三种不同时期妇女骨密度测量值研究分析

目的:调查具有正常生育能力、围绝经期和绝经早期妇女骨密度(BMD)测量值和身体成分的变化,分析身体成分对BMD的影响。方法:采用韩国Osteo Sys公司生产的EXA-3000型前臂双能X线骨密度测定器,检测在体检中心健康体检者非惯用手前臂远端BMD,对300例围绝经期妇女、300例绝经早期妇女和300例正常生育妇女进行BMD测量,记录身高、体重及体质量指数(BMI)。结果:围绝经期和绝经早期妇女的体质量、BMI和BMD均低于对照组。结论:低体重是绝经后妇女发生骨质疏松(OP)的重要危险因素之一;骨量流失从围绝经期开始,绝经后骨质疏松防治工作应及早实施。     

北京地区围绝经期妇女骨质疏松流行病学调查与分析

目的了解北京地区围绝经期妇女骨密度(BMD)水平以及骨质疏松(OP)的患病率,分析影响OP的有关因素,评价OP的单光子筛查方法.方法采用分层整群概率比率的方法在北京地区抽取10个群体,对2 429名40～65岁围绝经期妇女进行问卷调查和BMD测定.结果(1)OP患病率为37.9%.50岁以上各年龄组患病率明显高于40岁组(P＜0.001).城市妇女OP患病率明显高于农村妇女(P＜0.001).(2)绝经组BMD均值为0.591±0.110,未绝经组BMD均值为0.702±0.100(P＜0.001).(3)骨折发生率为5.9%.骨折好发部位依次为下肢、手腕、腰椎.(4)与BMD呈显著正相关的因素有生育年龄、体重、喝牛奶、锻炼、居住地农村.呈显著负相关的因素有年龄、生育次数、哺乳时间、吸烟等.(5)单光子筛查方法的灵敏度为83.3%,特异度为70.7%.结论围绝经期妇女BMD变化的原因主要是受年龄、绝经因素的影响.预防OP应提倡加强锻炼、不吸烟,妊娠期和哺乳期每日喝牛奶等.研究提示测量BMD有助于预测骨折发生的危险性.单光子骨密度测定适于在患OP的高危人群中作为筛查方法.     

妇女骨密度与雌激素变化的关系

妇女经历不同的生理阶段,体内性激素会发生很大变化,从而影响人体生理代谢系统.我们于1998年测定了217例包括绝经前、围绝经期及绝经后妇女的3种性激素与腰椎、桡骨的骨密度(BMD),旨在探讨妇女性激素变化对骨密度的影响及其相互关系.现将结果报道如下.     

148例围绝经期妇女双能X线骨密度结果分析

目的:探讨围绝经期妇女年龄、月经情况、身高、体重与骨密度(BMD)的关系,筛选绝经后骨质疏松症的高危人群。方法:随机选取148例2004年9～11月青岛市部分金融系统女职员健康查体中的围绝经期(40～60岁)妇女,加查双能X线BMD(已筛除影响骨代谢性疾病如糖尿病、甲亢等及药物因素,如性激素补充),将BMD测定结果与其年龄、月经情况、体重、身高进行相关分析。结果:148例围绝经期妇女平均腰椎低骨量发生率为26.35%。50～60岁妇女腰椎低骨量发生率为48.44%,明显高于40～50岁妇女(9.52%);绝经者腰椎低骨量发生率为61.70%,明显高于未绝经者(9.90%);体重低于60kg者腰椎低骨量发生率为36.92%,高于体重在60kg以上者(18.07%);身高在160cm以下者腰椎低骨量发生率为44.12%,高于身高在160cm以上者(21.05%),其差异均有统计学意义;年龄、绝经与否、身高、体重与左髋部BMDt值无相关性。结论:围绝经期妇女腰椎低骨量发生率与绝经、年龄及其身高体重有关,绝经、年龄50岁以上、体重60kg以下、身高160cm以下的妇女是发生绝经后骨质疏松症的高危人群。     

