泉州市某医院老年人骨密度调查及其与体质量指数的关系

目的调查福建省泉州市某医院老年人骨密度及其与体质量指数的关系。方法选取2011年5月至2014年5月在福建省泉州市某医院就诊的800例老年人,采用双能X线骨密度仪测定其腰椎、左侧股骨颈、大粗隆及Ward's三角的骨密度,记录入选老年人群的身高、体质量及年龄,计算体质量指数并根据测定的骨密度统计各年龄段骨质疏松的发生率。结果不同部位骨密度在两性之间的差异有统计学意义(P0.01)。男性86~90岁、91~95岁年龄段左股骨颈、大粗隆、Ward's三角、L1、L3、L4及L1~4的骨密度与60~65岁年龄段比较,差异具有统计学意义(P0.05)。女性86~90岁、91~95岁年龄段左股骨颈、大粗隆、Ward's三角、L2、L3、L4及L1~4的骨密度与60~65岁年龄段比较,差异具有统计学意义(P0.05)。66~70岁、71~75岁、76~80岁、81~85岁、86~90岁,男性与女性骨质疏松发生率比较,差异均有统计学意义(P0.01或P0.05)。年龄与大粗隆、左股骨颈及Ward's三角骨密度呈负相关(P0.01)。体质量及体质量指数与大粗隆、左股骨颈、腰椎L1~L4、Ward's三角骨密度呈正相关(P0.01)。结论随着年龄增长,福建省泉州市老年人群骨质疏松发生率会逐渐升高,其中体质量及体质量指数是骨质疏松的保护因素。     

阿仑膦酸钠治疗男性骨质疏松的随访研究

目的 探讨阿仑膦酸钠治疗男性骨质疏松对骨转换标记物的影响和1年随访后骨密度变化. 方法 78例男性骨质疏松患者.年龄60～82岁,应用阿仑膦酸钠每周70 mg,治疗12个月.治疗前和治疗后3个月、12个月分别测定血骨钙素(BGP)和Ⅰ型胶原吡啶交联终肽(ICTP)和血骨特异碱性磷酸酶(BSALP).腰椎和股骨颈骨密度测定采用双能X线骨密度仪,测量部位为1～4腰椎(L1-4)后前位和左侧全髋(股骨颈、大转子、Ward's三角、股骨干). 结果 阿仑膦酸钠治疗3个月、12个月后,血ICTP、BGP和BSALP分别下降45.8%和51.6%、32.0%和37.5%、35.3%和39.9%.治疗后12个月L1-4骨密度提高11.8%,股骨颈骨密度提高11.4%.治疗后3个月、12个月血ICTP下降与L1-4骨密度提高呈正相关(r分别为0.28、0.295,P<0.05和P<0.01),与治疗后12个月股骨颈骨密度提高呈正相关(r分别为0.262、0.333,P<0.05和P<0.01);血BGP与治疗后12个月LI1-4骨密度提高呈正相关(r分别为0.322、0.401,均为P<0.01),与治疗后12个月股骨颈骨密度呈正相关(r分别为0.277,0.284,均为P<0.05);治疗后3个月、12个月血BSALP下降与治疗后12个月L1-4骨密度提高呈正相关(r分别为0.133、0.231,均为P<0.05),与治疗后12个月股骨颈骨密度提高呈正相关(r分别为0.248、0.317,均为P<0.01). 结论 骨转换标记物BGP、ICTP和BSALP早期变化可预测阿仑膦酸钠治疗男性骨质疏松患者1年后骨密度的变化.     

