围绝经期妇女Colles’骨折患者骨密度分析

目的探讨由轻创伤引起的伸直型桡骨远端骨折(Colles骨折)与骨密度的关系,为骨质疏松的预防和治疗提供依据。方法对286例40～58岁由轻创伤引起的Colles骨折女性患者和232例同年龄无骨折史来我院健康检查的女性,用双能X线骨密度仪测量腰椎、左股骨上端骨密度,对数据进行统计分析。结果骨折组BMD明显低于对照组,围绝经期妇女骨质疏松检出率Colles骨折组为31.82%,对照组为12.16%。结论围绝经期妇女由轻创伤引起的Colles骨折与BMD有密切关系。围绝经期妇女更应该重视骨质疏松症的防治,以避免骨折发生。     

寂静的杀手——骨质疏松症

<正>目前,全球约有2亿女性患有骨质疏松症,60~70岁之间的女性约1/3患有骨质疏松症,80岁或以上的女性约2/3患有骨质疏松症,约有30%的50岁以上的妇女伴有一处或多处椎体骨折,约20%的50岁以上的男性会在余生发生骨质疏松性骨折。在欧洲每30秒就有1个人发生骨质疏松性髋部骨折。骨质疏松症对生活质量和生命威胁极大,了解骨质疏松症,尽早预防和治疗,对个人、家庭和社会都具有重要意义。     

围绝经期妇女脆性骨折危险因素分析

目的 了解围绝经期女性脆性骨折的危险因素,更好地预防围绝经期女性骨折的发生.方法 以36例年龄40～59岁住院治疗的脆性骨折女性作为研究组,与同年龄段无骨折史的80例女性对照分析脆性骨折的危险因素和骨质疏松情况.结果 围绝经期妇女脆性骨折的危险因素主要包括多次分娩、绝经、哺乳时间段、居住在农村、无喝牛奶习惯、无体育锻炼习惯、骨质疏松.研究组骨质疏松发生率为44.4%,高于对照组的25%(χ2 =4.39,P<0.05).骨折妇女中50～59岁年龄组骨质疏松发生率高于40～49岁骨折妇女.结论 围绝经期女性应通过平衡膳食、适当运动等综合措施改善骨质疏松,减少脆性骨折的发生.     

老年骨质疏松性骨折的影响因素及社区康复效果

目的探讨老年骨质疏松性骨折的影响因素及社区康复治疗对患者的治疗效果。方法选取2015年1月—2017年1月同济大学附属杨浦医院收治的老年骨质疏松症患者300例,根据患者是否出现骨折分为对照组(n=150,非骨折组)和观察组(n=150,骨折组),对比分析老年骨质疏松性骨折的影响因素,同时给予社区康复治疗,探讨社区康复治疗效果。结果经骨折的影响因素分析结果显示,年龄、TC、LDL、总髋部BMD水平及阳光照射情况均为老年骨质疏松患者骨折发生的影响因素(P0.05);经logistic回归分析显示,女性、年龄较大、缺乏阳光照射和总髋部BMD水平低均为老年骨质疏松患者发生骨折的独立危险因素(P0.05);老年骨质疏松性骨折患者经社区康复治疗其前屈后伸痛、翻身痛、负重痛及总髋部BMD水平均有所改善(P0.05)。结论女性、年龄较大、缺乏阳光照射及总髋部BMD水平低均为老年骨质疏松患者发生骨折的独立危险因素,临床医生应根据患者的实际情况有针对性地实施社区康复。     

原发性骨质疏松症的诊断

原发性骨质疏松症是以骨量减少、骨组织显微结构退化（表现为骨小梁结构破坏、变细和断裂）为特征,以致骨的脆性增高而使骨折危险性增加的一种全身性疾病.目前,我国60岁以上的老龄人口为1.3亿,老年人群中骨质疏松症的患病率已达12.4%（男性8.5%、女性15.7%）,估计全球有2亿人患骨质疏松症.20%的骨质疏松症患者有发生骨质疏松性骨折的可能.据世界卫生组织预测,至2050年,全球半数以上的妇女髋部骨折将发生在亚洲地区.骨质疏松症和骨质疏松性骨折已成为全球共同关注的健康问题.     