北京地区围绝经期妇女骨质疏松流行病学调查与分析

目的 :了解北京地区围绝经期妇女骨密度 (BMD)水平以及骨质疏松 (OP)的患病率 ,分析影响 OP的有关因素 ,评价 OP的单光子筛查方法。方法 :采用分层整群概率比率的方法在北京地区抽取 10个群体 ,对 2 4 2 9名 4 0～ 6 5岁围绝经期妇女进行问卷调查和 BMD测定。结果 :(1) OP患病率为 37.9%。 5 0岁以上各年龄组患病率明显高于 4 0岁组 (P<0 .0 0 1)。城市妇女 OP患病率明显高于农村妇女 (P<0 .0 0 1)。 (2 )绝经组 BMD均值为 0 .5 91± 0 .110 ,未绝经组 BMD均值为 0 .70 2± 0 .10 0 (P<0 .0 0 1)。(3)骨折发生率为 5 .9%。骨折好发部位依次为下肢、手腕、腰椎。 (4 )与 BMD呈显著正相关的因素有 :生育年龄、体重、喝牛奶、锻炼、居住地农村。呈显著负相关的因素有 :年龄、生育次数、哺乳时间、吸烟等。 (5 )单光子筛查方法的灵敏度为 83.3% ,特异度为70 .7%。结论 :围绝经期妇女 BMD变化的原因主要是受年龄、绝经因素的影响。预防 OP应提倡加强锻炼、不吸烟 ,妊娠期和哺乳期每日喝牛奶等。研究提示测量 BMD有助于预测骨折发生的危险性。单光子骨密度测定适于在患 OP的高危人群中作为筛查方法。     

围绝经期女性血清雌二醇及卵泡刺激素变化规律及其与腰椎、髋部和股骨颈骨密度的关系

目的探索围绝经期女性血清雌二醇(E2)、卵泡刺激素(FSH)变化规律与其腰椎、髋部、股骨颈骨密度(BMD)的关系。方法选取2014年1月-2015年1月在该院进行体检的围绝经期妇女440例为研究对象,分为绝经前组(220例)和绝经后组(220例)。测定两组血清E2、FSH水平及其腰椎、髋部、股骨颈BMD值,并进行组间比较。结果绝经后组妇女血清E2与绝经前组比较明显减少,而血清FSH与绝经前组比较明显增加,差异均有统计学意义(P0.05)。绝经后组妇女腰椎、髋部、股骨颈BMD值与绝经前组比较均有明显减少,组间差异均有统计学意义(P0.05)。绝经前低骨量组和绝经后低骨量组血清E2水平均较正常骨量组明显减少,而血清FSH水平均较正常骨量组明显增加,差异均有统计学意义(P0.05)。血清E2水平与腰椎BMD、髋部BMD、股骨颈BMD均呈正相关关系(P0.05);血清FSH水平与腰椎BMD、髋部BMD、股骨颈BMD均呈负相关关系(P0.05)。结论绝经后女性BMD明显减少,雌激素水平变化可能影响骨代谢,应引起临床的高度关注。     

社区围绝经期妇女健康状况分析

为了解社区围绝经期妇女的健康状况和行为状况 ,以便有针对性地对她们进行健康教育和健康干预 ,从1997～ 2 0 0 0年 ,对自愿接受调查随访和健康检查的社区围绝经期妇女每年进行问卷调查和健康检查。结果显示 :35 8名围绝经期妇女中 ,绝经者占 16 .48% ,平均绝经年龄为 48.79岁 ;绝经后妇女的性生活质量明显下降 ;围绝经期妇女的健康状况和行为状况在各年龄段之间有很大差异 ;身高和体重的变化在各年龄段的分布差异明显 ;户外活动和体育锻炼对身高和体重的变化有显著影响 ;围绝经期妇女骨质疏松症的发生率为 2 5 .42 % ,绝经后的妇女骨质疏松症的发生明显高于未绝经期妇女 ;高血压、乳房疾病和妇科疾病在围绝经期妇女中占有相当比例 ,且在各年龄段的分布也有显著差异。提示部分围绝经期妇女的保健意识不强 ,保健知识贫乏。因此要加强围绝经期妇女的健康教育。     

围绝经期及绝经与性功能障碍

女性进入围绝经期及绝经后性功能障碍明显增加,绝经与性功能障碍的关系一直未明确.目前认为是多种因素的结果,神经内分泌因素、血管因素、社会心理因素均与之有一定的关系.近来研究发现,雌、雄激素水平下降是围绝经期及绝经妇女性功能障碍的主要原因之一;除传统治疗外,应用激素补充治疗能有效改善围绝经期及绝经妇女的性功能,提高性生活质量.     