老年男性骨密度与年龄和性激素关系的研究

目的 探讨老年男性骨密度与年龄和性激素之间的关系.方法 双能X线吸收测定法(DEXA)测定360例老年男性腰椎正位(L1～4)、股骨颈、股骨大转子、ward's三角区和股骨干的骨密度,化学发光法测定血清总睾酮和雌二醇.根据年龄和骨密度进行分值,比较不同骨密度老年男性年龄和性激素的差异.结果 360例中共检出骨质疏松者48例,骨密度减少者72例,非骨质疏松者240例.老年男性股骨颈、股骨大转子、Ward's三角区、股骨干的骨密度随年龄的增长而下降(F值分别为3.038,3.029,3.024,3.021,P<0.05),年龄大于80岁组股骨颈、股骨大转子、Ward's三角区、股骨干骨密度分别为(0.701±0.140)、(0.682±0.185)、(0.629±0.211)、(0.986±0.160)g/cm2;年龄大于70岁组分别为(0.829±0.156)、(0.765±0.170)、(0.698±0.187)、(1.042±0.190)g/cm2;年龄大于60岁组分别为(0.875±0.138)、(0.800±0.130)、(0.731±0.145)、(1.071±0.125)g/cm2,但L1～4的骨密度差异无统计学意义(F=2.988,P>0.05).骨密度正常、骨密度减低和骨质疏松组血清总睾酮水平差异无统计学意义(F=3.032,P>0.05),而血清雌二醇水平在骨密度正常、骨密度减低和骨质疏松组分别为(180.6±62.3)、(130.5±39.9)、(110.5±68.5)ρmol/L,随骨密度减少,血清雌二醇水平降低,且差异有统计学意义(F=3.059,P<0.05).结论 老年男性骨密度随年龄增加而下降,雌激素水平可能影响老年男性骨质疏松的发生.     

住院老年患者骨骼肌减少与骨密度的关系

目的探讨住院老年患者骨骼肌质量、骨骼肌指数与骨密度的关系,以及骨骼肌减少与骨质疏松的关系,为老年骨质疏松及脆性骨折患者的临床防治开拓新思路。方法连续选取重庆医科大学附属第一医院住院老年患者562例,测量身高、体重,计算体重指数(BMI),利用双能X线骨密度仪(DXA)测量不同部位骨密度(BMD)和T值、四肢骨骼肌质量(ASMM)、骨骼肌指数(RSMI)、脂肪百分比(fat%),用Pearson相关性分析法研究各变量之间的关系,用Logistic回归法研究骨骼肌减少、骨质疏松、脆性骨折的关系。结果不同性别老年患者RSMI均与BMD显著正相关(腰椎:男性r=0.203,P0.01,女性r=0.165,P0.01;髋部:男性r=0.253,P0.01,女性r=0.225,P0.01),且均与BMI呈高度正相关性(男性r=0.777,P0.01;女性r=0.791,P0.01),BMD亦与BMI呈显著正相关(腰椎:男性r=0.319,P0.01,女性r=0.236,P0.01;髋部:男性r=0.199,P0.01,女性r=0.211,P0.01)。老年女性骨质疏松和脆性骨折患病率明显高于男性,而老年男性骨骼肌减少的检出率则显著高于女性。老年男性骨骼肌减少与骨质疏松存在明显的相关性(β=0.774,P=0.002,OR=2.168),而老年女性二者无明显相关性。结论骨质疏松与骨骼肌减少存在性别差异,老年男性二者存在明显正相关,老年女性二者无显著相关;脆性骨折与骨质疏松及骨骼肌减少均密切相关,增加肌肉量对老年人群骨质疏松及骨折的防治有重要意义。     

