辛伐他汀对绝经伴血脂代谢异常女性跟骨骨密度的影响

目的 研究辛伐他汀对绝经后伴血脂代谢异常女性跟骨骨密度的影响。方法 分析885名绝经后口服辛伐他汀治疗血脂代谢异常（TC>5.18mmol/L 或 LDL-C> 3.37mmol/L）女性的跟骨骨密度,并依据T值分为骨质正常、骨量减少、骨质疏松。结果 治疗前跟骨骨密度为305.3± 59.2 mg/cm2,骨质正常、骨量减少、骨质疏松的人数分别为115、446、324,口服辛伐他汀（20mg/d）治疗3月后骨密度为309.7±56.3 mg/cm2,骨质正常、骨量减少、骨质疏松的人数为117、459、319,12月后跟骨骨密度为312.5±60.9 mg/cm2,骨质正常、骨量减少、骨质疏松的人数为122、460、303。结论 绝经后伴血脂代谢异常女性应用辛伐他汀（20mg/d）治疗12个月后跟骨骨密度增高,但对骨质疏松患病风险无影响。     

高钙尿症的治疗

在草酸钙肾结石的患者中,半数的男性及75%为女性,因有家族性血钙正常的高钙尿,尿钙排量在4mg/kg/天以上。高钙尿排泄时,由于增加了尿的超饱和,可加速形成草酸钙结晶,而减少尿钙的排泄量,可降低结石形成率。如噻嗪类利尿剂使钙排量降低50%,因而结石形成率降至治疗前的15%。还可用低钙饮食及阻止钙吸收的纤维素磷酸钠来降低尿钙排泄。家族性高钙尿症看来是良性的,除有结石危险外,生长正常,无明显骨骼疾病。     

特发性高钙尿症的诊断

特发性高钙尿症（idiopathic hypercalciuria,IH）是指儿童24h尿钙排出量大于4mg／kg,成年女性24h尿钙〉6．2mmol（250mg）,成年男性24h尿钙〉7．5mmol（300mg）,常伴有血尿和尿路结石,血钙正常而又无病因可寻的一组疾病。该病由Albright在1953年发现,随访观察约20％男性、15％女性可出现肾结石,而在肾结石患者中,     

包头地区人群骨密度影响因素研究

目的 研究影响包头地区人群骨密度的相关因素。方法 采用病例-对照研究方法。收集来自包头医学院第一附属医院进行健康体检的596例女性和230例男性流行病学资料，用双能X线吸收仪对研究对象进行骨扫描，按骨密度检测值分为正常对照组和骨质疏松及骨量流失组。采用 Logistic回归法分析影响骨密度的相关因素。结果 经Logistic回归分析，饮酒是女性发生骨质疏松的危险因素，吸烟、饮酒是男性发生骨质疏松的危险因素。补钙是人群保护因素。结论 包头地区 男、女性通过补钙均可预防骨质疏松；饮酒与女性骨量流失及骨质疏松显著相关，吸烟、饮酒与男性骨量流失及骨质疏松显著相关。     

兰州地区城乡女性居民骨密度测定分析

目的探讨甘肃兰州地区城乡女性居民骨密度特点。方法对兰州城镇社区及村镇部分居民 以及乏力、骨痛为主诉就诊者,城乡居民各2000名（均排除继发性骨质疏松症）,采用美国GE双能X 线骨密度测定仪进行正位腰椎（1^_4)和股骨颈骨密度测定。结果乡镇居民骨密度低于城镇居民, 观察人数城乡居民均2000人,其中正常骨量百分比城乡居民分别为41%、20%;骨量减少百分比为 34% ,43% ;骨质疏松城乡居民分别为25% ,38%。正常骨量城镇居民百分比明显高于乡镇居民,而 骨量减少组及骨质疏松比例乡镇居民髙于城镇居民（P <0.05),有统计学意义。结论城镇女性人 群腰椎L,_4各年龄组骨密度较乡镇女性高,说明乡镇女性人群长期慢性劳损、髙强度劳动以及营养 失调均会使骨丢失增加,导致骨质疏松。     

