上海地区绝经后妇女骨质疏松症危险因素流行病学研究

Epidemiologic studies on the risk factors for osteoporosis in postmenopausal women in Shanghai area

目的通过绝经后骨质疏松症的分布特征和易发因素相关性分析，探讨绝经后骨质疏松症的病因机理和危险因素。方法选取社区50～69岁绝经1年以上妇女，以问卷调查，结合DXA测量BMD值，以及血清1α，25（OH）2D3等骨代谢指标测定，分析与骨丢失的相关性。结果骨质疏松症的发生率随增龄和绝经年限的延长而上升，绝经年龄早、生育胎数多、哺乳时间长是低骨量的重要危险因素，而使用雌激素、长期饮用牛奶、维持一定体重对骨量值有保护作用。此外，绝经后OP妇女的血清1α，25（OH）2D3和25（OH）D3含量均明显低于非OP妇女，血清1α，25（OH）2D3含量与BMD值呈高度相关（r=0．693，P〈0．01）。骨代谢相关指标分析表明，绝经后OP表现为高骨转换型，维生素D与PTH状态，以及DPD／Cr等均是评价绝经后OP患者的重要指标。结论妇女绝经后有一个快速的骨丢失过程，而血清1α，25（OH）2D3水平的低下是绝经后骨量丢失的一个重要原因。为维护骨骼健康，应维持其底物25（OH）D3在正常范围内。

Objective The aims of the study were to determine the distribution of osteoporosis in postmenopausal women and to clarify the correlations between the risk factors and bone loss in postmenopausal women, in order to reveal the possible pathology and risk factors. Methods Postmenopausal women who were 50 - 69 years old and large than one year since menopause were selected randomly and invited to participate in the studies. All subjects participating in the study completed a questionnaire and bone mineral density was measured by DXA. Meanwhile, to study the mechanism of postmenopausal osteoporosis, the biochemical markers in serum and urinary were measured for women suffering from osteoporosis and for healthy women. And the correlations between the biochemical markers and BMD were analyzed. Results The present study showed that in postmenopausal women, the BMD declined with increasing age and YSM （Year Since Menopause）. Multiple factor analysis showed that early menopause, more pregnancies and longer breastfeeding time were evaluated as risk factors for low bone mass or increased bone loss in postmenopausal women, while an adequate intake of milk, usage of estrogen and higher body weight would reduce the osteoporosis risk. Meanwhile, it could be concluded that the level of serum 1α,25 （OH）2 D3 and 25 （OH）D3 in osteoporotic women were greatly lower than that in no osteoporotic women. The fact that the levels of 1α,25 （OH）2D3 were correlated positively with BMD in postmenopausal women revealed that lower levels of 1α,25（OH）2D3 could be a significant risk factor associated with fast rate of bone loss. The studies on the biochemical markers indicated that the level of vitamin D metabolism, PTH and DPD/Cr could have good value for predicting rapid bone loss in postmenopausal women. Conclusion A rapid bone loss was associated with meno- pause and increasing age. Otherwise, low levels of serum 1α,25 （OH）2 D3 were significantly associated with fast rate of bone loss in postmenopausal women. And for optimal bone health, postmenopausal women should maintain 25（OH） D3 within normal range.