肝硬化患者骨密度的改变

目的:探讨肝硬化患者腰椎、股骨骨密度的改变以及肝功能、血钙、血磷、体质量指数(BMI)等相关因素的关系.方法:102名受试者分为两大组:肝硬化组60例.其中Child-Pugh A级22例,B级18例,C级20例:正常对照组42例,两组均同步检测其腰椎、股骨骨密度Ca2+、P3+及胆碱脂酶.另外收集肝硬化患者的年龄、BMI以及肝功能等指标.结果:肝硬化组腰椎、股骨骨密度均较对照组明显降低(p<0.05或0.01).Child C腰椎骨密度较对照组、Child A级差异明显,统计学有显著性差异(0.851±0.207 vs 1.070±0.22,1.036±0.192,均P<0.05).肝硬化患者的腰椎、股骨骨密度均与BMI有直线相关性(r=2.3,2.418,均P<0.05),同时腰椎骨密度还与胆碱酯酶有直线相关性(r=2.734,P<0.05).结论:慢性肝硬化患者腰椎骨密度的改变比股骨明显;胆碱酯酶反应了肝脏的储备能力与肝脏损害的程度,一定程度上可预测肝硬化腰椎骨密度是否改变.     

老年人身体脂肪分布与骨密度关系的研究

目的 研究中国宁波市老年人骨密度(BMD)与年龄、体质指数(BMI)、身体脂肪(体脂)、肌肉的关系. 方法 选择宁波市老年男性61例,用双能X线吸收法测量法(DXA)测定腰椎BMD、全身BMD和体脂、肌肉分布,并与63例老年女性进行对照. 结果 老年男性腰椎BMD与年龄呈负相关(r=-0.401,P<0.01),与BMI、全身肌肉比例、躯干肌肉比例、全身脂肪比例及躯干脂肪比例呈正相关(分别为r=0.560,P<0.01;r=0.249,P<0.05;r=0.214,P>0.05;r=0.276,P<0.05;r=0.217,P<0.01);全身BMD与年龄呈负相关(r=-0.423,P<0.01),与BMI、全身肌肉比例、躯干肌肉比例、全身脂肪比例和躯干脂肪比例呈正相关(分别为r=0.542,P<0.01;r=0.314,P<0.05;r=0.197,P>0.05;r=0.253,P<0.05;r=0.191,P>0.01).老年女性腰椎BMD及全身BMD与年龄(r=0.364,P<0.01;r=0.412,P<0.01)、BMI(r=0.413,P<0.01;r=0.49,P<0.01)、全身肌肉比例(r=0.246,P<0.05;r=0.246,P<0.01)、躯干肌肉比例(r=0.215,P<0.05;r=0.320,P<0.01)、全身脂肪比例(r=0.361,P<0.01;r=0.507,P<0.01)及躯干脂肪比例(r=0.434,P<0.01;r=0.422,P<0.01)呈正相关. 结论 老年女性体脂与BMD相关性较男性更为密切;躯干脂肪与腰椎BMD呈正相关,提示向心性肥胖可能对腰椎BMD有保护作用.     

瘦素和可溶性瘦素受体在类风湿关节炎中的变化及其与骨质疏松的关系研究

目的 探讨类风湿关节炎(RA)患者外周血瘦素(LEP)和可溶性瘦素受体(sLEP-R)水平的变化及其与RA患者的骨质疏松间的相关性.方法 采用酶联免疫吸附试验(ELISA)法测定64例RA患者和60名健康人外周血中LEP和sLEP-R水平,采用双能X线骨密度吸收仪测定骨密度,分析RA患者中LEP和sLEP-R水平的变化与RA患者骨密度、骨质疏松发生之间的相关性.结果 ①和健康对照组相比,RA组外周血LEP水平明显升高,sLEP-R水平明显降低(P<0.01).②RA患者各测定部位的骨密度均明显低于健康对照组(P<0.01),其骨质疏松发生率为35.9%,明显高于健康对照组中的15.0%(P<0.01).③RA患者外周血LEP水平与年龄呈正直线相关(P<0.01),与各测定部位骨密度呈负相关(P<0.05).RA患者外周血sLEP-R水平与年龄呈负相关(P<0.01),与各测定部位骨密度呈正相关(P<0.05).RA患者外周血LEP或sLEP-R水平与患者的临床及实验室指标间均无相关(P>0.05).④Logistic Regression多元回归法分析显示:外周血sLEP-R水平为RA患者中骨质疏松发生的独立的保护因素,OR=3.089,P=0.017,CI95%:0.017～7.108.结论 RA患者外周血LEP水平明显升高,sLEP-R水平明显降低,它们的变化与骨代谢状态的变化密切相关.外周sLEP-R水平为RA患者中骨质疏松发生的独立的保护因素.     