甲状旁腺嗜酸性细胞瘤伴微小癌1例

甲状旁腺肿瘤较为少见,甲状旁腺癌更罕见。我院近期手术治疗甲状旁腺癌1例。报告如下。病人男性,25岁。因发现颈前肿物1年于2005-03-20入院。1年前因脑外伤检查发现右颈前有一肿物,如鸽卵大小。声音无嘶哑。同时伴有右髋关节疼痛,右肾结石。入院查体:颈前可见局限性隆起,右甲状腺下极可触及一直径约4cm大小肿物,颈部淋巴结未触及肿大。辅助检查:碱性磷酸酶(ALP)1600U/L,血清磷0.68mmol/L,血清钙3.0mmol/L,尿钙2.01mmol/L,24h尿钙4.6mmol/L,总尿量2300mL;甲状腺功能正常;肾功能正常;甲状旁腺激素-全段(iPTH):1703ng/L。右髋关节诸骨骨…     

绵阳地区中老年人骨量减少和骨质疏松患病状况分析

目的用双能X线骨密度检测仪检测绵阳地区中老人群骨密度,了解我国中老年人群骨量减少和骨质疏松的患病率。方法对绵阳地区城市、郊区及农村5039例50岁以上人自愿者(其中男性1895例,女性3144例)进行骨密度检测,对腰椎、股骨骨密度检测,并采用世界卫生组织(WHO)标准分类:骨量正常、骨量减少和骨质疏松。结果女性骨量减少和骨质疏松患病率分别为35%和48%,其中70~79岁以上骨量减少和骨质疏松患病率分别为19%和67%,80岁以上骨质疏松患病率为100%。男性骨量减少和骨质疏松患病率分别为10%和6%,70岁以下无骨量减少和骨质疏松患病患者,70~79岁以上骨量减少和骨质疏松患病率分别为8%和6%,80岁以上骨量减少和骨质疏松患病率分别为22%和13%。不同年龄组别间骨量减少和骨质疏松的患病率差异显著有统计学意义(P0.01),相同年龄组女性显著高于男性(P0.01)。结论绵阳地区中老年人群中骨质减少和骨质疏松患病率高,尤其是高龄女性;80岁以上女性骨质疏松患病率为100%,男性骨量减少和骨质疏松患病率为35%。     

健康体检人群骨质疏松状况调查

目的了解健康体检人群骨质疏松状况,分析引起骨质疏松的原因及相关防护措施,为骨质疏松的防治提供依据。方法对2011年3月-2012年2月在武汉科技大学附属天佑医院体检保健科健康体检的2093例左前臂桡骨远端骨超声检测资料进行统计学分析。结果体检者中,骨量减少613例,占29.29%,其中男性为253例,占23.94%,女性360例,占34.75%;骨质疏松521例,占24.89%,其中男性155例,占14.66%,女性366例,占35.33%。骨质疏松的发生率在不同年龄段之间,男、女性别间差异均有统计学意义(P0.05)。结论健康体检人群骨质疏松发生率较高,且与年龄呈明显正相关,女性明显高于男性,应加强预防和及早治疗。     

沈阳市2697名健康体检者超声跟骨骨密度调查分析

目的 了解沈阳地区健康男、女的骨密度情况。方法 回顾性分析2008~2010年中国医科大学附属盛京医院体检中心体检的1216名女性和1481名男性沈阳市健康体检者的骨密度，检测方法为定量超声跟骨骨密度测定。结果 女性平均T值-1.216±0. 960，男性平均T值-0.750±1. 028,二者差异显著；女性骨质疏松93例，占7.65%.，骨量减少663例，占52. 56%;男性骨质疏松37例，占 2.5%，骨量减少616例，占41.59%_。结论 女性各年龄段T值均低于男性，随着年龄增加，男女T值 均逐渐下降，进入围绝经期后女性T值下降更为迅速，定量超声跟骨骨密度测定可以作为骨量减少及骨质疏松的筛查手段。     

