补充钙和维生素D对北京城区老年妇女体成分和骨量的影响
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摘要
[研究目的]
钙和维生素D是维持骨骼健康和体重正常的必需营养素,我国老年妇女由于钙和维生素D缺乏导致的骨质疏松和超重、肥胖普遍存在。国外大量研究表明,适量补充钙和维生素D能够有效地改善老年妇女的骨量丢失和超重肥胖状况,但国内相关研究较少,而东西方之间的种族和膳食习惯等存在较大差异,因此,在我国进行这样一项研究是十分必要的。
本文主要研究补充钙和维生素D对北京城区老年绝经妇女骨矿物含量(BMC)和体成分(BC)的作用,以期为老年人尤其是老年绝经妇女多发的骨质疏松(OP)和老年性超重和肥胖提供预防和治疗的依据和参考,从而延缓老年妇女骨量降低的速度,减少骨折的发生,抑制其体脂过快增长,预防与之相关的慢性病,提高老年人晚年的生活质量,减少家庭、社会和国家的负担。
[研究方法]
用整群随机抽样的方法在春末夏初从北京3个城区17个社区中随机选取60岁以上老年绝经妇女400名,用量表和体检的方法进行现况研究。再从现况研究的400名老年妇女中随机选取305人作为干预研究对象,并随机分为两组,单纯补钙组(A组)和补钙+维生素D组(B组),分别服用钙剂和钙+维生素D各-年,比较其干预前后身体各部位的体成分和骨量是否有所改变。
[结果]
1、现况研究结果
北京城区老年妇女平均年龄是(68.7±5.6)岁,血钙平均水平为2.087mg,血清25(OH)D平均水平为(14.4±5.7)ng/ml,其中维生素D缺乏的比例达到62.4%,不足的比例为21.8%,处于正常水平的比例仅为15.8%。研究对象BMI均值为(25.9±3.6)kg/m2,PBF的均值为(39.2±5.3)%,以PBF和BMI判定的超重率分别达到：17.4%和48.5%,肥胖率分别达到76.7%和22.3%。研究对象全身、腰椎和股骨颈的BMD分别为(0.829±0.090)、(0.916±0.125)和(0.679±0.106)g/cm2,腰椎(L2-4)和股骨颈骨量减少的检出率分别为41.8%和38.5%,骨质疏松检出率分别为14.2%和12.3%。
研究结果显示,血清25(OH)D水平与身高、体重相关性不显著(r=0.04,r=-0.06,P>0.05),与全身、髋部及双下肢的体脂百分比(PBF)、髋部和双下肢的体脂(BF)均呈显著负相关(r=-0.14～-0.10,P<0.05),与全身、股骨颈、大转子、腹中部和双上肢部位的BMD呈显著正相关(r=0.114～0.168,P<0.05)；血清25(OH)D正常组研究对象全身、髋部和右下肢的PBF均显著低于25(OH)D不足组和缺乏组,其中全身PBF分别低2.4%和5.8%；血清25(OH)D正常组研究对象全身及全身各部位(腹中部除外)的BMD水平均显著高于25(OH)D不足组和缺乏组,其中全身BMD分别高4.7%和6.4%,股骨颈BMD分别高7.3%和8.9%。
2、干预研究结果
A、B组老年妇女血钙水平分别为2.25mg和2.28mg,血清25(OH)D水平分别为14.66ng/ml和23.98ng/ml,,干预后B组老年妇女的血清25(OH)D水平显著高于A组(P<0.05),前者比后者高63.66%;A组老年妇女体重和BMI有所增加,而B组有所减少；B组老年妇女全身、腹中部、髋部以及双下肢的PBF和BF的减少量均高于A组,两组之间均无显著性差异(P>0.05)；B组老年妇女全身、腰椎、髋部、和左右下肢的BMD显著高于A组(P<0.05),分别比A组高3.4%、5.8%、5.8%、4.5%和3.8%。
干预后,两组老年妇女全身、腹中部和左下肢部位的BF和PBF均有所减少,与干预前相比均有显著性差异(P<0.05),其中,A、B两组全身的BF和PBF分别比干预前降低4.8%、3.5%和5.3%、5.2%；干预后两组老年妇女全身和双上肢部位的LBM均有所增加,显著高于干预前(P<0.05),分别比干预前高出2.3%和1.5%。干预后A组老年妇女Wards'三角、大转子和双上肢部位的BMD有所增长,Wards'三角和双上肢部位的BMD与干预前相比有显著性差异(P<0.05),分别比干预前高出7.5%、3.5%和1.9%；干预后B组老年妇女全身、腰椎、股骨颈、大转子、Wards'三角、髋部、右下肢和双上肢部位的BMD均有所增长,干预后全身、髋部、Wards'三角和双上肢部位的BMD显著高于干预前(P<0.05),分别比干预前高出1.0%、2.7%、8.9%、3.8%和2.6%。
[结论]
北京城区老年妇女血清维生素D水平不足和缺乏的现象比较普遍,维生素D水平较高者体脂和体脂百分比水平较低,维生素D营养状况与全身、腰椎、股骨近端、髋部以及四肢骨量密切相关,提示良好的维生素D营养状况对维持我国老年绝经妇女适宜体重和骨骼健康有重要意义。
同时补充钙和维生素D能够有效减缓老年妇女的骨量丢失,增加骨密度,同时能够帮助其减少体脂,控制体重,因此补充适宜的钙和维生素D对于老年肥胖和骨质疏松的预防有一定作用,单纯补钙不如同时补充钙和维生素D对体成分和骨密度的改善效果明显。
OBJECTIVE Calcium and vitamin D are the essential nutrients to maintain the bone health and normal weight, osteoporosis resulting from deficiency of calcium and vitamin D of Chinese postmonapausal older women was prevalence. A large number of studies abroad have shown that supplement of calcium and vitamin D can effectively improve the bone health and overweight or obesity of older women. However, domestic researches were relatively deficient and there are large differences between race and diatery habits of east and west, so it is very necessary to perform such a research in our country.