妇女围绝经期综合征发生率及相关因素的调查

[目的]了解妇女围绝经期综合征发生率及相关因素,为制定干预措施提供依据。[方法]对自愿接受调查的围绝经期妇女256人进行问卷调查,资料由Epilnfo 5.0和SPSS软件包处理。[结果]256名围绝经期妇女中,已绝经者35.6%,未绝经者64.5%,有围绝经期症状者65.6%;围绝经期综合征的发生与年龄、文化程度有关(P<0.05)。更年期症状改良Kupperman评分13项症状中发生频率较高的依次为:失眠36.3%、易激动29.8%、心悸25.0%、头痛22.0%、性生活质量下降17.9%。围绝经期妇女性生活质量与是否有更年期症状、绝经时间长短和更年期症状程度相关。回归方程:Y=-1.777-0.847绝经时间 2.278症状评分,与更年期症状程度呈正相关,与绝经时间呈负相关。[结论]围绝经期综合症的不同症候群的发生及其程度与女性的年龄和文化程度相关。     

围绝经期及绝经后妇女健康问卷分析

目的:了解围绝经期和绝经后妇女身心健康状况。方法:采用妇女健康问卷表,对161例围绝经期妇女(围绝经期组)和163例绝经后妇女(绝经后组)从身体状况、自我意识、血管运动、焦虑、性生活、睡眠共6个因素、35个项目,进行量化问卷调查分析。结果:围绝经期妇女症状出现率为100.0%,绝经后为96.20%,围绝经期性生活问题出现率显著高于绝经后期(P<0.05),绝经后血管运动评分显著高于围绝经期组(P<0.05),各项评分在工人与干部组间无明显差异(P>0.05),围绝经期组小学-文盲文化层次焦虑评分显著高于中学、大专-大学层次(P<0.05)。结论:围绝经期和绝经后妇女普遍存在生理和心理不适,在围绝经期以性生活障碍较为常见,绝经后以血管运动失调为主,低文化层次妇女对围绝经症状出现较强的焦虑情绪,但不同职业对围绝经期症状无明显影响。     

Vasomotor symptoms are not associated with reduced bone mass in postmenopausal women: the Rancho Bernardo Study

The association of menopause-related vasomotor symptoms with later bone mineral density (BMD) at axial and appendicular sites was examined in community-dwelling older women. Subjects were 894 postmenopausal women from the Rancho Bernardo Study who had BMD measured in 1988-1991 and responded to a 1989 mailed survey that included questions about menopause symptoms. Mean age was 73 years (SE +/- 9.5, range 47-97), and mean age at menopause was 47 years (SD +/- 6.8, range 21-62). Vasomotor symptoms were recalled by two thirds (68%) and night sweats by 36% of all women, with no significant differences in symptom frequency by age or type of menopause. Postmenopausal estrogen (PME) had been used by 644 women (72%) for an average duration of 12.3 (+/-11) years. Among women who reported current estrogen use with a duration >3 years, those who experienced vasomotor symptoms had significantly higher BMD at the lumbar spine (p = 0.01), femoral neck (p = 0.05) and midshaft radius (p = 0.05) compared with women who did not experience symptoms. Vasomotor symptoms were not associated with BMD among past or never PME users or among women who reported current PME use for 3 or fewer years. Analyses stratified by age, type of menopause, or when PME use began showed similar results. Women who reported night sweats also had no difference in BMD compared with women without night sweats. In conclusion, vasomotor symptoms are not a marker for low BMD years after menopause in women with access to healthcare. Vasomotor symptoms significantly increased the likelihood of continued use of PME, which was in turn associated with higher BMD levels.     

Menopause, menstrual and reproductive history, and bone density in northern Italy.

STUDY OBJECTIVE: To analyse the relationship between menstrual and reproductive factors and the risk of low bone mineral density (BMD). DESIGN: This was a population based screening programme carried out between 1991 and 1993 among 1373 perimenopausal women in northern Italy by means of dual photon absorptiometry at the lumbar spine. MAIN RESULTS: BMD was strongly related to the age at menopause. In comparison with women reporting menopause below 45 years of age, the odds ratios (OR) of being in the lowest compared with the highest BMD tertile were 0.7 (95% confidence interval (CI) 0.3,1.5) and 0.3 (95% CI 0.1,0.8), respectively, in those with menopause at age 45-49 and above 50 years: the trend in risk was significant. Likewise, the risk of being in the lowest tertile increased with years since the menopause. Compared with women who reported they had undergone the menopause less than two years before interview, the OR of being in the lowest BMD tertile were 2.1 (95% CI 1.1,4.3), 2.3 (95% CI 1.1, 5.0), and 5.7 (95% CI 2.5,12.9) respectively in women who reported menopause 2-5, 6-9, and > or = 10 years earlier. The protective effect on bone density of late age at menopause was observed in different strata of years since menopause. Likewise, the increasing risk of a low BMD with increasing years since the menopause was evident in strata of different age at menopause. No relationships were observed between BMD and the age at menarche, characteristics of menstrual cycles, and the duration of menses. Likewise, no association emerged between reproductive history, including parity and age at first pregnancy, and BMD. CONCLUSIONS: In this Italian population the risk of being in the lowest BMD tertile decreased with increasing age at menopause and increased with years since menopause. No relationships emerged between BMD and other menstrual characteristics or reproductive factors.     

