70岁以上老年骨质疏松症DEXA诊断检查部位的选择探讨

目的:探讨70岁以上老年骨质疏松症(osteoporsis,OP)用双能X线骨密度仪(dual energy x-ray absorptiometry,DEXA)诊断检查时,测定部位的不同是否造成漏诊。方法:应用DEXA测定了50例70岁以上临床上有明显的骨质疏松症状者(有症状组)以及50例70岁以上无临床症状的健康体检者(无症状组),对同一检查对象同时测定腰椎(L2-4)正位及左股骨(total)、股骨颈(neck)的骨密度(bone mineral density,BMD),并比较两组不同部位OP的检出率。结果:50例有症状组腰椎(L2-4)测出OP31例(62%),股骨(total)和股骨颈(neck)共测出OP45例(90%)(t=10.638,P<0.01);,50例无症状组腰椎(L2-4)测出OP20例(40%),股骨(total)和股骨颈(neck)共测出OP38例(76%)(t=13.16,P<0.01);结论:70岁以上老年人临床上无论是否合并明显的OP症状,用DEXA诊断检查时,测定部位的不同可能对OP的诊断有影响,髋部OP检出率高于腰椎,最好是同时测定腰椎和髋部的BMD,以防造成漏诊。

Validation of quantitative computed tomography-derived areal bone mineral density with dual energy X-ray absorptiometry in an elderly Chinese population

Background The performance of computed tomography X-ray absorptiometry （CTXA） against the dual energy X-ray absorptiometry （DXA） as standard has not been studied in Chinese population. The aim of this study was to evaluate the precision of this measurement and validate the value of quantitative computed tomography （QCT） by comparing CTXA results with DXA results in an elderly Chinese population. Methods One hundred and three females of 46 to 76 years old and 49 males of 52 to 76 years old were recruited from the Prospective Urban Rural Epidemiology study. All subjects underwent hip scans by both QCT and DXA on the same day. For precision determination, 30 subjects had duplicate DXA hip scans. The hip QCT data of a subset of 27 subjects were separately analyzed by two observers and reanalyzed by one observer at a different time. The inter- and intra-observer variations of CTXA measurement were assessed, and the difference and correlation between CTXA and DXA results were analyzed. Results The inter- and intra-observer variations of CTXA were 0.070 and 0.024 g/cm^2 in the femoral neck （FN）, and 0.030 and 0.012 g/cm2 in the total hip （TH）, which were comparable to the DXA inter-scan variations （0.013 g/cm2 for FN and 0.014 g/cm2 for TH）. The results of CTXA bone mineral density （BMD） were highly correlated with those of DXA （R2 = 0.810 for FN and R2 = 0.878 for TH）. The BMD values of CTXA in FN and TH were lower than those of DXA by 21.0% and 17.8% （P〈0.05）, respectively. However, after appropriate transformation, the difference was eliminated and a comparable T score could be obtained. Conclusions CTXA shows good agreement with DXA for the measurement of BMD in the proximal femur, which makes QCT suitable for the quantification of bone mineral content in the hip and helpful for the diagnosis of osteoporosis.

双能X线吸收法腰椎侧位骨密度测定的临床研究

目的评价双能X线吸收法测定腰椎骨密度时侧位的临床价值。方法178例女性患者(按年龄分组)接受腰椎后前位和侧位骨密度测定,以BMD表示骨密度值,以T值为标准判断骨量正常、骨量减少和骨质疏松,评价腰椎后前位与侧位T值对骨量减少程度的判断和骨质疏松诊断的差别。结果①各年龄组患者腰椎后前位BMD值均高于侧位值;②各年龄组患者腰椎后前位及侧位T值对骨量减少程度的判断有显著性差别;③当大于50岁时,腰椎后前位及侧位T值对骨质疏松诊断有显著性差别。结论腰椎侧位对女性患者骨量减少程度的判断和骨质疏松的诊断(>50岁)都有一定临床价值。