This paper aimes at studying the role of supplying calcium and vitamin D to the bone mineral composition and body composition of urban postmonapausal women in Beijing, and providing the experience to the prevention and treatment of osteoporosis, overweight and obesity of Chinese older women, postponing the bone loss, reducing the bone fracture rate, restrainting the excessive growth of body fat, preventing the relative chronic diseases, improving the quality of older women life, releasing the burden of state, society and family.
METHODS A total of 400 community-dwelling women were selected randomly from 17 community of 3 districts in Beijing with cluster random sampling methods. Cross-section survey used questionnaire and physical examination. In intervention study,305 women were randomly chosed from 400 objects of cross-section survey, which were divided into two groups randomly. Calcium group(A group) and calcium adding vitamin D group(B group), who took supplemention of calcium and calcium adding vitamin D for one year respectively. We observe if the bone mineral density and body composition improved after controlling confounding factors, and the range. RESULTS 1、Cross-section survey results.
The mean age of urban older women of Beijing were (68.7±5.6), mean serum calcium level was 2.087mg, mean serum 25(OH)D was (14.4±5.7) ng/ml. Vitamin D deficiency rate was 62.4%, insufficient rate was 21.8%, and the vitamin D in normal was only 15.8%. Mean BMI of the subject was (25.9±3.6)kg/m2, mean value of PBF was (39.2±5.3)%, and the overweight rate was up to 17.4% and 48.5%, obesity rate was 76.7% and 22.3%, which were calculated by PBF and BMI. BMD of subjects at total, lumbar spine(L2-4) and femneck were respectively (0.829±0.090), (0.916±0.125) and (0.679±0.106)g/cm2, The rate of osteoporosis at lumbar spine(L2-4) and femneck of of urban postmonapausal women in Beijing were respectively 14.2%.and 12.3%, and bone loss rate were 41.8% and 38.5%.
Serum 25(OH)D level was not correlated with height and weight(r=0.04, r=-0.06, P>0.05), and were positively correlated with PBF at total, pelvis and lower limbs, and with BF at pelvis and lower limbs(r=-0.14～-0.10,P<0.05). Serum 25(OH)D level was positively correlated with BMD at total and femneck(r=0.165, r=0.184, P<0.05). PBF of subjects with 25(OH)D normal group was significantly higher than that of subjects with vitamin D insufficient or vitamin D deficiency at total, pelvis and right lower limb, with 2.4% or 5.8% lower at total. BMD of subjects with 25(OH)D normal group is significantly higher than that of subjects with vitamin D insufficient or vitamin D deficiency in all parts except midriff, with 4.7% or 6.4% higher at total body, and 7.3% or 8.9% more at femneck.
2、Intervention trial results
The mean serum calcium level of older women of A and B group were respectively 2.25mg and 2.28mg, the serum 25(OH)D concentration of A and B group were 14.66ng/m/ and 23.98ng/ml respectively, serum 25(OH)D concentration of B group was higher than A group significantly(P<0.05), with 63.66% higher. The weight and BMI of group A increased, while B group decreased. BMD of the B groups at total, lumbar spine, lower limb and pelvis were significantly higher than A group, with 3.4%,5.8%,4.5%,5.8% and 3.8% higher respective.
BF and PBF at toal, midriff and left lower limb of the two group all decreased after intervention, and the difference were significant(P<0.05). BF and PBF at total of A and B group were respectively 4.8%m,3.5% and 5.3%,5.2% lower than preintervention. LBM at total and bi-upper limbs were increased, and were 2.3% and 1.5%higher than preintervention(P<0.05). BMD at Wards', norland and bi-upper limbs of A group increased, BMD of Wards'and bi-upper limbs were 7.5%,3.5%and 1.9% higher than preintervention(P<0.05). BMD at total, lumbar spine(L2-4), femneck, norland, Wards'and bi-upper limbs all increased, and 1.0%,2.7%,8.9%,3.8% and 2.6% higher than preintervention.