老年2型糖尿病患者并骨质疏松症临床分析

目的探讨老年2型糖尿病(T2DM)患者骨质疏松的患病率. 方法将老年T2DM患者338例分为60～69岁和70～79岁组,应用DPX-L骨密度仪测定患者腰椎、左侧股骨Ward'区骨密度,并与非老年(50～59岁)T2DM患者199例及本地区健康老年人(老年对照组)531例进行骨密度及骨质疏松患病率的比较. 结果 (1)女性老年T2DM组腰椎、Ward's区的骨质疏松患病率均高于非老年T2DM组,但低于老年对照组,差异均有显著性(P＜0.05～0.001, 70～79岁组腰椎除外);(2)男性老年T2DM组腰椎骨质疏松的患病率与非老年T2DM组和老年对照组比较,差异无显著性;60～69岁组Ward's区骨质疏松的患病率高于非老年T2DM组和同龄对照组,但70～79岁组低于同龄对照组,差异均有显著性(P＜0.05～0.001);(3)老年T2DM组患病前的体质指数(BMI)高于老年对照组,差异有显著性(P＜0.05～0.001). 结论老年T2DM患者骨质疏松的患病率因年龄、性别和部位的不同而表现为高于或等于非老年T2DM患者,低于或等于健康老年人.     

老年女性糖尿病患者的骨密度和骨丢失率与人体测量学指标

目的 探讨老年女性2型糖尿病患者骨密度和骨丢失率与人体测量学指标的关系.方法 采用双能X线吸收法(DXA),测定754例老年女性2型糖尿病患者腰椎和髋部骨密度.人体测量学指标采用四分位数(Q)分组,比较各组间骨密度和骨丢失率的差异.结果 体质量分组的Q1～Q4各组的平均骨密度(g/cm2):股骨颈分别为0.555±0.097、0.585±0.086、0.637±0.089和0.673±0.099,髋部总体分别为0.611±0.111、0.657±0.103、0.713±0.100和0.755±0.110;平均骨丢失率(%):股骨颈分别为30.4±12.2、26.6±10.8、20.1±11.2和15.6±12.5,髋部总体分别为29.2±12.8、23.9±11.9、17.5±11.6和(12.6±12.8).骨密度分别依次为Q1组＜Q2组＜Q3组＜Q4组,骨丢失率依次为Q1组＞Q2组＞Q3组＞Q4组,各组间差异均有统计学意义(均为P＜0.01).骨丢失率与年龄和绝经年限呈负相关(r=-0.108～0.277,均为P＜0.01),与身高、体质量和体质指数呈正相关(r=0.146～0.503,均为P＜0.01).结论 老年女性2型糖尿病患者的骨密度和骨丢失率随人体测量学指标而变化,体质量和体质指数较大者,骨密度较高和骨丢失率较小.     

老年男性外周动脉疾病与骨质疏松的相关性

目的 探讨老年男性外周动脉疾病与骨质疏松之间的相关性.方法 选取222例查体老年男性患者,按踝臂指数<0.9者入选外周动脉疾病组(87例),踝臂指数≥0.9者为非外周动脉疾病组(135例).收集两组患者身高、体重、骨密度、踝臂指数、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇等指标进行组间比较及相关性分析.结果 两组老年男性除年龄差异有显著性外,其余各项骨密度指标无统计学差异.相关分析表明双侧踝臂指数与髋部骨密度呈显著正相关(r=0.254、0.208、0.247,P<0.01),且二者分别与身高、体重、低密度脂蛋白显著相关(P<0.01),与舒张压有相关性(P<0.05),而与年龄呈显著负相关(P<0.01).结论 提示外周动脉疾病与骨质疏松之间可能存在共同危险因素.     

