绝经后骨质疏松患者的全段甲状旁腺素变化及其意义

为了解甲状旁腺功能在绝经后骨质疏松发病中的作用，本文采用免疫放射法测定３１例绝经后骨质疏松患者和２７例健康绝经后妇女的全段甲状旁腺素（１－８４肽，ＩＰＴＨ），同时了解这一变化与骨密度（用双能Ｘ线吸收仪测定）及骨吸收生化指标尿吡啶啉的相关性。结果发现绝经后骨质疏松患者较对照组ＩＰＴＨ明显增高，且ＩＰＴＨ值与尿吡啶啉的变化正相关，与骨密度值负相关。提示甲状旁腺功能增高所致的骨吸收增加是绝经后骨质疏松的发病机理之一。     

Menopause-related changes in bone mineral density in Japanese women: A longitudinal study on lumbar spine and proximal femur

We investigated 2-year longitudinal changes of bone mineral density (BMD) in lumbar spine and proximal femur in 64 Japanese women aged 38–67. Forty subjects were premenopausal (mean age 44.9) and 24 postmenopausal (mean age 54.6) at enrollment of the study. Six subjects experienced menopause during the 2-year study period and were defined as the perimenopausal group. Measurements of BMD were performed using dual-energy X-ray absorptiometry at L2–4, femoral neck, greater trochanter, and Ward's triangle. Paired t test revealed no significant decrease in BMD at any site in the premenopausal group. Significant annual decrease in BMD was observed in the perimenopausal group at L2–4, femoral neck, and greater trochanter. A similar tendency was observed in Ward's triangle, but did not reach statistical significance. In the postmenopausal group, significant decrease in BMD was found at the proximal femur, but not at L2–4. Significant inverse correlation between age and change rate of BMD was found at L2–4, but not at the proximal femur, in premenopausal women. In postmenopausal women, there was a significant association between body weight (BW) change and change rate in BMD at L2–4, femoral neck, or greater trochanter. This association was not found in the premenopausal group. These results suggest that effect of menopause on BMD may be different in individuals and sites of the skeleton. BW change may affect change in BMD in postmenopausal women. However, the limited variability in both BW and BMD changes among premenopausal women in this study may explain the poor association between change in BW and change in BMD in the premenopausal group. As individual differences in each group is considerably large, annual measurements of BMD may be necessary to find possible candidates for early intervention.     

Bone changes in postmenopausal Spanish women

Summary Total body bone mass (TBBM), axial bone mass (trunk=chest and spine), and peripheral bone mass (arms and legs) were determined in 258 normal, slow bone mass loser, postmenopausal women, as determined by previous biochemical studies, in order to study the degree of bone mass reduction due to menopause. The subjects of this study were divided into 5-year groups on a year-since-menopause basis. The first group corresponded to 1–5 years since menopause, and the last group to 25 years or over since menopause. An important and significant reduction in trunk bone mass (-12.3%, P<0.001) and TBBD (-5.8%, P<0.002), without changes in head, arms, and legs was observed in the first 5-year group. In the next 5-year group, a significant reduction was observed in all body areas, but at a higher rate in the peripheral skeleton (-9% in arms and -7.3% in legs). A slow down in bone mass loss was observed in the period between 10 and 25 years since menopause. These values became significant again after 25 years since menopause at the axial (-28.9%, P<0.001) and TBBD (-20.3%, P<0.05) level. Aside from providing percentages of bone mass reduction with respect to age and time since menopause, these data also indicate that measurements of specific body areas may not be extrapolated to others due to different loss in different body areas, and that there is a marked bone loss rate in the axial skeleton in the first 5 years since menopause.     