CONCLUTIONS The level of serum 25(OH)D of urban postmonapausal women in Beijing were insufficient widely, the women who have higher serum 25(OH)D level have lower BF and PBF. There was closely correlation between vitamin D status and BMD at total, lumbar spine, proximal femneck, pelvis and four limbs, which relealed that good nutrition status of vitamin D is very important to maintain normal weight and bone health of Chinese postmonapausal older women.
Suppling calcium and vitamin D at the same time can release the bone loss of older women effectively, increase their bone mineral density, and help to reduce body fat and control weight. So the supplemention of calcium and vitamin D is likely to prevent obesity and ostesporosis of older women, which effects was better than simple adding calcium.
钙和维生素D是维持骨骼健康和体重正常的必需营养素,我国老年妇女由于钙和维生素D缺乏导致的骨质疏松和超重、肥胖普遍存在。国外大量研究表明,适量补充钙和维生素D能够有效地改善老年妇女的骨量丢失和超重肥胖状况,但国内相关研究较少,而东西方之间的种族和膳食习惯等存在较大差异,因此,在我国进行这样一项研究是十分必要的。
本文主要研究补充钙和维生素D对北京城区老年绝经妇女骨矿物含量(BMC)和体成分(BC)的作用,以期为老年人尤其是老年绝经妇女多发的骨质疏松(OP)和老年性超重和肥胖提供预防和治疗的依据和参考,从而延缓老年妇女骨量降低的速度,减少骨折的发生,抑制其体脂过快增长,预防与之相关的慢性病,提高老年人晚年的生活质量,减少家庭、社会和国家的负担。
[研究方法]
用整群随机抽样的方法在春末夏初从北京3个城区17个社区中随机选取60岁以上老年绝经妇女400名,用量表和体检的方法进行现况研究。再从现况研究的400名老年妇女中随机选取305人作为干预研究对象,并随机分为两组,单纯补钙组(A组)和补钙+维生素D组(B组),分别服用钙剂和钙+维生素D各-年,比较其干预前后身体各部位的体成分和骨量是否有所改变。
[结果]
1、现况研究结果
北京城区老年妇女平均年龄是(68.7±5.6)岁,血钙平均水平为2.087mg,血清25(OH)D平均水平为(14.4±5.7)ng/ml,其中维生素D缺乏的比例达到62.4%,不足的比例为21.8%,处于正常水平的比例仅为15.8%。研究对象BMI均值为(25.9±3.6)kg/m2,PBF的均值为(39.2±5.3)%,以PBF和BMI判定的超重率分别达到：17.4%和48.5%,肥胖率分别达到76.7%和22.3%。研究对象全身、腰椎和股骨颈的BMD分别为(0.829±0.090)、(0.916±0.125)和(0.679±0.106)g/cm2,腰椎(L2-4)和股骨颈骨量减少的检出率分别为41.8%和38.5%,骨质疏松检出率分别为14.2%和12.3%。
研究结果显示,血清25(OH)D水平与身高、体重相关性不显著(r=0.04,r=-0.06,P>0.05),与全身、髋部及双下肢的体脂百分比(PBF)、髋部和双下肢的体脂(BF)均呈显著负相关(r=-0.14～-0.10,P<0.05),与全身、股骨颈、大转子、腹中部和双上肢部位的BMD呈显著正相关(r=0.114～0.168,P<0.05)；血清25(OH)D正常组研究对象全身、髋部和右下肢的PBF均显著低于25(OH)D不足组和缺乏组,其中全身PBF分别低2.4%和5.8%；血清25(OH)D正常组研究对象全身及全身各部位(腹中部除外)的BMD水平均显著高于25(OH)D不足组和缺乏组,其中全身BMD分别高4.7%和6.4%,股骨颈BMD分别高7.3%和8.9%。
2、干预研究结果
A、B组老年妇女血钙水平分别为2.25mg和2.28mg,血清25(OH)D水平分别为14.66ng/ml和23.98ng/ml,,干预后B组老年妇女的血清25(OH)D水平显著高于A组(P<0.05),前者比后者高63.66%;A组老年妇女体重和BMI有所增加,而B组有所减少；B组老年妇女全身、腹中部、髋部以及双下肢的PBF和BF的减少量均高于A组,两组之间均无显著性差异(P>0.05)；B组老年妇女全身、腰椎、髋部、和左右下肢的BMD显著高于A组(P<0.05),分别比A组高3.4%、5.8%、5.8%、4.5%和3.8%。
干预后,两组老年妇女全身、腹中部和左下肢部位的BF和PBF均有所减少,与干预前相比均有显著性差异(P<0.05),其中,A、B两组全身的BF和PBF分别比干预前降低4.8%、3.5%和5.3%、5.2%；干预后两组老年妇女全身和双上肢部位的LBM均有所增加,显著高于干预前(P<0.05),分别比干预前高出2.3%和1.5%。干预后A组老年妇女Wards'三角、大转子和双上肢部位的BMD有所增长,Wards'三角和双上肢部位的BMD与干预前相比有显著性差异(P<0.05),分别比干预前高出7.5%、3.5%和1.9%；干预后B组老年妇女全身、腰椎、股骨颈、大转子、Wards'三角、髋部、右下肢和双上肢部位的BMD均有所增长,干预后全身、髋部、Wards'三角和双上肢部位的BMD显著高于干预前(P<0.05),分别比干预前高出1.0%、2.7%、8.9%、3.8%和2.6%。
[结论]
北京城区老年妇女血清维生素D水平不足和缺乏的现象比较普遍,维生素D水平较高者体脂和体脂百分比水平较低,维生素D营养状况与全身、腰椎、股骨近端、髋部以及四肢骨量密切相关,提示良好的维生素D营养状况对维持我国老年绝经妇女适宜体重和骨骼健康有重要意义。
同时补充钙和维生素D能够有效减缓老年妇女的骨量丢失,增加骨密度,同时能够帮助其减少体脂,控制体重,因此补充适宜的钙和维生素D对于老年肥胖和骨质疏松的预防有一定作用,单纯补钙不如同时补充钙和维生素D对体成分和骨密度的改善效果明显。
OBJECTIVE Calcium and vitamin D are the essential nutrients to maintain the bone health and normal weight, osteoporosis resulting from deficiency of calcium and vitamin D of Chinese postmonapausal older women was prevalence. A large number of studies abroad have shown that supplement of calcium and vitamin D can effectively improve the bone health and overweight or obesity of older women. However, domestic researches were relatively deficient and there are large differences between race and diatery habits of east and west, so it is very necessary to perform such a research in our country.
