ESTROGEN STATUS AND HEREDITY ARE MAJOR DETERMINANTS OF PREMENOPAUSAL BONE MASS
ESTROGEN STATUS AND HEREDITY ARE MAJOR DETERMINANTS OF PREMENOPAUSAL BONE MASS
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DOI：
10.1172/jci116138
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发表时间：
1992-12-01
影响因子：
15.9
通讯作者：
CIVITELLI, R
中科院分区：
文献类型：
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作者：
ARMAMENTOVILLAREAL, R;VILLAREAL, DT;CIVITELLI, R
为了分析它们对绝经前骨量的相对影响，我们研究了63名绝经前妇女(年龄19-40岁)终生雌激素暴露对椎体骨密度(VBD)的影响，通过雌激素评分(ES；根据初潮年龄、初潮以来平均月经周期长度和避孕药的使用来计算)、遗传和一些环境因素进行了评估。与骨密度正常的女性(Z分数和-1)相比，低VBD的受试者(Z分数和lt；初潮年龄(13.8±-1.7pg/ml比12.6+/-1.4pg/ml，P=0.001)；血清雌二醇水平(46.9+/-37pg/ml比86.6+/-57pg/ml，P=0.023)和雌酮水平(46.9+/-60pg/ml比178.8+/-9.0pg/ml，P=0.023)。同样，VBD最低四分位数的女性的ES(15.3+/-4.5vs.18.1+/-2.7vs.18.1+/-2.7，P=0.006)和较高的初潮年龄(13.9+/-1.9vs.12.8+/-.4，P=0.02)显著低于上四分位数的女性。低VBD组月经不调者(52vs.23%，P=0.03)和骨质疏松症家族史阳性者(86vs.61%，P=0.04)高于VBD正常组。经一元线性回归分析，VBD与ES呈正相关(r=0.44，P=0.001)，与初潮年龄呈负相关(r=-0.30，P=0.03)，而与年龄、体重指数、产次、哺乳期、体力活动、日照暴露量、膳食钙和维生素D摄入量无相关性。通过偏相关分析校正所有其他变量的影响后，VBD与ES的相关性有所改善(Pearson偏相关r=0.57，P=0.01)，这也揭示了膳食钙对VBD的显著贡献。经逐步多元回归分析，ES是VBD的唯一显著独立决定因素(R2=0.24)。因此，绝经前雌激素暴露，可能是遗传易感性，而不是环境因素，是绝经前峰值骨量发展的主要决定因素。
To analyze their relative effects on premenopausal bone mass, we have studied the impact of lifelong estrogen exposure, assessed by an estrogen score (ES; computed on age at menarche, average length of menstrual cycles since menarche, and use of birth control pills), heredity, and some environmental factors on vertebral bone density (VBD), of 63 premenopausal women (age, 19-40 yr). Compared with women with normal bone density (Z score > -1), subjects with low VBD (Z score < -1) had significantly lower ES (15.1+/-3.9 vs. 18.7+/-2.4, P = 0.001), higher age at menarche (13.8+/-1.7 vs. 12.6+/-1.4 yr, P = 0.005), and lower serum estradiol (46.9+/-37 vs. 86.6+/-57 pg/ml, P = 0.023) and estrone levels (107.4+/-60 vs. 178.8+/-9.0 pg/ml, P = 0.05). Likewise, women in the lowest quartile for VBD had significantly lower ES (15.3+/-4.5 vs. 18.1+/-2.7, P = 0.006) and higher age at menarche (13.9+/-1.9 vs. 12.8+/-.4, P = 0.02) than those in the upper three quartiles. A higher proportion of subjects with irregular menses (52 vs. 23%, P = 0.03) and a positive family history of osteoporosis (86 vs. 61%, P = 0.04) was found in the low VBD group compared with subjects with normal VBD. VBD correlated positively with ES (r = 0.44, P = < 0.001) and negatively with age at menarche (r = -0.30, P = 0.03) by simple linear regression, whereas no correlation was found between VBD and age, body mass index, parity, lactation, physical activity, sunlight exposure, and dietary calcium and vitamin D intakes. The correlation between VBD and ES improved after correcting for the effect of all the other variables by partial correlation analysis (Pearson partial r = 0.57, P = < 0.01), which also disclosed a significant contribution of dietary calcium to VBD. However, ES was the only significant independent determinant of VBD, by stepwise multiple regression analysis (R2 = 0.24). Therefore, premenopausal estrogen exposure, and possibly genetic predisposition, rather than environmental factors, are the major determinants for the development of peak bone mass before menopause.