Bone mineral density in Iranian patients: Effects of age, sex, and body mass index

Introduction: Osteoporosis is a multifactorial skeletal disease that is characterized by reduced bone mineral density (BMD). BMD values depend on several factors such as age, sex and age at menopause. The purpose of this study was to determine the prevalence and changes in bone mineral density in Iranian patients. Methods: Three hundred patients were selected through random sampling technique in 2009. BMD was assessed by Norland (Excell) technique at the lumbar and femoral neck. Weight and height were measured through standard methods. A thorough history was taken from each patient. The data was analyzed using SPSS software version 13.0. P-values less than 0.05 were considered statistically significant. Results: From among the 300 studied patients, 86.6% were female. their mean age was 52.7 years. Their average body mass index (BMI) was 28.14 kg/m2. Mean T-Score at lumbar spine and femoral neck was -1.07 ±1.19 and -1.75 ± 1.33 respectively. Mean BMD value at lumbar spine and femoral neck was 0.92 ± 0.19 and 0.77 ± 0.16 respectively. The prevalence of osteoporosis at lumbar spine and femoral neck was 33.7% and 16.7, respectively. There was a significant correlation between age, BMI and BMD values (P-Value Conclusion: This study shows that ageing and low BMI are risk factors associated with bone loss. it is recommended to measure BMD and implement prevention programs for high-risk people.

The Relationship between Bone Mineral Density and Obesity in Women

The aim of this study was to determine the relationship between obesity and osteoporosis. A total of 30 Saudi women, aged between 20 and 50 years, were selected randomly. We calculated each subject’s body mass index (BMI) and determined their lumbar and femur bone mineral densities using dual-energy X-ray absorptiometry (DXA). We examined the interaction between obesity and bone mineral density (BMD) using logistic regression, after adjusting for age, family history of osteoporosis, maternal fractures, smoking, and any sedentary lifestyles. BMI was shown to be the most effective independent variable with respect to bone density. We evaluated the Pearson correlation coefficients of BMI, BMD of the lumbar spine, and BMD of the femoral neck with reference to the variables of the study, and found a significant correlation (P 30 kg/m2) were at increased risk of osteoporosis at the femoral neck and severe osteopenia in the lumbar spine.

Factors associated with trabecular bone score in postmenopausal women with type 2 diabetes and normal bone mineral density

BACKGROUND Osteoporosis and type 2 diabetes(T2D)have been recognized as a widespread comorbidity leading to excess mortality and an enormous healthcare burden.In T2D,bone mineral density(BMD)may underestimate the risk of low-energy fractures as bone quality is reduced.It was hypothesized that a decrease in the trabecular bone score(TBS),a parameter assessing bone microarchitecture,may be an early marker of impaired bone health in women with T2D.AIM To identify clinical and body composition parameters that affect TBS in postmenopausal women with T2D and normal BMD.METHODS A non-interventional cross-sectional comparative study was conducted.Potentially eligible subjects were screened at tertiary referral center.Postmenopausal women with T2D,aged 50-75 years,with no established risk factors for secondary osteoporosis,were included.BMD,TBS and body composition parameters were assessed by dual-energy X-ray absorptiometry.In women with normal BMD,a wide range of anthropometric,general and diabetes-related clinical and laboratory parameters were evaluated as risk factors for TBS decrease using univariate and multivariate regression analysis and analysis of receiver operating characteristic(ROC)curves.RESULTS Three hundred twelve women were initially screened,176 of them met the inclusion criteria and underwent dual X-ray absorptiometry.Those with reduced BMD were subsequently excluded;96 women with normal BMD were included in final analysis.Among them,43 women(44.8%)showed decreased TBS values(≤1.31).Women with TBS≤1.31 were taller and had a lower body mass index(BMI)when compared to those with normal TBS(Р=0.008 and P=0.007 respectively).No significant differences in HbA1c,renal function,calcium,phosphorus,alkaline phosphatase,PTH and 25(ОН)D levels were found.In a model of multivariate linear regression analysis,TBS was positively associated with gynoid fat mass,whereas the height and androgen fat mass were associated negatively(all P<0.001).In a multiple logistic regression,TBS≤1.31 was associated with lower gynoid fat mass(adjusted odd ratio[OR],0.9,95%confidence interval[CI],0.85-0.94,P<0.001),higher android fat mass(adjusted OR,1.13,95%CI,1.03-1.24,P=0.008)and height(adjusted OR,1.13,95%CI,1.05-1.20,P<0.001).In ROC-curve analysis,height≥162.5 cm(P=0.04),body mass index≤33.85 kg/m2(P=0.002),gynoid fat mass≤5.41 kg(P=0.03)and android/gynoid fat mass ratio≥1.145(P<0.001)were identified as the risk factors for TBS reduction.CONCLUSION In postmenopausal women with T2D and normal BMD,greater height and central adiposity are associated with impaired bone microarchitecture.

