Can we stop bone loss and prevent hip fractures in the elderly?
Can we stop bone loss and prevent hip fractures in the elderly?
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我们能阻止老年人骨质流失并预防髋部骨折吗？
DOI：
10.1007/bf01623440
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发表时间：
2005
影响因子：
4
通讯作者：
F. Duboeuf
中科院分区：
文献类型：
--
作者：
P. Meunier;M. Chapuy;M. Arlot;P. Delmas;F. Duboeuf
髋部骨折的两个主要决定因素是福尔斯和导致股骨固有脆性的骨丢失。大量股骨骨丢失在整个老年持续存在，髋部骨折的风险持续呈指数级增加;因此，减少或阻止这种丢失将导致髋部骨折发生率的显著降低。预防措施可以在儿童时期通过钙和运动增加峰值骨量、在更年期后使用长期雌激素替代治疗来实现，也可以通过使用维生素D和钙补充剂来进行老年人的晚期预防。维生素D不足和钙摄入不足在生活在机构或家中的老年人中非常常见，对这些不足的累积反应是刺激甲状旁腺激素分泌的负钙平衡。这种老年继发性甲状旁腺功能亢进是股骨骨丢失的决定因素之一，可以通过补充钙和维生素D来逆转。我们在一项为期3年的前瞻性对照研究中发现，在3270名生活在疗养院的老年非卧床妇女中，每天服用补充剂（1.2 g钙和800 IU维生素D3）可使髋部骨折的数量减少23%（意向治疗分析）。同时，血清甲状旁腺激素浓度降低了28%，低基线血清25-羟基维生素D浓度恢复到正常值。治疗18个月后，维生素D3-钙组股骨近端总骨密度增加了2.7%，安慰剂组减少了4.6%（p<0.001）。这种预防措施是安全的，可以推荐给生活在机构中的人。它也可以用于其他老年受试者，这些受试者由于钙摄入量低、缺乏日光照射、股骨骨密度低、血清甲状旁腺激素浓度高、血清25-羟基维生素D浓度低和先前的福尔斯史而处于特定风险中。需要前瞻性研究来进一步评估这些风险因素。
The two main determinants of hip fractures are falls and bone loss leading to an intrinsic femoral fragility. Substantial femoral bone loss continues throughout old age, with a continuous and exponential increase in the risk of hip fracture; thus any reduction or arrest of this loss will induce an important reduction in the incidence of hip fracture. Preventive measures may be achieved during childhood by increasing peak bone mass with calcium and exercise, by using long-term estrogen replacement therapy after menopause, but also by using vitamin D and calcium supplements for late prevention in the elderly. Vitamin D insufficiency and a deficit in calcium intake are very common in the elderly living either in institutions or at home and the cumulative response to these deficits is a negative calcium balance which stimulates parathyroid hormone secretion. This senile secondary hyperparathyroidism is one of the determinants of femoral bone loss and can be reversed by calcium and vitamin D supplements. We have shown in a 3-year controlled prospective study that the daily use of supplements (1.2 g calcium and 800 IU vitamin D3) given in a large population of 3270 elderly ambulatory women living in nursing homes reduced the number of hip fractures by 23% (intention-to-treat analysis). In parallel, serum parathyroid hormone concentrations were reduced by 28% and low baseline serum 25-hydroxy vitamin D concentration returned to normal values. After 18 months of treatment the bone density of the total proximal femoral region had increased by 2.7% in the vitamin D3-calcium group and decreased by 4.6% in the placebo group (p<0.001). This prevention is safe and can be recommended for people living in institutions. It could also be useful in other elderly subjects at particular risk due to a low calcium intake, an absence of solar exposure, a low femoral bone density, a high serum parathyroid hormone concentration, a low serum 25-hydroxyvitamin D concentration and a previous history of falls. Prospective studies are needed for further evaluation of these risk factors.
年龄对骨矿物质调节激素的影响。
影响因子：
4.1
作者：
Epstein,S;Bryce,G;Hinman,JW;Miller,ON;Riggs,BL;Hui,SL;JohnstonJr,CC
通讯作者：
JohnstonJr,CC
随着女性年龄的增长，维生素 D 代谢受损。
DOI：
10.1172/jci111373
发表时间：
1984
期刊：
The Journal of clinical investigation
影响因子：
--
作者：
Tsai,KS;Heath3rd,H;Kumar,R;Riggs,BL
通讯作者：
Riggs,BL
影响因子：
39.2
作者：
ETTINGER, B;GENANT, HK;CANN, CE
通讯作者：
CANN, CE