Reproductive factors influencing bone mineral density in postmenopausal women

This study examined the relationship between reproductive characteristics and bone mineral density (BMD) in postmenopausal women who had been referred to the menopause clinics of the National Population and Family Development Board and of the Hospital Kuala Lumpur from July 2011 to January 2012. The participants of this study were 201 postmenopausal Malaysian women aged 45–71 years. Some socio-demographic, lifestyle, and reproductive factors were recorded. Calcaneal BMD was measured by quantitative ultra-sonography. Correlations of reproductive factors with BMD were assessed by Pearson’s correlation test and multiple regression analysis. Age at menopause was not significantly correlated with BMD, while the years after menopause, age at the first menstrual period, number of pregnancies, and total lactation periods were inversely correlated with it. Among reproductive factors, only the association between lactation duration and BMD remained significant after adjusting for age, body mass index, activity, and calcium intake. The results indicated that except for prolonged total time of lactation, other reproductive factors were not significantly associated with BMD in postmenopausal women.     

A review of bone mineral density scans referred by a community-based menopause clinic in 1997

Osteoporosis is a growing public health issue for the UK's ageing population. Many older women want know if they are at risk of osteoporosis and if preventive treatment, particularly in the form of hormone replacement therapy (HRT), would be advisable. This results in many women being referred for bone mineral density (BMD) scanning, whether or not they have recognised risk factors for osteoporosis. We present the results of a review of 228 referrals for BMD scan from a community-based menopause clinic. The results are categorised by the indications for the scan. The implications for the future of BMD investigations are considered in the light of ongoing discussion about population screening.     

Long-term assessment of forearm bone mineral density in postmenopausal former users of depot medroxyprogesterone acetate

Background

There are many controversies on the association between depot medroxyprogesterone acetate (DMPA) and bone mineral density (BMD). This study reevaluated BMD in postmenopausal women who had used DMPA as a contraceptive until they reached menopause and compared them with non-users. BMD had previously been measured in these women either at 1 year or 2–3 years after menopause and was reassessed in these women 2 years later. Therefore, comparisons were made between the first and third years and between the second to third and fourth to fifth years after menopause.

Study Design

BMD was reevaluated using dual-energy X-ray absorptiometry at two parts of the non-dominant forearm up to 5 years after menopause in 79 women between 46 and 61 years old: 24 former DMPA users and 55 former copper intrauterine device (IUD) users.

Results

With respect to the former DMPA users, only the BMD measurement at the distal radius in the first year (mean±SEM, 0.425±0.017) was significantly higher than the third-year measurement (0.406±0.017) (p<.015). No significant differences were found at the ultradistal radius. There were no significant differences between the groups of former DMPA and IUD users with respect to BMD measurements either at the distal radius or at the ultradistal radius. There was a direct relationship between higher body mass index (kg/m²) and higher BMD at the distal radius between the first and third years. At the ultradistal radius, there was an indirect relationship between older age and lower BMD between the first and third years in both groups.

Conclusions

No statistically significant differences were found in forearm BMD measurements between postmenopausal women who had been long-term users of DMPA and those who had been long-term users of an IUD until menopause. Evaluation of BMD after the menopause showed slightly higher values in former DMPA users compared with non-users.     

Forearm bone mineral density in postmenopausal former users of depot medroxyprogesterone acetate

Background

The aim of the study was to compare the bone mineral density (BMD) of postmenopausal women who had used depot-medroxyprogesterone acetate (DMPA) or a copper intrauterine device (IUD) as a comparison group until menopause.

Study Design

BMD was measured using dual-energy X-ray absorptiometry at the nondominant forearm for up to 3 years following menopause in 135 women aged 43-58 years: 36 former DMPA users and 99 former IUD users.

