Riggs B L, Wahner H W, Seeman E, Offord K P, Dunn W L, Mazess R B, Johnson K A, Melton L J
J Clin Invest. 1982 Oct;70(4):716-23. doi: 10.1172/jci110667.
We measured bone mineral density (BMD) of the proximal femur, lumbar spine, or both by dual photon absorptiometry in 205 normal volunteers (123 women and 82 men; age range 20 to 92 yr) and in 31 patients with hip fractures (26 women and 5 men; mean age, 78 yr). For normal women, the regression of BMD on age was negative and linear at each site; overall decrease during life was 58% in the femoral neck, 53% in the intertrochanteric region of the femur, and 42% in the lumbar spine. For normal men, the age regression was linear also; the rate of decrease in BMD was two-thirds of that in women for femoral neck and intertrochanteric femur but was only one-fourth of that in women for lumbar spine. This difference may explain why the female/male ratio is 2:1 for hip fractures but 8:1 for vertebral fractures. The standard deviation (Z-score) from the sex-specific age-adjusted normal mean in 26 women with hip fracture averaged -0.31 (P < 0.05) for the femoral neck, -0.53 (P < 0.01) for the intertrochanteric femur, and +0.24 (NS) for the lumbar spine; results were similar for 5 men with hip fractures. By contrast, for 27 additional women, ages 51-65 yr, with only nontraumatic vertebral fractures, the Z-score was -1.92 (P < 0.001) for the lumbar spine. Thus, contrary to the view that osteoporosis is a single age-related entity, our data suggest the existence of two distinct syndromes. One form, "postmenopausal osteoporosis," is characterized by excessive and disproportionate trabecular bone loss, involves a small subset of women in the early postmenopausal period, and is associated mainly with vertebral fractures. The other form, "senile osteoporosis," is characterized by proportionate loss of both cortical and trabecular bone, involves essentially the entire population of aging women and, to a lesser extent, aging men, and is associated with hip fractures or vertebral fractures or both.
我们采用双能X线吸收法测量了205名正常志愿者（123名女性和82名男性；年龄范围20至92岁）以及31例髋部骨折患者（26名女性和5名男性；平均年龄78岁）股骨近端、腰椎或两者的骨密度（BMD）。对于正常女性，各部位BMD随年龄的变化呈负向线性关系；一生中股骨颈骨密度总体下降58%，股骨转子间区域下降53%，腰椎下降42%。对于正常男性，年龄回归也呈线性；股骨颈和股骨转子间区域BMD的下降速率为女性的三分之二，但腰椎仅为女性的四分之一。这种差异可能解释了为何髋部骨折的女性/男性比例为2:1，而椎体骨折为8:1。26例髋部骨折女性患者股骨颈的骨密度标准差（Z值）相对于按性别和年龄调整后的正常均值平均为-0.31（P<0.05），股骨转子间为-0.53（P<0.01），腰椎为+0.24（无统计学意义）；5例髋部骨折男性患者的结果相似。相比之下，另外27名年龄在51至65岁之间、仅有非创伤性椎体骨折的女性，腰椎的Z值为-1.92（P<0.001）。因此，与骨质疏松症是单一的年龄相关疾病这一观点相反，我们的数据表明存在两种不同的综合征。一种形式为“绝经后骨质疏松症”，其特征是小梁骨过度且不成比例地丢失，涉及绝经早期的一小部分女性，主要与椎体骨折相关。另一种形式为“老年性骨质疏松症”，其特征是皮质骨和小梁骨均成比例丢失，基本上涉及所有老年女性人群，在老年男性中程度较轻，与髋部骨折或椎体骨折或两者均相关。