Quantitative Evaluation of Fat Composition in Lumbar Vertebral Body and Paraspinal Muscle by Proton Density Fat Fraction with MRI

Purpose: Bone marrow and muscle adiposity have been considered to correlate with osteoporosis and Sarcopenia. Proton Density Fat Fraction (PDFF) can be measured by Magnetic Resonance Imaging (MRI). The purpose of the present study was to measure PDFF in the lumbar spine, paraspinal muscle and subcutaneous fat tissue. Methods: Participants were comprised of 30 patients (18 males, 12 females;age range, 14 - 87 years) who underwent MRI due to low back symptoms. PDFFs for the body of the fourth lumbar vertebra (L4), paraspinal muscle, and subcutaneous fat were measured. Results: PDFFs of the vertebral body and subcutaneous fat were significantly higher than that of paraspinal muscle (p < 0.001). PDFF was significantly higher for subcutaneous fat than for the vertebral body (p < 0.001). Although no significant differences in PDFF of the vertebral body, paraspinal muscle, and subcutaneous fat between females and males, PDFFs of the vertebral body and paraspinal muscle were significantly higher in older subjects (>63 years) than in younger subjects (Conclusions: PDFF of the vertebral body was significantly higher than that of paraspinal muscle. PDFFs of the vertebral body and paraspinal muscle were significantly lower in younger subjects than in older subjects.

Overweight and abdominal fat are associated with normal bone mineral density in patients with ulcerative colitis

BACKGROUND Low bone mineral density(BMD)is common in patients with inflammatory bowel disease.However,nutritional risk factors for low BMD in the ulcerative colitis(UC)population are still poorly understood.AIM To investigate the association of anthropometric indicators and body composition with BMD in patients with UC.METHODS This is a cross-sectional study on adult UC patients of both genders who were followed on an outpatient basis.A control group consisting of healthy volunteers,family members,and close people was also included.The nutritional indicators evaluated were body mass index(BMI),total body mass(TBM),waist circumference(WC),body fat in kg(BFkg),body fat in percentage(BF%),trunk BF(TBF),and also lean mass.Body composition and BMD assessments were performed by dual-energy X-ray absorptiometry.RESULTS The sociodemographic characteristics of patients with UC(n=68)were similar to those of healthy volunteers(n=66)(P>0.05).Most patients(97.0%)were in remission of the disease,58.8%were eutrophic,33.8%were overweight,39.0%had high WC,and 67.6%had excess BF%.However,mean BMI,WC,BFkg,and TBF of UC patients were lower when compared to those of the control group(P<0.05).Reduced BMD was present in 41.2%of patients with UC(38.2%with osteopenia and 2.9%with osteoporosis)and 3.0%in the control group(P<0.001).UC patients with low BMD had lower BMI,TBM,and BFkg values than those with normal BMD(P<0.05).Male patients were more likely to have low BMD(prevalence ratio[PR]=1.86;95%confidence interval[CI]:1.07-3.26).Those with excess weight(PR=0.43;95%CI:0.19-0.97)and high WC(PR=0.44;95%CI:0.21-0.94)were less likely to have low BMD.CONCLUSION Patients with UC in remission have a high prevalence of metabolic bone diseases.Body fat appears to protect against the development of low BMD in these patients.