腰椎侧位骨密度测定的应用价值研究

目的 :观察应用双能X线测定腰椎椎体骨密度时正位和侧位结果的差别 ,探讨腰椎侧位测定骨密度辅助诊断骨质疏松症的价值。方法 :以 16 6名平均年龄为 6 4 .7岁的老年女性骨质疏松症患者为对象 ,测试其腰椎骨密度值 ,观察不同年龄受试者腰椎正、侧位骨密度的差别 ,以及由此测试结果得到的诊断骨质疏松结论的差别。结果 :全部受试者的椎体正位骨密度检测均高于侧位(P <0 0 1) ,但在 113名年龄小于 6 5岁的受试者中 ,以此诊断骨质疏松症的结果并无显著性差异(P >0 0 5 ) ;5 3名年龄大于 6 5岁的受试者中 ,根据正、侧位骨密度的变化得到的骨质疏松症诊断出现较大偏差 (P <0 0 5 )。根据正位骨密度测定诊断骨质疏松症约有三分之一漏诊率。结论 :对绝经期骨质疏松患者可以用传统的正位腰椎骨密度测定的方法来诊断 ,不需另作侧位测定 ,对老年性骨质疏松症患者 ,则应加作腰椎侧位骨密度测定 。

青春期女性骨密度与月经状况的关系

目的了解昆明12～14岁女性骨密度水平并就影响因素进行分析。方法利用双能X线骨密度测定仪测量昆明市某中学98名12～14岁青少年腰椎及髋部骨密度（Bone Mineral Density，BMD），采用问卷调查形式了解与骨密度相关因素。结果女生腰椎、股骨颈、大转子骨密度明显高于男生（P〈0．05）；月经初潮年龄早的女生骨密度较高（P〈0．05）。结论青春期（12～14岁）阶段女生骨密度较同年龄段男生高，该年龄段女生骨密度与月经初潮年龄有关。

原发性骨质疏松症的诊断和治疗

骨质疏松症分为原发性骨质疏松症和继发性骨质疏松症。该病的诊断主要根据病史、骨密度检测、生化检测、影像学检测、骨活检等几个方面进行综合评价。双能量X线吸收法已成为临床常规检查。对患者进行骨质疏松症风险评估的目的是确定骨折的风险因素,以及决定是否应该接受治疗。治疗分为药物和非药物治疗,后者又包括饮食营养和体育锻炼,药物治疗又分为基础性药物治疗和针对性药物治疗。

儿童青少年身体脂肪含量和非脂体重的变化分析

目的:分析儿童、青少年身体脂肪含量(FM)和去脂全重(FFM)及其随年龄变化特点及性别差异。方法选择7～15岁体重正常的儿童180名,男、女及每个年龄组各约10名,采用双能 X 线吸收测量法(DEXA)测量身体成分。根据公式 FFMI(kg·m^2,去脂体重指数)=FFM(kg)/身高~2(m^2)和 FMI(kg·m^2,脂肪含量指数)=FM(kg)/身高~2(m^2),计算 FFMI 和 FMI。结果 7～13岁儿童 FM 及全身脂肪含量占体重百分比随年龄增加而增加,13岁以后有所下降,女高于男。7～15岁男、女儿童 FFMI 随年龄增加而增加,男生青春期 FFMI 增长加速,增加总量为女生的2倍,7～15岁男生 FMI 先增后降,女生则一直呈上升趋势,女生 FMI 增加总量为男生的2倍。男生身高与 FMI 相关性差,11～15岁男生的身高与 FFMI 呈显著性正相关。7～10岁女生身高与 FMI 呈显著性正相关,9～10岁女生的身高与 FFMI 呈显著性正相关(P<0.05)。男、女儿童的 BMI 与 FMI 均呈显著性正相关,男生相关系数大于女生。13～15岁男生和7～15岁女生的BMI 与 FFMI 呈显著性正相关(P<0.05)。结论青春期前后儿童脂肪含量及分布随年龄而变化,男女差异有显著性。男性脂肪向分布加速期发生在12岁,女性在10岁。男生 BMI 随年龄增长而增加,主要为 FFMI 的增加,尤其是青春期男生。女生 BMI 的增长为 FFMI 和 FMI 的同时增加。

