绝经后女性血清硒水平与骨质疏松骨密度和骨代谢指标相关性研究

目的探索血清硒水平与绝经后妇女骨代谢指标以及腰椎和髋部骨密度之间相关性。方法检测156例正常骨密度和162例骨质疏松症的血清硒、25-羟基维生素D、PTH、骨钙素、PINP、CTX和NTX/Cr等指标水平。腰椎和股骨颈的BMD通过双能X线吸收法测量。探索了血清硒水平与骨密度的关系。结果骨质疏松症女性的血清硒水平低于正常骨密度的女性(P0.05)。在骨质疏松症妇女中,血清硒水平与年龄、绝经年限、BMI、PTH、骨钙素、PINP、CTX和NTX/Cr水平呈负相关,与25-羟基维生素D水平呈正相关。在正常骨密度组,血清硒水平与这些参数均未发现明显的相关性。调整年龄和BMI后,腰椎和股骨颈骨密度与血清硒及25-羟基维生素D水平呈显著正相关,与绝经年限、PTH、骨钙素、PINP、CTX和NTX/Cr呈负相关。对年龄和BMI进行调整后,进行多元回归分析以确定BMD的预测因子,血清硒和PINP、CTX是腰椎和股骨颈骨密度的显著预测因子。结论绝经后女性患者血清硒水平降低与腰椎和股骨颈骨密度降低密切有关。     

血清催产素浓度与绝经后女性骨密度相关性研究

目的探讨催产素与绝经后妇女骨代谢指标以及腰椎和髋部骨密度之间相关性。方法检测185例骨密度正常和132例患骨质疏松症女性的血清催产素、瘦素、雌激素和骨代谢指标浓度。腰椎和股骨颈的BMD通过双能X线吸收法测量。结果患骨质疏松症女性的血清催产素浓度低于骨密度正常的女性(P0.05)。骨质疏松症组中血清催产素浓度与年龄、绝经年限、体质量指数(body mass index,BMI)和血清PINP、BLAP和CTX浓度呈负相关;与瘦素和雌激素具有明显正相关性;在正常骨密度组中,血清催产素浓度和各种指标未发现明显的相关性。调整年龄和BMI后,腰椎和股骨颈骨密度仍然与绝经年限以及血清PINP、BLAP和CTX浓度呈负相关,与雌激素、瘦素和催产素浓度呈正相关。对年龄和BMI进行调整后,进行多元回归分析显示绝经年限、血清催产素、PINP和CTX是腰椎和股骨颈骨密度的显著预测因子。结论绝经后女性患者较高的血清催产素水平与较高的腰椎和股骨颈骨密度有关。     

脂质运载蛋白2和老年2型糖尿病患者骨密度和骨转换标志物的相关性研究

目的探讨脂质运载蛋白2(lipocalin 2,LCN2)对老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者骨代谢的影响。方法研究对象共119例,其中84例为老年T2DM患者,35例为非T2DM对照。采取静脉血检测空腹血糖(fasting plasma glucose,FPG)、糖化血红蛋白(glycosylated hemoglobin,Hb Alc)、25-羟维生素D[25(OH)D]、I型胶原交联羧基末端肽(collagen type 1 cross-linked C-telopeptide,CTX)、Ⅰ型前胶原氨基端延长肽(type 1 N-terminal procollagen,P1NP)、全段甲状旁腺素以及肌酐、血钙(Ca)、血磷(P)等指标,用ELISA法检测血清LCN2。用双能X线骨密度仪检测股骨颈和腰椎1~4(L1~4)的骨密度(bone mineral density,BMD)。结果老年T2DM患者血清LCN2水平高于非T2DM对照组(197.13±42.15 ng/m L vs172.29±54.71 ng/m L,P=0.01)。按照血清LCN2水平三分位数将T2DM患者分为3组。其中腰椎BMD、股骨颈BMD、P1NP和CTX伴随LCN2水平增高而增高,而FPG和Hb A1c伴随LCN2水平增高而降低(所有趋势P0.05)。Pearson相关性分析显示,LCN2和T2DM患者BMD呈正相关(股骨颈:r=0.350,P=0.001;腰椎:r=0.355,P=0.001),和骨转换标志物呈正相关(P1NP:r=0.354,P=0.001;CTX:r=0.438,P0.001),和糖代谢指标呈负相关(FPG:r=-0.321,P=0.003;Hb A1c:r=-0.342,P=0.002)。进一步回归分析显示,LCN2是T2DM患者腰椎BMD的影响因素(P0.05)。结论血清LCN2水平和老年T2DM患者骨代谢相关,LCN2水平增高可能有助于BMD的增加。     