Methods of predicting vertebral body fractures of the lumbar spine

Lumbar vertebral body(VB) fractures are increasingly common in an ageing population that is at greater risk of osteoporosis and metastasis. This review aims to identify different models, as alternatives to bone mineral density(BMD), which may be applied in order to predict VB failure load and fracture risk. The most representative models are those that take account of normal spinal kinetics and assess the contribution of the cortical shell to vertebral strength. Overall, predictive models for VB fracture risk should encompass a range of important parameters including BMD, geometric measures and patient-specific factors. As interventions like vertebroplasty increase in popularity for VB fracture treatment and prevention, such models are likely to play a significant role in the clinical decision-making process. More biomechanical research is required, however, to reduce the risks of post-operative adjacent VB fractures.

利用DXA评估系统性红斑狼疮患者中肌少症的现患率

目的评估系统性红斑狼疮(systemic lupus erythematosus,SLE)患者中肌少症的现患率,分析SLE共病肌少症患者的体成分变化,探讨SLE患者肌少症发生的危险因素。方法共纳入114例SLE患者(病例组)和114例健康对照者(对照组)。采用双能X线吸收法(dual energy X-ray absorptiometry,DXA)测量两组的肌肉质量,通过握力和步速分别评估患者的肌力和体能。根据欧洲老年人肌少症工作组及亚洲肌少症工作组诊断标准对SLE患者进行肌少症诊断及分期,将SLE患者分为肌少症组及非肌少症组,比较组间患者的体成分及骨密度等指标的差异,分析SLE患者共病肌少症的影响因素。结果SLE患者的平均病程为(79.6±72.8)个月。45.6%(n=52)的SLE患者共病肌少症,其中22.8%(n=26)的患者为肌少症前期,16.7%(n=19)的患者为肌少症期,6.1%(n=7)的患者为严重肌少症期。肌少症组患者的体重、体质指数、脂肪质量指数、全身瘦组织含量、瘦质量指数、全身去脂体重、去脂体重指数均低于非肌少症组和对照组。肌少症组的骨矿物质含量、腰椎和股骨骨密度明显低于对照组。多因素回归分析显示,体质指数(OR=0.61,P<0.001,95%CI:0.49~0.75)和职业劳动强度(OR=2.0,P=0.009,95%CI:1.19~3.34)是SLE患者共病肌少症的影响因素。结论SLE患者中约半数共病肌少症,共病肌少症SLE患者的脂肪、肌肉含量和重要部位骨密度下降,其中体质指数和职业劳动强度是SLE患者出现肌少症的影响因素。

基于健康体检人群分析青年骨量异常的现状及影响因素

目的分析北京市参加健康体检人群中的青年骨量异常患者的特点及影响因素,为骨量减少和骨质疏松的防治提供依据和参考。方法收集2023年1-7月在首都医科大学附属北京友谊医院健康体检行骨密度检查且年龄≤40岁人群共973人,其中,骨量异常青年人群348人,骨量正常青年人群625人,选取潜在相关指标分析青年体检人群的骨量异常发生情况及可能影响因素。结果青年体检人群骨量异常发生率为35.77%,其中,骨量减少人群占91.67%,骨质疏松症人群占8.33%,男性占57.47%,女性占42.53%。通过单变量分析,骨量异常的发生与多种因素有关,包括性别、年龄、体重、身体质量指数、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血尿酸,吸烟与饮酒等(P<0.05);进一步的多变量Logistic回归分析表明,年龄(OR=1.045)、较低的身体质量指数(OR=0.761)、甘油三酯(OR=2.828)、血尿酸(OR=1.007)、饮酒(OR=5.238)、吸烟(OR=1.853)是发生骨量异常的危险因素(P<0.05)。结论青年人群骨量减少和骨质疏松检出率呈上升趋势,应重视健康体检,并积极进行骨密度早期筛查。

骨密度测量仪评估老年人骨密度与参数的关系

目的:探讨骨密度测量仪评估老年人群骨密度与相关参数的关系。方法:选取2019年3月~2021年3月收治的老年髋部骨折患者100例作为骨折组,老年体检者100例作为对照组。探讨骨密度测量仪评估老年人群骨密度与相关参数的关系。结果:骨折组患者在颈骨颈、股骨转子间、腰椎、Ward’s区及腰椎部位的骨密度、FNCT及FNCT/FNW均低于对照组,FMCW值高于对照组,骨质疏松组腰椎BMD与25-(OH)D3呈正相关,与Total-P1NP、β-CTX、N-MID等骨代谢志物呈负相关。结论:通过监测骨代谢指标水平有利于辅助临床早期诊断骨质疏松症。

