Obesity alters cortical and trabecular bone density and geometry in women.
Obesity alters cortical and trabecular bone density and geometry in women.
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DOI：
10.1007/s00198-010-1305-3
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发表时间：
2011-02
影响因子：
4
通讯作者：
Shapses, S. A.
中科院分区：
文献类型：
--
作者：
Sukumar, D.;Schlussel, Y.;Riedt, C. S.;Gordon, C.;Stahl, T.;Shapses, S. A.
本研究的目的是使用定量计算机断层扫描确定体重指数与骨小梁和皮质骨之间的关系。较高的体重指数（BMI）与骨小梁和皮质骨参数、血清甲状旁腺激素呈正相关，与皮质体积骨密度（vBMD）和血清25-羟基维生素D呈负相关。当BMI大于35 kg/m2时，肥胖会影响vBMD，并可能解释该人群中没有低BMD的骨折风险较高。成人肥胖对骨小梁和皮质骨、几何形状和强度的影响尚未完全解决。本研究的目的是确定体重指数与骨小梁和皮质骨质量和几何形状之间的关系，在广泛的体重范围内。我们检查了211名女性（25-71岁; BMI 18-57 kg/m2），这些女性被分为三类BMI（kg/m2），包括正常体重（BMI<25），超重和肥胖I级（BMI 25-35）和肥胖II-III级（BMI>35），以及绝经状态。通过外周定量计算机断层扫描测量胫骨远端4%、38%和66%处的体积骨矿物质密度（mg/cm 3）、骨小梁和皮质成分以及几何特征，并分析血清中的甲状旁腺激素（PTH）和25-羟基维生素D（25 OHD）。BMI越高，骨小梁和皮质BMC、面积和PTH值越大（r>0.39，p<0.001），但皮质vBMD和25 OHD值越低（r>-0.27，p<0.001）。当控制小腿肌肉面积时，脂肪面积与皮质vBMD呈负相关（r=-0.16，p<0.05）。BMI和PTH均较高的绝经前肥胖女性皮质vBMD较低（r<-0.40，p<0.001）。虽然年龄是大多数骨骼变量的预测因子，但脂肪质量解释了vBMD的更多方差，瘦体重和25 OHD解释了几何和力量指数的更大方差（p<0.05）。重度肥胖（BMI>35）增加骨小梁vBMD，并且在存在较高PTH的情况下，与较低皮质vBMD相关，而不影响骨几何形状和强度。肥胖者较低的皮质vBMD是否会随着时间的推移影响骨折风险，需要进一步研究。
The goal in this study was to determine the relationship between body mass index and trabecular and cortical bone using quantitative computed tomography. A higher body mass index (BMI) was positively associated with trabecular and cortical bone parameters, and serum parathyroid hormone, and negatively associated with cortical volumetric bone mineral density (vBMD) and serum 25-hydroxy-vitamin D. When BMI is greater than 35 kg/m2, adiposity affects vBMD and may explain the higher fracture risk in this population without low BMD. The influence of adult obesity on the trabecular and cortical bone, geometry, and strength has not been fully addressed. The goal in this study was to determine the relationship between body mass index and trabecular and cortical bone mass and geometry, over a wide range of body weights. We examined 211 women (25–71 years; BMI 18–57 kg/m2) who were classified into three categories of BMI (kg/m2) including normal-weight (BMI<25), overweight and obese-class I (BMI 25–35) and obese-class II–III (BMI>35), and also by menopausal status. Volumetric bone mineral density (mg/cm3), trabecular, and cortical components as well as geometric characteristics at the 4%, 38%, and 66% from the distal tibia were measured by peripheral quantitative computed tomography, and serum was analyzed for parathyroid hormone (PTH) and 25-hydroxy-vitamin D (25OHD). Higher BMI was associated with greater values of trabecular bone and cortical BMC and area and PTH (r>0.39, p<0.001), but lower cortical vBMD and 25OHD (r>−0.27, p<0.001). When controlling for lower leg muscle area, fat area was inversely associated with cortical vBMD (r=−0.16, p<0.05). Premenopausal obese women with both higher BMI and PTH had lower cortical vBMD (r<−0.40, p<0.001). While age is a predictor for most bone variables, fat mass explains more variance for vBMD, and lean mass and 25OHD explain greater variance in geometric and strength indices (p<0.05). Severe obesity (BMI>35) increases trabecular vBMD and in the presence of a higher PTH is associated with a lower cortical vBMD without compromising bone geometry and strength. Whether or not a lower cortical vBMD in obesity influences fracture risk over time needs to be further explored.
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