IL-33与绝经后骨质疏松女性骨密度和骨代谢指标相关性研究

目的 探索血清白细胞介素-33(IL-33)与绝经后骨质疏松女性骨密度和骨代谢指标相关性。方法 采用酶联免疫吸附法测定50例绝经后骨质疏松患者和50例正常绝经后妇女血清IL-33水平。采用双能X线骨密度仪(DXA)测量患者和对照组的骨密度(BMD)。检测维生素D、钙、碱性磷酸酶(ALP)、甲状旁腺激素(PTH)水平,以及1型胶原C末端肽(CTX)和1型前胶原N端前肽(P1NP)等骨转换指标。结果 在绝经后骨质疏松症女性中,IL-33水平显著低于健康对照组[(3.53±2.45) pg/mL vs (13.72±5.39) pg/mL,P=0.007];Spearman相关分析表明血清IL-33水平与年龄、BMI、PTH、CTX和P1NP水平呈负相关,与腰椎BMD和股骨颈BMD呈正相关。多元回归分析表明,年龄、BMI、腰椎BMD、PTH、股骨颈BMD和血清CTX和P1NP水平是骨质疏松症患者血清IL-33水平降低的独立预测因子。结论 血清IL-33降低是绝经后骨质疏松患者股骨颈和腰椎骨密度降低和骨转换增速的危险因素。     

强直性脊柱炎患者血清TNF-a、BGP和CTX水平与骨密度的关系

目的探讨强直性脊柱炎(AS)患者骨质疏松(OP)的发病机制。方法分别测定36例男性AS患者血清肿瘤坏死因子-a(TNF-a)、骨钙素(BGP)I、-型胶原C末端肽(CTX)水平及腰椎和股骨颈的骨密度(BMD)值,并与20例健康者对照。结果AS早期腰椎和股骨颈BMD均低于对照组,晚期股骨颈BMD更低于对照组。AS血清TNF-a、CTX水平较对照组显著增高(P<0.01;P<0.05),而血清BGP水平较对照组无显著差差异(P>0.05)。AS患者中OP组TNF-a、CTX水平较NOP组显著增高(P<0.01;P<0.05),OP组中血清TNF-a与CTX呈正相关,与股骨颈密度呈负相关;与BGP无明显相关性。结论AS患者主要是由于骨吸收增加而导致骨质疏松的发生。血清TNF-α水平的增高可促进骨吸收加强,是AS骨质疏松的重要原因之一。降低血清TNF-a水平,对AS患者骨质疏松的防治可能有积极的意义。     

绝经后骨质疏松症女性血清IL-31和腰椎、股骨颈骨密度相关性研究

目的探索绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)患者血清白介素31(IL-31)水平与骨密度(bone mineral density,BMD)相关性。方法采用双能X线吸收法对80例OP患者(50~75岁)和90例健康对照者(50~75岁)进行腰椎和股骨颈BMD检测。血清IL-31、BAP、BGP和TRACP-5b水平通过酶联免疫吸附法检测。使用自动电化学发光系统测量血清I型胶原交联N-末端肽(NTX-1)和25-羟基维生素D[25(OH)D]水平。结果OP妇女的IL-31水平明显高于健康对照组[(45.12±6.65)μg/L vs(27.58±5.09)μg/L,P=0.002]。绝经后骨质疏松患者血清IL-31水平与年龄、BMI、BAP、BGP、TRACP-5b、NTX和25(OH)D呈正相关。腰椎和股骨颈骨密度与年龄、IL-31、BAP、TRACP-5b和NTX之间有显著的负相关。在偏相关分析中调整年龄和BMI后,IL-31和腰椎和股骨颈骨密度之间存在显著负相关。结论绝经后骨质疏松症患者血清IL-31水平升高,与BMD呈负相关。     

