Age-related loss of proximal femoral strength in elderly men and women: the Age Gene/Environment Susceptibility Study--Reykjavik.
Age-related loss of proximal femoral strength in elderly men and women: the Age Gene/Environment Susceptibility Study--Reykjavik.
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DOI：
10.1016/j.bone.2011.12.001
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发表时间：
2012-03
期刊：
影响因子：
4.1
通讯作者：
Keyak, J. H.
中科院分区：
文献类型：
--
作者：
Lang, T. F.;Sigurdsson, S.;Karlsdottir, G.;Oskarsdottir, D.;Sigmarsdottir, A.;Chengshi, J.;Kornak, J.;Harris, T. B.;Sigurdsson, G.;Jonsson, B. Y.;Siggeirsdottir, K.;Eiriksdottir, G.;Gudnason, V.;Keyak, J. H.
髋部骨折的风险随着年龄的增长而迅速上升，尤其是女性。骨折风险的增加反映了与年龄相关的跌倒风险变化和股骨近端强度的下降。为了更好地了解股骨近端密度、结构和强度随年龄变化的程度（作为性别的函数），我们对男性和女性股骨近端容积定量计算机断层扫描（vQCT）图像进行了纵向分析，分析了骨小梁和皮质骨特性的变化，并使用受试者特定的有限元建模（FEM）来估计骨强度的变化。在AGES-Reykjavik研究中，在2002-2006年的基线访视和5.05±0.25年后的第二次访视时进行髋关节vQCT扫描。其中，223名受试者（111名男性，112名女性，年龄68-87岁）被随机选择。在与DXA量化的总股骨区域相似的区域中评估受试者的三个骨变量的纵向变化：面积骨矿物质密度（aBMD）、小梁体积骨矿物质密度（tBMD）和皮质与总组织体积的比值（cvol/ivol）。还使用左侧股骨近端的FEM模型评价了他们的骨强度变化。在单肢站立载荷（FStance）下分析模型，该载荷接近髋关节的正常生理载荷，以及接近大转子后外侧的载荷（FFall）。我们计算了aBMD、tBMD、cvol/ivol、FFall和FStance的5年绝对值和百分比变化。采用Mann-Whitney检验比较性别间骨变量的变化，采用Wilcoxon符号秩检验比较载荷条件间骨强度的变化。采用多元（线性）回归确定FFall和FStance变化与基线年龄和5年体重减轻的相关性。男性和女性的股骨近端密度和结构指数均下降（aBMD：男性−3.9± 6.0%，女性−6.1±6.2%; tBMD：男性−14.8± 20.3%，女性−23.9±26.8%; cvol/ivol：男性−2.6± 4.6%，女性−4.7± 4.8%，性别差异：p<0.001）。男性和女性在每种负荷条件下均出现骨强度损失（Fstance：男性−4.2± 9.9%，女性−8.3±8.5%; FFall：男性−7.0± 15.7%，女性−12.8±13.2%;所有较基线的变化p<0.0001）。在两种负荷条件下，骨强度损失的性别差异具有统计学意义（FStance和FFall的P <0.001），男性（p<0.01）和女性（p <0.0001）中FFall的损失率高于FStance。在两种负荷条件下，校正基线年龄和体重减轻后，力量损失的性别差异具有统计学意义（p< 0.01）。在这些多线性模型中，男性的骨丢失率随年龄的增加而增加（FFall：p=0.002; FStance：p=0.03），女性的骨强度丢失随体重减轻程度的增加而增加（FStance：p=0.003）。与FStance相比，FFall的损失更高，这支持了之前在动物和人体研究中的发现，即在正常生理负荷下受应力的骨的子体积在老化中得到相对更好的保护。髋部骨强度损失的性别差异与老年妇女髋部骨折的发生率较高一致。
The risk of hip fracture rises rapidly with age, and is particularly high in women. This increase in fracture risk reflects both the age-related change in the risk of falling and decrements in the strength of the proximal femur. To better understand the extent to which proximal femoral density, structure and strength change with age as a function of gender, we have carried out a longitudinal analysis of proximal femoral volumetric quantitative computed tomographic (vQCT) images in men and women, analyzing changes in trabecular and cortical bone properties, and using subject-specific finite element modeling (FEM) to estimate changes in bone strength. In the AGES-Reykjavik Study vQCT scans of the hip were performed at a baseline visit in 2002–2006 and at a second visit 5.05±0.25 years later. From these, 223 subjects (111 men, 112 women, aged 68–87 years) were randomly selected. The subjects were evaluated for longitudinal changes in three bone variables assessed in a region similar to the total femur region quantified by DXA: areal bone mineral density (aBMD), trabecular volumetric bone mineral density (tBMD) and the ratio of cortical to total tissue volume (cvol/ivol). They were also evaluated for changes in bone strength using FEM models of the left proximal femur. Models were analyzed under single-limb stance loading (FStance), which approximates normal physiologic loading of the hip, as well as a load approximating a fall onto the posterolateral aspect of the greater trochanter (FFall). We computed five-year absolute and percentage changes in aBMD, tBMD, cvol/ivol, FFall and FStance. The Mann-Whitney Test was employed to compare changes in bone variables between genders and the Wilcoxon Signed Rank Test was used to compare changes in bone strength between loading conditions. Multiple (linear) regression was employed to determine the association of changes in FFall and FStance with baseline age and five-year weight loss. Both men and women showed declines in indices of proximal femoral density and structure (aBMD: men −3.9±6.0%, women −6.1±6.2%; tBMD: men −14.8±20.3%, women −23.9±26.8%; cvol/ivol: men −2.6±4.6%, women −4.7±4.8%, gender difference: p<0.001). Both men and women lost bone strength in each loading condition (Fstance: men −4.2±9.9%, women −8.3±8.5%; FFall: men −7.0±15.7%, women −12.8±13.2%; all changes from baseline p<0.0001). The gender difference in bone strength loss was statistically significant in both loading conditions (p<0.001 for FStance and P<0.01 for FFall) and FFall was lost at a higher rate than FStance in men (p<0.01) and women (p<0.0001). The gender difference in strength loss was statistically significant after adjustment for baseline age and weight loss in both loading conditions (p< 0.01). In these multi-linear models, men showed increasing rates of bone loss with increasing age (FFall: p=0.002; FStance: p=0.03), and women showed increasing bone strength loss with higher degrees of weight loss (FStance:p=0.003). The higher loss of FFall compared to FStance supports previous findings in animal and human studies that the sub-volumes of bone stressed under normal physiologic loading are relatively better protected in aging. The gender difference in hip bone strength loss is consistent with the higher incidence of hip fracture among elderly women.
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DOI：
10.1097/01.blo.0000164400.37905.22
发表时间：
2005-08-01
影响因子：
4.2
作者：
Keyak, JH;Kaneko, TS;Skinner, HB
通讯作者：
Skinner, HB
影响因子：
6.2
作者：
Marshall, Lynn M.;Lang, Thomas F.;Orwoll, Eric S.
通讯作者：
Orwoll, Eric S.
影响因子：
6.2
作者：
Orwoll, Eric S.;Marshall, Lynn M.;Keaveny, Tony M.
通讯作者：
Keaveny, Tony M.
影响因子：
2.4
作者：
Keyak, JH;Rossi, SA
通讯作者：
Rossi, SA
DOI：
10.1046/j.1532-5415.2003.51558.x
发表时间：
2003-12-01
影响因子：
6.3
作者：
Ensrud, KE;Ewing, SK;Cummings, SR
通讯作者：
Cummings, SR