Androgens and bone density in women with hypopituitarism

Hypopituitarism is associated with osteopenia and a reduction in lean body mass. We have recently demonstrated markedly reduced serum androgen levels in women with hypopituitarism. We hypothesized that serum androgen levels and lean body mass are important determinants of bone mineral density (BMD) in women with hypopituitarism. In addition, because IGF-I may stimulate androgen secretion in women, we investigated whether GH administration results in an increase in serum androgen levels. Sixteen women with a history of pituitary disease of adult-onset and serum GH levels less than 5 ng/ml on stimulation testing underwent BMD and body composition testing by dual-energy x-ray absorptiometry. Univariate regression analysis revealed strong correlations between androgen levels and BMD [lateral spine BMD and dehydroepiandrosterone sulfate (DHEAS) (r = 0.68, P = 0.03), total hip BMD and free T (r = 0.60, P = 0.01), Ward's triangle BMD and DHEAS (r = 0.68, P = 0.004), Ward's triangle BMD and free T (r = 0.54, P = 0.03), femoral neck BMD and free T (r = 0.52, P = 0.04), and femoral neck BMD and DHEAS (r = 0.51, P = 0.04)]. When adjusted for age using Z scores, correlations at the femoral neck no longer reach significance. Correlations between androgens and BMD at other sites, including anterior-posterior spine and total body, were not significant, and neither total T nor androstenedione correlated with BMD at any site. Lean body mass strongly correlated with BMD [total hip (r = 0.80, P = 0.0002), total body (r = 0.78, P = 0.0003), trochanter (r = 0.74, P = 0.001), Ward's triangle (r = 0.56, P = 0.02), femoral neck (r = 0.53, P = 0.04), and anterior-posterior spine (r = 0.52, P = 0.04)]. In stepwise regression models, DHEAS determined 47% of the variation in Ward's triangle BMD (R(2) = 0.47, P = 0.004) and 46% of lateral spine BMD (R(2) = 0.46, P = 0.03). Lean body mass determined 64% of the variation in total hip BMD (R(2) = 0.64, P = 0.0002), 62% of total body (R(2) = 0.62, P = 0.0003), and 55% of trochanter BMD (R(2) = 0.55, P = 0.001). Subjects were then randomized to receive GH at a dose of 12.5 microg/kg per day or placebo for 12 months in a double-blind protocol. Serum androgen levels were obtained at baseline, 1, 3, 6, 9, and 12 months after initiation of GH. Androgen levels did not increase in the women receiving GH for 12 months, compared with those receiving placebo. Stimulation of androgen secretion is therefore unlikely to be a mechanism underlying the improvement in BMD, body composition, or quality of life observed with GH administration. In conclusion, androgen levels and lean body mass may be important determinants of BMD in women with hypopituitarism. It remains to be determined whether androgen replacement therapy itself or an increase in lean body mass achieved as a result of androgen administration will result in an improvement in BMD in this population.     

Serum oestradiol and oestrogen-receptor gene polymorphism are associated with bone mineral density independently of serum testosterone in normal males