中老年女性骨转换指标与骨密度和骨质疏松风险的关系

目的了解中老年女性骨转换指标变化对骨密度(BMD)和骨质疏松患病风险的影响。方法 632名健康中老年女性(年龄40~89岁),测定空腹血清骨特异性碱性磷酸酶(BAP)、骨钙素(OC)、骨I型胶原C-末端肽(s CTX)和N-末端肽(s NTX),以及腰椎和近端股骨骨密度(BMD),并分析这些骨转换指标与BMD和骨质疏松患病风险的关系。结果本研究检测的各种骨转换指标与腰椎、股骨颈和髋部BMD呈显著负相关(r=-0.238~-0.528,P均=0.000)。调整年龄、身高、体重和体重指数后,血清BAP、OC和s CTX与腰椎和股骨颈BMD的偏相关系数仍然有显著性意义。多元线性回归分析显示,这些骨转换指标对腰椎BMD是一个有意义的负性决定因素,大约可以解释腰椎BMD 7.6%~27.9%的变异性。各种骨转换指标水平最高的四分位组(Q4)与最低的组(Q1)比较,腰椎、股骨颈和髋部的骨质疏松患病风险,分别显著增加4.6~15倍(OR=4.6~15,95%CI:2.6~30),3.2~13倍(OR=3.2~13,95%CI:1.5~36)和3.0~13倍(OR=3.0~13,95%CI:1.3~44)。结论本研究揭示了中老年女性骨转换指标与BMD和骨质疏松患病风险的关系,提示骨转换指标水平变化是中老年女性BMD的重要决定因素,骨形成指标和/或骨吸收指标水平增加者骨质疏松患病率和患病风险大大增加。     

凝溶胶蛋白与绝经后女性股骨颈及腰椎骨密度的相关性研究

目的探讨凝溶胶蛋白(GSN)在绝经后女性血浆中的水平并分析与股骨颈及腰椎骨密度(BMD)的相关性。方法选取我院2015年1月至2019年5月期间在我院正常体检人员。纳入绝经后女性110名。与此同时,在我院体检中心选择非绝经期女性110例。采用Hologic?QDR-4500 DXA骨密度仪测定股骨颈、腰椎(L_1-L_4)的BMD。BMD数据以g/cm~2和T评分表示。T评分-2.5定义为骨质疏松症,T评分在-1～-2.5间定义为骨量减少,T评分-1定义为骨密度正常(正常BMD组)。骨质疏松症或骨量减少定义为低BMD组,骨密度正常定义为正常BMD组。采用酶联免疫吸附试验(ELISA)测定GSN水平。结果绝经后女性年龄、SBP、DBP、TC、FBS高于绝经前女性(P0.05);而股骨颈-BMD、腰椎(L_1-L_4)-BMD、GSN低于绝经前女性(P0.05)。股骨颈-BMD组中,低BMD组的年龄、吸烟比例、TC、FBS、GSN高于正常BMD组(P0.05);而BMI、HDL低于正常BMD组(P0.05)。腰椎(L_1-L_4)-BMD组中,低BMD组的年龄、TC、FBS、GSN高于正常BMD组(P0.05);而BMI、HDL低于正常BMD组(P0.05)。股骨颈-BMD与年龄、吸烟、FBS、pGSN呈负相关(r=-0.435、-0.301、-0.243、-0.609),与HDL、BMI呈正相关(r=0.395、0.365)。腰椎(L_1-L_4)-BMD与年龄、p GSN呈负相关(r=-0.463、-0.433),与BMI呈正相关(r=0.398)。年龄、BMI、GSN是股骨颈-BMD独立影响因素;年龄、GSN是腰椎(L1-L4)-BMD独立影响因素。结论 GSN是股骨颈-BMD、腰椎(L_1-L_4)-BMD的独立影响因素。因此,GSN水平升高可能预测绝经后女性骨质疏松症的发生及进展。     

