血清性激素水平与老年男性骨代谢指标及骨密度的关系

目的：探讨老年男性血清性激素表达水平与骨代谢指标及骨密度之间的关系。方法：收集老年男性患者230例,年龄65～95岁,分别测定雌二醇（E2）、睾酮、游离睾酮（FT）、性激素结合球蛋白（SHBG）、脱氢表雄酮（DHEA）、骨钙素、骨碱性磷酸酶（BALP）、25-羟维生素D3及尿Ⅰ型胶原交联氨基末端肽（NTX）等指标,同时利用双能X线分别测定髋关节及腰椎（L1～L4）的骨密度,分析老年男性骨密度、骨代谢指标与血清性激素以及年龄与骨密度的相关性。结果：血清E2、FT与腰椎及髋关节的骨密度呈正相关,而睾酮、SHBG、DHEA与骨密度无关。血清E2、FT与骨代谢指标NTX、BALP呈负相关,血清E2与25-羟维生素D3呈正相关,而睾酮、SHBG、DHEA与骨代谢指标NTX、BALP无关。年龄与腰椎L1、L2、L4、L1～4及髋部骨密度呈负相关,与腰椎L3骨密度无关。结论：老年男性骨密度的变化受性激素中FT、E2表达水平的影响,而受E2的影响程度超过雄激素。血清FT及血清E2的水平可作为老年男性骨质疏松症的独立观察指标。

Correlation between serum sex hormone levels and parameters of bone metabolism and bone mineral density in aged men

Objective To investigate the correlation between serum sex hormone levels and parameters of bone metabolism or bone mineral density in aged men. Methods Serum estradiol （E2）, testosterone, free testosterone （FT）, sex hormone binding globulin（SHBG）, dehydroepiandrosterone（DHEA）, osteocalcin, bone alkaline phosphatase（BALP）, 25- hydroxy-vitamin D3, and urine type I collagen-crosslinked N-telopeptides（NTX） were measured in 230 aged 65-95 years patients. Lumbar （L1-L4） and hip bone mineral density were measured with dual energy X-ray absorptiomertry. Results Serum E2, FT levels are positively correlated with lumbar （L1-L4） and hip bone mineral density in aged men. There was no correlation between serum testoterone, SHBG, DHEA and bone mineral density of hip and lumbar. E2, FT levels were negatively correlated with parameters of bone metabolism （BALP, NTX） in aged men. E2 was positively correlated with 25- hydroxy-vitamin D3. There was no correlation between serum testoterone, SHBG, DHEA and parameters of bone metabolism （BALP, NTX）. Age was negatively correlated with lumbar （L1、L2、L4、L1-4） and hip bone mineral density, but uneorrelated with lumbar （L3） bone mineral density. Conclusions E2, FT are positively correlated with lumbar （L1-L4） and hip bone mineral density in aged men. The influence of E2 is more important than androgen. Therefore, serum E2 and FT levels can be used as independent parameters for osteoporosis in aged men.