Lepiarz-Rusek Wanda, Kokocińska Danuta
Oddział Reumatologii Wojewódzkiego, Szpitala Specjalistycznego Nr 5 w Sosnowcu.
Przegl Lek. 2005;62(7):641-9.
Osteoporosis is the most frequent metabolic bone disease. Until recently it was believed to mainly affect women in menopause. A review of the literature indicates that a lot of the research to date on women. The patogenesis of bone loss in men has not been explained yet. It has not been determined what is the contribution of androgens as opposed to environmental factors and stimulants. The behaviour of bone turnover markers during ageing and their role in diagnosing the risk of osteoporosis development and fractures in men are not clear. The objective of the paper was to evaluate bone metabolism markers and to determine their relevance in early diagnosis of osteoporosis in men, and to determine any possible impact of testosterone concentration on bone mass. The study covered 100 volunteers-males, aged 40-85. All were subjected to a densitometric examination, using theDEXA method, of three regions of the osseous system: lumbar spine in anterior-posterior height, proximal femur, distal radius. Based on these results, subjects were divided into three groups: without osteoporosis, with osteopenia and with osteoporosis. In all men the serum level of the following was marked: 1) 3 markers of bone formation: osteocalcin (BGP), bone alkaline phosphatase (b-ALP) and Procollagen I Aminoterminal propeptide (PINP); 2) 2 markers of bone resorption: Collagen Type I Crosslinked C-telopeptide (Ctx) and Tartarate Resistant Acid Phosphatase (TRAP); 3) testosterone. The results obtained were subjected to thorough statistical analisis. Mean concentrations of bone metabolism, testosterone and calcium consumption in the groups examined were compared by mean of ANOVA variance analysis and the smallest significant difference test. Relationship between markers of bone resorption and formation, testosterone level and bone mineral density (BMD) were shown by means of Pearson linear correlation. The relevance of markers in the diagnosing of osteoporosis in men was evaluated by means of the ROC curves. The results obtained lead to the following conclusions: Among the markers of bone turnover analysed, Collagen Typ I Crosslinked C-telopeptide (Ctx-serum) is the most useful marker in the diagnosis of osteoporosis in men, followed by Tartarate Resistant Acid Phosphatase (TRAP) and osteocalcin (BGP). There is no relationship between bone mineral density and serum testosterone level.
骨质疏松症是最常见的代谢性骨病。直到最近,人们还认为它主要影响绝经后的女性。对文献的回顾表明,迄今为止许多研究都集中在女性身上。男性骨质流失的发病机制尚未得到解释。尚未确定雄激素相对于环境因素和刺激物的作用。骨转换标志物在衰老过程中的行为及其在诊断男性骨质疏松症发展风险和骨折方面的作用尚不清楚。本文的目的是评估骨代谢标志物,确定它们在男性骨质疏松症早期诊断中的相关性,并确定睾酮浓度对骨量的任何可能影响。该研究涵盖了100名年龄在40至85岁之间的男性志愿者。所有人都使用双能X线吸收法(DEXA)对骨骼系统的三个区域进行了骨密度检查:腰椎前后位、股骨近端、桡骨远端。根据这些结果,受试者被分为三组:无骨质疏松症组、骨量减少组和骨质疏松症组。对所有男性的血清水平进行了以下指标的检测:1)三种骨形成标志物:骨钙素(BGP)、骨碱性磷酸酶(b-ALP)和I型前胶原氨基端前肽(PINP);2)两种骨吸收标志物:I型胶原交联C末端肽(Ctx)和抗酒石酸酸性磷酸酶(TRAP);3)睾酮。对所得结果进行了全面的统计分析。通过方差分析和最小显著差异检验比较了所检查组中骨代谢、睾酮和钙消耗的平均浓度。通过Pearson线性相关性分析显示了骨吸收和形成标志物、睾酮水平与骨矿物质密度(BMD)之间的关系。通过ROC曲线评估了标志物在男性骨质疏松症诊断中的相关性。所得结果得出以下结论:在所分析的骨转换标志物中,I型胶原交联C末端肽(血清Ctx)是男性骨质疏松症诊断中最有用的标志物,其次是抗酒石酸酸性磷酸酶(TRAP)和骨钙素(BGP)。骨矿物质密度与血清睾酮水平之间没有关系。