Lomholt S, Amstrup A K, Moser E, Jakobsen N F B, Mosekilde L, Vestergaard P, Rejnmark L
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus, Denmark,
Calcif Tissue Int. 2015 Apr;96(4):284-94. doi: 10.1007/s00223-015-9955-y. Epub 2015 Jan 23.
Unexplained high bone mineral density (BMD) is a rare condition and the mechanisms responsible are yet to be described in detail. The aim of the study was to identify patients with unexplained high BMD from a local DXA database and compare their radiological phenotype with an age- and a gender-matched group of population-based controls. We defined high BMD as a DXA Z-score ≥ + 2.5 at the total hip and lumbar spine. We characterized the findings as "unexplained" if no osteodegenerative changes, bone metabolic disease, or arthritis at the hip or lumbar spine was observed. All participants were investigated with high-resolution peripheral quantitative computed tomography (HR-pQCT), QCT, DXA, fasting blood samples, a 24-h urine sample, and questionnaires. The DXA database contained data on 25,118 patients. Initially, 138 (0.55%) potential participants with high BMD were identified, and during the study ten additional cases were identified from new DXA scans. Sixty-seven patients accepted to participate in the study, and among these we identified 15 women and one man with unexplained high BMD. These 15 women had higher BMD throughout the skeleton relative to controls, similar area/volume at the hip and the distal extremities, a higher number of trabeculae, which was thicker than in the controls, and a higher finite element estimated bone strength. The 15 women were heavier and had a higher fat mass then controls. We conclude that patients with unexplained high BMD have a generalized high BMD phenotype throughout their skeleton, which is characterized with a denser microarchitecture.
不明原因的高骨密度（BMD）是一种罕见病症，其相关机制尚未得到详细描述。本研究的目的是从本地双能X线吸收法（DXA）数据库中识别出不明原因高骨密度的患者，并将他们的放射学表型与年龄和性别匹配的基于人群的对照组进行比较。我们将高骨密度定义为全髋和腰椎的DXA Z值≥ +2.5。如果在髋部或腰椎未观察到骨退行性改变、骨代谢疾病或关节炎，我们将这些发现归类为“不明原因”。所有参与者均接受了高分辨率外周定量计算机断层扫描（HR-pQCT）、定量CT（QCT）、DXA、空腹血样、24小时尿样及问卷调查。DXA数据库包含25,118名患者的数据。最初，识别出138名（0.55%）潜在的高骨密度参与者，在研究期间，从新的DXA扫描中又识别出10例。67名患者同意参与研究，其中我们识别出15名女性和1名男性患有不明原因的高骨密度。相对于对照组，这15名女性全身骨骼的骨密度更高，髋部和远端肢体的面积/体积相似，小梁数量更多且比对照组更厚，有限元估计的骨强度更高。这15名女性比对照组体重更重且脂肪量更高。我们得出结论，不明原因高骨密度的患者全身骨骼具有普遍的高骨密度表型，其特征是微观结构更致密。
