Arlot M E, Sornay-Rendu E, Garnero P, Vey-Marty B, Delmas P D
INSERM U 403, E. Herriot Hospital, Lyon, France.
J Bone Miner Res. 1997 Apr;12(4):683-90. doi: 10.1359/jbmr.1997.12.4.683.
We measured the bone mineral density (BMD) at various skeletal sites (total body, hip, anteroposterior [AP] and lateral [lat] spine, and forearm) in a large population-based cohort of women aged 31-89 years (the OFELY cohort), and results were analyzed according to age and postmenopausal years. A significant apparent bone loss was found before the menopause in cancellous bone, i.e., at the lat spine and Ward's triangle (-10%; p < 0.05-0.001). Cross-sectional analysis indicated that, after the menopause, apparent bone loss was accelerated within the 10 years following menopause, continued thereafter at all sites except the AP spine, and was again accelerated in elderly menopausal for more than 25 years. Between 30 and 80 years, BMD decreased by 15 to 44% (T score -1.6 to -3.4) according to the site. The amount of apparent bone loss was highest at the Ward's triangle when expressed in percentage (44%) and at the mid- and distal radius when expressed in number of standard deviations from the peak bone mass (-3.4). As a result, the percentage of women classified as osteoporotic according to the World Heath Organization, i.e., with a T score < or = -2.5, varied substantially from site to site and was highest at the radius (37% and 46%) and lateral spine (25-31%), intermediate at the Ward's triangle, AP spine, and whole body BMD, and lowest at the whole body bone mineral content, femoral neck, and trochanter (10-12%). In conclusion, this cross-sectional but large study suggests that there is a moderate apparent premenopausal bone loss that occurs only at cancellous bone sites and that apparent bone loss is accelerated at most skeletal sites after the age of 75 years. Because of the highly variable coefficient of variation of the peak bone mass at various skeletal sites, the percentage of postmenopausal women identified as being osteoporotic varies widely according to the site of measurement.
我们在一个基于人群的大型队列中，测量了31至89岁女性（OFELY队列）不同骨骼部位（全身、髋部、前后位[AP]和侧位[lat]脊柱以及前臂）的骨密度（BMD），并根据年龄和绝经年限对结果进行了分析。发现在绝经前松质骨中存在明显的骨质流失，即侧位脊柱和沃德三角区（-10%；p<0.05 - 0.001）。横断面分析表明，绝经后，明显的骨质流失在绝经后的10年内加速，此后除AP脊柱外的所有部位持续存在，并且在绝经超过25年的老年女性中再次加速。在30至80岁之间，根据部位不同，BMD下降了15%至44%（T值为-1.6至-3.4）。以百分比表示时，明显骨质流失量在沃德三角区最高（44%），以相对于峰值骨量的标准差数量表示时，在桡骨中、远端最高（-3.4）。因此，根据世界卫生组织标准被归类为骨质疏松症（即T值≤-2.5）的女性百分比在不同部位差异很大，在桡骨处最高（37%和46%）和侧位脊柱处（25 - 31%），在沃德三角区、AP脊柱和全身BMD处居中，在全身骨矿物质含量、股骨颈和大转子处最低（10 - 12%）。总之，这项横断面但规模较大的研究表明，绝经前仅在松质骨部位存在中度明显的骨质流失，并且在75岁以后大多数骨骼部位的明显骨质流失加速。由于不同骨骼部位峰值骨量的变异系数差异很大，绝经后被确定为骨质疏松症的女性百分比根据测量部位的不同而有很大差异。
