Marcus R, Greendale G, Blunt B A, Bush T L, Sherman S, Sherwin R, Wahner H, Wells B
Department of Medicine, Stanford University, Palo Alto, California.
J Bone Miner Res. 1994 Sep;9(9):1467-76. doi: 10.1002/jbmr.5650090920.
We assessed the cross-sectional relationship of age, menopausal years, body mass, previous estrogen use, and ethnic background to bone mineral status in a sample of 875 healthy postmenopausal women at the time they were recruited from the community to participate in a multicenter clinical trial. The women were 1-10 years postmenopause, 45-64 years of age, and had not received estrogen replacement therapy within 3 months of enrollment. Of the participants, 89% were white, 69% had a spontaneous menopause, and 53% had a history of previous estrogen replacement therapy. Bone mineral density (BMD) of the lumbar spine (L2-4) and proximal femur was measured by dual-energy x-ray absorptiometry. Results were consistent with a significant negative linear regression of BMD on age or years from menopause. Body mass index (BMI) correlated significantly with BMD at all sites (L 2-4 r = 0.28; femoral neck r = 0.34, p < 0.0001). BMD adjusted for age and BMI were higher at both sites in women who had taken estrogen versus those who had not (L2-4 0.976 +/- 0.009 versus 0.932 +/- 0.01; femoral neck 0.740 +/- 0.006 versus 0.708 +/- 0.008, p < 0.05). Adjusted BMD also increased with duration of ERT. Parity was negatively associated with L2-4 BMD (p = 0.03) but did not correlate significantly with BMD at the femoral neck. Black women had the highest L2-4 BMD, and Hispanic women had the highest femoral neck BMD, even when results were adjusted for age and BMI. When data were corrected for differences in bone size, these interethnic differences were no longer significant. We conclude that increased body mass is positively correlated with BMD, and this may confer a degree of skeletal protection to heavier postmenopausal women. Exposure for 5 years to exogenous estrogen is associated with significantly increased age- and BMI-adjusted BMD.
我们在从社区招募来参与一项多中心临床试验的875名健康绝经后妇女样本中，评估了年龄、绝经年限、体重、既往雌激素使用情况和种族背景与骨矿物质状态之间的横断面关系。这些妇女绝经1至10年，年龄在45至64岁之间，且在入组前3个月内未接受过雌激素替代治疗。参与者中，89%为白人，69%自然绝经，53%有过雌激素替代治疗史。采用双能X线吸收法测量腰椎（L2 - 4）和股骨近端的骨密度（BMD）。结果与BMD随年龄或绝经年限呈显著负线性回归一致。体重指数（BMI）与所有部位的BMD均显著相关（L2 - 4，r = 0.28；股骨颈，r = 0.34，p < 0.0001）。调整年龄和BMI后，服用雌激素的妇女在两个部位的BMD均高于未服用者（L2 - 4，0.976 ± 0.009对0.932 ± 0.01；股骨颈，0.740 ± 0.006对0.708 ± 0.008，p < 0.05）。调整后的BMD也随ERT持续时间增加。产次与L2 - 4 BMD呈负相关（p = 0.03），但与股骨颈BMD无显著相关性。即使在调整年龄和BMI后，黑人女性的L2 - 4 BMD最高，西班牙裔女性的股骨颈BMD最高。当对骨大小差异进行校正后，这些种族间差异不再显著。我们得出结论，体重增加与BMD呈正相关，这可能为体重较重的绝经后妇女提供一定程度的骨骼保护。5年的外源性雌激素暴露与年龄和BMI调整后的BMD显著增加相关。