OBJECTIVES: The physiological effects of oestrogens on bone in men were largely unanticipated until recently, when oestrogen deficiency in males with aromatase deficiency and oestrogen resistance was found to cause osteoporosis and delayed fusion of epiphyses despite sufficient serum testosterone. This raises the possibility that in normal men oestrogens rather than androgens are of physiological importance in bone maturation. In the present study, we examined the association of serum oestradiol (E2) compared to that of free testosterone (FT) with bone mineral density (BMD) in normal men. The effect of oestrogen receptor (ER) gene polymorphism on BMD in men was also addressed. SUBJECTS: Eighty-one Thai men aged 20-79 years. All were healthy and did not take medication which may affect calcium and bone metabolism. BMD was assessed by DEXA. Dietary calcium was assessed by a 3-day dietary record. Serum E2 and FT concentrations were measured by radioimmunoassay. Polymorphism at intron 1 of the alpha isoform of ER gene was determined by PCR-RFLP. Small p represents the presence of the restriction site while capital P indicates the absence of the restriction site. RESULTS: Serum FT decreased with increasing age (r = -0.58, P < 0.0001) while E2 did not. However, there was a positive association between E2 and FT (r = 0.28, P < 0.05). Serum FT was related to BMD at femoral neck (r = 0.26, P < 0.05) and Ward's triangle (r = 0.30, P < 0.01) while E2 was related to BMD at anteroposterior (AP) lumbar spine (r = 0.29, P < 0.05), femoral neck (r = 0.23, P < 0.05) and femoral trochanter (r = 0.27, P < 0.05). Besides FT and E2, age, body weight, fat mass and fat-free mass were also correlated to BMD at various skeletal sites. Using stepwise multiple linear regression to control for the confounding effects among these factors, fat-free mass was found to be strongly associated with BMD at most skeletal sites. Serum E2 was related to BMD independently of other factors including FT at AP lumbar spine (r = 0.22, P < 0.05), femoral neck (r = 0.26, P < 0.01), femoral trochanter (r = 0.22, P < 0.05) and Ward's triangle (r = 0.26, P < 0.01) while serum FT was not associated with BMD at any site after controlling for E2 and other related factors. Concerning ER alpha gene polymorphism, 27 (33.3%) of the subjects had pp genotype, while 42 (51.9%) and 12 (14.8%) Pp and PP genotypes, respectively. After controlling for age, body weight, fat mass, fat-free mass, calcium intake, FT and E2, the presence of P allele was associated with higher BMD at AP L2-L4 (P < 0.05). CONCLUSIONS: Serum oestradiol is more related to bone mass than free testosterone in normal men. Oestrogen-receptor gene polymorphism is also associated with bone mass in men independently of oestradiol levels. Serum oestradiol together with oestrogen-receptor genotype may partly determine bone mass in males.     

Proximal femur density in type 1 and 2 diabetic patients.

This study reports on the proximal femur mineral content in 36 Type 1 and 60 Type 2 diabetic patients. Bone mass measurements were performed in the neck, Ward's triangle and in the trochanteric area of the femur, using dual-photon absorptiometry with 153Gd. Bone mineral density (BMD) was significantly decreased in Type 1 diabetic men and women as well in Type 2 men, when compared with a non diabetic matched population. In Type 1 men, neck and Ward's triangle densities were reduced from 0.94 +/- 0.05 to 0.86 +/- 0.11 (p = 0.007) and from 0.87 +/- 0.10 to 0.74 +/- 0.14 g.cm-2 (p = 0.011), respectively. In Type 1 women, BMD was reduced from 0.97 +/- 0.10 to 0.90 +/- 0.10 g.cm-2 (p = 0.023) in the femoral neck. In Type 2 men, BMD in Ward's triangle was also significantly lower than in controls: 0.69 +/- 0.14 vs 0.76 +/- 0.19 g.cm-2, respectively (p = 0.001). In contrast, no bone loss was observed in a group of Type 2 overweight diabetic women. No statistical correlation was observed between bone loss and age, duration of diabetes, body mass index, C-peptide levels, daily insulin doses, HbA1 and the presence of diabetic complications. In conclusion, long-standing Type 1 diabetic men and women and Type 2 diabetic men have a decrease in the proximal femur bone mass. Type 2 diabetic women appear to be protected from diabetic osteopenia.     

Endogenous sex steroid, GH and IGF-I levels in normal elderly men: relationships with bone mineral density and markers of bone turnover.

