Bone mineral density and walking ability of elderly patients with hip fracture: a strategy for prevention of hip fracture

The main risk factors for proximal femoral fracture include the hazard of falling and osteoporosis. The change in walking ability of patients before injury was evaluated over the last 10 years in a rapidly advancing aging society in Tokyo, Japan. The bone quality of patients was clarified in order to develop a strategy for prevention of hip fractures. The subjects were 157 women with proximal femoral fractures treated between 1989 and 1993 (group A) and 216 women treated between 1999 and 2003 (group B). Bone mineral density (BMD) of the radius of the patients showed slightly lower values than those of the elderly general population, but no statistically significant difference was observed in each age group except for the 75-79-year-old age group (p<0.05). Many patients had problems in walking, and 27% of patients in group A and 44% in group B could not walk outdoors or go shopping alone before the injury, and their bone mineral density was reduced. For the prevention of hip fractures, it is important to improve the physical function to avoid falls, which directly cause hip fracture. Patients who have difficulty performing effective physical exercise because of reduced walking ability require medication for osteoporosis.     

中老年女性骨关节炎患者骨密度的特点

目的　通过测量骨关节炎患者腰椎和髋部骨密度 ,探讨骨关节炎患者骨密度的特点及骨关节炎与骨质疏松症的关系。方法　本组研究对象均为中老年女性膝关节骨关节炎患者 ,其中 5 9例测量了腰椎和髋部骨密度 ,12例仅测量了腰椎骨密度。所有患者均按Kellgren分级标准对膝关节进行了评分。结果　绝经后妇女膝关节X线评分随Kellgren分级级数的增高患者腰椎骨密度均值逐渐增高 ,4级骨关节炎患者腰椎骨密度均值明显高于 2级患者 (P <0 0 5 ) ,而髋部骨密度均值随Kellgren分级级数的增高差异无显著性。如以低于同性别同部位峰值骨量的 2 0SD为骨质疏松诊断标准 ,腰椎和髋部符合骨质疏松症诊断的分别为 4 3 7%和 77%。在控制年龄和骨关节炎的影响后 ,股骨颈骨密度与体重指数的偏相关系数为 0 4 0 7(P <0 0 1)。结论　中老年女性骨关节炎患者中同时患有骨质疏松症的比例较高 ,同髋部骨密度测量相比 ,腰椎骨密度测量受骨关节炎影响较大。     

Femoral and spinal bone mineral density in Japanese osteoporotics with hip fracture

In the present study, bone mineral density (BMD) of femoral neck and lumbar spine was compared between 38 Japanese female patients with hip fracture (age 63–89 years, mean±SD 76±7 years) and 162 age-matched female controls (age 62–90 years, mean±SD 75±7 years). BMD was measured in the femoral neck and lumbar spine (L2–4) using dual-photon absorptiometry (Norland model 2600). BMD values of femoral neck as well as lumbar spine were significantly lower in patients with hip fracture than in controls (0.504±0.097 v 0.597±0.101,p<0.01, for femoral neck; 0.661±0.146 v 0.720±0.128,p<0.05, for lumbar spine). Patients with hip fracture and controls were stratified according to their BMD levels at two measuring sites, and the ratio of the number of patients and controls at each BMD level was calculated as an indicator of fracture rate. This ratio showed an exponential increase as the femoral neck BMD declined, but only a gradual increase as the lumbar spine BMD declined. Specificity-sensitivity analysis revealed that BMD values of 0.59 and 0.54 g/cm² at the femoral neck provided a specificity of 52% and 68% with a sensitivity of 90% and 75%, respectively. These findings suggest that Japanese patients with hip fracture are more osteoporotic than age-matched controls and that the selective measurement of femoral neck would be useful for predicting the risk of hip fracture.     