绝经后活动性类风湿性关节炎患者低骨密度的相关危险因素分析

目的分析绝经后活动性类风湿性关节炎(rheumatoid arthritis,RA)患者出现低骨密度相关的危险因素。方法研究对象为106例患有活动性RA的绝经后妇女,患者按体质量指数(BMI)分组:I组消瘦(18.5～24.9 kg/m~2,n=36),II组超重(25.0～29.9 kg/m~2,n=35),III组肥胖(30.0 kg/m~2,n=35)。检测这些患者的股骨BMD和血清BTM水平:骨钙素(OC)和I型胶原交联C-端肽片段(CTX)和骨桥蛋白(OPN)、抵抗素、高敏C反应蛋白、白细胞介素-6、肿瘤坏死因子(TNF)-a。结果与较瘦的女性相比,肥胖女性的总股骨BMD和总T评分显然更高(P0.05);发现BMD和CTX水平与体重存在显著相关性(P0.05)。调整股骨颈BMD后,BMI与TNF-α水平呈负相关(P0.05)。骨钙素水平与抵抗素呈负相关(P0.05),CTX水平与OPN呈正相关(P0.05);并发现BTM和BMD与其他炎症指标之间的关联。观察到OPN水平与体重、腰围和绝经后时间之间呈负相关性(P0.05)。结论本研究结果表明,体重和OPN、抵抗素和TNF-α在绝经后活动性RA患者的骨密度降低中起重要作用。     

强直性脊柱炎患者骨密度及骨代谢标志物的变化

目的观察强直性脊柱炎(AS)患者骨密度(BMD)及骨代谢标志物的变化。方法 AS组:2013年1月-2015年2月,52例,男40例、女12例,年龄(32.33±13.51)岁;健康对照组:50例,男38例、女12例,年龄(31.52±11.87)岁。检测双股骨颈、腰椎1-4BMD与T值;血清骨钙素(BGP)、I型原胶原氨基端前肽(PINP)、I型胶原C-末端肽(CTX);AS组检测C-反应蛋白(CRP)、血沉(ESR),计算病情活动指数(BASDAI)及功能指数(BASFI)。采用t检验与相关分析。结果 (1)AS组男、女性双股骨颈BMD(0.943±0.163,0.940±0.148)低于对照组(1.179±0.142,1.176±0.141);腰椎1-4BMD(1.057±0.179,1.069±0.187)低于对照组(1.199±0.121,1.202±0.166);(2)AS组双股骨颈、腰椎1-4骨质疏松及骨量减少分别是57.69%和61.53%;(3)AS组双股骨颈、腰椎1-4BMD与BASDAI呈负相关性(r=-0.426、-0.478)(P0.05);(4)AS组男、女性BGP含量(13.47±4.36、13.85±3.75)低于对照组(21.57±3.18、20.77±4.19)(P0.05),PINP含量(24.47±3.53、23.66±4.73)低于对照组(32.25±4.33、31.17±3.20)(P0.05),CTX含量(0.80±0.13、0.74±0.17)高于对照组(0.37±0.10、0.37±0.13)(P0.05);(5)AS组BGP与双股骨颈、腰椎1-4BMD呈正相关性(r=0.475、0.431)(P0.05),CTX呈负相关性(r=-0.516、-0.466)(P0.05)。结论 AS患者存在BMD降低,BGP、PINP含量减少,CTX增加,导致骨质疏松,应采取防治措施。     