Different rates of forearm bone loss in healthy women with early or late menopause

The aim of this study was to evaluate whether healthy women with early or late menopause have different rates of age- and menopause-related bone loss, and whether premature menopause really represents a risk factor for osteopenia. Healthy women aged from 27 to 84 years (n=2204), with no history of fractures, were divided into two groups according to their age at menopause (AAM): group A with AAM43, and group B with AAM50 years. Bone mineral density (BMD) was measured in the distal non-dominant forearm by single-photon absorptiometry. Group B had a significantly lower average BMD than group A (group A, 0.430±0.074 g/cm²; group B, 0.419±0.081;p=0.003); however, the average age of group A was significantly lower, and weight and height were significantly higher. When women older than 50 years of age were divided into five age-matched subgroups, BMD was significantly lower in women with AAM43 years up to 60 years; after that age this difference disappeared and, in the oldest subgroups, BMD was significantly lower in group B than in group A. Independent variables such as age, AAM and body mass index (BMI) explain about 30% of the variation of BMD, using a multiple linear regression analysis. In both groups age and BMI weighted more than AAM in determining BMD. When BMD was plotted versus either chronological age or years since menopause, women with late menopause showed a significantly faster bone loss than those with early menopause. In conclusion, women with premature menopause have a lower peripheral bone mass than women with later menopause up to 60 years of age, but not later, when the risk of fractures is higher. This seems to be due to the fact that women with late menopause lose bone faster than those with early menopause.     

2型糖尿病患者双能X线骨密度测定

目的观察2型糖尿病对骨密度的影响。方法应用双能X线骨密度仪(DXA)测定110例糖尿病的患者腰椎和髋部的骨密度(BMD)，并与对照组配对比较。结果糖尿病的患者骨密度与对照组比较呈明显下降，差异有显著性。结论采用配对设计，2型糖尿病患者多部位骨密度较对照组明显下降。     

绝经后妇女年龄、绝经年龄、绝经年限与腰椎和髋部骨密度的关系分析

目的 探讨绝经后妇女年龄、绝经年龄、绝经年限与腰椎和髋部骨密度的关系.方法 调查248名健康的绝经后妇女的年龄、绝经年龄、绝经年限,测量身高、体重、正位腰椎（L2～L4）、髋部骨密度进行分析.结果 随着绝经年限的增长,腰椎和髋部骨密度逐渐降低.单因素相关分析表明年龄、绝经年限与腰椎及髋部各部位骨密度呈显著负相关（P＜0.01）,绝经年龄与腰椎及髋部各部位骨密度无显著相关性（P＞0.05）.调整身高、体重指数后,年龄、绝经年龄与腰椎及髋部骨密度呈显著负相关（P＜0.01）,绝经年龄与腰椎及髋部各部位骨密度无显著相关性（P＞0.05）.多元逐步回归分析显示绝经年限与腰椎、股骨颈及股骨大转子的骨密度呈显著负相关（P＜0.01）,年龄与腰椎、股骨颈及Ward三角区骨密度呈显著负相关（P＜0.05）.结论 年龄、绝经年限与腰椎和髋部骨密度有关.     

Bone mineral density in children after renal transplantation

A successful kidney transplantation (Tx) offers good quality of life for children suffering from chronic renal failure. However, some metabolic abnormalities may not be corrected and may persist after Tx despite good graft function. Post-Tx bone disease seems to be a universal finding in adult Tx recipients, and is most probably related to steroids. Reports on bone mineral density (BMD) in children after renal Tx are not uniform. Recent studies suggest that BMD is normal when corrected for height. However, longitudinal studies show a transient decrease in BMD in the early post-Tx period. These controversial results raise the issue of the correct interpretation of dual-energy X-ray absorptiometry in children with stunted growth. Etiopathogenetic factors of the decreased BMD, preventive and thera- peutic measures are discussed. In conclusion, the results of dual energy X-ray absorptiometry should be interpreted with caution, especially in children with disturbed growth. Received: 3 May 1999 / Revised: 16 January 2000 / Accepted: 23 January 2000     