Results

Mean duration of use was (mean±SEM) 9.4±3.8 and 14.7±6.2 years for the DMPA and IUD groups, respectively. One year after menopause, mean distal radius BMD was 0.435 and 0.449 in DMPA and IUD users, respectively, and 0.426 and 0.447 at 2-3 years following menopause. Ultra-distal BMD was 0.369 and 0.384 in DMPA and IUD users, respectively, at 1 year, and 0.340 and 0.383 at 2-3 years.

Conclusions

At 1 and 2-3 years following menopause, no significant differences were observed in the BMD of postmenopausal women aged 43-58 years, who had used DMPA or an IUD until menopause.     

基因多态性及环境因素与绝经后妇女骨密度的相关性研究

目的探讨雌激素受体(ER)基因多态性、维生素D受体(VDR)基因多态性以及环境因素与绝经后农村妇女的骨密度(BMD)的关系。方法随机抽取武汉农村绝经后妇女90名,汉族,年龄在45~65岁,应用问卷调查了解膳食摄入及户外活动情况;采用双能X线吸收仪(DXEA)测量腰椎及髋部的BMD;应用多聚酶联反应-限制性片断长度多态性(PCR-RFLP)检测ER和VDR的多态性。结果ER的Px单倍体型对各部位BMD均无显著性影响。VDR的BsmⅠ酶切位点多态性会影响腰椎的骨密度,Bb型的BMD比bb型要低,差异有显著性(P<0·05),但调整了年龄、体重、身高和膳食后,差异未见显著性。当联合研究ER和VDR基因多态性时,发现Px单倍体型同时伴有Bb的基因型的BMD最低,差异有显著性(P<0·05),调整年龄、体重、身高和膳食后,差异未见显著性。膳食钙、蛋白质、碳水化合物及能量与BMD简单相关;多元回归分析发现年龄(负相关)和体重(正相关)是绝经后妇女骨密度的最重要的预测因子,另外,与腰椎相关的因素还有绝经年龄及碳水化合物的摄入量;与股骨颈相关的因素还有绝经年龄。结论绝经后妇女BMD与ER的Px单倍体型未显示相关,与VDR的BsmI多态性可能相关,但环境因素会影响基因型与BMD的相关性。     

Dietary iron positively influences bone mineral density in postmenopausal women on hormone replacement therapy

The associations of dietary intakes of iron and calcium on change in bone mineral density (BMD) were examined over 1 y in healthy nonsmoking postmenopausal women (mean age 55.6 +/- 4.6 y) stratified by hormone replacement therapy (HRT) use (HRT, n = 116; no HRT, n = 112). BMD was measured at lumbar spine L(2)-L(4), trochanter, femur neck, Ward's triangle, and total body using dual-energy X-ray absorptiometry at baseline and 1 y. Mean nutrient intakes were assessed using 8-d diet records. All women received 800 mg/d of supplemental elemental calcium. Regression analyses examined the effects of iron and calcium intakes on BMD change adjusting for years past menopause, baseline BMD, weight change, exercise, and energy intake. The interaction of iron with calcium on BMD change was assessed using tertiles of iron and calcium intake and estimated marginal mean change in BMD. Iron was associated (P < or = 0.05) with greater positive BMD change at the trochanter and Ward's triangle in women using HRT. Calcium was associated (P < or = 0.05) with BMD change at the trochanter and femur neck for women not using HRT. In women using HRT in the lowest tertile of calcium intake, change in femur neck BMD increased linearly as iron intake increased. In women not using HRT, BMD increased in the women in the highest tertile of calcium intake. We conclude that HRT use appears to influence the associations of iron and calcium on change in BMD.     

Pre-menopausal simple hysterectomy and post-menopausal female bone mineral density

This study aimed to evaluate the bone mineral density (BMD) of post-menopausal women with previous pre-menopausal hysterectomy including bilateral ovarian conservation compared to a group of non-hysterectomized women with natural menopause. Data from a cross-sectional study of 30 pre-menopausally hysterectomized women evaluated in the post-menopause were compared with 102 naturally post-menopausal women, analyzing their respective bone densitometry, measuring the femoral and lumbar spinal BMD. Multiple regression analysis of the 132 women showed that age and body mass index (BMI) were heavily associated with femoral and lumbar spinal BMD, BMI directly associated, and age inversely associated with BMD. In addition, 30 hysterectomized women were matched by age and BMI to the 30 non-hysterectomized women, and bone densitometry did not show significant differences in BMD. These findings suggest that pre-menopausal hysterectomy with bilateral ovarian conservation does not appear to cause an additional reduction in bone mass when evaluated in the post-menopausal phase.