骨质疏松症的预防

世界卫生组织（WHO）已经把骨质疏松症列为仅次于心血管病的第二大公众健康问题。目前,全球约有2亿女性患有骨质疏松症。据估计,50岁以上的妇女中有40％会发生骨质疏松性骨折,约有1／5的50岁以上的男性会在余生发生骨质疏松性骨折。在过去的10年里,与骨质疏松症有关的骨折成倍增加,每年都会导致超过150万例椎体或非椎体骨折的发生,给患者的健康和生存质量造成很大的影响。     

骨质疏松性骨折的相关因素分析

目的从体重指数因素入手,探讨骨质疏松性骨折的有关因素,期望能对骨质疏松性骨折的防治策略的制定提供理论依据。方法随机选取2010年1月至2012年10月在我院骨科因髋部骨折和腕部骨折住院治疗的老年女性病人262例,其中髋部骨折患者129例,腕部骨折患者133例。以体重指数为可估变量,以骨折类型为因变量进行协方差分析。结果髋部骨折患者的平均体重指数为21.5±0.4,低于标准体重,腕部骨折患者的平均体重指数25.2±0.3,高于标准体重指数,且差异均有统计学意义(P<0.05)。结论体重指数的增加对骨质疏松性髋部骨折是一个保护因素,对骨质疏松性腕部骨折却是一个危险因素。     

FRAX和Garvan法评估中老年人群骨折风险效果比较

目的比较骨折风险评价工具(FRAX)和Garvan nomogram法(Garvan)对国内中老年人群骨折风险的评估效果。方法选取2013年7月—2015年6月江东区东柳街道社区卫生服务中心体检或就诊的50~89岁居民,检测骨密度(BMD),调查及随访骨折相关情况;分性别、BMD、是否实际发生骨折、引用参数(BMD、体重或BMI)和评估部位(髋部或任意部位)比较两种方法评估的骨折风险。结果共纳入422人,其中男性71人,女性351人,平均年龄(64.07±8.15)岁。除引用BMI或体重评估髋部骨折方式外,Garvan评估骨折风险均高于FRAX(P0.05)。FRAX及Garvan评估女性10年内任意部位骨折风险均高于男性(均P0.01);两种方法评估准确性均为女性高于男性。FRAX及Garvan评估骨折风险均随BMD减少呈递增趋势(P0.05)。引用BMD参数时,FRAX及Garvan对骨质疏松者髋部及任意部位的骨折评估AUC在0.77~0.80,准确性中等。经过1年随访发生骨折9例,发生率为2.13%。两种方法对骨折与未骨折对象的评估骨折风险比较差异均无统计学意义(P0.05);对1年骨折的评估风险AUC均0.70,准确性较低。结论 FRAX及Garvan对骨质疏松患者骨折评估风险较高;两种方法的评估准确性无明显差别。     

腰椎和股骨颈骨质疏松症检出率比较分析

目的：探讨测量部位对骨质疏松症诊断的影响。方法：测量50岁以上人群1087人(男性525例,女性562例)腰椎和股骨颈骨密度,以本次流调骨峰值减去2．5标准差为诊断骨质疏松症标准,分别进行统计,并比较不同测量部位骨质疏松检出率;同时摄T4—L4例位片筛选出压缩性骨折患者,比较不同测量部位骨质疏松检出率。结果：两性随年龄增加,两部位BMD逐渐降低,同年龄组女性骨密度低于男性;男性股骨颈骨密度比腰椎骨密度诊断骨质疏松阳性检出率高,女性腰椎BMD诊断骨质疏松症的检出率高于股骨颈BMD的检出率。结论：女性腰椎BMD诊断骨质疏松敏感性优于股骨颈BMD。     

湖州市围绝经期女性骨质疏松症危险因素分析

目的分析湖州市围绝经期女性骨质疏松症的危险因素。方法选取2017年1月-2019年9月至浙江中医药大学附属湖州市中医院体检的40～55岁女性572例,测量骨密度(BMD),分析骨质疏松症的危险因素。结果 572例围绝经期女性中,骨质疏松症29例,发生率为5.07%。随年龄增加,BMD呈下降趋势。年龄 50岁、体质指数18.5 kg/m~2、生育次数2次、妊娠次数 2次、维生素D缺乏是围绝经期女性骨质疏松症的危险因素,每日日照时间≥1 h、重度体力活动是保护因素(均P0.05)。结论湖州市围绝经期女性骨质疏松症发生率较高,年龄大、低体质量、生育及妊娠次数多、维生素D缺乏是围绝经期女性骨质疏松症的危险因素,日照时间长、重度体力活动是保护因素。医务人员应重点对围绝经期女性危险人群加强健康教育,指导其养成科学、健康的生活方式,预防骨质疏松症发生。     

