Barbu C, Roman A, Rotaru R, Fica S
Universitatea de Medicină şi Farmacie Carol Davila Bucureşti, Facultatea de Medicină, Departamentul de Endocrinologie Spitalul Elias Bucureqti.
Rev Med Chir Soc Med Nat Iasi. 2006 Apr-Jun;110(2):291-4.
Our objective was to explore whether a casual determination of 24-hour urinary calcium excretion and serum total alkaline phosphatase (TAP), in osteoporotic postmenopausal women are independent predictors for osteoporotic fracture. Subjects were 121 women with postmenopausal osteoporosis (mean age 62.8 +/- 9.9) segregated in two study groups based on prevalence of osteoporotic fractures (51 women with prevalent fractures and 70 without fractures), similar in terms of age and BMI. We measured bone mineral density (BMD) by DXA at lumbar spine and femoral neck. Vertebral fracture assessment was done by plain X ray evaluation. Routine blood tests and extensive endocrine evaluation were performed in all patients to exclude secondary causes of osteoporosis. Serum TAP, calcium, phosphate and urinary calcium excretion was measured to evaluate bone metabolism. We did not find any significant differences between groups regarding lumbar T score (-3.1/-2.9 SD), femoral neck T score (-2.2/-1.8 SD), lumbar Z score (-1.5/-1.9 SD) or femoral neck Z score (-1.5/-1.8 SD). Serum TAP was higher in fracture group (211.5 UI) comparing to non-fracture osteoporotic women (208.3 UI) without statistical significance. We were not able to find any significant difference between groups in terms of urinary calcium excretion (9.13/5.4 mEq/24h) or serum total calcium (4.8/4.9 mmol/l).
in spite of a mean TAP near the upper limit of normal range which could be related to low bone mass, there is no significant relationship to fracture risk in osteoporotic postmenopausal women. Based on our data, a casual measurement of urinary calcium excretion seems irrelevant for BMD independent fracture risk assessment in this clinical setup.
我们的目的是探讨在绝经后骨质疏松女性中，随意测定的24小时尿钙排泄量和血清总碱性磷酸酶（TAP）是否为骨质疏松性骨折的独立预测因素。研究对象为121名绝经后骨质疏松女性（平均年龄62.8±9.9岁），根据骨质疏松性骨折的患病率分为两个研究组（51名有既往骨折的女性和70名无骨折的女性），两组在年龄和体重指数方面相似。我们通过双能X线吸收法（DXA）测量腰椎和股骨颈的骨密度（BMD）。通过普通X线评估进行椎体骨折评估。对所有患者进行常规血液检查和广泛的内分泌评估，以排除骨质疏松的继发原因。测量血清TAP、钙、磷和尿钙排泄量以评估骨代谢。我们发现两组在腰椎T值（-3.1/-2.9标准差）、股骨颈T值（-2.2/-1.8标准差）、腰椎Z值（-1.5/-1.9标准差）或股骨颈Z值（-1.5/-1.8标准差）方面没有显著差异。骨折组的血清TAP（211.5国际单位）高于无骨折的骨质疏松女性（208.3国际单位），但无统计学意义。我们未能发现两组在尿钙排泄量（9.13/5.4毫当量/24小时）或血清总钙（4.8/4.9毫摩尔/升）方面有任何显著差异。
尽管平均TAP接近正常范围上限，这可能与低骨量有关，但在绝经后骨质疏松女性中，TAP与骨折风险之间没有显著关系。根据我们的数据，在这种临床情况下，随意测量尿钙排泄量似乎与独立于骨密度的骨折风险评估无关。