This paper aimes at studying the role of supplying calcium and vitamin D to the bone mineral composition and body composition of urban postmonapausal women in Beijing, and providing the experience to the prevention and treatment of osteoporosis, overweight and obesity of Chinese older women, postponing the bone loss, reducing the bone fracture rate, restrainting the excessive growth of body fat, preventing the relative chronic diseases, improving the quality of older women life, releasing the burden of state, society and family.
METHODS A total of 400 community-dwelling women were selected randomly from 17 community of 3 districts in Beijing with cluster random sampling methods. Cross-section survey used questionnaire and physical examination. In intervention study,305 women were randomly chosed from 400 objects of cross-section survey, which were divided into two groups randomly. Calcium group(A group) and calcium adding vitamin D group(B group), who took supplemention of calcium and calcium adding vitamin D for one year respectively. We observe if the bone mineral density and body composition improved after controlling confounding factors, and the range. RESULTS 1、Cross-section survey results.
The mean age of urban older women of Beijing were (68.7±5.6), mean serum calcium level was 2.087mg, mean serum 25(OH)D was (14.4±5.7) ng/ml. Vitamin D deficiency rate was 62.4%, insufficient rate was 21.8%, and the vitamin D in normal was only 15.8%. Mean BMI of the subject was (25.9±3.6)kg/m2, mean value of PBF was (39.2±5.3)%, and the overweight rate was up to 17.4% and 48.5%, obesity rate was 76.7% and 22.3%, which were calculated by PBF and BMI. BMD of subjects at total, lumbar spine(L2-4) and femneck were respectively (0.829±0.090), (0.916±0.125) and (0.679±0.106)g/cm2, The rate of osteoporosis at lumbar spine(L2-4) and femneck of of urban postmonapausal women in Beijing were respectively 14.2%.and 12.3%, and bone loss rate were 41.8% and 38.5%.
Serum 25(OH)D level was not correlated with height and weight(r=0.04, r=-0.06, P>0.05), and were positively correlated with PBF at total, pelvis and lower limbs, and with BF at pelvis and lower limbs(r=-0.14～-0.10,P<0.05). Serum 25(OH)D level was positively correlated with BMD at total and femneck(r=0.165, r=0.184, P<0.05). PBF of subjects with 25(OH)D normal group was significantly higher than that of subjects with vitamin D insufficient or vitamin D deficiency at total, pelvis and right lower limb, with 2.4% or 5.8% lower at total. BMD of subjects with 25(OH)D normal group is significantly higher than that of subjects with vitamin D insufficient or vitamin D deficiency in all parts except midriff, with 4.7% or 6.4% higher at total body, and 7.3% or 8.9% more at femneck.
2、Intervention trial results
The mean serum calcium level of older women of A and B group were respectively 2.25mg and 2.28mg, the serum 25(OH)D concentration of A and B group were 14.66ng/m/ and 23.98ng/ml respectively, serum 25(OH)D concentration of B group was higher than A group significantly(P<0.05), with 63.66% higher. The weight and BMI of group A increased, while B group decreased. BMD of the B groups at total, lumbar spine, lower limb and pelvis were significantly higher than A group, with 3.4%,5.8%,4.5%,5.8% and 3.8% higher respective.