Bone mass in axial spondyloarthritis: A literature review

AIM: To review the published literature reporting bone loss in patients with axial spondyloarthritis (SpA) particularly those studies using dual X-ray absorptiometry (DXA) methods.METHODS: This literature review examines the reported bone mass in patients with ax-SpA, particularly those using the DXA methods. The MEDLINE, Web of Science and Scopus databases were searched for relevant articles published between September 1992 and November 2013. Some of used search terms were ankylosing spondylitis (AS), SpA, spondyloarthropathy, bone loss, bone mass, osteopenia, bone mineral density, osteoporosis (OP), densitometry. Studies in which bone loss was investigated by using DXA in patients with SpA were eligible. Each article was reviewed and the key elements were noted.RESULTS: There were 286 hits on MEDLINE, 200 on Web of Science and 476 on Scopus. After applying inclusion and exclusion criteria, we identified 55 articles in our systematic search. The sample size of the studies varied from 14 to 332 patients with SpA. The reported age range varied from 25 to 56 years in the reviewed studies. The symptom duration of patients with axSpA varied from 1.6 to 49 years. There were more males than females in these studies. Most of the recruited females were premenopausal women. Reported HLA-B27 positivity changed between 19% to 95%. The prevalence of OP and osteopenia in patients with SpA varied from 3%-47% to 5%-88%, respectively, in the included studies. In particular, the prevalence of OP and osteopenia ranged from 2.0%-47.0% and 5.0%-78.3%, respectively, in patients with AS. There are conflicting results regarding the relationship among disease activity, acute phase response and bone mass. Some studies suggest good correlation of bone mass with disease activity and acute phase reactants.CONCLUSION: Bone loss may be determined in patients with axSpA at the lumbar spine or proximal femur even in the early phase of the disease and may be associated with inflammation (bone marrow edema) at the vertebral colon.     

Bone mineral density measured by dual-energy X-ray absorptiometry in healthy finnish women

Summary A cross-sectional study of 351 healthy Finnish women aged 20–76 years was done to establish reference values of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DEXA). The effects of age and of several physical and lifestyle factors on BMD of the lumbar spine and proximal femur (femoral neck, trochanter, and Ward's triangle area) were investigated. Altogether 58 women were excluded from the final analysis due to significant spinal osteoarthritis or other diseases or drugs known to influence calcium or bone metabolism. The precision of the method was 0.9, 1.2, 2.7, and 2.4% in the lumbar, femoral neck, Ward's triangle and trochanter area, respectively. Lumbar BMD was increased by 30% (P<0.001) in 15 patients with osteoarthritis (21% of women 50 years or older), but it was apparently unaffected in 5 cases with aortic calcification. Except for the trochanter area, BMD diminished along with age, and this was significant after the menopause. The peak of mean BMD was observed at the age of 31–35 years in the spine and at the age of 20–25 years in the femoral neck and Ward's triangle. BMD was in a positive relationship to weight both in premenopausal and postmenopausal women and to the use of oral contraceptives in premenopausal women and to that of estrogen replacement therapy in postmenopausal women. Labors and pregnancies had a weak positive effect on BMD in premenopausal women. As compared with nonusers premenopausal women who had used alcohol showed a slightly decreased BMD of Ward's triangle. In postmenopausal women there was a positive correlation between alcohol intake and BMD.     

Bone loss around failed femoral implant measured by dual-energy X-ray absorptiometry

Periprosthetic bone mineral density (BMD) and its changes after primary total hip arthroplasty (THA) have been studied extensively, but quantitative data on BMD around loosened prostheses are still lacking. In this study, using dual-energy X-ray absorptiometry (DXA), we determined periprosthetic BMD in 19 patients with failed primary THA. There was a decrease in BMD (8.8%–25.5%) in every Gruen zone as compared with the patient's non-operated (control) side. Although the bone loss was most significant in the proximal femur, as in primary THA, the pattern of bone loss around the failed THA differred from the typical remodeling seen after successful THA. We suggest that quantitation of bone mass around the failed femoral stem is possible. Remarkable generalized bone loss around the stem is associated with a loosened prosthesis. Received: November 12, 1999 / Accepted: December 24, 1999     