不同骨密度测量方法在补钙剂评价中的应用

目的:评价某补钙为主保健食品增加大鼠骨密度的功效,比较双能X线吸收法(DEXA)与阿基米德定律法在骨密度测量中的应用。方法:参照《保健食品检验与技术评价规范》(2003版")增加骨密度功能检验方法"方案一,将45只断乳Sprague-Dawley大鼠按体质量随机分为碳酸钙对照组、低钙对照组和保健品低、中、高剂量组(0.17、0.33、1.00g/kg),对某保健食品进行评价。结果:保健品高剂量组及碳酸钙对照组大鼠在钙表观吸收率、质量增加量、骨密度及骨钙含量上明显高于低钙对照组(P<0.05)。除骨密度外,保健品高剂量组同碳酸钙对照组相比各指标差异不显著;DEXA法与阿基米德定律法所测骨密度结果相关性较好。结论:该保健食品对大鼠有增加骨密度作用;DEXA法与阿基米德定律法均可用于动物实验中骨密度的测定。

封蜡骨密度对双能X线骨密度仪与定量CT分析骨矿成份中的矫正研究及应用

目的探讨封蜡密度对双能X线骨密度仪与定量CT分析骨矿成分中的矫正及应用。方法取2015年6月~2017年3月医院收治的股骨颈骨折患者20例,患者均行手术治疗,术前进行常规检查,并且分别以DXA、QCT检查双侧髋关节骨密度(P1),测定20例离体股骨头骨密度参数,离体标本初步处理后与参考模量建模,再次进行DXA、QCT扫描(P2)、封蜡后初测质量及排开水体积,获得大体骨密度(P3),制备骨块,复测骨快密度(P4),将获得的标本经过氢氟酸溶解后测定溶液中骨矿成分密度P5。结果 20例骨密度患者DXA测定P1、P2时间点矿骨成分,均低于P3、P4及P5(P<0.05);20例股骨颈骨折患者QCT不同疾病严重程度不同时间点骨密度测定比较差异无统计学意义(P>0.05);DXA检测轻度不同时间点骨密度水平,均低于中级及重级(P<0.05);中级患者不同时间点骨密度,均高于重级(P<0.05);相关性研究显示:封蜡骨密度测定精度与DXA P1、P2成正相关性(P<0.05);与P3、P4及P5呈负相关性(P<0.05)。结论封蜡骨密度对双能X线骨密度仪与定量CT分析骨矿成分中具有良好的矫正作用,具有广泛的应用前景,值得推广应用。

全髋关节置换术后假体周围骨密度动态观察

目的 :运用双能 X线骨密度仪动态观察全髋关节置换术后假体周围骨密度 ( BMD)变化。方法 :对4 1例全髋关节置换术后患者股骨及髋臼假体周围 BMD进行 1 2个月的动态观察 ,并与 2 3例术后 5年以上的患者比较。其中股骨柄假体周围 BMD按 Gruen法分为 7个兴趣区 ( R1 -7)分析 ;髋臼假体周围按 De Lee和Charnley法分为 3个兴趣区 ( R - )分析。并将各时相 BMD值与术后一周内测值比较。结果 :股骨柄假体周围 BMD平均值 ( NETAVG I)在术后 6个月降至 92 .1 2 % ,术后 1 2月又上升至 94 .0 8%。其中以股骨柄近端周围松质骨 BMD下降最为明显。近端外侧 ( R1 )为 83.78% ,内侧 ( R7)为 88.31 %。髋臼假体周围 BMD( NE-TAVG )在术后 6个月平均下降至 78.2 8% ,术后 1 2月上升至 85 .2 1 %。以臼杯假体内侧 ( R )失骨量最多 ,降至 70 .2 2 %。术后 5年患者股骨柄假体周围 BMD平均值与 1 2月组比较无明显差异 ;但髋臼杯周围下降明显 ( P<0 .0 5 )。结论 :DEXA是监测 THA假体周围 BMD变化的有效方法。全髋关节置换术后假体周围的松质骨的骨吸收、丢失是导致假体松动的重要原因 ;而密质骨相对失骨量较少。