There are studies concerning the association among endogenous sex steroids, growth hormone (GH), insulin-like growth factor-I (IGF-I) and bone mineral density (BMD) in both men and women. However, little is known concerning the association of these parameters with markers of bone turnover in healthy elderly men. We studied the association of BMD (dual energy X-ray absorptiometry of spine, hip and forearm) and markers of bone turnover (bone-specific alkaline phosphatase, serum C-terminal propeptide of type I collagen, and serum osteocalcin reflecting formation, urine deoxypyridinoline and calcium excretion in relation to creatinine excretion reflecting resorption) with endogenous sex steroids, GH and IGF-I in 14 elderly normal men (age range 60-79 years). There was a negative correlation between age and dehydroepiandrosterone sulphate (DHEAS) (r=-0.60, p=0.022) and a positive correlation between GH and IGF-I (r=0.53, p=0.048). Serum estradiol concentrations correlated with BMD at distal 1/3 radius (r=0.41, p=0.1) and mid-radius (r=0.47, p=0.08), and negatively correlated with age (r=-0.45, p=0.09). There was no correlation of estradiol with bone turnover markers, testosterone, free testosterone, DHEAS, GH and IGF-I. Serum GH and IGF-I levels showed no correlation with BMD (all sites) and bone turnover markers. Serum total testosterone concentrations positively correlated with BMD at distal 1/3 radius (r=0.47, p=0.09), femoral neck (r=0.56, p=0.037) and Ward's triangle (r=0.49, p=0.07). These data suggest that serum estradiol and testosterone levels are associated with BMD in elderly men, possibly indicating their contribution to skeletal maintenance in old age. However, correlations of IGF-I, GH and DHEAS with BMD and bone turnover markers are lacking in the group studied.     

Mandibular and palatal tori, bone mineral density, and salivary cortisol in community-dwelling elderly men and women.

BACKGROUND: This investigation evaluated the relationship between the presence of tori and bone mineral density (BMD) and salivary cortisol levels. METHODS: A total of 230 healthy, community-dwelling elderly men (n = 129) and women (n = 101) aged 60 and older participated in this study. Forty-three women were on hormone replacement therapy (HRT). This was a component of a 5-year longitudinal study measuring subjects' body composition, hormone levels, physical activity, and diet every 6 months. Subjects were examined for the presence of tori by visual inspection and digital palpation. BMD at six sites was measured by dual-energy X-ray absorptiometry. Salivary cortisol levels were measured by radioimmunoassay. RESULTS: Twenty-three percent of all subjects had mandibular tori, 13% had palatal tori, and 12% had both mandibular and palatal tori. Mandibular tori were more common in men, and palatal tori were more common in women. The presence of mandibular tori was significantly correlated with BMD of the lumbar spine, femoral neck, trochanter, and Ward's triangle for all subjects, and with the femoral neck and trochanter of women not on HRT. Men with palatal tori had lower levels of salivary cortisol in the evening. CONCLUSIONS: This study documented the high prevalence of mandibular and palatal tori in a group of 230 elderly, community-dwelling subjects. Women not on HRT and all subjects taken as a group with mandibular tori had higher BMD. The presence of tori at young adulthood may be a marker of higher BMD in the future and of a lower risk for developing osteoporosis.     

Biochemical markers of nutrition and bone mineral density in the elderly

BACKGROUND: Protein depletion is detrimental in bone health, but the association between bone mineral density (BMD) and serum albumin is controversial. We recently showed a positive association between femur BMD and total lymphocyte count (TLC), a validated marker of protein nutrition status, in hip-fractured women. OBJECTIVE: To investigate the association between femur BMD and both serum albumin and TLC in hip-fractured men and women. METHODS: 286 of 315 hip-fractured patients (243 women and 43 men) consecutively admitted to a rehabilitation hospital were studied. BMD was measured by DXA in the unfractured femur. The correlation between BMD and both TLC and serum albumin was studied by Pearson's coefficient and Bonferroni adjustment. RESULTS: In women a positive correlation was observed between, TLC but not albumin, and BMD measured in the total femur (r = 0.26; p < 0.01), femur neck (r = 0.21, p < 0.01), trochanter (r = 0.22, p < 0.01), intertrochanteric area (r = 0.25, p < 0.01) and Ward's triangle (r = 0.17, p < 0.05). Conversely in men a positive correlation was found between albumin, but not TLC, and BMD measured in the total femur (r = 0.50, p < 0.01), femur neck (r = 0.52, p < 0.01), intertrochanteric area (r = 0.52, p < 0.01) and Ward's triangle (r = 0.49, p < 0.01). Linear multiple regression showed that the associations were independent of age, weight, height, body mass index, erythrocyte sedimentation rate, time between surgery and blood sample collection and type of hip fracture. CONCLUSION: Our results support the role of protein nutrition in bone health, at least in elderly frail patients. TLC and serum albumin were suitable markers, however sex-related differences in their usefulness were observed.     