BF and PBF at toal, midriff and left lower limb of the two group all decreased after intervention, and the difference were significant(P<0.05). BF and PBF at total of A and B group were respectively 4.8%m,3.5% and 5.3%,5.2% lower than preintervention. LBM at total and bi-upper limbs were increased, and were 2.3% and 1.5%higher than preintervention(P<0.05). BMD at Wards', norland and bi-upper limbs of A group increased, BMD of Wards'and bi-upper limbs were 7.5%,3.5%and 1.9% higher than preintervention(P<0.05). BMD at total, lumbar spine(L2-4), femneck, norland, Wards'and bi-upper limbs all increased, and 1.0%,2.7%,8.9%,3.8% and 2.6% higher than preintervention.
CONCLUTIONS The level of serum 25(OH)D of urban postmonapausal women in Beijing were insufficient widely, the women who have higher serum 25(OH)D level have lower BF and PBF. There was closely correlation between vitamin D status and BMD at total, lumbar spine, proximal femneck, pelvis and four limbs, which relealed that good nutrition status of vitamin D is very important to maintain normal weight and bone health of Chinese postmonapausal older women.
Suppling calcium and vitamin D at the same time can release the bone loss of older women effectively, increase their bone mineral density, and help to reduce body fat and control weight. So the supplemention of calcium and vitamin D is likely to prevent obesity and ostesporosis of older women, which effects was better than simple adding calcium.
引文
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[2]武阳丰,马冠生,胡永华等.中国居民的超重和肥胖流行现状[J]. 中华预防医学杂志,2005,39(5)：316-320.
[3]许俐,陈艳,卢斌. 中老年妇女骨密度与体成分、下肢肌力及抗骨折能力的相关性分析[J]. 现代预防医学,2006,33(8)：1384-1385.
[4]熊学华,余克强,刘庆思. 维生素D与骨质疏松[J]. 中医正骨,2002,14(6)：54-55.
[5]邹秀兰,王新民,刘燕群等. 骨质疏松症及钙与维生素D在骨质疏松防治中的地位[J]. 实用医学进修杂志,2005,33(2)：72-82.
[6]孙志香,张振鹏,吴静. 骨质疏松研究进展[J].Labeled Immunoasaya & Clin Med,2005,12(2):110-113.
[7]吴玲,毕鸿雁,马蕾等.骨质疏松症的预防及治疗进展[J]. 中国综合临床,2007,23(8)：764-766.
[8]柴生廷,庄洪,魏合伟.骨质疏松性骨折流行病学研究进展[J]. 中医正骨,2004,16(2)：55-56.
[9]薛延.骨质疏松症的流行病学概况[J]. 新医学,2007,38(1)：7-8.
[10]李毅, 于秋滨,陶天尊等. 中老年妇女骨质疏松症的流行病学调查[J].中国骨质疏松杂志,2007,13(4)： 263-266.
[11]李清亚,王育才.应用人体脂肪分析仪测定老年人体脂含量[J]. 营养学报,1995,17(1)：47-49.
[12]盛彤,杨惠民, 田金洲等. 老年性骨量减少与骨质疏松症症候特点的分析比较[J]. 北京中医药大学学报(中医临床版),2008,15(4)： 12-14.
[13]Sutcliffe JF. A review of in vivo experimental methods to determine the composition of the human body [J]. Phys Med Biol,1996,41(5):791-833.
[14]叶广俊.现代儿童少年卫生学[J]..北京：人民卫生出版社,1999 21 3：39-49.
[15]Vasant Hirani, Paola Primatesta. Vitamin D concentrations among people aged 65 years and over living in private households and institutions in England: population survey[J]. Age and ageing.2005 34:485-491.
[16]刘东亮.老年性骨质疏松的预防[J].柳州医学,2005,19(3)：134-136.
[17]杨欣.老年妇女骨质疏松症的防治[J].中国实用妇科与产科杂志,2007,23(11)：824-827.
[18]Chapuy MC, Pamphile R,Paris E, et al. Conbined calcium and vitamin D supplementation in elderly women:confirmation of reversal of secondary hyperparathyroidism and hip fracture risk:the Decalvos Ⅱ study[J]. Osteoporos Int,2002,13:257-264.
[19]Daniel J, Raiten, Mary Frances. Vitamin D and health in the 21st century:bone and beyond[J].. Am J Clin Nutr,2004,80(suppl):1673-1677.
[20]David R, Fraser. Vitamin D-deficiency in Asia. Journal of Steroid Biochemistry& Molecular Biology[J].2004,89:491-495.
[21]Michael F Holick. Sunlight and vitamin D for bone health and prevention of autoimmune disease, cancers and cardiovascular disease[J]. Am J Clin Nutr,2004, 80(suppl):1678-1688.
[22]Heike A Bischoff-Ferrari, Edward Giovannucci. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes[J]. Am J Clin Nutr,2006,84:18-28.
[23]孙平,蔡德鸿,黄震.1,25(OH)2D3对骨代谢的影响[J].广东医学杂志,2007,28(1)：152-155.
