Manocha Anjali, Srivastava L M, Bhargava Seema
Department of Biochemistry, Sir Ganga Ram Hospital, New Delhi, 110060 India.
Indian J Clin Biochem. 2017 Jul;32(3):261-265. doi: 10.1007/s12291-016-0610-9. Epub 2016 Aug 26.
Lead exposure is increasingly becoming an important risk factor for osteoporosis. In adults, approximately 80-90 % of absorbed lead is stored in the bones. These bone lead deposits are released into the blood during periods of enhanced bone resorption like menopause, forming a potential endogenous source of lead exposure. Postmenopausal women are at a higher risk for bone lead release because of hormonal and age related changes in bone metabolism. Estrogen deficiency is associated with increase in osteoclasts number and activity leading to both the early and late form of osteoporosis. Hence, high blood lead level coupled with concomitant environmental exposure exposes women in this age group to lead related adverse outcomes like hypertension, reduced kidney and neurocognitive functions as well as increased risk of atherosclerosis and cardiovascular mortality. A few studies have also identified coexisting variates like ethnicity, occupation, residence, education, smoking, alcohol medications, water etc. as significant determinants of bone and blood lead in women, thus increasing the magnitude of postmenopausal bone changes. Hence, interventions focused on reducing the intensity of bone resorption during menopause will help decrease exposure to endogenous lead. This would play a significant role in decreasing the morbidity and mortality associated with menopause. Also, identification of modifiable factors that prevent bone lead release will reduce the risk of chronic lead exposure and improve the health outcomes of post-menopausal women.
铅暴露正日益成为骨质疏松症的一个重要风险因素。在成年人中,约80% - 90%被吸收的铅储存在骨骼中。在诸如更年期等骨吸收增强时期,这些骨骼中的铅沉积物会释放到血液中,形成潜在的内源性铅暴露源。由于骨代谢中与激素和年龄相关的变化,绝经后女性骨铅释放的风险更高。雌激素缺乏与破骨细胞数量和活性增加有关,会导致早期和晚期骨质疏松症。因此,高血铅水平加上环境暴露,使该年龄组的女性面临与铅相关的不良后果,如高血压、肾脏和神经认知功能下降,以及动脉粥样硬化风险增加和心血管疾病死亡率上升。一些研究还确定了种族、职业、居住、教育、吸烟、饮酒、用药、水质等共存变量是女性骨骼和血铅的重要决定因素,从而增加了绝经后骨骼变化的程度。因此,专注于降低更年期骨吸收强度的干预措施将有助于减少内源性铅暴露。这将在降低与更年期相关的发病率和死亡率方面发挥重要作用。此外,识别可改变的预防骨铅释放的因素将降低慢性铅暴露风险,并改善绝经后女性的健康状况。