Cummings S R, Browner W S, Bauer D, Stone K, Ensrud K, Jamal S, Ettinger B
Department of Medicine, University of California, San Francisco, USA.
N Engl J Med. 1998 Sep 10;339(11):733-8. doi: 10.1056/NEJM199809103391104.
In postmenopausal women, the serum concentrations of endogenous sex hormones and vitamin D might influence the risk of hip and vertebral fractures. In a study of a cohort of women 65 years of age or older, we compared the serum hormone concentrations at base line in 133 women who subsequently had hip fractures and 138 women who subsequently had vertebral fractures with those in randomly selected control women from the same cohort. Women who were taking estrogen were excluded. The results were adjusted for age and weight.
The women with undetectable serum estradiol concentrations (<5 pg per milliliter [18 pmol per liter]) had a relative risk of 2.5 for subsequent hip fracture (95 percent confidence interval, 1.4 to 4.6) and subsequent vertebral fracture (95 percent confidence interval, 1.4 to 4.2), as compared with the women with detectable serum estradiol concentrations. Serum concentrations of sex hormone-binding globulin that were 1.0 microg per deciliter (34.7 nmol per liter) or higher were associated with a relative risk of 2.0 for hip fracture (95 percent confidence interval, 1.1 to 3.9) and 2.3 for vertebral fracture (95 percent confidence interval, 1.2 to 4.4). Women with both undetectable serum estradiol concentrations and serum sex hormone-binding globulin concentrations of 1 microg per deciliter or more had a relative risk of 6.9 for hip fracture (95 percent confidence interval, 1.5 to 32.0) and 7.9 for vertebral fracture (95 percent confidence interval, 2.2 to 28.0). For those with low serum 1,25-dihydroxyvitamin D concentrations (< or =23 pg per milliliter [55 pmol per liter]), the risk of hip fracture increased by a factor of 2.1 (95 percent confidence interval, 1.2 to 3.5).
Postmenopausal women with undetectable serum estradiol concentrations and high serum concentrations of sex hormone-binding globulin have an increased risk of hip and vertebral fracture.
在绝经后女性中，内源性性激素和维生素D的血清浓度可能会影响髋部和椎体骨折的风险。在一项针对65岁及以上女性队列的研究中，我们将133例随后发生髋部骨折的女性和138例随后发生椎体骨折的女性在基线时的血清激素浓度与来自同一队列的随机选择的对照女性的血清激素浓度进行了比较。正在服用雌激素的女性被排除在外。结果根据年龄和体重进行了调整。
血清雌二醇浓度不可测（<5 pg/ml[18 pmol/L]）的女性，与血清雌二醇浓度可测的女性相比，随后发生髋部骨折的相对风险为2.5（95%置信区间，1.4至4.6），随后发生椎体骨折的相对风险为2.5（95%置信区间，1.4至4.2）。血清性激素结合球蛋白浓度为1.0 μg/dl（34.7 nmol/L）或更高与髋部骨折的相对风险2.0（95%置信区间，1.1至3.9）和椎体骨折的相对风险2.3（95%置信区间，1.2至4.4）相关。血清雌二醇浓度不可测且血清性激素结合球蛋白浓度为1 μg/dl或更高的女性，髋部骨折的相对风险为6.9（95%置信区间，1.5至32.0），椎体骨折的相对风险为7.9（95%置信区间，2.2至28.0）。对于血清1,25-二羟维生素D浓度低（≤23 pg/ml[55 pmol/L]）的女性，髋部骨折的风险增加了2.1倍（95%置信区间，1.2至3.5）。
血清雌二醇浓度不可测且血清性激素结合球蛋白浓度高的绝经后女性发生髋部和椎体骨折的风险增加。