不同峰值骨量对诊断青岛地区成年女性骨质疏松敏感性的比较

目的比较青岛地区正常汉族成年女性峰值骨密度(PBMD)数据库与骨密度仪自身所应用数据库差异,以及对骨质疏松症(OP)诊断的影响。方法应用法国DMS公司CHALLENGER型双能X线骨密度仪(DXA)对青岛地区汉族人868例25～83岁女性居民进行腰椎(L2-L4)部位和左侧髋部(股骨颈、大转子、Wards三角区)6个骨骼区域的BMD。统计分析获得本地区正常汉族人女性骨密度(BMD)数据库,将其PBMD及标准差与法国CHALLENGER型DXA骨密度仪所应用数据库的PBMD及标准差进行比较分析,并分别用两组数据库对191例脆性骨折患者进行诊断,观察两者诊断阳性率的差异。结果青岛地区汉族人群6个骨骼区域BMD随年龄变化,不同部位骨峰值出现的时间不同,腰椎在25～29岁,髋部在40～44岁,其骨密度峰值骨量高于法国DMS公司CHALLENGER型DXA的峰值骨量,两个数据库的标准差无明显差异。应用本地区正常汉族人女性BMD数据库可提高对脆性骨折患者骨质疏松的诊断率约50%。结论通过建立青岛地区汉族人群女性的骨密度数据库,确立青岛地区PBMD标准,与仪器PBMD比较显著提高了本地区汉族人群女性的骨质疏松症诊断准确率。

Cerebral artery evaluation of dual energy CT angiography with dual source CT

Background Conventional computed tomography angiography （CTA） is time consuming, user-dependent and has poor image quality in skull base region. This study assessed the feasibility of a new method, dual energy CTA for depicting the cerebral artery.Methods Phantom scan was done with head CTA sequences on dual source CT and 64 spiral CT for radiation dose calculation. Dual energy CTA was done with dual source CT on 36 patients who were suspected of having cerebral vascular disease. Three series axial images in 0.75 mm thick, 0.4 mm increment were acquired, which were named with 80 kV, 140 kV and merged images; 80 kV and 140 kV images were transferred into dual energy software, and maximum intensity projection （MIP） image was generated quickly by dual energy bone remove （DEBR group）; merged images were transferred into In Space software to acquire MIP image through manual conventional bone remove （CoBR group）. Post processing time and reading time were compared. Image qualities of the two groups were compared, mainly focusing on skull base segments of internal carotid artery and bone subtraction. ANOVA and SNK tests were applied for radiation dose comparison. Student＇s t test and Wilcoxon rank sum test were applied for assessing differences between data for significance. Cohen＇s kappa was used for interobserver agreement. Results Radiation dose of phantom scan showed dual energy CTA was between digital bone subtraction and conventional CTA. The post processing time and reading time were much shorter in DEBR than CoBR, and image quality in skull base was much higher in DEBR than CoBR （P〈0.01）. There was no significant difference for suprasellar vessels between two groups （P〉0.5）. Interobserver agreement for all vessel segments was excellent （kappa=0.97）. Conclusions Dual energy CTA is a reliable, new modality for depicting cerebral artery, overcoming the limitation of conventional CTA in the skull base region. It can save much time in post processing and reading than conventional CTA.

Managing osteoporosis in ulcerative colitis: Something new?