血清睾酮与老年男性原发性骨质疏松症的关系

目的 探讨血清睾酮与老年男性原发性骨质疏松的关系，为防治老年男性原发性骨质疏松症提供理论依据。方法 双能X线骨密度仪测定腰椎(L1-4)骨密度；全自动生化分析法测定尿钙、肌酐；AKP用比色法，Ca、Mg用MTB法，P用磷酸亚铁胺法；放射免疫法测定血清E2、T、BGP、CT、PTH-m。获得的参数骨质疏松组与正常对照组比较。结果 男性原发性骨质疏松组骨代谢生化指标与同年龄同性别的对照组比较，血清Ca、P、Mg、Cu以及PTH-m、E2、AKP、BGP两组差异无显著性；血清降钙素显著降低；尿钙与肌酐比值非常明显地增多；男性主导性激素睾酮骨质疏松组非常明显地低于对照组。结论 老年男性原发性骨质疏松的发病因素虽然是多方面的，但血清睾酮水平的降低是老年男性骨质疏松症发病的一个非常重要的原因。     

Bone mass loss in calcium stone disease: focus on hypercalciuria and metabolic factors

BACKGROUND: Several authors have observed that idiopathic calcium stone formers show a bone mass reduction, which is more evident in those with idiopathic hypercalciuria. The aim of this work was the evaluation of osteopenia and osteoporosis rate in a group of idiopathic calcium stone formers. The influence of hypercalciuria, nutritional factors and anthropometric parameters on bone mass was evaluated in these patients as well. METHODS: We enrolled 196 idiopathic calcium stone formers; 102 males, and 94 females. All subjects underwent a metabolic study. BMC and BMD were evaluated as well as QUS. RESULTS: Males showed greater weight, height, BMI, densitometric values and plasma creatinine, uric acid, urea, sodium, magnesium, GFR and urinary osmolarity than females. Moreover males excreted more uric acid, urea, creatinine, sulphate, phosphate, oxalate and citrate than females. The prevalence of osteopenia and osteoporosis, according to T-score, was 54% and 14% respectively. Hypercalciuria was demonstrated in 21.7% of the patients. Hypercalciuric men showed a higher excretion of urea, phosphate, sulphate and magnesium. CONCLUSIONS: Our results confirm the importance of QUS in the evaluation of stone formers' bone mass. Anthropometric characteristics and dietary habits seem to play a role in bone loss. We did not demonstrate any influence of hypercalciuria on bone mass. Although the pathogenesis of bone loss in stone formers still remains unclear, it can be hypothesized that a slight degree of metabolic acidosis, probably of alimentary origin, may be involved in the reduction of bone mass.     

Calcium and osteoporosis

The loss of bone which starts at the menopause is self-limiting (exponential) and possibly mainly trabecular. It merges into an age-related linear loss of bone which is probably mainly cortical. The menopause is associated with a rise in obligatory urinary calcium loss resulting from an increase in the filtered load of calcium which may be due to the complexed fraction. The dependence of the urinary hydroxyproline on the urinary calcium and sodium suggests that the bone resorption is a response to calcium losses rather than a primary event. In osteoporotic women, there is a further increase in filtered load of calcium and obligatory calcium loss, frequently coupled with malabsorption of calcium. Urinary hydroxyproline can be suppressed by calcium administration in those with normal absorption and by calcitriol in those with calcium malabsorption. It is known that calcium deficiency causes osteoporosis in experimental animals, but there is controversy about the role of calcium deficiency in the pathogenesis of human osteoporosis. Calcium supplementation inhibits cortical bone loss in postmenopausal women but there is some doubt as to whether it can inhibit trabecular bone loss in women close to the menopause. This may be partly a matter of dose, formulation and time of administration.     

Prevalence of Low Forearm Bone Density in a Bulgarian Female Referral Population

Osteoporosis is one of the leading causes of morbidity and mortality in the elderly population. The prevalence of osteoporosis and osteopenia in Bulgaria is unknown except for preliminary data. We tried to determine retrospectively the prevalence of osteopenia and osteoporosis in a referral female population; 8869 consecutive Bulgarian women (age 20–87 years) were included. Information about known risk factors for low bone mass was recorded. Forearm bone mineral density was measured at the distal radius+ulna site by single X-ray absorptiometry (DTX-100 device). T- and Z-scores were calculated from Bulgarian reference data. In the total study sample 15.16% had osteoporosis and 28.8% had osteopenia. In women aged 50 years and over the corresponding prevalence was 20.45% and 32.5%. Age-adjusted prevalence of osteoporosis and osteopenia started rising after age 55 years. Corresponding mean T-scores also declined and the osteoporosis threshold of –2.5 SD was reached in the age group 70–74 years. Z-scores in all age groups were between 0 and –0.6, thus excluding major selection bias. This is the first large-scale Bulgarian study designed to look for the prevalence of osteopenia and osteoporosis in a referral population. It may become the starting point for future screening and intervention strategies in our country. Received: 30 March 2001 / Accepted: 3 August 2001     