[24]Zofkova I, Hill M. Long-term 1,25(OH)2D3 therapy increases bone mineral density in osteopenic women[J]. European Journal of Clinical Nutrition,2000,54: 626-631.
[25]Marieke B.Snijder, Rob M. van Dam, Marjolein Visser, Dorly J. H. Deeg, Jacqueline M. Dekker, Lex M. Bouter, Jaap C. Seidell, and Paul Lips. Adiposity in Relation to Vitamin D Status andParathyroid Hormone Levels:A Population-Based Study in Older Men and Women[J]. J Clin Endocrinol Metab, July 2005,90(7):4119-4123.
[26]Garnero, Goldner WS, Stoner. Prevalence of vitamin D insufficiency and deficiency in morbidly obese patients:a comparison with non-obese controls[J]. Journal of bone and mineral metabolism.2001,18(4):579-582.
[27]Anne C. Looker. Body Fat and Vitamin D Status in Black Versus White Women[J]. Clin Endocrinol Metab, February 2005,90(2):635-640.
[28]Kremer R, Campbell PP, Reinhardt T, et al. Vitamin D status and its relationship
to body fat, final height, and peak bone mass in young women[J]. Nutrition Journal 2005,5 (12):1176-1179.
[29]Steinar Konradsen,Harald Ag,Fedon Lindberg,Sofie Hexeberg,Rolf Jorde.Serum 1,25-dihydroxy vitamin D is inversely associated with body mass index[J].Europe Journal of Nutrition.2008,47:87-91.
[30]Anne-Thea McGill*1,4, Joanna M Stewart4, Fiona E Lithander1,2,3,Caroline M Strikl and Sally D Poppitt1'2 Relationships of low serum vitamin D3 with anthropometry and markers of the metabolic syndrome and diabetes in overweight and obesity[J]. Nutrition Journal 2008,7,4:10.1186/1475-2891-7-4.
[31]Marieke B. Snijder, Rob M. van Dam, Marjolein Visser, Dorly J. H. Deeg, Jacqueline M. Dekker,Lex M. Bouter, Jaap C. Seidell, and Paul Lips. Adiposity in Relation to Vitamin D Status andParathyroid Hormone Levels:A Population-Based Study in Older Men and Women[J]. Clin Endocrinol Metab, July 2005,90(7):4119-4123.
[32]Steinar,Konradsen, Harald, et al. Serum 1,25-dihydroxy vitamin D is inversely associated with body mass index[J]. Eur J Nutr.2008 47:87-91.
[33]Ensrud KE,Duong T, Cauley JA, et al. Low fractional calcium absorption increase the risk for hip fracture in women with low calcium intake. Study of Osteoporotic Fractuer Research Group[J]. Ann Intern Med,2000, 132:345-353.
[34]张川,符诗聪.人群中维生素D缺乏的研究.中国骨质疏松杂志,2007,13(7)：527-530.
[35]朱国英,王洪复,徐培康等.绝经后妇女骨丢失与1,25-二羟维生素D的相关性研究[J],2001,81(23)：1443-1446.
[36]梁桂山,陈阳生,刘晓霞.骨质疏松症的首选药物——骨化三醇[J].中国医药研究,2005,3(5)：384-385.
[37]Bischoff-Ferrari HA,Zhang Y, Kiel DP, Felson DT.Positive association between serum 25-hydroxyvitamin D level and bone density in osteoarthritis. Clinical Epidemiology Unit[J]. Arthritis Rheum.2005, Dec 15,53(6):821-6.
[38]Arya V, Bhambri R, Godbole MM, et al. Vitamin D status and its relationship with bone mineral density in healthy Asian Indians[J]. Osteoporos Int,2004, 15:56-61.
[39]Malavolta N, Pratelli L, Frigato M, et al. The relationship of vitamin D status to
bone mineral density in an Italian population of postnienopausal women[J]. Osteoporos Int,2005,16:1691-1697.
[40]Dawson-Hughes B, Dallal GE, Krall EA, et al. Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women[J]. Ann Intern Med,1991,115:505-12.
[41]刘华章,王海清.原发性骨质疏松症的流行病学研究进展[J].医学临床研究,2005,22(10)：1474-1476.
[42]Teegarden D. Calcium intake and reduction in weight for fat mass[J]. Nutr, 2003,133(suppl):249-251.
[43]Parikh SJ. Calcium intake and adiposity[J]. Am J Clin Nutr,2003,77(2): 281-287.
[44]Davis KM, Heaney RP, Recker RR, et al. Calcium intake and body weight[J]. Clin Endocrinol Metab,2000,85(12):4635-4638.
[45]Resnick LM. Calcium metabolism in hypertention and allied metabolic disorders[J]. Diabetes Care.1991,14:505-520.
[46]Zemel MB. Mechanisms of diary modulation of adiposity[J]. Nutr 2003, 133(suppl):252-256.
