Change in bone mineral density as a function of age in women and men and association with the use of antiresorptive agents
Change in bone mineral density as a function of age in women and men and association with the use of antiresorptive agents
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DOI：
10.1503/cmaj.071416
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发表时间：
2008-06-17
影响因子：
14.6
通讯作者：
Goltzman, David
中科院分区：
文献类型：
--
作者：
Berger, Claudie;Langsetmo, Lisa;Goltzman, David
背景：测量骨密度是诊断和评估骨质疏松症最常用的方法。我们试图估计25-85岁加拿大人骨密度的平均变化率作为年龄的函数，按性别和抗吸收药物的使用分层。方法：我们对9423名参与者进行了纵向队列研究。我们在1995-1997年的基线、3年（参与者仅40-60岁）和5年的随访中测量了腰椎、全髋关节和股骨颈的骨矿物质密度。我们使用测量值来计算个体的变化率。结果：所有3个骨骼部位的骨质流失在40-44岁的女性中开始。全髋关节骨质流失特别快，在50-54岁从绝经前过渡到绝经后的女性中骨质流失最严重，5年内从基线变化为-6.8%（95%可信区间[CI] -7.5%至-4.9%）。在70岁以上的女性中，下降的速度，特别是在整个髋关节，再次增加。所有三个骨骼部位的骨质流失在男性中开始较早（25-39岁）。在35岁及以上的男性中，全髋关节骨密度下降的速度几乎是恒定的，而在65岁以上的男性中，骨密度下降的速度则有所增加。在50-79岁的男女参与者中，抗骨吸收药物的使用与骨质流失的减少有关。解释：在65岁以上的女性和男性中，髋骨骨矿物质密度的加速流失可能是该年龄组患者髋部骨折发生率增加的重要因素。我们在两性中观察到的骨质流失的程度表明，在没有额外的危险因素或治疗的情况下，重复检测骨密度来诊断骨质疏松症可以推迟到每5年。
Background: Measurement of bone mineral density is the most common method of diagnosing and assessing osteoporosis. We sought to estimate the average rate of change in bone mineral density as a function of age among Canadians aged 25-85, stratified by sex and use of antiresorptive agents.Methods: We examined a longitudinal cohort of 9423 participants. We measured the bone mineral density in the lumbar spine, total hip and femoral neck at baseline in 1995-1997, and at 3-year (participants aged 40-60 years only) and 5-year follow-up visits. We used the measurements to compute individual rates of change.Results: Bone loss in all 3 skeletal sites began among women at age 40-44. Bone loss was particularly rapid in the total hip and was greatest among women aged 50-54 who were transitioning from premenopause to postmenopause, with a change from baseline of -6.8% (95% confidence interval [CI] -7.5% to -4.9%) over 5 years. The rate of decline, particularly in the total hip, increased again among women older than 70 years. Bone loss in all 3 skeletal sites began at an earlier age (25-39) among men than among women. The rate of decline of bone density in the total hip was nearly constant among men 35 and older and then increased among men older than 65. Use of antiresorptive agents was associated with attenuated bone loss in both sexes among participants aged 50-79.Interpretation: The period of accelerated loss of bone mineral density in the hip bones occurring among women and men older than 65 may be an important contributor to the increased incidence of hip fracture among patients in that age group. The extent of bone loss that we observed in both sexes indicates that, in the absence of additional risk factors or therapy, repeat testing of bone mineral density to diagnose osteoporosis could be delayed to every 5 years.