骨密度结合股骨近端几何参数预测老年髋部骨折

目的研究老年人骨密度(Bone mineral density,BMD)值结合股骨近端几何参数是否能提高骨质疏松性髋部骨折危险性的预测。方法将85例绝经后妇女髋部骨折患者按骨折类型分组, 其中52例股骨颈骨折,33例转子间骨折。对照组100例老年女性。在骨盆片上测量股骨近端几何参数,在股骨颈、Ward’s三角和转子处测量BMD值,对结果进行统计学处理分析。结果骨折组的BMD值均低于对照组(P<0．01);股骨干皮质厚度与股骨颈BMD值有相关性(r=0．45,P< 0．01);逐步线性回归分析结果显示股骨距内侧皮质厚度、转子处BMD值、颈干角和Ward’s三角 BMD值相结合是预测髋部骨折最好方法(r=0．74,r2=0．53,P<0．01)。结论骨密度值结合放射学测量股骨近端几何参数能提高对骨质疏松性髋部骨折及骨折类型的预测。     

Impairment of bone turnover in elderly women with hip fracture

Summary Hip fracture is one of the most severe consequences of osteoporosis affecting aged women. However, abnormalities of bone turnover responsible for bone loss in this condition have not been clearly defined. To further evaluate the bone metabolic status of women sustaining hip fracture, we have prospectively measured serum osteocalcin as a marker of bone formation and urinary excretion of pyridinoline (Pyr) and deoxypyridinoline (D-pyr) cross-links as markers of bone collagen degradation in 174 independently living women (80 ± 8 years) within a few hours after a hip fracture. Comparison was made with 77 age-matched controls (80 ± 5 years) and 17 premenopausal women (39 ± 3 years). In addition 15 of the patients were followed with daily measurements during the first postoperative week. At the time of admission osteocalcin was 20% lower in the fractured women compared to the elderly controls (7.6 ± 3.8 vs. 9.5 ± 4.5 nglml,P = 0.001). Pyr and D-pyr were 36% and 40% higher, respectively (P = 0.0001), than in elderly controls and 85% and 76% higher than in premenopausal controls (P = 0.0001). Serum osteocalcin did not correlate with the cortisol level measured at the same time (r = 0.03, ns), nor with serum albumin and creatinine. Serum osteocalcin remained unchanged within 18 hours after fracture, whereafter it progressively decreased until the third postoperative day. No correlation was noted between the excretion of pyridinoline cross-links and the time elapsed from fracture.These data suggest that the abnormal levels of osteocalcin and pyridinolines are unrelated to traumatically induced acute changes, but reflect abnormalities of bone turnover existing prior to the fracture. Thus, hip-fracture patients have biochemical evidence of decreased bone formation and increased bone resorption when compared to age-matched controls. We suggest that these abnormalities may play a role in the decrease of the bone mass and the consequently increased bone fragility that characterize the osteoporotic hip fracture in the elderly.     

骨折病史对中老年人群髋部骨密度影响的研究

目的 利用NHANES数据库分析50岁之前骨折病史是否影响患者50岁后的髋部骨密度。方法 纳入NHANES数据库5个调查年份的人群数据,通过筛查选出完成髋部骨密度检查并完成自我报告骨折病史调查者,通过统计学分析比较骨折组与非骨折组髋部骨密度的差异。结果 共纳入研究个体10 476例,其中非骨折组9 536人,骨折组940人,骨折组男性比率明显高于女性。骨折组人群平均年龄(62.8±9.1)岁,BMI值(29.24±5.77) kg/m2,非骨折组人群平均年龄(64.7±9.5)岁,BMI值为(28.55±5.59) kg/m2,结果差异有统计学意义。骨折组人群的合并症中肾功能障碍及关节炎显著高于非骨折组。协方差分析结果提示骨折组的髋部骨密度,股骨颈、大转子、转子间及Ward三角骨密度均显著下降。亚组分析结果显示髋部骨折组及腕部骨折组的骨密度均显著下降,而脊柱骨折组患者骨密度差异无统计学意义。结论 50岁之前骨折病史将会导致患者50岁之后髋部骨密度显著下降,尤其是腕部骨折及髋部骨折病史。     