Osteoporosis and Coronary Atherosclerosis in Asymptomatic Postmenopausal Women

Estrogen deficiency is a risk factor for osteoporosis and coronary artery disease. Osteoporosis can be evaluated by measuring bone mineral density (BMD). Coronary atherosclerotic burden can be evaluated by measuring coronary calcium using electron beam computed tomography (EBT) of the heart. We compared coronary calcium scores in 45 asymptomatic postmenopausal women with normal and low BMD. BMD of the lumbar spine and proximal femur was measured by dual X-ray absorptiometry (DXA), and coronary calcium was measured quantitatively by EBT. Women were divided into control, osteopenia, and osteoporosis groups based on the T score of the lumbar spine. Women were similar in age, years since menopause, height, weight, and body mass index (BMI). BMD ± SD (g/cm²) of L1–L4 was 0.96 ± 0.11, 0.83 ± 0.03, and 0.73 ± 0.05, in control, osteopenia, and osteoporosis group, respectively. The total coronary calcium score ± SD (relative units) was 41.9 ± 83.1, 115.1 ± 181.9, and 221.7 ± 355.4 for control, osteopenia, and osteoporosis group, respectively; the score was significantly higher in the osteoporosis than in the control group. This study provides initial data suggesting that women with osteoporosis may have a higher risk of developing coronary atherosclerosis.     

High Prevalence of Osteoporosis in Patients with Chronic Liver Disease Prior to Liver Transplantation

Osteoporosis is a common complication of liver transplantation. Its pathogenesis is multifactorial, but preexisting bone disease in patients with chronic liver disease is likely to play an important role. The aim of this study was to evaluate bone mineral density in adult patients with chronic liver disease prior to liver transplantation. A total of 243 consecutive patients (128 male, 115 female; mean age 51.1years) with chronic liver disease undergoing assessment for transplantation, were recruited over a 4-year period. BMD measurements were made using dual energy X-ray absorptiometry in the lumbar spine (L1-L4) and femoral neck (FN). Osteoporosis and osteopenia were defined by WHO criteria. Osteoporosis at either L1-L4 or FN was present in 36.6%, osteopenia in 48.1%, and normal BMD in only 15.2% of patients. There was no difference in prevalence of osteoporosis between males and females (P = 0.442). Women with osteoporosis were on average 10 years older (56.2 +/- 1.4 years) than those with normal bone density (46.4 +/- 2.3 years) P = 0.002; in men, no statistically significant age effect was found. Patients with osteoporosis had on average lower body weight than those with normal bone density (64.9 +/- 1.8 kg vs 74.2 +/- 2.2 kg) P = 0.003. T-scores in patients with cholestatic liver disease were lower than in non-cholestatic disease and the lowest BMD values were found in patients with cystic fibrosis. Logistic regression revealed that in women, increasing age (P = 0.004; OR = 1.12; CI 1.04-1.21) and lower body weight (P = 0.01; OR = 0.95; CI 0.91-0.99) were significant independent risk factors for osteoporosis but menopausal status (P = 0.1; OR = 0.24; CI 0.05-1.32) and presence or absence of cholestasis (P = 0.326; OR = 1.54; CI 0.65-3.67) were not. There were no independent risk factors in men. This study demonstrates a high prevalence of osteoporosis in patients with chronic liver disease prior to liver transplantation, men and women being equally affected. With the exception of increasing age and lower body weight in women, no independent risk factors were found, emphasizing the importance of BMD measurements in these patients and the need for prophylactic measures to optimize bone health.     