肌少症病人超声参数与体质指数、骨密度及骨骼肌质量指数的关系

目的:探究肌少症病人超声参数与体质指数、骨密度及骨骼肌质量指数的关系。方法:选取山西医科大学第二医院2023年1月1日—2024年1月1日收治的60例肌少症病人为研究组,选取同期来院体检的50名性别、年龄匹配的健康志愿者为对照组。两组均接受超声检查,记录腓肠肌肌肉厚度、肌肉最大横截面积、肌肉硬度(收缩及舒张时杨氏模量值)及双能X线吸收法检查,记录骨密度、四肢肌肉量并计算骨骼肌质量指数及体质指数。对比两组上述指标差异,使用Logistic回归分析筛选肌少症影响因素,使用受试者工作特征(ROC)曲线分析超声参数对肌少症诊断效能,使用Pearson相关系数分析研究组超声参数与体质指数、骨密度及骨骼肌质量指数的相关性。结果:Logistic回归分析结果显示:腓肠肌肌肉厚度、肌肉最大横截面积、收缩及舒张时杨氏模量值、体质指数、骨密度及骨骼肌质量指数是肌少症的独立影响因素(P<0.05);腓肠肌肌肉厚度、肌肉最大横截面积、收缩、舒张时杨氏模量值诊断肌少症ROC曲线下面积分别为0.908,0.958,0.909,0.932;Pearson相关分析结果显示,肌少症病人腓肠肌肌肉厚度、肌肉最大横截面积、收缩及舒张时杨氏模量值与体质指数、骨密度及骨骼肌质量指数均呈正相关(P<0.05)。结论:超声参数有助于筛查诊断肌少症,超声参数、腓肠肌肌肉厚度、肌肉最大横截面积、肌肉硬度与体质指数、骨密度及骨骼肌质量指数存在明显关联。

人体成分与跟骨骨密度因果关联:一项孟德尔随机化研究

目的采用孟德尔随机化方法研究人体成分与跟骨骨密度的因果关系。方法利用全基因关联分析数据,暴露因素为全身脂肪量、全身水分量和去脂体质量,结局变量为跟骨骨密度。采用IVW法、MR-Egger法、加权中位数法、简单模式法、加权模式法进行孟德尔随机化分析,并行异质性、敏感性、多效性分析以检验结果可靠性。结果IVW法显示全身脂肪量与跟骨骨密度存在正向因果关系(β=1.10,95%CI 1.05~1.15,P<0.001),MR-Egger法、加权中位数法、加权模式法与IVW法结果一致,敏感性分析显示单核苷酸多态性无异质性和水平多效性;IVW法显示全身水分量与跟骨骨密度因果关系无统计学意义(β=0.96,95%CI 0.91~1.02,P>0.05);IVW法显示去脂体质量与跟骨骨密度之间因果关系无统计学意义(β=0.97,95%CI 0.91~1.03,P>0.05)。结论人体全身脂肪量与跟骨骨密度存在正向因果关系。