Bone mineral density in healthy Kuwaiti women

Objective This study aimed to measure bone mineral density (BMD) of the lumber spine and femur regions in healthy adult Kuwaiti women, and to evaluate the influence of body size on BMD results. Methods Bone mass measurement was performed by dual-energy X-ray absorptiometry at the lumbar spine (L2-L4) and femur (four regions) of healthy ambulatory Kuwaiti females aged between 20 and 80 years. Body size measurements and a detailed questionnaire on past medical and gynecologic history, as well as lifestyle factors, were administered to all subjects. After excluding those with apparent or suggested abnormalities affecting bone mass, only 805 women from 4,887 were included and served as the target subjects. Results The spine BMD values for Kuwaiti women up to 69 years old were lower than their US counterparts; the peak value was established in the fifth decade. Femur neck BMD was relatively stable up to menopause. Spine osteoporosis was prevalent among 10% of the subjects, compared with 4% in the femoral neck. Regression analysis revealed that each kilogram of body weight has a change of 0.3% in premenopausal women and 0.5–0.6% in the older group. In multiple regressions that included the three factors (height, weight and age), the effect of age superseded that of weight in the older group of women, where there was a detrimental annual effect on spine and femur (neck and total hip) BMD by 0.9%, while each kilogram of body weight had a constructive effect by 0.4 and 0.3%. In the premenopausal women, the positive effect of 1 kg of body weight was equivalent to about 1 year of aging in the trochanter region and half a year in the total hip region. Conclusion The BMD value of healthy Kuwaiti women tend to be lower than the US reference at the lumber spine in all age groups but showed higher values for femur neck only in the age group of late 30s through 60 years. Weight has a stronger effect on BMD than does the height. The prevalence of osteoporosis in the lumber spine was more than double that in the femur neck in postmenopausal women.     

Bone mineral density in Norwegian premenopausal women

The aims of this study were: 1) to determine bone mineral density (BMD) in different age groups, 2) to determine the prevalence of low BMD, and 3) to determine the possible association between BMD and a number of risk factors in Norwegian premenopausal women. BMD of the lumbar spine (L₂–L₄), total body, and the hip (total femur, femur neck, and trochanter) were measured using dual-energy X-ray absorptiometry (Prodigy, Lunar) in 145 randomly selected women aged 13–39 years. Information on other factors thought to influence BMD was obtained through questionnaire and a clinical interview. The group aged 25–29 years had the highest mean BMD in the total body, lumbar spine, and total femur while the group aged 13–19 years had the highest mean BMD in the femur neck and the trochanter. The mean BMD values of Norwegian premenopausal women were 3.4–5.1% higher than US/European reference data (P<0.05). Five percent of the study sample aged 20–39 years were defined with low BMD (Z-score <–2) using the standard values from this study. Weight-bearing physical activity, body weight, body height, and age were positively associated with BMD, whilst menstrual dysfunction and previous pregnancy were associated with lower BMD in some of the measurement sites. The results show that the factors associated with BMD are extensive, and the strategies to prevent low BMD have to be multifactorial. A follow-up study should be conducted on the study sample to investigate actual mean BMD values and BMD changes through time.     

A study of bone mineral density in women with forearm fracture in Northern Ireland

A group of Northern Ireland women aged 40–75 years of age with low-trauma forearm fracture were studied to determine the incidence of such fractures and the prevalence of osteoporosis in this fracture population. A total of 1,147 subjects were identified in 1997 and 1998 throughout Northern Ireland following low-trauma forearm fractures, as well as 699 residents in the Eastern Health and Social Services Board (EHSSB), enabling calculation of the annual incidence rate of new low-trauma forearm fractures at 2.69/1,000 population aged 40–75. A total of 375 participants consented to have bone mineral density (BMD) measurements undertaken at the femoral neck, spine, and forearm using a Lunar Expert bone densitometer. Osteoporosis at the femur was present in 14% of women, at the spine in 29%, and at the forearm in 32%. A total of 45% were osteoporotic at one or more measured sites, but only 18% were on treatment for osteoporosis. Additional significant risk factors identified included an early menopause in 24.5% and current or previous corticosteroid use in 13%. Only 1.6% received information on treatment of osteoporosis at the time of fracture. Increased awareness is needed in both primary and secondary care including fracture services to improve treatment of women with low-trauma fracture.     

