绝经后妇女前臂骨骨量丢失的相关危险因素研究

摘要

Objective To explore forearm bone loss-related risk factors in postmenopausal women. Methods A total of 153 healthy women, over one year since menopause, were recruited to measure hone mineral density (BMD) of the non-dominant forearm, including the distal end of the radius and ulna, proximal end of the radius and ulna, and proximal radius alone, using peripheral dual X-ray absorptiometry ( pDXA ).General information of all subjects was collected with a questionnaire. In addition, urine pyridinoline, serum estradiol, parathyroid hormone, osteocalcin, and alkaline phosphatase were measured. Results It was showed that in postmenopausal women, the BMD values at all examined forearm sites declined along with aging and YSM (years since menopause). The speed of the decline was obvious in the first ten years after menopause, and was gradually moderate thereafter, which was in accordance with the axial bone measurement. Early menopause time, multiple pregnancies, and longer breasffeeding time were risk factors of bone loss and the incidence of osteoporosis in postmenopausal women. Comparing with those in postmenopausal women without osteoporosis, the serum levels of estrogen and calcium were lower, and serum PTH and urine Pyd/Cr were higher in postmenopausal women with osteoporosis. The postmenopausal osteoporosis appeared in high bone turnover type. The usage of estrogen would reduce the early bone lose occurred in early menopause. However, the usage of estrogen was only account for 9. 3％ of people.Conclusion Bone loss in forearm bone was similar with that in the axial bone. pDXA would bo useful to screen high risk population in the society. Years since menopause, procreation status, and usage of estrogen would be the important risk factors that influenced bone mass in postmenopausal women.%目的 探讨绝经后妇女前臂骨骨量丢失的相关危险因素.方法 采用美国NORLAND-Stratec 周围型双能X线骨矿测量仪(pDXA)测量了183例绝经1年以上的女性健康志愿者非优势侧前臂远端桡+尺骨(distal radius+ulna)、近端桡+尺骨(proximal radius+ulna)以及近端桡骨(proximal radius)的BMD值,以问卷调查方法收集研究对象的一般情况,并测定了尿吡啶酚、血清雌二醇、甲状旁腺激素、骨钙素和碱性磷酸酶等指标.结果 绝经后妇女前臂骨不同测量部位的BMD值均随年龄增长和绝经年限的延长呈加速下降,尤其是绝经后头十年内下降速度明显,此后逐步趋向缓和,其趋势与中轴骨测量结果一致.绝经早、绝经年限长、怀孕次数多和哺乳时间长等因素是绝经后女性骨丢失和骨质疏松症发生的重要危险因素.此外,与非OP的绝经后健康妇女相比,绝经后患OP妇女的雌激素水平明显下降、血钙水平较低,血PTH和尿Pyd/Cr等明显升高,表现为高骨转换型.使用雌激素替代治疗可减缓绝经后早期骨量丢失,但使用人数比例仅为9.3%.结论 妇女绝经后前臂骨骨量丢失规律同中轴骨改变,可采用周围型双能X线骨矿测量仪测量前臂骨BMD用于社区高危人群筛查.绝经年限、生育状况和雌激素使用情况等是影响绝经后妇女骨量值的重要因素.