Kuh D, Muthuri S, Cooper R, Moore A, Mackinnon K, Cooper C, Adams J E, Hardy R, Ward K A
Medical Research Council Unit for Lifelong Health and Ageing (D.K., S.M., R.C., A.M., K.M., R.H.), University College London, London WC1B 5JU, United Kingdom; Medical Research Council Lifecourse Epidemiology Unit (C.C., K.A.W.), University of Southampton, Southampton SO16 6YD, United Kingdom; Clinical Radiology and Academic Health Science Centre (J.E.A.), Manchester Royal Infirmary, Central Manchester University Hospital, National Health Service Foundation Trust and University of Manchester, Manchester M13 9PT, United Kingdom; and Medical Research Council Human Nutrition Research (K.A.W.), Cambridge CB1 9NL, United Kingdom.
J Clin Endocrinol Metab. 2016 Oct;101(10):3827-3837. doi: 10.1210/jc.2016-1828. Epub 2016 Jul 29.
Previous studies of menopausal age and length of reproductive life on bone are limited by retrospective reproductive histories, being cross-sectional, or lacking gold standard bone technologies or information on hormone replacement therapy (HRT) or surgical treatment.
The objective of the study was to investigate age at menopause, length of reproductive life, and HRT use in relation to volumetric and areal bone mineral density (vBMD, aBMD), bone size, and strength in women aged 60-64 years.
This was a birth cohort study that followed up for 64 years with prospective measures of age at menarche and menopause and monthly HRT histories.
The study was conducted in England, Scotland, and Wales.
Participants included 848 women with a known type of menopause and bone measures at 60-64 years.
Peripheral quantitative computed tomography measurements of the distal radius total and trabecular vBMD were measured. Diaphyseal radius total and medullary cross-sectional area, cortical vBMD, and polar strength strain index (SSI); dual-energy x-ray absorptiometry measurements of aBMD at the lumbar spine and total hip were also measured.
A 10-year increase in age at natural (but not surgical) menopause was associated with 8.2% (95% confidence interval [CI] 1.3%-15.1%, P = .02) greater trabecular vBMD and a 6.0% (95% CI 0.51%-11.5%, P = .03) greater total vBMD; findings were similar for length of reproductive life. A 10-year difference in HRT use was associated with a 6.0% (95% CI 2.6%-9.3%, P < .001) greater polar SSI and a 0.9% (95% CI 0.4%-1.5%, P = .001) greater cortical vBMD. These estimates changed little on adjustment. Estimates for aBMD were consistent with those for peripheral quantitative computed tomography.
The positive effects on trabecular vBMD of later natural menopause and longer reproductive life persisted into early old age. HRT use was associated with greater radius cortical vBMD and polar SSI and aBMD.
既往关于绝经年龄和生殖寿命对骨骼影响的研究存在局限性，如采用回顾性生殖史、横断面研究方法，或缺乏金标准骨技术，或缺乏激素替代疗法（HRT）或手术治疗的相关信息。
本研究旨在调查60 - 64岁女性的绝经年龄、生殖寿命和HRT使用情况与体积骨密度和面积骨密度（vBMD、aBMD）、骨大小及强度之间的关系。
这是一项出生队列研究，对初潮年龄和绝经年龄以及每月HRT使用情况进行了64年的前瞻性测量。
研究在英格兰、苏格兰和威尔士进行。
参与者包括848名60 - 64岁、绝经类型已知且有骨测量数据的女性。
测量桡骨远端总体积骨密度和小梁体积骨密度的外周定量计算机断层扫描。测量骨干半径总和、髓腔横截面积、皮质骨密度和极向强度应变指数（SSI）；还测量腰椎和全髋部的面积骨密度的双能X线吸收法测量值。
自然绝经（而非手术绝经）年龄每增加10岁，小梁体积骨密度增加8.2%（95%置信区间[CI] 1.3% - 15.1%，P = 0.02），总体积骨密度增加6.0%（95% CI 0.51% - 11.5%，P = 0.03）；生殖寿命方面的结果相似。HRT使用情况每相差10年，极向SSI增加6.0%（95% CI 2.6% - 9.3%，P < 0.001），皮质骨密度增加0.9%（95% CI 0.4% - 1.5%，P = 0.001）。调整后这些估计值变化不大。面积骨密度的估计值与外周定量计算机断层扫描的估计值一致。
自然绝经年龄较晚和生殖寿命较长对小梁体积骨密度的积极影响持续到老年早期。HRT的使用与桡骨皮质骨密度、极向SSI和面积骨密度增加有关。
