Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; MRC Nutrition and Bone Health Research Group, Clifford Allbutt Building, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 OAH, United Kingdom.
Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom; SAMRC/Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Bone. 2022 Nov;164:116543. doi: 10.1016/j.bone.2022.116543. Epub 2022 Sep 1.
Menopause transition is associated with accelerated bone loss, though data are limited from sub-Saharan African (SSA). Our objective was to describe bone density, geometry and estimated strength in women by menopause status and to explore whether patterns differed within those living with HIV.
Radius and tibia peripheral QCT data were collected for Black South African women (n = 430) aged 40-61 years with verified menopause and HIV status. pQCT outcomes were distal 4 % radius and tibia total cross-sectional area (CSA), total volumetric bone mineral density (vBMD), and compressive bone strength (BSIc); proximal 66 % radius and 38 % tibia cortical vBMD, total CSA, cortical thickness, and Stress-strain Index (SSI). Linear regression assessed associations between pre, peri-, and postmenopausal groups and pQCT outcomes adjusting for age, height, and weight, and then stratified by HIV status. Mean [95%CI] and tests for trend (p-trend) across menopausal groups are presented.
Women were mean (SD) age 49.2 (5.3) years, with a body mass index (BMI) of 32.4 (6.3) m/kg, and 18 % were living with HIV. After adjustment, later menopause stage was associated with lower 4 % radius total mean [95%CIs] vBMD (premenopause: 345.7 [335.8,355.5] vs. postmenopause: 330.1 [322.7,337.6] mg/cm, p-trend = 0.017) and BSIc (premenopause: 0.39 [0.37,0.41] vs. postmenopause: 0.36 [0.35,0.37] g/cm; p-trend = 0.012). Similar trends were observed at the 66 % radius for cortical vBMD (premenopause: 1146.8 [1138.9,1154.6] vs. postmenopause: 1136.1 [1130.1,1142.0] mg/cm; p-trend = 0.028) and cortical thickness (premenopause: 2.01 [1.95,2.06] vs. postmenopause: 1.93 [1.89,1.98] mm; p-trend = 0.036). After stratification by HIV status a similar patten was observed in women with HIV (cortical vBMD premenopause: 1152.9 [1128.5,1177.2] mg/cm vs. postmenopause: 1123.6 [1106.0,1141.2] mg/cm, p-trend = 0.048). Total CSA varied little by menopause or HIV status at either radius sites; few differences were found at the tibia.
In black South African women, menopause is associated with lower bone density and strength at the distal radius, a common site of osteoporotic fracture, in addition to lower cortical density and thickness at the proximal radius. Although the sample size was small, following stratification by HIV, women living with HIV had evidence of lower cortical density across menopause stages, unlike those without HIV. These findings raise concern for the incidence of Colles' fractures in postmenopausal women in South Africa; longitudinal studies of fracture incidence and implications of living with HIV are required.
描述绝经状态下南非黑人女性的骨密度、骨几何结构和骨强度，并探讨是否存在 HIV 感染者之间的差异。
对 40-61 岁的南非黑人女性（n=430）进行桡骨和胫骨外周定量计算机断层扫描（pQCT）数据采集，这些女性的绝经状态和 HIV 状况均已得到证实。pQCT 结果包括远端 4%桡骨和胫骨总横截面积（CSA）、总容积骨密度（vBMD）和压缩骨强度（BSIc）；近端 66%桡骨和 38%胫骨皮质 vBMD、总 CSA、皮质厚度和应变-应变指数（SSI）。线性回归用于评估绝经前、围绝经期和绝经后组与 pQCT 结果之间的关系，同时调整年龄、身高和体重，并按 HIV 状况进行分层。呈现了绝经组之间的平均[95%CI]和趋势检验（p-trend）。
女性的平均（SD）年龄为 49.2（5.3）岁，体重指数（BMI）为 32.4（6.3）m/kg，18%的人携带 HIV。调整后，较晚的绝经阶段与较低的远端桡骨总平均[95%CI]vBMD 相关（绝经前：345.7 [335.8,355.5] vs. 绝经后：330.1 [322.7,337.6] mg/cm，p-trend=0.017）和 BSIc（绝经前：0.39 [0.37,0.41] vs. 绝经后：0.36 [0.35,0.37] g/cm，p-trend=0.012）。在桡骨 66%处也观察到类似的皮质 vBMD 趋势（绝经前：1146.8 [1138.9,1154.6] vs. 绝经后：1136.1 [1130.1,1142.0] mg/cm，p-trend=0.028）和皮质厚度（绝经前：2.01 [1.95,2.06] vs. 绝经后：1.93 [1.89,1.98] mm，p-trend=0.036）。按 HIV 状况分层后，在 HIV 感染者中也观察到了类似的模式（皮质 vBMD 绝经前：1152.9 [1128.5,1177.2] mg/cm vs. 绝经后：1123.6 [1106.0,1141.2] mg/cm，p-trend=0.048）。在桡骨的两个部位，绝经或 HIV 状况对总 CSA 的影响都很小；在胫骨处，差异很小。
在南非黑人女性中，绝经与远端桡骨骨密度和强度降低有关，这是骨质疏松性骨折的常见部位，此外，还与桡骨近端皮质密度和厚度降低有关。尽管样本量较小，但按 HIV 分层后，与未感染 HIV 的女性相比，感染 HIV 的女性在整个绝经阶段都有较低的皮质密度证据。这些发现引起了人们对南非绝经后妇女发生科雷氏骨折的担忧；需要进行骨折发生率的纵向研究和 HIV 感染的影响研究。