The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX® tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that are also applied to the patients with osteoporosis. Therefore, a reasonable advice is to consider pharmacological treatment for osteoporosis in those UC patients who already present fragility fractures, which bring a high risk of subsequent fractures. Therapy has also to be considered in patients with a high risk of fracture even if it did not yet happen, and particularly when they had long periods of corticosteroid therapy or cumulative high dosages. In patients without fragility fractures or steroid treatment, a medical decision about treatment could be guided by the FRAX tool to determine the intervention threshold. Among drugs for osteoporosis treatment, the bisphosphonates are the most studied ones, with the best and longest evidence of efficacy and safety. Despite this, several questions are still open, such as the duration of treatment, the necessity to discontinue it, the indication of therapy in young patients, particularly in those without previous fractures. Further, it has to be mentioned that a long-term bisphosphonates use in primary osteoporosis has been associated with an increased incidence of dramatic side-effects, even if uncommon, like osteonecrosis of the jaw and atypical sub-trochanteric and diaphyseal femoral fractures. UC is a long-lasting disease and the majority of patients is relatively young. In this scenario primary prevention of fragility fracture is the best cost-effective strategy. Vitamin D supplementation, adequate calcium intake, suitable physical activity (when possible), removing of risk factors for osteoporosis like smoking, and avoiding falling are the best medical acts.

Adipokines and C-reactive protein in relation to bone mineralization in pediatric nonalcoholic fatty liver disease

AIM: To investigate bone mineral density (BMD) in obese children with and without nonalcoholic fatty liver disease (NAFLD); and the association between BMD and serum adipokines, and high-sensitivity C-reactive protein (HSCRP). METHODS: A case-control study was performed. Cases were 44 obese children with NAFLD. The diagnosis of NAFLD was based on magnetic resonance imaging (MRI) with high hepatic fat fraction (≥ 5%). Other causes of chronic liver disease were ruled out. Controls were selected from obese children with normal levels of aminotransferases, and without MRI evidence of fatty liver as well as of other causes of chronic liver diseases. Controls were matched (1-to 1-basis) with thecases on age, gender, pubertal stage and as closely as possible on body mass index-SD score. All participants underwent clinical examination, laboratory tests, and whole body (WB) and lumbar spine (LS) BMD by dual energy X-ray absorptiometry. BMDZ-scores were calcu- lated using race and gender specific LMS curves. RESULTS: Obese children with NAFLD had a significantly lower LS BMDZ-score than those without NAFLD [mean, 0.55 (95%CI: 0.23-0.86) vs 1.29 (95%CI: 0.95-1.63); P < 0.01]. WB BMD Z-score was also decreased in obese children with NAFLD compared to obese children with no NAFLD, though borderline significance was observed [1.55 (95%CI: 1.23-1.87) vs 1.95 (95%CI: 1.67-2.10); P = 0.06]. Children with NAFLD had significantly higher HSCRP, lower adiponectin, but similar leptin levels. Thirty five of the 44 children with MRI-diagnosed NAFLD underwent liver biopsy. Among the children with biopsy-proven NAFLD, 20 (57%) had nonalcoholic steatohepatitis (NASH), while 15 (43%) no NASH. Compared to children without NASH, those with NASH had a significantly lower LS BMD Z-score [mean, 0.27 (95%CI: -0.17-0.71) vs 0.75 (95%CI: 0.13-1.39); P < 0.05] as well as a significantly lower WB BMD Z-score [1.38 (95%CI: 0.89-1.17) vs 1.93 (95%CI: 1.32-2.36); P < 0.05]. In multiple regression analysis, NASH (standardized β coefficient, -0.272; P < 0.01) and HSCRP (standardized β coefficient, -0.192; P < 0.05) were significantly and independently associated with LS BMD Z-score. Similar results were obtained when NAFLD (instead of NASH) was included in the model. WB BMD Z-scores were significantly and independently associated with NASH (standardized β coefficient, -0.248;P < 0.05) and fat mass (standardized β coefficient, -0.224;P < 0.05). CONCLUSION: This study reveals that NAFLD is associated with low BMD in obese children, and that systemic, low-grade inflammation may accelerate loss of bone mass in patients with NAFLD.