Preferential low bone mineral density of the femoral neck in patients with a recent fracture of the proximal femur

Bone mass is an important determinant of resistance to fractures. Whether bone mineral density (BMD) in subjects with a fracture of the proximal femur (hip fracture) is different from that of age-matched controls is still debated. We measured BMD of the femoral neck (FN) on the opposite side to the fracture, as well as femoral shaft (FS) and lumbar spine (LS) BMD by dual-photon absorptiometry in 68 patients (57 women and 11 men, mean age 78.8±1.0) 12.4±0.8 days after hip fracture following a moderate trauma. These values were compared with BMD of 93 non-fractured elderly control subjects (82 women and 11 men), measured during the same period. As compared with the controls, FN BMD was significantly lower in fractured women (0.592±0.013 v. 0.728±0.014 g/cm²,P<0.001) and in fractured men (0.697±0.029 v. 0.840±0.052,P<0.05). Expressed as standard deviations above or below the mean BMD of age and sex-matched normal subjects (Z-score), the difference in FN BMD between fractured women and controls was highly significant (–0.6±0.1 v. +0.1±0.1,P<0.001). As compared with mean BMD of young normal subjects, BMD was decreased by 36.9±1.4 and 22.4±1.5% (P<0.001) in fractured and control women, respectively. There was no significant difference between FN BMD of 33 women with cervical and 24 with trochanteric hip fractures (0.603±0.017 v. 0.577±0.020). FN BMD was lower than 0.705 g/cm² in 90% of fractured women. The prevalence of fracture increased with decreasing FN BMD, reaching 100% with values below 0.500 g/cm². FS and LS BMD were significantly lower in women with hip fracture than in controls (1.388±0.036 v. 1.580±0.030,P<0.001, for FS, and 0.886±0.027 v. 0.985±0.023,P<0.01, for LS), but these differences were not significant when expressed as a Z-score. In men with a recent hip fracture, FS BMD was significantly lower than in controls (1.729±0.096 v. 2.069±0.062,P<0.01), but the difference at the LS level did not reach statistical significance. These results indicate that both women and men with a recent hip fracture had decreased bone mineral density of the femoral neck, femoral shaft and lumbar spine. However, the difference appeared to be of higher magnitude for the femoral neck suggesting a preferential bone loss at this site.     

A nomogram for predicting lifetime hip fracture risk from radius bone mineral density and age

A statistical model for predicting a woman's lifetime risk of hip fracture using her bone mineral density at menopause has been proposed by Black et al. (1992b). We made an additional assumption concerning the correlation of bone mineral density between any two ages among postmenopausal women and applied the modified model to baseline ages between 50 and 85 years and any bone mineral density level likely to be observed in the population. The results are displayed in a form more convenient for application of this model in the clinical setting.     

Low serum concentrations of Irisin are associated with increased risk of hip fracture in Chinese older women

Objective

Irisin derived from muscle in response to exercise may be the molecular entity responsible for muscle wasting-osteoporosis connectivity in the elderly. The objective of the study was to determine whether serum Irisin (sIrisin) provides information on hip fracture prediction which were independent of bone mineral density (BMD) and the fracture risk assessment tool (FRAX) algorithm.

Better discrimination of hip fracture using bone density,geometry and architecture

Bone density predicts the risk of hip fracture. Because hip strength is determined by bone geometry and architecture as well as density, we tested which variables in geometry and architecture were independent discriminators of hip fracture and, if combined with density, improved the discrimination of fracture from non-fracture over bone density alone. The design was a case-control study. The subjects were Caucasian women over the age of 60 years who had sustained a hip fracture after the age of 58 years (n=22), and controls matched for age and weight (n=43) and unmatched controls (n=317) with no history of hip fracture. Variables in density, geometry and architecture were obtained from dual-energy X-ray absorptiometry images and from radiographs of the upper end of the femur. In a univariate model, of the measures of bone mass, the best discriminator of hip fracture was bone mineral density of the neck of femur; of the geometric measurements, it was hip axis length; and of the measurements of bone architecture, it was Singh grade. In a multivariate model, these three variables were shown to be independent discriminators of hip facture. When hip axis length was combined with bone mineral density, there was significant improvement in discrimination of hip fracture (p=0.014), and when Singh grade was combined with hip axis length and bone mineral density there was a further significant improvement (p=0.002). In logistic regression models using hip axis length and Singh grade adjusted for femoral neck bone mineral density, age and weight, the area under the receiver-operating characteristics (ROC) curve for femoral neck density, hip axis length and Singh grade together was significantly greater than for femoral neck density alone (p=0.006). Models that combine bone mass (density), geometry (hip axis length) and architecture (Singh grade) significantly improve the discrimination of hip fracture over bone density by itself. If these models can be shown to be equally useful in predicting hip fracture prospectively and can be obtained from dual-energy X-ray absorptiometry, their use will increase the ability to identify subjects at most risk of hip fracture.     

