 20-69 years was performed to establish reference values of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DEXA). The effects of age, and of some physical and lifestyle factors on BMD of the lumbar spine and proximal femur (femoral neck, Ward's triangle and trochanter) were investigated. The maximal mean BMD was observed at the age of 20-29 years in all the measurement sites. Except for the trochanteric area, BMD diminished along with age, the over-all decrements being 4%, 11%, and 23% in the lumbar, femoral neck and Ward's triangle areas, respectively. BMD was in a positive relationship to weight and height in all the measurement sites. The adjusted (for age, height and weight) BMDs were higher (P less than 0.05) in the group of daily dietary calcium intake greater than 1200 mg as compared with the group of lowest calcium intake (less than 800 mg day-1) in the three femoral areas. Cigarette smoking or alcohol drinking had no obvious effect on BMD.     

膳食中植物雌激素摄入量与绝经后妇女骨密度的关系

目的通过调查绝经后妇女日常膳食中各种植物雌激素成分摄入量及骨密度分布情况,分析植物雌激素摄入量与绝经后妇女骨密度的关系,为绝经后骨质疏松的预测及其有效的个体化膳食提供参考依据。方法选取符合调查要求的南昌市160例绝经后妇女,通过食物频率问卷（FFQ）、3 d饮食称重记录、24 h膳食回顾,收集研究对象人口学特征和膳食资料,计算食物中各种植物雌激素的含量。通过双能X线吸收法测量受试者腰椎L2-4和髋部骨密度（BMD）。结果总植物雌激素低、中、高摄入组的腰椎BMD及股骨BMD比较差异均无统计学意义（P〉0.05...