The Investigation On The Present Situation Of The Community Women With Osteoporosis And The Study On The Biochemical Factors Correlated Bone Mineral Density

Chapter one Study on the present situation and the correlated factors of the community women with osteoporosisIntroduction: To realize the incidence rate and the correlated factors of the community women' osteoporosis during the period of premenopausal, perimenopausal and postmenopausal in Changsha. In order to find out the danger factor and the protection factor influencing on Bone Mineral Density (BMD) of the community women, and to provide support for preventing and curing osteoporosis in community.Materials and Methods: To adopt the method of random samplings of the whole group, seperately collected samples from the community of Central South Specification for the engineering survey, Mawangdui community of Changsha, and the community of Xiangya Hospital. According to the content of the self-tabled questionnaire, the surveyor made home investigations to the community women with adopted standards at the age of 20-80. And accompanied the research subjects to the hospital, inspected their survey index such as Body Mass Index (BM), BMD and so on. Analyzed the incidence rate of the community women' osteoporosis during the period of premenopausal, perimenopausal and postmenopausal and its correlations with age, menopausal state. Made deep research on the correlated factors influencing on women with osteoporosis. Adopted Epidata3.0 to build data base, made statistical analysis of data by using software package of SPSS 13.0.Results: The total incidence rate of the community women with osteoporosis in Changsha was 17.0%. Among which, the incidence rate of the community women with osteoporosis was 0.3% before 40 years old; separately, 5.4% at age that ranged from 40 to 49; 20.1% at age that ranged from 50 to 59; 44.8% at age that ranged from 60 to 69; 70.0% over 70 years old. The incidence rate of postmenopause women with osteoporosis was higher than that of premenopausal women with osteoporosis, the former was 22.9 times as much as the latter. The incidence rate of the community menopausal women with osteoporosis increased with the prolongation of age and since year menopause. The regression analysis of the unconditioned Logistics was used here, and found out that the old age(OR=1.832), late age of menarche(OR=2.589), post-menopausal (OR=1.507) , the prolongation of menopausal age (OR=2.168) , many times of parturition (OR= 1.449) were the danger factors of osteoporosis; high BMI (OR=0.514) and regular physical activity (OR=0.484) were the protection factors.Conclusion: The incidence rate of the community women with osteoporosis increased with the prolongation of age and year since menopause; the incidence rate of postmenopause women with osteoporosis was highest, that of perimenopausal took second place, that of premenopausal was lowest. That the old age, late age of menarche, postmenopausal, the prolongation of year since menopause, many times of parturition were the danger factors of osteoporosis; high BMI and regular physical activity were the protection factors.Chapter two Study on correlations between fat, the adipocytokine and bone mineral density in postmenopausal womenIntroduction: Low Body Mass Index (BMI) was a danger factor of osteoporosis. Fat tissue of people with low BMI was cut down. The latest research showed that excreted factors of fat cells could regulate bone metabolism. Excreted factors of fat cells (called fat cells for short) mainly include adiponectin, leptin, resistin, apelin, visfatin. We make further step to explor the crrelations between body fat, lean body mass and adiponectin, leptin, resistin, Apelin, visfatin concentration and BMD; and so as to provide experimental support for preventing and curing osteoporosis in the community.Materials and Methods: Serum concentrations of adiponectin, leptin, resistin, visfatin and serum levels of 25-hydroxyvitamin D, intact parathyroid hormone, insulin were measured with ELISA. Serum levels of estradiol, total testerone were detected by Chemical immunoassay. Bone mineral density (BMD) value were measured by using DXA at the total body, lumbar spine, total hip, and total forearm. Body composition including lean tissue mass and body fat mass were measured by DXA. The correlations between adiponectin, leptin, resistin, visfatin concentration and BMD, were made by using Pearson's correlation analysis and Partial correlation analysis. Multivariate linear stepwise regression analysis was performed to determine how much of the variance in BMD at various skeletal regions could be explained by age, year since menopause, BMI, lean mass, fat mass, physical activity, adiponectin, leptin, resistin, visfatin, estradiol, testerone , 25-hydroxyvitamin D, insulin, parathyroid hormone.Results: Pearson's correlation analysis showed that: serum adiponectin levels were negatively related to BMD at total body, lumbar spine, total hip and total forearm (r=-0.181, r=-0.208, r=-0.228, r=-0.203, respectively, p<0.05). After adjusting age and fat mass, the correlation with BMD remained (r=-0.131, r=-0.140, r=-0.149, r=-0.172, respectively, p<0.05). Serum leptin levels were positively related to BMD at total hip and total forearm (r=0.162, r=0.210, respectively, p<0.05). After adjusting age and fat mass, the correlation with BMD at total forearm (r=0.157, p<0.05) existed, but the correlation with BMD at total hip disappeared. There were no correlations between serum resistin, apelin, visfatin and BMD at total body, lumbar spine, total hip and total forearm. The multivariate linear stepwise regression analysis showed that, year since menopause, lean mass, and adiponectin were chief predictors of BMD at total body, lumbar spine, total hip and total forearm. Moreover, serum adiponectin levels increased in postmenopausal women with osteoporosis; but there was no difference comparing serum levels of leptin, resistin, apelin and visfatin with control group.Conclusion: Serum adiponectin levels were negatively related to BMD at total body, lumbar spine, total hip and total forearm. Adiponectin was the chief predictors of BMD at total body, lumbar spine, total hip and total forearm. Serum adiponectin levels increased in postmenopausal women with osteoporosis. It guided that, preventing and monitoring works in the community should be conducted activity in postmenopausal women with high serum adiponectin levels.Chapter three Study on correlations between serum leptin, adiponectin, resistin, apelin, visfatin concentration and bone turn-over biochemical makers in postmenopausal womenIntroduction: To explore the correlations between adiponectin, apelin, leptin, resistin, and Bone alkaline phosphatase (BAP), cross-linked N-telopeptide of type I collagen (NTX) in postmenopausal Chinese women. To provide reference for the mechanism study on osteoporosis, and for in-depth preventing and curing osteoporosis.Materials and Methods: Serum bone alkaline phosphatase (BAP) and bone cross-linked N-telopeptides of typeâ… collagen (NTX) of 287 postmenopausal women at the age of 40-80 were measured with ELISA. The correlations between adiponectin, leptin, resistin, apelin, visfatin concentration and BAP, NTX were determined by using Pearson's correlation analysis and Partial correlation analysis.Results: Serum adiponectin levels were positively related to BAP and NTX (r=0.202, r=0.215, respectively, p<0.05). After adjusting age and fat mass, the correlation remained (r=0.169, r=0.183, respectively, p<0.05). Serum leptin levels were positively related to NXT, but not BAP (r=-0.119, p<0.05). After adjusting age and fat mass, the correlation disappeared. There were no correlations between serum visfatin, resistin, apelin and BAP, NTX. BAP and NTX were negatively related to BMD at total body, lumbar spine, total hip and total forearm. And after adjusting age and BMI, the correlation remained. The levels of serum adiponectin, BAP, NTX increased in postmenopausal women with osteoporosis.Conclusion: Adiponectin were positively correlated with bone formation marker and bone resorption marker. It suggested that adiponectin may exert a negative effect on bone mass by promoting excessive bone resorption associated with bone loss in postmenopausal women. The levels of serum adiponectin, BAP, NTX increased in postmenopausal women. Serum adiponectin, BAP, NTX were serum biochemical marker of OP patient. It pointed out that, preventing, diagnosing and monitoring works in the community should be conducted activity in postmenopausal women with high levels of serum adiponectin, BAP, NTX.