Determinants of bone mineral density in Chinese-American women

Summary Few data are available regarding bone mineral density (BMD) and its determinants among Chinese Americans. We identified determinants of BMD among 359 Chinese-American women in order to identify risk factors for low BMD in this burgeoning population. BMD in Chinese-American women is influenced by a number of factors, including immigration. Introduction Osteoporosis and low BMD are common among Chinese women, including Chinese Americans, who are a growing population at risk for osteoporosis in the US. Few data are available regarding BMD and its determinants among Chinese-American women. Methods In this study, we examined predictors of BMD in 359 ambulatory Chinese-American women, ages 20–90, using stepwise multiple regression analysis. Variables in the model included age, weight, height, menarche age, years since menopause, immigration age, years in US, percentage of life in US, number of pregnancies, oral contraceptive use, family history of osteoporosis, family history of hip fracture, daily calcium intake, exercise, time outdoors, alcohol consumption and tobacco use. Results Among premenopausal women, weight was the strongest predictor of BMD, accounting for 10.5% of the variance at the lumbar spine (LS), 15.2% at the total hip (TH) and 16.6% at the femoral neck (FN). Time outdoors was also a positive predictor of BMD (1.4% at LS, 2.8% at TH and 1.6% at FN), while family history of osteoporosis (1.4% at TH) and age (3.7% at FN) were negative predictors. Among postmenopausal women, greater BMD at the LS and TH was associated with greater weight and earlier immigration age. Weight accounted for 16.4% of the variance at the LS and 19.8% at the TH; immigration age accounted for 3.1% of the variance at the LS and 4.1% at the TH. At the FN, years since menopause and weight were predictors of BMD, accounting for 14.4% and 8.7% of the variance, respectively. While older age at immigration had a negative effect on BMD, years in and proportion of life in the United States were not significant predictors of BMD. Conclusions Bone mineral density in Chinese-American women is influenced by a number of biological and lifestyle factors, including immigration. The results of this study provide new insights into risk factors for low bone density as they relate to environmental determinants in the growing population of Chinese-American women.     

Bone mineral density and its relationship with body mass index in postmenopausal women with type 2 diabetes mellitus in mainland China

Bone mineral density (BMD) and its association with body mass index (BMI) are uncertain in postmenopausal women with type 2 diabetes mellitus (T2DM) in mainland China. This study was performed to assess this association including 1,042 postmenopausal women with T2DM and 919 non-diabetic control subjects. Bone mineral density of the posteroanterior spine and of the left hip was measured by use of dual-energy X-ray absorptiometry. Diabetic participants were divided into three groups according to BMI, i.e. low BMI (DML < 18.5 kg/m²), intermediate BMI (DMM 18.5–24.9 kg/m²), and high BMI (DMH ≥ 25 kg/m²). The BMD values of diabetic subjects between groups exhibited a significant gradient difference, with DML < DMM < DMH. On the fitting curves, where BMD in various skeletal regions varied with age, BMDs of DML were approximately 15% lower than those of DMM, and those of DMM were approximately 10% lower than those of DMH. For prevalence and risks of osteoporosis a gradient difference was observed among diabetic groups, DML > DMM ≈ control > DMH. The osteoporosis risk was higher for the hip than for the lumbar spine, especially in DML. This study indicated that postmenopausal women with T2DM had higher BMD and lower osteoporosis risk in the lumbar spine, and that lower BMI was an indicator of osteoporosis in mainland China.     