Green coffee bean extract improves obesity by decreasing body fat in high-fat diet-induced obese mice

Objective:To evaluate possible lipid catabolism and body fat regulation effects of 3-caffeoylquinic acid in Green coffee bean extract(GCBE) in high-fat diet(HFD)-induced obese mice.Methods:Obesity was induced in mice using a HFD for four weeks.Then,mice were fed only HFD or HFD with GCBE at 50,100,and 200 mg/kg.Fatty acid synthesis mechanism regulation of body fat was investigated through real-time PCR and Western blot assay.Body fat reduction was measured through dual-energy X-ray absorptiometry.Results:In HFD-induced obese mice,GCBE treatment significantly decreased body weight gain,liver weight and white adipose tissue weights with regulation of adipose tissue lipolysis hormones,like adiponectin and leptin.GCBE treatment decreased mR NA expression levels of adipogenesis and adipocyte metabolism related genes in adipose tissues and the liver,and decreased the corresponding protein expression.Dual energy X-ray absorptiometry measurements were used to compare body fat between mice on high-fat and those treated with GCBE.GCBE treated mice had a lower fat mass compared to HFD alone fed mice and relative body weight and fat mass were markedly decreased.Conclusions:GCBE has a potential anti-obesity effect with lowering body fat accumulation by regulating adipogenesis and lipid metabolism-related genes and proteins in WAT and liver.

陕西地区股骨上段骨折风险阈值研究

目的找出最佳的预测老年人群股骨上段骨折风险的方法。方法利用双能X线吸收仪(DEXA)和其他工具,测量30具尸体骨右侧股骨上段的骨密度、几何形态以及股骨上段极限强度。然后,通过物理公式分析摔倒时股骨上段的受力情况。结果 (1)女性各项参数多数低于男性。(2)股骨颈骨密度与股骨上段载荷之间的相关性最佳(r2=0.807),推导出预测股骨上段骨折风险回归方程。(3)股骨颈宽度与股骨上段极限强度的相关性较好。(4)推导出骨折风险阈值。结论 (1)陕西地区老年人股骨上段骨折发生率较低,与体型小导致摔倒时的暴力低有关。(2)股骨颈骨密度为较好的骨折风险预测指标。与几何形态结合可提高预测能力。(3)通过骨折风险阈值公式早期预防骨质疏松骨折的发生。

Relationship between peak oxygen uptake and regional body composition in Japanese subjects

Purpose： To investigate the link between peak oxygen uptake and regional body composition by dual energy X-ray absorptiometry （DEXA） in Japanese subjects. Methods： A total of 93 men （42.2 ± 12.3 years old） and 106 women （43.5 ± 12.3 years old） were enrolled in this cross-sectional investigation study. Peak oxygen uptake was measured by the breath-by-breath method. Regional body composition i.e., body fat mass, lean body mass, and body fat percentage was evaluated using DEXA. In addition, metabolic risk parameters were also evaluated. Results： Peak oxygen uptake was 37.6± 8.7 mL/kg/min in men and 31.1 ± 6.4 mL/kg/min in women, and decreased with age in both genders. Peak oxygen uptake was significantly correlated with total body fat percentage （men： r = -0.684, p 〈 0.0001; women： r = -0.681, p 〈 0.0001）. These associations remained even after adjusting for age and total lean body mass. However, peak work rate was positively and significantly correlated with leg lean body mass. Conclusion： Peak oxygen uptake was closely correlated with total body fat percentage in both genders. Aerobic exercise as well as leg resistance training might be useful for improving peak oxygen uptake in Japanese subjects. Copyright