老年2型糖尿病患者血尿酸水平与骨代谢、骨密度及骨质疏松的关系

目的探讨老年2型糖尿病患者血尿酸水平与骨代谢标志物、骨密度及骨质疏松的相关关系。方法选取2018-2019年于北京大学国际医院内分泌科门诊就诊及住院的年龄60岁以上的老年2型糖尿病患者,共计577人,其中男性289人,女性288人(均为绝经后女性)。对所有研究对象进行一般临床资料调查、生化指标及甲状旁腺素(PTH)、25羟维生素D[25(OH)D]、骨钙素(OC)、血清I型前胶原N-末端前肽(P1NP)、I型胶原交联C-末端肽(β-CTX)测定,计算估算肾小球滤过率(eGFR),双能X线吸收法(DXA)测定股骨颈(FN)及腰椎(L1~4)骨密度(bone mineral density,BMD)。将血尿酸(SUA)四分位法分层比较分析股骨颈及腰椎总BMD变化趋势,Pearson和Spearman相关分析SUA与血钙(Ca)、PTH及OC、P1NP、CTX、25(OH)D、腰椎及股骨颈BMD的关系,多因素Logistic回归分析SUA与骨质疏松的关系。结果SUA第4分组BMI、肌酐(Cr)、股骨颈及总腰椎BMD水平明显高于第1分位组,SUA第4分组eGFR水平明显低于第1分位组,差异具有统计学意义(P<0.05);Pearson相关分析显示SUA与股骨颈BMD(r=0.082,P=0.002)、糖尿病病程(r=0.129,P=0.005)、BMI(r=0.201,P=0.000)正相关,与eGFR负相关(r=-0.434,P=0.000),Spearman相关分析显示SUA与腰椎总BMD(r=0.168,P=0.003)、Ca(r=0.147,P=0.001)正相关,与β-CTX负相关(r=-0.157,P=0.001),与PTH、25(OH)D、OC、P1NP无相关性(P>0.05)。以老年2型糖尿病合并骨质疏松为因变量,多因素Logistic回归显示,调整年龄、eGFR、BMI、HbA1c后,SUA是老年2型糖尿病患者发生骨质疏松的保护因素(P=0.039,OR=0.452,95%CI:0.212~0.962)。结论在老年2型糖尿病患者中,正常偏高的血尿酸水平可能减少骨质疏松的发生风险。     

Relation of axial bone mass to habitual calcium intake and to cortical bone loss in healthy early postmenopausal women

A group of 60 healthy early postmenopausal women participating in an ongoing study on the effect of habitual calcium intake on the rate of cortical bone loss at the radius, were subjected to additional skeletal measurements at the lumbar spine and femoral neck. The women were between 58 and 64 years of age, and 3 to 10 years postmenopausal. No correlations were found between habitual calcium intake (range 560 to 2580 mg/day) and either bone mineral content of the radius, the lumbar spine and the femoral neck, or spine deformity index. Body mass index was found to be positively correlated with bone mass indices of the radius (decrease of BMD and BMD) and femoral neck (BMC), but not with of the lumbar spine (BMC, BMD and SDI), even after adjustments had been made for confounding factors. Although the rate of cortical bone loss at the radius correlated significantly with bone mineral content of lumbar spine and femoral neck, the error in predicting bone mass of the lumbar spine or the femoral neck from longitudinal measurements of cortical bone at the radius was high. The rate of cortical bone loss did not correlate with the spine deformity index. We conclude that in healthy women in early menopause, the bone mineral content of both the appendicular and the axial skeleton are not influenced by habitual calcium intake. A higher body mass index has a protective effect on the appendicular skeleton but appears to be less protective to the axial skeleton. Longitudinal measurements of cortical bone mass are of limited value to predict bone density of the appendicular and axial skeleton.     

Relations between calcidiol serum levels and bone mineral density in postmenopausal women with low bone density

The relationship between vitamin D and bone density was studied in 150 selected, mature (45–74), postmenopausal women with a lumbar spine Z score below 0. Vitamin D status was evaluated using calcidiol serum levels. Serum calcitriol and parathyroid hormone (PTH) values were also evaluated in some subjects. Bone mass was evaluated by ascertaining bone density and Z and T scores in the lumbar spine and femur region. The reference group consisted of 25 premenopausal women. The postmenopausal group was divided into subgroups according to age, i.e., under or over 60 years old. Additionally, the whole group was also subdivided according to their lumbar spine Z scores into group I (Z>-1), group II (Z<-1; >-2), and group III (Z<-2). Group III of postmenopausal women had higher PTH and lower calcitriol levels than premenopausal women. Calcidiol serum levels were lower in postmenopausal women groups II or III than in the group I and premenopausal women. Calcidiol serum levels and the bone mass values for the lumbar spine were correlated positively in all the postmenopausal women; in the women over 60 years of age, calcidiol levels also correlated with the bone mass values expressed as the bone density in three femur regions: femoral neck, trocanter, and Ward's triangle. In conclusion, mature postmenopausal woman showed high PTH levels and low calcidiol and calcitriol values. Calcidiol status is significantly related to bone mineral density in the lumbar spine and in women over 60 years, calcidiol levels also correlated with bone density in the femur regions.     

