健康和骨折女性骨矿密度及其骨折阈值的测定

Determination of bone mineral density and threshold of fracture in healthy and fractured women

目的初步确定天津市女性骨矿密度（ＢＭＤ）正常参考值范围，探讨骨质疏松的诊断标准及骨折危险阈值。方法用双能Ｘ线吸收法（ＤＥＸＡ）对４５２例健康女性和５５例绝经后骨折患者ＢＭＤ进行测定。结果腰椎２～４、股骨和全身ＢＭＤ峰值分别在３０～３９、２０～２９和４０～４９岁。ＢＭＤ与年龄、绝经年限呈负相关（均为Ｐ＜０．０１），以绝经后最初５年的降低率最高；ＢＭＤ与身高呈正相关，６０岁以上妇女的体重和脂肪量与各部位ＢＭＤ呈正相关（Ｐ＜０．０５或０．０１）。以２０～４０岁女性腰椎ＢＭＤ均值减２．５标准差（ｓ）为界限值（０．８３ｇ／ｃｍ２），５５例骨折患者中４６例（８３．６％）腰椎ＢＭＤ低于界限值。结论该界限值作为女性骨质疏松诊断标准和脊椎骨折危险阈值可能较为合理。

Objective To define preliminarily normal reference range of bone mineral density (BMD) in Tianjin females and probe into the criterion of diagnosis and the threshold of fracture risk for osteoporosis. Methods BMD of the lumbar 2 4;femur and total body skeleton was measured by dual energy X ray absorptiometry (DEXA) in 452 healthy women and 55 women with spine fracture after menopause. Results The peak BMD of spine, femur and tatol body skeleton was observed at aged the fourth, third and fifth decade respectively. BMD was negatively related to age ( P <0 01). In healthy postmenopausal women, BMD levels of all sites were diminished along with duration after menopause in a negative relationship ( P <0 01), and this was significant within the first five years after menopause. There was a positive correlation between BMD of each site and body weight in all women, but similar correlation between BMD and body weight or fat mass only in women aged 60 and over ( P <0 05 or 0 01). Taken the mean value of spine BMD of young females aged 20 40 years minus 2 5 standard deviation ( s ) (0 83g/cm 2) as a cutoff value, the spine BMD of 46 women with fracture (83%) were lower than that. Conclusions It is reasonable to take the cutoff value as a criterion of diagnosis or the threshold of spine fracture risk for osteoporosis in women.