Intestinal hyperabsorption of calcium and low bone turnover in hypercalciuric postmenopausal osteoporosis

Hypercalciuria of intestinal origin has been linked with bone loss in calcium nephrolithiasis and idiopathic osteoporosis. This retrospective data analysis was performed to explore potential pathogenetic link between intestinal hyperabsorption of calcium and postmenopausal osteoporosis. Data were retrieved from postmenopausal women who were evaluated for osteoporosis or osteopenia at the Mineral Metabolism Clinic of UT Southwestern Medical Center. A total of 319 patients underwent the test of calciuric response to oral calcium load to obtain an indirect measure of intestinal calcium absorption. Serum and urinary biochemistry and L2–L4 bone mineral density (BMD) were compared between five quintiles of calciuric response. There was a statistically significant trend toward a rise in 24-h urinary calcium and a decrease in urinary deoxypyridinoline (DPD) and BMD, with increasing order of quintiles. The presentation of those in the 1st quintile was consistent with vitamin D insufficiency or deficiency, with impaired calcium absorption, secondary hyperparathyroidism, and stimulated bone turnover (high normal urinary DPD). In contrast, patients in the 5th quintile displayed a picture of absorptive hypercalciuria of stone disease, with intestinal hyperabsorption of calcium, high or high normal urinary calcium and suppressed bone turnover (low or low normal urinary DPD). Thus, the assessment of intestinal calcium absorption in a seemingly homogeneous group of postmenopausal women with osteoporosis or osteopenia revealed a spectrum of calciuric response whose extremes may represent two physiologically distinct subtypes that have important diagnostic and therapeutic implications.     

Monitoring and management of bone status in patients on chronic glucocorticoid treatment--the Medscheme experience.

OBJECTIVE: Review of administrative databases to gain insight into the investigation, management and sequelae of bone disease in patients on long-term glucocorticoid treatment. DESIGN: Retrospective analysis of 1998 pharmaceutical and clinical claims data for +/- 2 million lives administered by Medscheme. Data were extracted for members registered with the chronic medication programme as eligible for chronic glucocorticoid treatment. Those identified were subjected to further review for evidence of osteoporosis and/or hip fracture. Subgroup analysis of peri- and postmenopausal women was carried out and compared against a control group. MAIN OUTCOME MEASURES: Osteoporosis investigation and treatment rates in males and females; frequency of hip fractures; prescribing profiles; role of underlying disease, glucocorticoid route, gender and age in development of osteoporosis. RESULTS: A total of 1,614 subjects (54% females) was registered for chronic glucocorticoid treatment. Osteoporosis was diagnosed in 14.1% of females and 5.9% of males across a broad age range. Hip fractures were recorded for one female and three males. The subgroup analysis showed that osteoporosis was +/- 1.5 times more common in women receiving glucocorticoids than in peri- and postmenopausal controls, and that there was greater use of vitamin D and calcium supplementation and bisphosphonates in those exposed to glucocorticoids. Multivariate analysis showed overall that female gender, increasing age and oral glucocorticoids were significantly related to osteoporosis. CONCLUSION: Reference to UK and US data suggests that while local practitioners are aware of the effect of glucocorticoids on bone, the level of awareness is probably suboptimal, especially with regard to male patients.     

Prevalence and risk factors of distal radius and calcaneus bone mineral density in Korean population

To estimate the prevalence and the related risk factors of low bone mineral density of the calcaneus and the distal radius, a community-based study was conducted in three rural areas of Korea. A total of 1420 women and 732 men aged 40 years and older participated in this study. Information on sociodemographic characteristics and the potential risk factors for osteoporosis were collected by an interviewer-administered standardized questionnaire. Bone mineral density (BMD) of the calcaneus and the distal radius were measured by dual-energy X-ray absorptiometry (DXA). Three hundred and seventeen women and 183 men aged 20–29 years who participated in a regular health check-up were used as a reference population. Osteoporosis was defined using WHO criteria. Odds ratios of the risk factors of osteoporosis were calculated by the unconditional logistic regression model. The standardized prevalence of osteoporosis of the calcaneus was 8.4% for males and 27.3% for females using the Korean population of year 2000 as a standard population. The standardized prevalence of osteoporosis of the distal radius was 4.2% for males and 18.8% for females. Older age and lower body mass index (BMI) were related with low BMD in both the calcaneus and distal radius in males and females. The duration after menopause and the number of live births were an independent risk factor for osteoporosis of the calcaneus (OR=1.1, 95% CI=1.00–1.11; the duration after menopause; OR=2.0, 95% CI=1.20–3.35, the number of live birth) and a familial history of non-traumatic fractures or osteoporosis among the first-degree relatives was significantly related to a increased risk of osteoporosis of the distal radius in females (OR=2.9, 95% CI=1.36–6.31).     

