初潮及绝经年龄等因素与绝经后骨质疏松症发病的关系

Relationship between the age of menarche,menopause and other factors and postmenopause osteoporosis

目的探讨初潮年龄和绝经年龄、生育次数及哺乳时间与绝经后骨质疏松症发病的关系. 方法 1999年5月至2003年4月,对已绝经的1472 例妇女进行骨密度测定,并对不同月经初潮年龄、绝经年龄、生育次数及哺乳时间妇女的骨质疏松症发生率及骨密度进行分析比较.骨质疏松症的诊断标准为骨密度值低于或等于正常年轻妇女平均骨密度峰值减去2.5个标准差.结果 1472 例中,共发生骨质疏松症861例,发生率为58.5%.其中绝经年限为1～10年、初潮年龄≥17岁者336例,发生骨质疏松症119例(35.4%);初潮年龄≤13岁者276例,发生骨质疏松症75例(27.2%).1472例妇女中,初潮年龄11～13岁者,腰椎骨密度为(0.83±0.16)g/cm2;14～16岁者为(0.82±0.16)g/cm2;17～19岁者为(0.80±0.14) g/cm2;初潮年龄11～13岁者与17～19岁者比较,差异有统计学意义(P<0.05).1472例妇女中,年龄为55～65岁、绝经年龄≤48岁者156例,发生骨质疏松症98例(62.8%);绝经年龄≥54岁者80例,发生骨质疏松症33例(41.3%),两者比较,差异有统计学意义(P<0.01).1472例妇女中,生育次数≥4次者225例,腰椎、大转子及Ward三角区骨密度分别为(0.76±0.16)、(0.49±0.10)及(0.38±0.19)g/cm2;生育次数≤1次者475例,分别为(0.85±0.15)、(0.57±0.10)及(0. 52±0.11)g/cm2,两者各部位骨密度比较,差异均有统计学意义(P<0.05).1472例妇女中,哺乳时间≥36个月者249例,腰椎、Ward三角区骨密度分别为(0.76±0.16)及(0.40±0.10)g/m2;哺乳时间≤6个月者418例分别为(0.83±0.17)及(0.48±0.12)g/m2,两者各部位骨密度比较,差异均有统计学意义(P<0.05). 结论月经初潮时间晚及绝经时间早的妇女,骨质疏松症的发生率高;生育次数多,哺乳时间长的妇女的骨密度低于生育次数少、哺乳时间短的妇女.

Objective To evaluate the relationship between osteoporosis （OP） and the age of menarche and menopause, parity and lactation and bone mineral density （ BMD）. Methods BMD was measured in 1472 postmenopausal women by Norland XR-36 dual energy X-ray absorptiometry（DXA） from May 1999 to April 2003 in our hospital. All data of BMD were compared and statistically analyzed between women with different age of menarche and menopause, parity and lactation period. The diagnostic criteria of osteoporosis was defined by a loss of BMD greater than 2. 5 standard deviations below average peak BMD of young adult women. Results In all 1472 subjects, the incidence of osteoporsis is 58.5% （861/1472）. There was significant increase in osteoporosis of lumbar spine in women with the age of menarche ≥ 17 （ 119 out of 336 cases were with osteoporosis in lumbar）compared with women with age of menarche ≤ 13 （75 out of 276 cases were with osteoporosis in lumbar）. In women with menarche age of 11 - 13,14 - 16, 17 - 19, lumbar vertebral （ L2-4 ） BMD values were （ 0. 83 ± 0. 16 ）, （ 0. 82 ± 0. 16 ）, （ 0. 80 ± 0. 14 ） g/cm^2, respectively. There was significant increase in BMD of lumbar in the menarche age group of 11 - 13 compared with the age group of 17 - 19 in women within menopause 1 - 10 years （ P 〈 0. 05 ）. Among all women aged between 55 - 65, there was significant increase in OP in women with the menopause age ≤48 compared with menopause age ≥ 54 （ P 〈 0. 01 ） . BMD of the L2-4, Trochanter, Ward triangle was significantly increased in women who had had one delivery or being nulliparous compared with women having more than four deliveries ; BMD of the L2-4 , Ward ＇s triangle were significantly increased in women with less than six months of lactation compared with those lactating more than thirty-six months. Conclusions The later the menarche and the earlier the menopause, the higher the degree of osteoporosis; the more deliveries and period of lactation, the lower the BMD. Age is one of the high risk factors of osteoporosis.