The relationship between osteoarthritis of the hands,bone mineral density,and osteoporotic fractures in elderly women

To study the relationship between osteoarthritis (OA) and osteoporosis (OP), radiographic osteoarthritis lesions of the hands (HOA) were quantified in 300 healthy women, aged 75 years or more, as a subgroup of a cohort originally recruited for a multi-centre study of risk factors for femoral neck fracture. The HOA combined score (i.e. the sum of the grades of joint-space narrowing, osteophytes, erosions and joint misalignment), the osteophytosis score and the joint-space narrowing score were calculated on a radiograph of both hands. Bone mineral density (BMD) was measured using dual-energy X-ray absortiometry (Lunar DPX) at the femoral neck, Ward's triangle and the total body. BMDs of the total spine, lumbar spine, and the upper and lower limbs were derived from the regional analyses of the total body measurement. Correlations between bone mass, HOA scores and other variables were explored by multiple linear regression and stepwise logistic regression analysis. The HOA combined score was positively correlated with increasing age but not with body mass index. In the multiple regression analyses the HOA combined score positively correlated with BMD at all sites, except the femoral neck and Ward's triangle; the osteophytosis score correlated with BMD at all sites; and no correlation was found between BMD and the joint-space narrowing score. According to stepwise logistic regression and after adjustment of BMD for age, women with an HOA combined score higher than 20 had signficantly higher BMD values at all skeletal sites. Sixty-nine women (23%) reported a history of osteoporotic fracture; among them, 20 (6.6%) reported a history of vertebral fracture. The OA score of both subgroups was significantly lower than that of women with no history of fracture. These data suggest that in elderly women the severity of HOA is positively correlated with bone mass and that women with a high score of HOA more rarely report a history of osteoporotic fracture.     

Impact of degenerative spinal diseases on bone mineral density of the lumbar spine in elderly women

Degenerative diseases of lumbar spine commonly noted in elderly people may affect their lumbar spine bone mineral density (BMD). The aim of this study is to determine whether the degree of degenerative spinal diseases is correlated with lumbar spine and femoral neck BMD. This study included 630 women age 60 years or over (mean age 73.3 ± 6.9 years) visiting the Osteoporosis Outpatient Clinic at the Tokyo Metropolitan Geriatric Medical Center. Subjects underwent anteroposterior and lateral X-rays of the lumbar spine. The score of degenerative spinal diseases for each subject was calculated according to the scores for the Kellgren-Lawrence method, osteophyte formation, bone sclerosis, disk space narrowing, and spondylolisthesis involving L1-L2 through L4-L5 interspaces. Moreover, the number of vertebral fractures at L2 through L4 was recorded. The BMD of the second to fourth lumbar spine from anteroposterior projections and femoral neck were measured using an Expert-5000 (GE Lunar, Madison, WI USA). Most subjects had degenerative diseases of the lumbar spine. Scores for the Kellgren-Lawrence method, osteophyte formation, bone sclerosis, disk space narrowing, and spondylolisthesis were positively correlated with lumbar spine BMD, while they were not correlated with femoral neck BMD. Multiple regression analysis indicated that the scores for osteophyte formation, bone sclerosis, and disk space narrowing were independently correlated with lumbar spine BMD. Thus, in this study, the scores for degenerative spinal diseases were correlated with lumbar spine BMD, while they were not correlated with femoral neck BMD. This discrepancy indicates that degenerative spinal diseases are associated with increased lumbar spine BMD measurements. Femoral neck BMD therefore may be more appropriate than lumbar spine BMD in evaluating osteoporosis in elderly women.