[47]Reid TA, Chowdhury HA. Calcium supplementation suppresses bone turnover during weight reduction in postmenopausal women[J]. Bone Miner Res.1998,13: 1045-1050.
[48]Ortega BR. The role of dietary calcium and other nutrients in moderating body fat in old women[J]. Int J Obet Relat Metab Disord.2001,25(4):559-566.
[49]McGill E. Intakes of calcium and vitamin D predict body mass index in the population of northen Norway[J]. Nutr,2003,133(1):102-106.
[50]张刚,赵文华,付萍等.不同钙摄入量对我国青年女性骨密度影响的研究[J].卫生研究,2005,6(34)：729-731.
[51]马蓓蕾,蔡美琴.钙需要量的影响因素与骨质疏松[J].中国临床营养杂志,2006,14(4)：265-269.
[52]Peacock M, Liu G, Carey M, et al. Effect of calcium or 25OH vitamin D3 dietary supplementation on bone loss at the hip in men and wemen over the age of 60[J]. Clin Endocrinol Metav,2000,85(3):3011-3019.
[53]Welten DC, Kenper HC, Post GB, et al. A meta-analysis of the effect of calcium intake on bone mass in young and middle aged females and males[J]. Nutr, 1995,125(11):2802-2813.
[54]Ushiroyama J. The role of calcium and vitamin D in menopausal women[J]. Nutr.2001,8(2):84-95.
[55]Schaafsma A, Muskiet FA, Storm H, et al. Vitamin D and vitamin K supplementation of Dutch postmenopausal women with normal and low bone mineral densities[J].European Journal of Clinical Nutrition,2000,54:626-631.
[56]聂伟志,隋显玉,李立等.骨量与体重、体成分的关系[J].中医正骨,2004,16(10)：61-63.
[1]刘忠厚,杨定焯,朱汉民,等.中国人骨质疏松症建议诊断标准[J].中国骨质疏松杂志,2000,6(1)：1-3.
[2]陈少华,廖凤莲.女性骨质疏松的研究进展及健康教育[J].深圳中西结合杂志,2002,12(5)：314-315.
[3]阳旭峰,阳安宁.骨质疏松症的治疗进展[J].临床误诊误治,2007,20(10)：42-43.
[4]薛延.骨质疏松症的流行病学概况[J].新医学,2007,38(1)：7-8.
[5]马宗军,王一农.骨质疏松症流行病学研究现状[J].国际骨科学杂志,2007,28(5)：315-318.
[6]祝白春.综合营养措施对控制中老年妇女骨质疏松的作用[J].现代预防医学,2006,33(3)：78-81.
[7]李继斌.骨量影响因素研究进展[J].国外医学卫生学分册2000,27(4)：213-217.
[8]Peacock M, Liu G, Carey M, et al. Effect of calcium or 25OH vitamin D3 dietary supplementation on bone loss at the hip in men and wemen over the age of 60[J]. Clin Endocrinol Metav,2000,85(3):3011-3019.
[9]黄敬,赵亮,刘波等.探讨应用牛奶与钙剂对低骨密度老年人的作用[C].中华医学会第一次全国骨质疏松学术会议论文汇编,2001：155-156.
[10]Kerr D, Ackland T, Maslen B, et al. Resistance training over two years increases bone mass in calciurr replete postmenopausal women[J]. Bone Miner Res,2001, 5:175-181.
[11]唐翠霞.骨质疏松症的预防及护理[J].陕西中医杂志,2006,27(6)：749-750.
[12]李施.骨质疏松症重在早期预防教育[J].中国骨质疏松杂志,2004,(10)：374-376.
[13]Chen M, Chow SN. Additive effect of alfacalcidol on bone mineral density of the lumbar spine in Taiwanese postmenopausal women treated with hormone replacement therapy and calcium emtatopm:a randomizes two-year study[J]. Clin Endocrinol(Oxf), 2001,5 (5):253-258.
[14]Richy F, Schacht E, Bruyere O, et al. Vitamin D analogs versus native vitamin D in preventing bone loss and osteoporosis-related fractures:a comparative meta-analysis[J]. Calcif Tissue Int,2005,76:176-186.
[15]HannanMT, TuckerKL, Dawson-Hughes B, et al. Effect of dietary protein on bone loss in elderly men and women:the Framinghan Osteoporosis Study[J]. Bone Miner Res,2000,9:2504-2512.
[16]杜宁,陈伟珍,刘涛.大豆异黄酮治疗妇女绝经后骨质疏松疗效观察[J].世界中医骨伤科杂志,2001,3(3)：141-144.
[17]Sellmeyer DE, Stone KL, Sebastian A, et al. A high ratio of dietaru animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women[J]. Am J Clin Nutr,2001,73:118-122.
[18]Feskanich D, Willett W C, Stampfer M J, et al. Pretein consumption and bone fracture inwomen[J]. Am J Epidemiol,1996,14:472-479.
[2]武阳丰,马冠生,胡永华等.中国居民的超重和肥胖流行现状[J]. 中华预防医学杂志,2005,39(5)：316-320.
