女性随年龄增长不同骨胳部位的骨丢失

Age related bone loss at various skeletal sites in healthy women

目的评价健康女性随增龄，不同骨胳部位的骨丢失。方法用ＤＸＡＱＤＲ４５００Ａ型扇形束骨密度仪测量１６６４例１５～９６岁健康女性不同骨胳部位（腰椎正位和侧位、髋部和前臂）的骨密度（ＢＭＤ）。结果横断面分析显示，绝经时所有部位骨丢失显著（Ｐ＜０．０１～０．００１），其中松质骨占优势的部位（腰椎侧位和Ｗａｒｄ’ｓ三角）丢失最多（－１３％～－１９％，Ｐ＜０．００１）。所有部位绝经１５年内（＜６５岁）及２５年后（≥７５岁）呈快速丢失。预期寿命（≥７２岁）与峰值年龄比较，各部位ＢＭＤ减少３１％～５９％（平均３８．７％±７．７％），Ｗａｒｄ’ｓ区减少最多（－５９％）。骨质疏松（ＯＰ）检出率腰椎侧位（４１％～５８％）、桡骨（４３％～５８％）和Ｗａｒｄ’ｓ区（４６％）较高，腰椎正位（２９％）和股骨颈（１９％）较低。结论绝经早期腰椎侧位是诊断ＯＰ的最敏感部位。不同骨胳部位峰值骨量的变异度较高，致绝经后ＯＰ检出率随测量部位不同而显示较大差异。

Objective To evaluate the age related bone loss at various skeletal sites in healthy women. Methods Bone mineral density (BMD) at various skeletal sites spine anteroposterior (AP) and lateral (LAT) , hip, and forearm was measured by DXA with a QDR 4500A fan beam bone densitometer in 1664 healthy women, 15 to 96 years of age. Results Cross sectional analysis indicated that a significant apparent bone loss was found at the time of menopause at all skeletal sites (P<0.01 to P<0.001), the amount being highest in cancellous bone rich sites, i.e., LAT spine and Ward's triangle (-13% to -19%, P<0.001). Apparent bone loss was accelerated within the 15 years following menopause (age<65 years), continued thereafter at all sites with a relatively slow speed, and was then again accelerated in those elderly women more than 25 years post menopause (age≥75 years). Comparison of BMD between peak age and expected average life of women in China (age≥72 years), BMD decreased by 31% to 59% (mean±SD, 31.7%±7.7%) depending on the site examined, and the decrease was highest at the Ward's triangle (-59%). The percentages of postmenopausal women classified as osteoporotic according to the World Heath Organization criteria were higher at the lateral spine (41% to 58%), radius (43% to 58%) and Ward's triangle (46%), and lower at the AP spine (29%) and femoral neck (19%). Conclusion The lateral spine is most sensitive for diagnosis of osteoporosis among all the skeletal sites in the early postmenopausal women. Owing to the high variability of the peak bone mass at different skeletal sites, the percentage of postmenopausal women identified as being osteoporotic varies widely with the sites of measurement.