Posttransplant bone disease: evidence for a high bone resorption state

Loss of bone is a significant problem after renal transplant. Although bone loss in the first post transplant year has been well documented, conflicting data exist concerning bone loss after this time. It is equally unclear whether bone loss in long-term renal transplant recipients correlates with bone turnover as it does in postmenapausal osteoporosis. To examine these issues, we conducted a cross-sectional study to define the prevalence of osteoporosis in long-term (> 1 year) renal transplant recipients with preserved renal function (mean creatinine clearance 73 +/- 23 ml/min). Bone mineral density (BMD) was measured at the hip, spine and wrist by DEXA in 69 patients. Markers for bone formation (serum osteocalcin) and bone resorption [urinary levels of pyridinoline (PYD) and deoxypyridinoline (DPD)] were also measured as well as parameters of calcium metabolism. Correlations were made between these parameters and BMD at the various sites. The mean age of the patients was 45 +/- 11 years. Eighty eight percent of patients were on cyclosporine (12% on tacrolimus) and all but 2 were on prednisone [mean dose 9 +/- 2 mg/day)]. Osteoporosis (BMD more than 2.5 SD below peak adult BMD) at the spine or hip was diagnosed in 44% of patients and osteopenia was present in an additional 44%. Elevated levels of intact parathyroid hormone (i PTH) were observed in 81% of patients. Elevated urinary levels of PYD or DPD were present in 73% of patients and 38% had elevated serum levels of osteocalcin. Levels of calcium, and of 25(OH) and 1,25(OH)2 vitamin D were normal. In a stepwise multiple regression model that included osteocalcin, PYD, DPD, intact PTH, age, years posttransplant, duration of dialysis, cumulative prednisone dose, smoking, and diabetes: urinary PYD was the strongest predictor of bone mass. These results demonstrate that osteoporosis is common in long-term renal transplant recipients. The data also suggest that elevated rates of bone resorption contribute importantly to this process.     

Unrecognized Osteoporosis Is Common in Patients With a Well-Functioning Total Knee Arthroplasty

BackgroundPeri-prosthetic fractures after total knee arthroplasty (TKA) are associated with poorer outcomes and high costs. We hypothesize that osteoporosis is under-recognized in the TKA population. The purpose of this study is to report osteoporosis prevalence in a healthy cohort of patients with well-functioning TKA and to compare prevalence between males and females.MethodsThis study is a cross-sectional study of 30 adults (15 males/15 females) aged 59-80 years without known bone health issues who volunteered to undergo routine dual-energy X-ray absorptiometry 2-5 years (average 3.2 ± 0.8) after primary unilateral TKA. These data plus clinical risk factors were used to estimate fracture risk via the Fracture Risk Assessment Tool and skeletal status (normal, osteopenic, osteoporotic) was determined based on the World Health Organization definition. The National Osteoporosis Foundation criteria for treatment were applied to all patients.ResultsSix of 30 (20%) patients had T-score ≤ ?2.5. Eighteen of 30 (60%) patients had T-score between ?1 and ?2.5 and 6 (20%) patients had T-score ≥ ?1. Five patients with normal or osteopenic bone mineral density (BMD) had occult vertebral fractures. Eleven of 30 (36.7%) patients met National Osteoporosis Foundation criteria for pharmacologic treatment.ConclusionThe prevalence of occult osteoporosis meeting treatment guidelines after TKA is substantial in this sample (36.7%). BMD and osteoporosis prevalence are similar between men and women. This underappreciated prevalence of osteoporosis may contribute to peri-prosthetic fracture risk. Arthroplasty surgeons and bone health specialists must be aware of post-operative changes in bone density. These data support the further study of post-operative osteoporosis and consideration of routine BMD screening after TKA.Level of EvidenceIII.