The Fracture Risk Assessment Tool (FRAX®): applications in clinical practice

Osteoporosis is a serious health concern affecting millions of Americans, with many patients going undiagnosed and untreated. Fractures due to osteoporosis and fracture-related complications are the most clinically relevant and costly consequences of this disorder. The Fracture Risk Assessment Tool (FRAX?), released by the World Health Organization (WHO) in February 2008, is a major achievement in helping determine which patients may be candidates for pharmacological therapy for osteoporosis. This Web-based algorithm, which has been incorporated into some dual x-ray absorptiometry (DXA) reporting software, calculates the 10-year probability of major osteoporotic fracture (clinical vertebral, hip, forearm, or humerus) and the 10-year probability of hip fracture in men and women based on easily obtained clinical risk factors and bone mineral density (BMD) of the femoral neck (optional). The National Osteoporosis Foundation updated its U.S. guidelines in February 2008 to incorporate FRAX and recommends that all postmenopausal women and men aged ≥50 years with a hip or vertebral fracture, a T-score ≤-2.5 at the femoral neck or spine (excluding secondary causes), or low bone mass (T-score between -1.0 and -2.5) and a 10-year probability of hip fracture ≥3% or of major osteoporosis-related fracture ≥20% (based on FRAX) should be considered candidates for drug therapy. Despite its demonstrated clinical utility, FRAX has limitations and should not be used in all situations. Acceptance and clinical use of FRAX may help identify men and women at increased risk for osteoporotic fracture, but implementing the tool into clinical practice may be a challenge for busy physicians.     

上海市北蔡社区40～79.9岁女性骨密度分析

目的了解上海北蔡镇女性骨密度(Bone mineraldensity,BMD)变化规律,为本地区骨质疏松症的防治提供参考。方法随机抽取上海市北蔡镇3个居委1个行政村共884例40～79.9岁女性进行骨密度测定,同时进行问卷调查,使用美国GE公司的Lunar Prodigy Advance PA+300164型双能X线骨密度仪对正位腰椎和左股骨近端进行骨密度测定。结果随着年龄的增加髋部和腰部BMD逐渐下降,尤其45～49.5岁组开始至55～59.9岁组下降明显,而后缓慢下降。而腰部BMD在75～79.9岁组并不下降。结论上海北蔡镇女性骨密度随年龄增高而下降4,5～60岁女性应是重点预防人群。     

The prevalence of osteoporosis risk factors and physician intervention

To determine the prevalence of osteoporosis risk factors and the probability of physician risk recognition and intervention, the medical records of a cohort of 243 women aged 40 to 65 years were reviewed retrospectively. A historical cohort design was used. Risk factors present before the start of the study were identified. Osteoporosis risk recognition (discussion, problem list), osteoporosis specific intervention (counseling about risk, or estrogen or calcium supplementation), or nonspecific intervention (dietary, exercise, smoking, or alcohol counseling) were recorded over a 3-year follow-up period. Seventy-four percent of the women had two or more risk factors. The most common were perimenopausal or postmenopausal status (73%) and absence of estrogen supplementation (ever) (65%). During the period of the study, 46 women (19%) had received an osteoporosis-specific intervention. One hundred eleven women (46%) had received one of the above or a less specific intervention. The medical records of only 25 women (10%) documented an assessment of osteoporosis risk. Only menopausal status predicted osteoporosis intervention, and the probability of intervention decreased as the total number of risk factors increased. The data identify three groups of women who could benefit from increased risk-reduction strategies: premenopausal women, perimenopausal or postmenopausal women who have never previously taken supplemental estrogens, and women with multiple risk factors.     

围绝经期妇女健康问题的社区干预效果研究

目的探求改善和提高围绝经期妇女身心健康的社区干预综合措施。方法采用整群抽样的方法，抽取2个社区45～65岁的妇女进行社区干预，对干预前313名及干预后291名进行围绝经保健知、信、行及Greene症状评分法问卷调查，以评价社区干预的效果。结果接受调查的妇女平均年龄为（50．74±5．46）岁，67．2％为无业，68．1％为小学及以下文化程度。干预前后对围绝经期健康知识得分由（5．16±1．74）分提高至（6．09±1．77）分（t=6．15，P=0．000）：“认为老有所为”及“反对忽视围绝经期危害”的选择率分别由67．9％和55.3％提升至83．0％和73．5％（P〈0．05）：激素治疗由28．9％下降到14．5％（t=17.39，P=0．000）;Greene症状评分由（14．83±8．00）分下降至（12．19±6．25）分（t=4．49±0．000），且绝经相关的心理、躯体及性功能障碍症状得到明显改善（P〈0．05）.结论围绝经期妇女健康问题社区干预取得了良好的效果，但保健知识和保健行为之间尚存在着差距．有针对性地开展社区干预措施有利于促进围绝经期妇女的健康.     