围绝经期及绝经后期女性人体体成分与腰椎骨密度的相关分析

目的探讨围绝经期及绝经后期女性人体体成分与腰椎骨密度(bone mineral density,BMD)之间的关系,进一步分析该人群骨量减少的影响因素。方法招募2021年10月至2024年3月于首都医科大学附属北京妇产医院内分泌科就诊的围绝经期及绝经后期女性300例为研究对象。采用定量电子计算机断层扫描技术(quantitative computed tomography,QCT)测量腰椎骨密度,根据测量结果分为骨量正常组和骨量减少组,采用肌肉功能分析仪测定所有受试者的体质量、脂肪、下肢肌肉、膝关节活动等人体成分情况,采用更年期症状全面评估量表采集所有研究对象的年龄、绝经状态及活动类型。采用单因素方差分析比较骨量正常组和骨量减少组的人体体成分之间的差异性,采用多因素Logistic回归分析探讨骨量减少的危险因素。结果300例研究对象中,围绝经期女性148例(49%),平均年龄(51.40±5.03)岁;绝经后期女性152例(51%),平均年龄(53.59±6.04)岁。绝经后期女性的骨密度低于围绝经期女性,差异有统计学意义(P<0.05)。骨量减少组118例(39%),骨量正常组182例(61%)。骨量减少组女性年龄、脂肪百分比、绝经后期占比和无锻炼占比均高于骨量正常组,差异有统计学意义(P<0.05);而下肢肌肉分布系数、下肢肌力和有锻炼占比均低于骨量正常组,差异有统计学意义(P<0.05)。Spearman相关性分析结果表明围绝经期和绝经后期女性BMD与年龄、脂肪百分比、绝经后期占比均呈显著负相关(r=-0.492、-0.125、-0.287,P<0.05),而与下肢肌肉分布系数、下肢肌力、有锻炼占比均呈显著正相关(r=0.143、0.180、0.193,P<0.05)。二元Logistic回归分析结果显示,年龄大、脂肪百分比大、下肢肌肉分布少、锻炼少是骨量减少的危险因素(P<0.05)。结论与围绝经期女性相比,绝经后期女性的腰椎骨密度明显降低,围绝经期及绝经后期女性腰椎骨密度与人体体成分及活动类型密切相关,其中年龄大、脂肪百分比大、下肢肌肉分布少、锻炼少是骨量减少的危险因素(P<0.05)。建议临床医生关注此时期女性的腰椎骨密度及人体体成分的变化,以便通过及时合理的干预措施来提高她们的生活质量,预防骨质疏松的发生。

女性年龄与骨密度、骨质疏松的关系及发生骨质疏松的影响因素分析

目的分析女性年龄与骨密度、骨质疏松的关系及发生骨质疏松的影响因素。方法215例女性健康体检者,按不同年龄段划分,≤44岁为青年组(59例)、45~59岁为中年组(94例)、≥60岁为老年组(62例)。比较三组受试者腰椎1~4及股骨颈骨密度、骨质疏松发生情况,并比较发生与未发生骨质疏松受试者的基本临床资料{受教育程度、体质量指数(BMI)、酗酒、家族骨质疏松史、血清25-羟基维生素D[25(OH)D]水平、四肢骨骼肌指数(ASMI)、幽门螺杆菌(Hp)感染、匹兹堡睡眠质量指数(PSQI)},采用Logistic回归分析女性骨质疏松的影响因素。结果老年组腰椎1~4骨密度(0.95±0.10)g/cm^(2)及股骨颈骨密度(0.76±0.08)g/cm^(2)明显低于中年组的(1.04±0.13)、(0.93±0.10)g/cm^(2)、青年组的(1.09±0.16)、(1.02±0.12)g/cm^(2),且中年组低于青年组,差异有统计学意义(P<0.05)。215例受试者中,有31例发生骨质疏松,占比14.42%,其中老年组骨质疏松发生率30.65%(19/62)明显高于青年组的6.78%(4/59)、中年组的8.51%(8/94),差异有统计学意义(χ^(2)=18.678,P<0.05)。发生骨质疏松女性的BMI(21.88±1.39)kg/m^(2)、血清25(OH)D水平(13.59±1.45)mmol/L、ASMI(5.36±0.58)kg/m^(2)低于未发生骨质疏松的(23.86±1.17)kg/m^(2)、(16.24±1.71)mmol/L、(6.41±0.72)kg/m^(2),发生骨质疏松女性的Hp感染占比83.87%高于未发生骨质疏松的59.78%,差异有统计学意义(P<0.05);发生与未发生骨质疏松的女性受教育程度、酗酒、家族骨质疏松史、PSQI评分比较,差异无统计学意义(P>0.05)。经Logistic回归分析显示,Hp感染是女性发生骨质疏松的危险因素(OR>1,P<0.05),高BMI、血清25(OH)D水平、ASMI水平均是女性发生骨质疏松的保护因素(OR<1,P<0.05)。结论老年阶段女性骨密度较低,骨质疏松发生风险较高,且BMI、血清25(OH)D水平、ASMI、Hp感染是女性发生骨质疏松的影响因素,临床可据此提出具有针对性、科学合理的干预措施以减少女性骨质疏松的发生。

