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芬兰妇女中脂肪堆积会影响骨骼对负荷的适应性:一项跨越三代人的横向研究
Fat mass accumulation compromises bone adaptation to load in finnish women: A cross-sectional study spanning three generations
Xu L, Nicholson P, Wang Q-J, Wang Q, Alén M, Cheng S  2010/12/1 9:48:00 
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Journal of Bone and Mineral Research, 2010, Volume 25, Issue 11 
 

Body weight and lean mass correlate with bone mass, but the relationship between fat mass and bone remains elusive. The study population consisted of 396 girls and 138 premenopausal mothers and 114 postmenopausal grandmothers of these girls. Body composition and tibial length were assessed using dual-energy X-ray absorptiometry (DXA), and bone traits were determined at the tibia using peripheral quantitative computed tomography (pQCT) in the girls at the ages of 11.2±0.8, 13.2±0.9, and 18.3±1.0 years and in the mothers (44.7±4.1 years) and grandmothers (70.7±6.3 years). The values of relative bone strength index (RBSI), an index reflecting the ratio of bone strength to the load applied on the tibia, were correlated among family members (all p<.05). The mean values of RBSI were similar among 11- and 18-year-old girls and premenopausal women but significantly lower in 13-year-old girls and postmenopausal women. However, in each age group, subjects in the highest BMI tertiles had the lowest RBSI values (all p<.01). RBSI was inversely associated with body weight (all p<.01), indicating a deficit in bone strength relative to the applied load from greater body weight. RBSI was inversely associated with fat mass (all p<.001) across age groups and generations but remained relatively constant with increasing lean mass in girls and premenopausal women (all p>.05), indicating that the bone-strength deficit was attributable to increased fat mass, not lean mass. Moreover, the adverse effect of fat mass was age-dependent, with every unit increase in fat mass associated with a greater decrease in RBSI in pre- and postmenopausal women than in girls (all p<.001). This is largely due to the different capacity of young and adult bones to increase diaphyseal width by periosteal apposition in response to increased load. In summary, increasing body weight with fat accumulation is accompanied by an age-dependent relative bone-strength deficit in women because the beneficial effects of increased fat mass on bone, if any, do not compensate for the mechanical burden that it imposes. ©2010 American Society for Bone and Mineral Research.

Correspondence Address: Cheng, S.; Department of Health Sciences, University of Jyv, FIN-40014 Jyv, Finland; email:shulin.cheng@jyu.fi 
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 王燕燕 王曙

上海交通大学附属瑞金医院内分泌科

患者,女,69岁。2009年1月无明显诱因下出现乏力,当时程度较轻,未予以重视。2009年3月患者乏力症状加重,尿色逐渐加深,大便习惯改变,颜色变淡。4月18日入我院感染科治疗,诉轻度头晕、心慌,体重减轻10kg。无肝区疼痛,无发热,无腹痛、腹泻、腹胀、里急后重,无恶性、呕吐等。入院半月前于外院就诊,查肝功能:ALT 601IU/L,AST 785IU/L,TBIL 97.7umol/L,白蛋白 41g/L,甲状腺功能:游离T3 30.6pmol/L,游离T4 51.9pmol/L,心电图示快速房颤。
 

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