Bisphosphonate treatment prevents hip fractures in 70-79 year old women with osteoporotic vertebral fractures

According to the data of a fracture intervention trial, in women aged 55-80 years with vertebral fractures or osteoporosis diagnosed by bone mineral density measurement, treatment with the bisphosphonate alendronate prevented hip fractures with numbers-needed-to-treat within 5 years of treatment of 46 and 66, respectively. In a large risedronate hip fracture study, this new bisphosphonate only showed a beneficial effect in women aged 70-79 years with moderately severe osteoporosis as judged by femoral neck T-score, when one or more vertebral fractures were present at the start of the treatment. The number-needed-to-treat was 29. However, in women aged over 80 years and who were selected predominantly on the basis of clinical risk factors for hip fracture, no effect was found with this drug on hip fracture rate, suggesting that most were not osteoporotic and/or that the clinical risk factors used did not have the clinical utility in identifying hip fracture risk. Other factors besides osteoporosis may play a more important role in causing hip fracture in this elderly group. Diagnosis of osteoporotic vertebral fractures in women aged 70-79 years is predictive of not only new vertebral fractures but also of hip fractures, and could therefore form an indication for drug treatment.     

Can self-reported height and weight be used to calculate 10 year risk of osteoporotic fracture?

AObjectives

1) To determine the magnitude of error between self reported height and weight and measured height and weight, 2) To measure what affect this has on calculating 10 year probability of osteoporotic fracture using the World Health Organisation Fracture Risk Assessment Tool (FRAX®).

Design

Data collection from a nurse led community osteoporosis clinic.

Participants

214 post-menopausal women with at least one risk factor for osteoporosis.

Measurements

Self reported and measured height and weight, risk factors for osteoporosis, demographic details, and 10 year probability of hip fracture or any major osteoporotic fracture as measured by FRAX®.

Results

Patients over-reported their height by a mean (95% confidence interval) of 2.8 (2.3–3.2) cm and under reported their weight by a mean of 2.1 (1.3–2.6) Kg. The resulting underestimation of body mass index was 1.8 (1.3–2.0) units. Using self reported height and weight resulted in a significant over-estimation of 10 year risk of hip fracture and any major osteoporotic fracture when compared to measured height and weight; Median 10 probability of hip fracture 3.75% Vs 3.25% (p < 0.001 ), median 10 year probability of any major osteoporotic fracture 15% Vs. 14% (p < 0.001).

Conclusion

When calculating 10 year risk of fracture using the FRAX on line assessment tool, measured height and weight should be used instead of self-reported height and weight.

     

The gender- and age-specific 10-year and lifetime absolute fracture risk in Tromsø, Norway

Aim of this study is to estimate the gender- and age-specific 10-year and lifetime absolute risks of non-vertebral and osteoporotic (included hip, distal forearm and proximal humerus) fractures in a large cohort of men and women. This is a population-based 10 years follow-up study of 26,891 subjects aged 25 years and older in Tromsø, Norway. All non-vertebral fractures were registered from 1995 throughout 2004 by computerized search in radiographic archives. Absolute risks were estimated by life-table method taking into account the competing risk of death. The absolute fracture risk at each year of age was estimated for the next 10 years (10-year risk) or up to the age of 90 years (lifetime risk). The estimated 10-year absolute risk of all non-vertebral fracture was higher in men than women before but not after the age of 45 years. The 10-year absolute risk for non-vertebral and osteoporotic fractures was over 10%, respectively, in men over 65 and 70 years and in women over 45 and 50 years of age. The 10-year absolute risks of hip fractures at the age of 65 and 80 years were 4.2 and 18.6% in men, and 9.0 and 24.0% in women, respectively. The risk estimates for distal forearm and proximal humerus fractures were under 5% in men and 13% in women. The estimated lifetime risks for all fracture locations were higher in women than men at all ages. At the age of 50 years, the risks were 38.1 and 24.8% in men and 67.4 and 55.0% in women for all non-vertebral and osteoporotic fractures, respectively. The estimated gender- and age-specific 10-year and lifetime absolute fracture risk were higher in Tromsø than in other populations. The high lifetime fracture risk reflects the increased burden of fractures in this cohort.     