肥胖和骨质疏松之间的关联:一项两样本双向孟德尔随机化分析

背景:多项临床研究观察表明肥胖与骨质疏松症之间存在密切关系,但肥胖与骨质疏松症之间是否存在遗传因果效应尚不清楚。目的:利用大规模全基因组关联研究的汇总数据,通过孟德尔随机化分析探究肥胖和骨质疏松之间的关联。方法:肥胖数据来自人体特征遗传调查(GIANT)和英国生物样本库(UKBB)的汇总统计数据。骨质疏松症的数据来自从骨质疏松症遗传因素联盟(GeFOS)获得的2种骨密度表型:全身骨密度和跟骨骨密度。逆方差加权法为主要分析方法,基于Egger回归的孟德尔随机化法(Mendelian randomization method based on Egger regression,MR-Egger)和加权中位数法作为补充方法来计算肥胖遗传变异与骨质疏松症之间的因果关联。采用敏感性分析来验证结果的可靠性,利用Cochran’s Q检验分析结果的异质性,利用MR-Egger截距检验分析结果的水平多效性,留一法评估合并的逆方差加权法估计值是否具有潜在影响的单核苷酸多态性。结果与结论:①肥胖对骨质疏松症的影响:除身体质量指数与前臂骨密度外,身体质量指数、腰臀比、经身体质量指数调整的腰臀比与全身骨密度、跟骨骨密度、前臂骨密度、腰椎骨密度及股骨颈骨密度两两之间呈正向因果关系;进一步Meta分析显示,肥胖会增加骨密度的风险(OR=1.08,95%CI:1.05-1.11,P<0.01);②骨质疏松症对肥胖的影响:除了前臂骨密度、腰椎骨密度作为暴露因素对肥胖有因果关系外,其他数据集均显示全身骨密度、跟骨骨密度、股骨颈骨密度与肥胖之间不呈现因果效应;进一步Meta分析显示,骨密度并不会增加肥胖的风险(OR=0.99,95%CI:0.98-1.01,P<0.01)。③结果证实:肥胖与骨质疏松之间存在因果关系,即肥胖可能是骨质疏松症的危险性因素,但未发现骨质疏松症对于肥胖的因果关联。

基于孟德尔随机化探索全身骨密度对椎间盘退变的年龄特异性影响

目的使用孟德尔随机化方法,探索遗传预测的全身骨密度对椎间盘退变的年龄特异性影响,以及是否可能作为肥胖影响椎间盘退变的中介因素之一。方法从芬兰数据库和骨质疏松联盟中获取了椎间盘退变以及5个年龄层全身骨密度的全基因组关联研究数据。此外,考虑了与肥胖等相关的9个变量。为确保研究的可靠性,本研究采用了严格的分析框架,包括双向、多变量和两步孟德尔随机化分析。结果遗传预测的30岁以上个体全身骨密度与椎间盘退变发生具有提示性关联(0.01<P<0.05),其中46~60岁全身骨密度升高与椎间盘退变发生显著相关[逆方差加权(inverse variance weighting,IVW),OR=1.124,95%CI:1.063~1.1893,P=4.47E-05],并在多变量模型中仍保持显著性。在两步孟德尔随机化框架中,遗传预测的全身无脂肪质量(IVW,β=0.141,95%CI:0.033~0.249,P=1.023E-02)和躯干无脂肪质量(IVW,β=0.129,95%CI:0.024~0.234,P=1.575E-02)与46~60岁全身骨密度显著相关;遗传预测的肥胖相关性状均与椎间盘退变显著相关。未观察到循环瘦素水平或脂联素与全身骨密度或椎间盘退变有关(P>0.05)。结论遗传预测的46~60岁人群全身骨密度升高将增加椎间盘退变的发生风险,并且可能作为与无脂肪质量相关的肥胖影响椎间盘退变的中介因素之一。

