老年男性原发性骨质疏松症患者血清性激素的变化

目的探讨血清多种性激素的变化对老年男性原发性骨质疏松的影响。方法182例老年男性患者测定腰椎及髋部骨密度(双能X线骨密度仪)，分为正常、骨量减少与骨质疏松组，40例健康青年男性为对照组。所有受试者用放射免疫法测定血清总睾酮(TT)、雌二醇(E2)、硫酸脱氢表雄酮(DHEAS)、性激素结合球蛋白(SHBG)，用免疫比浊法测定血清白蛋白，并计算游离睾酮(FT)、生物有效性睾酮(Bio-T)、游离雄激素指数(FAI)、游离雌二醇(FE2)及生物有效性雌二醇(Bio-E2)结果老年男性在股骨颈、Ward三角及大转子骨密度明显低于青年男性；随年龄的增长，除SHBG外，其他性激素均有明显下降；老年男性中，Bio—T及FAI在骨质疏松组明显降低，其他激素无明显变化。结论老年男性骨密度降低与增龄引起的性激素下降密切相关，而具有生物活性的睾酮的降低是影响老年男性原发性骨质疏松的重要因素。

Effects of sex hormones on osteoporosis in elderly men

Objective To study the effects of several sex steroids on osteoporosis in elderly men. Method Spinal and hip bone mineral density (BMD) were measured by dual energy X-ray absorptiometry in 182 elderly men including healthy, osteopenia and osteoporosis group. Forty healthy young men were chosen as control. Total testosterone (TT), estradiol (E2), dehydroepiandrosterone sulfate (DHEAS) and sex hormone binding globulin (SHBG) were determined by RIA. Levels of free T (FT) , bioavailable T (Bio-T) , free androgen index (FAI) , free E2 (FE2) and bioavailable E2 (Bio-E2) were calculated. Results BMDs at femoral neck, Ward's triangle and shaft decreased significantly in elderly men compared to those in controls (P<0. 01, P<0. 05) . The levels of DHEAS, TT, FT, Bio-T, FAI, E2 , FE2 and Bio-E2 decreased dramatically with age whereas the level of SHBG increased (P<0. 01) with age grouth. In elderly population, Bio-T and FAI decreased significantly in osteoporosis group (P<0. 05) . Conclusion Sex steroids, especially bioactive testosterone play an important role in osteoporosis in elderly men.