The influence of osteophytes and aortic calcification on spinal mineral density in postmenopausal women

The assessment of vertebral bone mineral density (BMD) in the anterio-posterior projection has become widely used in the management and prevention of osteoporosis. Recently, it has been demonstrated that the presence of spinal osteophytes has a major impact on measured BMD in men, thus casting doubt on the value of these BMD measurements. We have assessed the impact of osteophytic and aortic calcification on spinal and femoral BMD measurements in 130 normal postmenopausal women, aged 45-71 yr. Lateral lumbar spine radiographs were obtained in all subjects and graded separately (0-3) for osteophytes and aortic calcification. Both forms of calcification increased with age, and BMD of all sites was correlated positively with body weight and negatively with age. The correlation coefficients between BMD and calcification scores were nonsignificant. Multiple regression analysis, including weight, age, and calcification scores, demonstrated a small but significant effect of osteophyte score on lumbar BMD (partial r2 = 0.04; P = 0.012) and a similar trend for Ward's triangle and the trochanteric region (partial r2 = 0.02; P less than 0.06). The aortic calcification score remained nonsignificant. It is concluded that the influence of spinal osteophytes on lumbar BMD in postmenopausal women is substantially less than that in men and is, therefore, unlikely to interfere with BMD estimation in most subjects. The relationship between proximal femoral BMD and osteophyte score suggests a real relationship between skeletal density and degenerative joint disease, as has been demonstrated by others.     

Lean mass and fat mass predict bone mineral density in middle-aged individuals with noninsulin-requiring type 2 diabetes mellitus

Objective Despite high bone mineral density (BMD), persons with type 2 diabetes are at greater risk of fracture. The relationship between body composition and BMD in noninsulin‐requiring diabetes is unclear. The aim was to examine how fat and lean mass independently affect the skeleton in this population. Research design and methods Subjects for this cross‐sectional analysis were men (n = 78) and women (n = 56) aged 40–65 years (56 ± 6 years) with uncomplicated, noninsulin‐requiring type 2 diabetes. Total body fat and lean mass, total body, hip and lumbar spine BMD were measured with dual energy X‐ray absorptiometry. Magnetic resonance imaging measured total abdominal, visceral and subcutaneous (SQ) fat. Results Subjects had normal all‐site BMD and were obese to overweight (body mass index 29–41 kg/m²) with controlled diabetes (HbA1c women 6·6 ± 1·2%, men 6·7 ± 1·6%). Lean mass was positively associated with total body, hip, femoral neck and hip BMD in both sexes. Fat mass, abdominal total and SQ fat were associated with total body and hip BMD in women. In multivariate analyses adjusted for sex, lean mass significantly predicted total, hip and femoral neck BMD in men and women. In unadjusted models, lean mass continued to predict BMD at these sites in men; fat mass also predicted total body, femoral and hip BMD in women. Conclusions In men and women with uncomplicated, noninsulin‐requiring diabetes, lean mass significantly predicted BMD at the total body, hip and femoral neck. Further research is needed to determine whether acquisition or maintenance of lean mass in T2DM can prevent hip fracture in this at‐risk population.