Body composition of healthy Spanish children

This paper shows the distribution of the body compartments, and the age and gender related changes in Spanish children. Subjects and Methods: A total of 231 healthy children from Madrid (Spain) were recruited and divided into 3 groups according to age (birth-5, 6-10, 11-15y). Body compartments (fat mass, lean mass and bone mass) measures were obtained from dual energy X-ray absorptiometry (DXA) scans. Total and regional body compositions were evaluated. Results: There were gender differences for TBFM (total body fat mass) in 11 - 15 year age group and for TLBM (total lean body mass) in all age groups except for the 6 - 10 year age group. TBMC (total bone mineral content) shows significant gender differences form birth. Conclusions: Contrary to boys, girls showed from early infancy a smaller proportion of muscle mass and a higher proportion of body fat (from the age of 10), with fat deposits being mostly peripheral. Bone mass and muscle mass values were higher in boys.

Females Had a Worse T-Score at Lumbar Region and Males Had a Worse T-Score at Femoral Region among Chronic Kidney Disease

Background: To evaluate bone-mineral-density-BMD determined by dual-energy X-ray absorptiometry-DEXA and bone turnover markers in chronic-kidney-disease-CKD patients. Method: An observational-clinical study of all patients who were scanned by DEXA-scan in 2018. All patients with low-bone-density or osteoporosis-based on World-Health-Organization-WHO definition were included. Results: 505 patients with abnormal-BMD, 87.3% were in early-stage CKD-stage I - II, 8.5% were in CKD-stage III - V and 4.2% did not have renal tests. 95 (18.8%) were male with a mean age of 57.0 years and 410 (81.2%) were females with a mean age of 55.8 years. Patients of ≥65 years had lower T-score than those who were younger than 65 years-old. Among CKD patients, those with late-CKD (stage III - V) had less BMD-measurements and lower T-score than those with early-CKD (stage I - II). A significant positive correlation exists between parathyroid hormone-PTH-level and the lower T-score. Female had a worse T-score at the lumbar-region whereas male had a worse T-score at the femoral-region. There was no significant difference between males and females for the T-score at hip-region. Conclusion: We observed a distribution of abnormal BMD among different age, sex and CKD groups. Measurements of BMD by DEXA might be a useful test to diagnose osteoporosis in CKD patients. Femoral and total hip areas were more affected, however DEXA might not be able to detect osteoporosis in the lumbar area of CKD patients. T-scores are lower in patients with more severe CKD and lower in elderly patients. PTH level is associated proportionally to the degree of bone loss. Early intervention and proper management must be implemented early among CKD patients with multidisciplinary team approach strategy. More studies are needed to determine if DEXA techniques are enough to distinguish the quantity of bone loss between different stages of CKD.

有领与无领股骨柄假体周围早期骨丢失的临床研究

目的:观察抗骨质疏松药及有领与无领股骨柄对全髋关节置换术后股骨侧假体周围骨密度的影响。方法:随机对80例行非骨水泥型人工髋关节假体置换患者,分成有领治疗组(1组)、对照组(2组);无领治疗组(3组)、对照组(4组),每组20例。1、3组均给予福善美+钙尔奇D3+仙灵骨葆胶囊口服,2、4组仅给口服钙尔奇D3片;各组分别于术后12d、3月、6月应用双能X线骨密度仪(DEXA)测量THA术后股骨柄假体周围的大转子(测1区)、离远端股骨柄0.5～1.0cm处股骨干(测2区)骨密度,同时测量健侧相同部位骨密度。结果:在12d和3月,1、2组相比差异无统计学意义(P>0.001)。在术后6月时,1、2组相比差异均有统计学意义(P<0.001),健侧更明显一些,说明用药能显著减少骨量流失。3、4组不论是患侧还是健侧,在术后6月时,测1区和测2区两组相比差异均有统计学意义(P<0.001)。1、3组在术后3m及6m时,不论是患侧还是健侧,各测量区骨密度比较差异均无统计学意义(P>0.05)。结论:1.使用有领柄还是无领柄对假体周围骨密度变化影响不大。2.福善美+钙尔奇D3+仙灵骨葆胶囊可预防假体周围早期骨丢失。