绝经妇女绝经后年限及年龄与骨量丢失率关系

目的探讨绝经后妇女的绝经年限及年龄与骨量丢失率关系。方法1999年5月-2003年4月,对已绝经的1467例妇女进行骨密度测定,并对不同绝经后妇女年龄、绝经年限与骨密度关系进行分析。结果1467例绝经后妇女中,以绝经1-5年期间和40-45岁时各部位骨密度作为基线值比较,绝经已超过35年或年龄大于80岁时各部位骨密度最低。其中按绝经年限腰椎、股骨颈、大转子、华氏三角区在绝经后6-10年间和超过35年时丢失速度最快;按年龄腰椎在56-65岁、股骨颈和华氏三角区在61-65岁、大转子在71-75岁及各部位大于80岁时丢失速度最快。结论绝经后妇女绝经年限及年龄增加,腰椎、股骨颈、粗隆、华氏三角区骨量丢失增加。绝经年限及年龄不同,各部位丢失速度不同。     

Epidemiological study on the bone mineral density of inhabitants in Miyama Village, Wakayama prefecture (Part II) bone mineral density of the spine and proximal femur

Reference values of bone mineral density (BMD) have mainly been based on hospital volunteers in Japan. Consequently, these values may be inappropriate for the use as a standard in the osteoporotic study. In order to establish reference values, BMD was measured of 400 age-stratified inhabitants of Miyama Village, utilizing dual energy x-ray absorptiometry (DEXA). The mean BMD of L2–L4 in males in each age group was 1.19±0.16 g/cm² (mean±standard deviation) in 40's, 1.15±0.19 g/cm² in 50's, 1.03±0.18 g/cm² in 60's and 1.06±0.25 g/cm² in 70's. The difference of BMD was statistically significant between the 50 and 60 age groups. On the other hand, in females the mean BMD of L2–L4 was 1.18±0.16 g/cm² in 40's; 0.99±0.18 g/cm² in 50's, 0.84±0.19 g/cm² in 60's and 0.78±0.17 g/cm² in 70's. The BMD was significantly lower in the 50 age group than in the 40 age group and was similarly lower in the 60 age group than in the 50 age group.     

双能X线骨密度仪测定成都市城区771例健康人骨密度结果分析

目的观察成都市城区健康人群骨密度变化规律,建立该型骨密度仪成都地区骨密度正常值,为骨质疏松诊断、防治提供参考依据。方法①采用EXPERT-XL双能X线骨密度仪(美国 LUNAR公司生产)测定成都市城区健康体检者771例,其中男性300例,女性471例,测量部位包括腰椎1～4和髋部;②按年龄、性别分别输入数据,以10岁为一年龄组,分别计算各组骨密度值,结果以x-±s表示。结果男性腰椎及股骨近端骨密度峰值出现在30～39岁,女性腰椎及股骨近端骨密度峰值出现在20～29岁,随着年龄增加,骨密度逐渐降低,男性在70岁后腰椎骨密度有反弹,而女性在50～59岁间骨密度下降迅速。结论本组健康人群骨密度数据将为成都地区骨质疏松诊断、防治提供参考依据;分析男性腰椎骨密度时应结合股骨近端骨密度;女性50岁后应注意预防、治疗骨质疏松,男性骨质疏松不容忽视。     

The effects of menopause on longitudinal bone loss from the spine

Summary Two hundred and thirty women aged 45–66 years were divided into three groups according to their menopausal status and were followed to assess the changes in vertebral bone mineral density (BMD). These included 71 premenopausal, 42 perimenopausal, and 117 postmenopausal women. Menopausal status was assessed through menstrual history and plasma concentrations of 17 estradiol and luteinizing hormone. BMD was measured by dual photon absorptiometry between 2 and 5 times over an average period of 27 months, and annual rates of changes were calculated by linear regression. BMD decreased significantly (P<0.0001) in the three groups during the follow-up. Mean (±SD) annual rate of change was-0.79±1.5% for premenopausal,-2.35±1.5% for perimenopausal, and-1.24±1.5% for postmenopausal women. There was no difference in the rates of bone loss between the perimenopausal group and the postmenopausal group within 3 years after menopause (1–2 years:-2.34±2.1%; 2–3 years:-1.9±1.5%). Thereafter, rates decreased exponentially with time since menopause to fall out at the same level as the premenopausal level. These longitudinal data indicate that vertebral bone loss begins before menopause and accelerates sharply during menopause to decline exponentially with time after 3 years.     