老年骨质疏松女性髋部骨密度、骨转换指标与血脂、血清尿酸相关性研究

目的研究老年骨质疏松女性髋部骨密度(bone mineral density,BMD)与血清总胆固醇(total cholesterol,TC)、血清甘油三酯(triglyceride,TG)、血清高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、血清低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)和血清尿酸(uric acid,UA)的相关性。方法收集2014年1月1日至2015年12月31日就诊的老年女性骨质疏松患者108例。记录患者的年龄、身高、体重、股骨颈BMD、股骨大转子BMD、股骨粗隆间BMD、髋部整体BMD、Ward’s区BMD、TC、TG、HDL-C、LDL-C、UA、血清I型胶原交联C末端肽(C-terminal crosslinking telopeptide of type I collagen,CTX)、I型原胶原N-端前肽(procollagen type I N propeptide,PINP)、25羟基维生素D(25-OH-Vit D,Vit D-T)及基础疾病情况等资料。髋部BMD、体质量指数(body mass index,BMI)、β-CTX、PINP、Vit D-T、TC、TG、LDL-C、HDL-C、UA相关性检验采用Pearson相关性检验。结果股骨颈BMD与年龄、β-CTX呈负相关,与BMI、Vit D-T、TG、UA呈正相关(r0,P0.05)。股骨大转子BMD与年龄、β-CTX呈负相关(r0,P0.05),与BMI、Vit D-T、TC、TG、LDL-C、UA呈正相关(r0,P0.05)。股骨粗隆间BMD与年龄、β-CTX、PINP呈负相关(r0,P0.05),与BMI、Vit D-T、TC、TG、UA呈正相关(r0,P0.05)。髋部整体BMD与与年龄、β-CTX呈负相关(r0,P0.05),与BMI、Vit D-T、TC、TG、LDL-C、UA呈正相关(r0,P0.05)。股骨Ward’s区BMD与年龄、β-CTX呈负相关(r0,P0.05),与BMI、Vit D-T、TC、LDL-C、UA呈正相关(r0,P0.05)。TC与β-CTX、PINP呈负相关(r0,P0.05),与Vit D-T、UA呈正相关(r0,P0.05)。TG与UA呈正相关(r0,P0.05)。HDL-C与Vit D-T、UA呈正相关(r0,P0.05)。LDL-C与β-CTX、PINP呈负相关(r0,P0.05),与Vit D-T、UA呈正相关(r0,P0.05)。结论骨质疏松患者髋部不同部位骨密度与血脂的相关性不同,适当水平的血清总胆固醇及尿酸有利于维持骨量,预防低骨量及骨质疏松的发生。     

儿童骨质密度不足相关研究概况

伴随诊断和治疗技术的发展,在儿童期发生的骨质密度减低逐渐引起了人们的重视。儿童低骨密度是由多种原因造成的,其中儿童在青春期生长高峰时,钙与维生素D摄入量不足是造成骨量减低的主要原因之一;导致骨量减低的其他临床相关因素还包括：成骨不良、佝偻病、少年类风湿、慢性关节炎,神经肌肉异常相关性骨量降低和特发性骨质疏松等疾病。为能够让临床医师早期认识与处理上述导致儿童期低骨质密度的问题,对儿童骨量降低提供有效的治疗,本文将对正常骨骼矿化过程、骨质密度测量技术,骨质降低的病理生理学机理和治疗方式选择的评估等方面展开综合性论述。     

骨密度结合股骨颈颈干角对各型髋部骨质疏松性骨折风险的预测

目的：探讨股骨近端骨密度和股骨颈颈干角与髋部骨质疏松性骨折的相关性。方法收集在我院住院的髋部骨折患者100例和健康老年对照组100例,采用美国GE公司生产的LUNAR-Bravo双能X线骨密度仪及其配置的高级骨科专用分析测量软件,分析股骨近端骨密度和股骨颈颈干角与骨质疏松的相关性。结果髋部骨折组与对照组比较,髋部骨折组BMD较对照组有明显下降,股骨外侧皮质骨厚度明显减小,股骨颈干角（ NSA）较对照组钝。结论髋部骨密度结合股骨颈颈干角变化特点可以提高对各型髋部骨质疏松骨折危险性的预测。