珠海市老年女性骨质疏松性骨折危险因素调查

目的 分析珠海市老年女性骨质疏松性骨折的影响因素,为降低老年女性骨折发生风险提供依据。方法 采用简单抽样方法分别抽取珠海市50~70岁女性骨质疏松性骨折病例为病例组、健康体检女性为对照组进行问卷调查,调查内容包括人口学特征、年龄、婚姻状态、家庭收入、文化程度、户外活动量、BMI、月经初潮年龄、绝经年龄、怀孕次数、生产胎儿数、骨折史、饮酒史、吸烟史、牛奶摄入频率等。采用单、多因素分析方法对影响该年龄段女性骨质疏松性骨折发生因素进行分析。结果 本研究共纳入200例50~70岁女性骨质疏松性骨折患者作为病例组和200名50~70岁健康女性为对照组。病例组和对照组人群均以60~70岁为主,分别占75.0%、66.5%,婚姻状态以已婚为主,分别占80.0%、85.0%。家庭月收入<5 000元分别占60.0%、55.0%,文化程度均以大专及以上为主,分别占60.0%、57.5%。有骨折史（OR=4.116）、有吸烟史（OR=3.904）和绝经年龄<45岁（OR=4.229）是50~70岁女性发生骨质疏松性骨折的危险因素,户外活动量≥60 min/d（OR=0.417）、牛奶摄入频率≥3次/周（OR=0.191）是该年龄段女性骨折疏松性骨折的保护因素。结论 户外活动量、骨折史、吸烟史、牛奶摄入频率和绝经年龄是50~70岁女性骨质疏松性骨折发生的影响因素,户外活动量较大、牛奶摄入频率较高可降低女性骨质疏松性骨折的发生风险。     

北京地区围绝经期妇女骨质疏松流行病学调查与分析

目的 :了解北京地区围绝经期妇女骨密度 (BMD)水平以及骨质疏松 (OP)的患病率 ,分析影响 OP的有关因素 ,评价 OP的单光子筛查方法。方法 :采用分层整群概率比率的方法在北京地区抽取 10个群体 ,对 2 4 2 9名 4 0～ 6 5岁围绝经期妇女进行问卷调查和 BMD测定。结果 :(1) OP患病率为 37.9%。 5 0岁以上各年龄组患病率明显高于 4 0岁组 (P<0 .0 0 1)。城市妇女 OP患病率明显高于农村妇女 (P<0 .0 0 1)。 (2 )绝经组 BMD均值为 0 .5 91± 0 .110 ,未绝经组 BMD均值为 0 .70 2± 0 .10 0 (P<0 .0 0 1)。(3)骨折发生率为 5 .9%。骨折好发部位依次为下肢、手腕、腰椎。 (4 )与 BMD呈显著正相关的因素有 :生育年龄、体重、喝牛奶、锻炼、居住地农村。呈显著负相关的因素有 :年龄、生育次数、哺乳时间、吸烟等。 (5 )单光子筛查方法的灵敏度为 83.3% ,特异度为70 .7%。结论 :围绝经期妇女 BMD变化的原因主要是受年龄、绝经因素的影响。预防 OP应提倡加强锻炼、不吸烟 ,妊娠期和哺乳期每日喝牛奶等。研究提示测量 BMD有助于预测骨折发生的危险性。单光子骨密度测定适于在患 OP的高危人群中作为筛查方法。     

观察微创球囊扩张经皮椎体后凸成形术在治疗老年人骨质疏松性胸腰椎骨折的疗效观察

目的探讨应用经皮椎体后凸成形术(PKP)在治疗老年人骨质疏松性胸腰椎骨折的临床疗效。方法选择2008年3月-2010年4月收治的26例骨质疏松性胸腰椎骨折患者采用PKP治疗,其中男11例,女15例;年龄55~70岁,平均67岁。其中T12 10例,L1 8例,L2 5例,L3 3例,应用视觉模拟疼痛评分(VAS)及伤椎形态变化,同时通过手术节段x线测量计算伤椎的高度恢复率及受伤节段后凸矫正率。结果手术全部成功,平均手术时间为40分钟,注入骨水泥平均3.8ml,本组患者平均随访时间为12个月。术后伤椎处疼痛均显著缓解,患者的VAS评分由术前的平均(7.1±1.5)分降至术后平均(1.2±0.4)分,椎体高度由术前平均(53.4±8.9)%升至术后的(83.6±10.2)%,椎体后凸畸Cobb角平均矫正9.4°。无严重并发症,患者对治疗效果满意。结论应用PKP治疗老年人骨质疏松性胸腰椎骨折可矫正后凸畸形、迅速缓解疼痛、有效恢复骨折椎体的高度,避免骨水泥渗漏,效果明显。