沈阳地区绝经后妇女绝经年限与股骨近端骨密度的关系分析

目的 探讨绝经年限与股骨近端BMD的关系。方法 随机调查沈阳地区285例健康的绝经后妇女，调查其年龄和绝经年限，测量其身高、体重、股骨近端骨密度(BMD)，应用SPSS软件统计分析。结果 随绝经年限的增加股骨近端各部位BMD有下降的趋势，随绝经年限的增加股骨近端各部位BMD下降速度减慢，并且相对而言Neck、Ward’s区的BMD下降速度高于其他部位。以年龄和体重指数(BMI)为协变量，经协方差分析显示Ward’s区BMD与绝经年限具有显著相关，而其他部位无显著相关。结论 对绝经后妇女应注意绝经早期的股骨近端BMD变化。     

Dietary determinants of post-menopausal bone loss at the lumbar spine: a possible beneficial effect of iron

Introduction Previous studies suggesting different effects of diet on post-menopausal bone loss may have given conflicting results because they sometimes failed to exclude confounding conditions or used imprecise methodology.Design To identify dietary determinants of bone loss from the lumbar spine after menopause in women not taking hormone replacement who developed no evidence of spondylotic or sclerotic degenerative disease, forty-three women were followed with repeated (mean = 12) measurements of bone mineral density (BMD) at L2–4 for 11–14 years. Eleven developed evidence suggestive of degenerative disease and were excluded. Diet was assessed at the beginning of the study and 2.5 years later using 3-day and 7-day periods of weighed intakes. Nutrients estimated were: carbohydrate, fat, protein, fibre, calcium, magnesium, iron, phosphorus, copper, zinc and six vitamins. We tested the ability of diet to predict post-menopausal bone loss using stepwise regression.Results Each woman’s BMD change was described by a single coefficient after log transformation of the BMD data. The best model for BMD loss including dietary factors alone had two significant determinants: daily energy or protein (p=0.0003) intake was adverse, while dietary iron (p=0.002) was predictive of bone maintenance, an effect that persisted if iron was expressed as a ratio to energy intake. Adding body mass index to the model increased the goodness of fit (R ²adj rose from 0.33 to 0.42) without affecting the statistical significance of the dietary determinants.Conclusions Diet may influence bone loss after menopause, with dietary iron (or an associated factor) possibly having a protective effect on bone at the spine.     

Bone density of the radius,spine, and hip in relation to percent of ideal body weight in postmenopausal women

Summary Bone mineral content (BMC) and bone mineral density (BMD) of the spine (L2–L4) and hip (at femoral neck, Ward's triangle, and greater trochanter sites) were determined by dual-photon absorptiometry (DPA), and of the radius by single-photon absorptiometry (SPA) in healthy postmenopausal women aged 40–70 years. The relationships of BMC and BMD to years since menopause were examined separately in 97 women who were above 115% of ideal body weight (IBW) and in 128 women below. The heavier women had significantly greater mean BMC and BMD at each site than did the normal-weight women. In the normal-weight women, there was a significant negative correlation between BMD and years since menopause at each measurement site except the greater trochanter. In the obese women, BMD decreased with increasing years since menopause at the radius site only and BMC declined with increasing years after menopause at the hip (femoral neck and Ward's triangle region) as well as the radius. Thus, body size is a significant determinant of BMD in this population. The pattern of loss of BMD from Ward's triangle and femoral neck regions of hip are similar to that of the spine. The BMC and BMD findings in the hip suggest that remodeling occurs at this weight-bearing site which has a favorable effect on bone strength.     