绝经后女性不同部位骨密度及FRAX预测值与BMI的相关性分析

目的:探讨绝经后女性不同部位骨密度(BMD)及骨折风险评估工具(FRAX)计算出的骨折风险与体质量指数(BMI)的相关性。方法:选取2020年9月至2021年8月于蚌埠医科大学第一附属医院就诊并进行BMD检查的绝经后女性313例,收集研究对象的人口统计学资料及BMD相关信息,并应用FRAX工具计算未来10年发生主要骨质疏松性骨折(脊椎、前臂、髋骨或肩部骨折)的概率(PMOF)和髋部骨折的概率(PHF),分析FRAX预测值与BMD和BMI的相关性,以及联合股骨颈T值的FRAX预测值和不联合股骨颈T值的FRAX预测值是否有差异。结果:腰椎、股骨颈、全髋的BMD随着BMI的增加而增加(P<0.01);FRAX预测值在联合股骨颈T值的情况下,随着BMI的增加,骨折风险逐渐下降(P<0.01);未联合股骨颈T值的FRAX预测值在BMI<28 kg/m^(2)时,随着BMI的增加,骨折风险逐渐下降(P<0.05),当BMI≥28 kg/m^(2)时,骨折风险开始出现上升趋势(P<0.05);在骨量减少人群中,难以筛选出骨折高危人群,FRAX严重低估了发生主要骨质疏松性骨折的风险。结论:体质量过低的人群BMD通常较低,使用FRAX评估其发生骨折的风险相对较高。

腰背肌功能锻炼预防脊柱骨折术后再骨折的临床价值

目的探究腰背肌功能锻炼预防脊柱骨折术后再骨折的临床价值。方法选择2019年8月至2021年2月确诊为脊柱骨折并接受手术治疗的90例患者为研究对象,按照随机数字表法将其分为研究组(n=45,术后接受腰背部肌肉功能锻炼)和对照组(n=45,开展常规术后康复锻炼),各45例。比较两组的视觉模拟量表(VAS)、Oswestry功能障碍指数(ODI)评分、椎体高度、骨密度及再骨折发生情况。结果入院时,两组的VAS评分比较,差异无统计学意义(P>0.05);术后1个月,研究组的VAS评分高于对照组,差异具有统计学意义(P<0.05);术后6、12个月,研究组的VAS评分低于对照组,差异具有统计学意义(P<0.05)。入院时、术后1个月,两组的ODI评分比较,差异无统计学意义(P>0.05);术后6、12个月,研究组的ODI评分低于对照组,差异具有统计学意义(P<0.05)。术后6、12个月,研究组的椎体前缘高度、中部高度高于对照组,差异具有统计学意义(P<0.05);入院时及术后6、12个月,两组的椎体后缘高度比较,差异无统计学意义(P>0.05)。术后12个月,研究组的骨密度高于对照组,差异具有统计学意义(P<0.05);两组的再骨折发生率比较,差异无统计学意义(P>0.05)。结论腰背肌功能锻炼有助于缓解脊柱骨折术后患者的疼痛程度,改善椎体功能,恢复椎体高度,增加骨密度,值得推广。

Osteoporosis affects both post-yield microdamage accumulation and plasticity degradation in vertebra of ovariectomized rats

Estrogen withdrawal in postmenopausal women increases bone loss and bone fragility in the vertebra. Bone loss with osteoporosis not only reduces bone mineral density (BMD), but actually alters bone quality, which can be comprehensively represented by bone post-yield behaviors. This study aimed to provide some information as to how osteoporosis induced by estrogen depletion could influence the evolution of post-yield microdamage accumulation and plastic deformation in vertebral bodies. This study also tried to reveal the part of the mechanisms of how estrogen deficiency-induced osteoporosis would increase the bone fracture risk. A rat bilateral ovariectomy (OVX) model was used to induce osteoporosis. Progressive cyclic compression loading was developed for vertebra testing to elucidate the post-yield behaviors. BMD, bone volume fraction, stiffness degradation, and plastic deformation evolution were compared among rats raised for 5 weeks (ovx5w and sham5w groups) and 35 weeks (ovx35w and sham35w groups) after sham surgery and OVX. The results showed that a higher bone loss in vertebral bodies corresponded to lower stiffness and higher plastic deformation. Thus, osteoporosis could increase the vertebral fracture risk probably through microdamage accumulation and plastic deforming degradation.

长沙地区体检人群不同血脂异常分型与骨密度的关系

目的:探究长沙地区体检人群不同血脂异常分型与骨密度之间关系。方法:对2019年5月至2022年5月期间527例到医院体检人群相关资料进行回顾性分析,收集患者基本资料及血脂、骨密度等资料,将血脂正常、高三酰甘油酯(TG)、高胆固醇(TC)、混合性高脂血症体检者分别纳入正常组(n=140)、高TG组(n=70)、高TC组(n=159)与混合组(n=158)。比较四组体检者血脂水平、骨密度水平,分析血脂水平与骨密度相关性,血脂水平对骨密度影响。结果:高TC组LDL-C水平最高,正常组与高TG组最低,除正常组与高TG组外,其他各组LDL-C水平比较存在统计学意义(P<0.05);高TC组与混合组TC水平显著高于正常组与高TG组(P<0.05);高TG组HDL-C水平最高,混合组HDL-C水平最低(P<0.05);混合组TG水平最高,正常组与高TC组最低,除正常组与高TC组外,其他各组TG水平比较存在统计学意义(P<0.05)。高TC组与混合组右跟骨超声声速水平显著低于正常组与高TG组(P<0.05)。右跟骨超声声速与LDL-C、TC、HDL-C及TG呈负相关关系(P<0.05)。多元线性回归分析显示,影响体检人群骨密度血脂指标依次为LDL-C、TC、TG以及HDL-C。结论:长沙地区体检人群血脂异常者骨密度降低,特别是TC与混合型血脂异常者需要定期筛查骨密度,以便及早发现骨量变化,并进行针对性预防处理。

老年2型糖尿病患者人体成分与骨密度的相关性

目的探讨老年2型糖尿病患者人体成分与骨密度的相关性,为评估老年2型糖尿病患者骨密度情况及预防骨质疏松提供依据。方法随机选取至航空总医院体检中心参加体检的老年人群(年龄≥65岁)为研究对象,其中,168例老年2型糖尿病体检者为疾病组,疾病组内根据骨密度T值分为骨量正常组(34例)、骨量减少组(77例)、骨质疏松组(57例)3个亚组;228例老年非糖尿病体检者为对照组。应用人体成分分析仪对两组人群的体重、体重指数、蛋白质、无机盐、体脂肪、肌肉量、瘦体重、体脂肪率、基础代谢率、腰臀比、内脏脂肪面积进行检测,应用双能X线骨密度仪测量骨密度。采用t检验、χ^(2)检验和Pearson相关性分析明确两组人群骨密度的相关因素;采用方差分析比较疾病组3个亚组人体成分的差别;应用多分类有序Logistic回归分析老年2型糖尿病患者骨质疏松的独立危险因素;绘制受试者操作特征曲线评价内脏脂肪面积预测骨质疏松的效能。结果疾病组体重、体重指数、蛋白质、无机盐、体脂肪、肌肉量、瘦体重、体脂肪率、基础代谢率、腰臀比、内脏脂肪面积高于对照组(P<0.05),骨密度低于对照组(P<0.05)。疾病组的骨密度与体脂肪率、内脏脂肪面积负相关(r=-0.193、r=-0.169,P<0.05),与蛋白质、肌肉量、瘦体重、基础代谢率正相关(r=0.192、r=0.162、r=0.161、r=0.161,P<0.05)。对照组骨密度与体重、体重指数、蛋白质、无机盐、肌肉量、瘦体重、基础代谢率正相关(r=0.327、r=0.256、r=0.388、r=0.351、r=0.364、r=0.364、r=0.364,P<0.001)。疾病组内3个亚组患者蛋白质、肌肉量、瘦体重、体脂肪率、基础代谢率、内脏脂肪面积差异有统计学意义(P<0.05)。疾病组多分类有序Logistic回归分析提示内脏脂肪面积是骨质疏松发生的危险性因素(OR=1.099,95%CI:[1.041,1.160],P<0.05),蛋白质是骨质疏松发生的保护性因素(OR=0.563,95%CI:[0.346,0.892],P<0.05)。内脏脂肪面积预测骨质疏松的受试者操作特征曲线下面积为0.729(95%CI:[0.652,0.806],P<0.001),诊断敏感性为68.4%,特异性为71.2%,假阳性率为28.8%。结论体脂肪率和内脏脂肪面积与老年2型糖尿病患者骨密度呈负相关关系;老年2型糖尿病合并骨质疏松患者体内蛋白质、肌肉含量明显减低,体脂肪率及内脏脂肪面积明显增高;蛋白质是老年2型糖尿病患者骨质疏松发生的保护性因素,内脏脂肪面积是骨质疏松发生的危险因素。利用人体成分分析仪了解老年2型糖尿病患者的人体成分,提高体内蛋白质含量及降低内脏脂肪面积,可预防骨质疏松及降低骨折风险。