Bone mineral density of the distal femur following uncemented total knee arthroplasty: a two-year follow-up of 11 knees using dual energy X-ray absorptiometry

Abstract In a prospective study, we evaluated the adaptive bone remodelling pattern of the distal femur using dual energy X-ray absorptiometry (DEXA) after total knee arthroplasty (TKA). Eleven patients underwent TKA with insertion of an Interax total knee system (Howmedica) because of primary osteoarthrosis of the knee. All patients received an uncemented femoral component with an uncoated cast-mesh ingrowth surface. The components had a 20-mm long central peg placed anteriorly just behind the anterior flange. DEXA scans were performed postoperatively at 2 weeks and at 3, 6, 12 and 24 months in the mediolateral plane of the distal femur and in the anteroposterior plane of the distal tibia and fibula. Compared to the immediate 2-week postoperative bone mineral density (BMD) value, we found no significant changes in BMD in 4 regions of interest (ROI) in the distal femur during the 2-year follow-up at 3 months. A temporary but significant decrease in BMD of 11.2% (95% CL, -17.3% to -5.0%) was observed in the most distal ROI just posterior to the fixation peg. Bone mineral content (BMC) of the distal tibia and fibula showed no significant changes in the operated and contralateral legs during the follow-up. The adaptive bone remodelling of the distal femur after TKA using an uncemented femoral component not previously examined by DEXA induced only a very limited and temporary loss of bone mineral.     

Risk assessment instruments for screening bone mineral density in a Mediterranean population

AIM To evaluate the power of six osteoporosis-screening instruments in women in a Mediterranean country.METHODS Data concerning several osteoporosis risk factors were prospectively collected from 1000 postmenopausal women aged 42-87 years who underwent dual-energy X-ray absorptiometry(DEXA) screening. Six osteoporosis risk factor screening tools were applied to this sample to evaluate their performance and choose the most appropriate tool for the study population.RESULTS The most important screening tool for osteoporosis status was the Simple Calculated Osteoporosis Risk Estimation, which had an area under the curve(AUC)of 0.678, a sensitivity of 72%, and a specificity of 72%, with a cut-off point of 20.75. The most important screening tool for osteoporosis risk was the Osteoporosis Self-assessment Tool, which had an AUC of 0.643, a sensitivity of 77%, and a specificity of 46%,with a cut-off point of-2.9.CONCLUSION Some commonly used clinical risk instruments demonstrate high sensitivity for distinguishing individuals with DEXA-ascertained osteoporosis or reduced bone mineral density.     

Bone Loss at the Os Calcis Compared with Sone Loss at the Knee in Individuals with Spinal Cord Injury

Abstract

Background/Objective: The objective of this study was to document acute bone loss at the os calcis and compare it with bone lossat the knee following spinal cord injury (SCI) as a potential proxy for bone loss in individuals with SCI.

Methods: Bone mineral density (BMD) was measured by dual energy x-ray absorptiometry (DEXA) at the knee and os calcis, whichalso was assessed by ultrasound in 6 individuals-5 with complete SCI and 1 with incomplete SCI-at means of 33.5 and 523 daysfollowing injury.

Results: Bone mineralwas progressively greater as measured from proximal to distal sites. The net average BMD of the knee declined24% (P = 0.017). The distalfemurlost 27% (P = 0.03 8) and the proximal tibia lost 32% (P = 0 .015) , whereas the os calcis lost3 8% (P = 0.001) as measured by DEXA and 49% (P<0.001) as estimated from ultrasound. The mean loss of 24'7'o at the kneewas significantly different from the loss percentages at the os calcis as measured by both techniques: DEXA (P = 0.036) andultrasound (P = 0.043). Differences between annualized loss rates at the knee and the os calcis measured by both techniques alsowere significant: DEXA (P = 0.032) vs ultrasound (P = 0.038). However, annualized loss rates demonstrated the same trend fordifferentiallass at the sites examined in the 5 individuals with complete injuries but not for the 1 participant with an incomplete injury.The loss rates were similar for the complete and incomplete participants at the os calcis, but not at the knee.

Conclusion: The BMD of the os calcis declined 3 8% by DEXA and 49% by ultrasound compared with 24% at the knee whenmeasured 1 to 1.5 years after injury. BMD of the os calcis and distal femur measured by DEXA in persons with complete SCI werehighly correlated (r = 0.84, P < 0.0001 ).