[3]许俐,陈艳,卢斌. 中老年妇女骨密度与体成分、下肢肌力及抗骨折能力的相关性分析[J]. 现代预防医学,2006,33(8)：1384-1385.
[4]熊学华,余克强,刘庆思. 维生素D与骨质疏松[J]. 中医正骨,2002,14(6)：54-55.
[5]邹秀兰,王新民,刘燕群等. 骨质疏松症及钙与维生素D在骨质疏松防治中的地位[J]. 实用医学进修杂志,2005,33(2)：72-82.
[6]孙志香,张振鹏,吴静. 骨质疏松研究进展[J].Labeled Immunoasaya & Clin Med,2005,12(2):110-113.
[7]吴玲,毕鸿雁,马蕾等.骨质疏松症的预防及治疗进展[J]. 中国综合临床,2007,23(8)：764-766.
[8]柴生廷,庄洪,魏合伟.骨质疏松性骨折流行病学研究进展[J]. 中医正骨,2004,16(2)：55-56.
[9]薛延.骨质疏松症的流行病学概况[J]. 新医学,2007,38(1)：7-8.
[10]李毅, 于秋滨,陶天尊等. 中老年妇女骨质疏松症的流行病学调查[J].中国骨质疏松杂志,2007,13(4)： 263-266.
[11]李清亚,王育才.应用人体脂肪分析仪测定老年人体脂含量[J]. 营养学报,1995,17(1)：47-49.
[12]盛彤,杨惠民, 田金洲等. 老年性骨量减少与骨质疏松症症候特点的分析比较[J]. 北京中医药大学学报(中医临床版),2008,15(4)： 12-14.
[13]Sutcliffe JF. A review of in vivo experimental methods to determine the composition of the human body [J]. Phys Med Biol,1996,41(5):791-833.
[14]叶广俊.现代儿童少年卫生学[J]..北京：人民卫生出版社,1999 21 3：39-49.
[15]Vasant Hirani, Paola Primatesta. Vitamin D concentrations among people aged 65 years and over living in private households and institutions in England: population survey[J]. Age and ageing.2005 34:485-491.
[16]刘东亮.老年性骨质疏松的预防[J].柳州医学,2005,19(3)：134-136.
[17]杨欣.老年妇女骨质疏松症的防治[J].中国实用妇科与产科杂志,2007,23(11)：824-827.
[18]Chapuy MC, Pamphile R,Paris E, et al. Conbined calcium and vitamin D supplementation in elderly women:confirmation of reversal of secondary hyperparathyroidism and hip fracture risk:the Decalvos Ⅱ study[J]. Osteoporos Int,2002,13:257-264.
[19]Daniel J, Raiten, Mary Frances. Vitamin D and health in the 21st century:bone and beyond[J].. Am J Clin Nutr,2004,80(suppl):1673-1677.
[20]David R, Fraser. Vitamin D-deficiency in Asia. Journal of Steroid Biochemistry& Molecular Biology[J].2004,89:491-495.
[21]Michael F Holick. Sunlight and vitamin D for bone health and prevention of autoimmune disease, cancers and cardiovascular disease[J]. Am J Clin Nutr,2004, 80(suppl):1678-1688.
[22]Heike A Bischoff-Ferrari, Edward Giovannucci. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes[J]. Am J Clin Nutr,2006,84:18-28.
[23]孙平,蔡德鸿,黄震.1,25(OH)2D3对骨代谢的影响[J].广东医学杂志,2007,28(1)：152-155.
[24]Zofkova I, Hill M. Long-term 1,25(OH)2D3 therapy increases bone mineral density in osteopenic women[J]. European Journal of Clinical Nutrition,2000,54: 626-631.
[25]Marieke B.Snijder, Rob M. van Dam, Marjolein Visser, Dorly J. H. Deeg, Jacqueline M. Dekker, Lex M. Bouter, Jaap C. Seidell, and Paul Lips. Adiposity in Relation to Vitamin D Status andParathyroid Hormone Levels:A Population-Based Study in Older Men and Women[J]. J Clin Endocrinol Metab, July 2005,90(7):4119-4123.
[26]Garnero, Goldner WS, Stoner. Prevalence of vitamin D insufficiency and deficiency in morbidly obese patients:a comparison with non-obese controls[J]. Journal of bone and mineral metabolism.2001,18(4):579-582.
[27]Anne C. Looker. Body Fat and Vitamin D Status in Black Versus White Women[J]. Clin Endocrinol Metab, February 2005,90(2):635-640.
[28]Kremer R, Campbell PP, Reinhardt T, et al. Vitamin D status and its relationship
to body fat, final height, and peak bone mass in young women[J]. Nutrition Journal 2005,5 (12):1176-1179.
[29]Steinar Konradsen,Harald Ag,Fedon Lindberg,Sofie Hexeberg,Rolf Jorde.Serum 1,25-dihydroxy vitamin D is inversely associated with body mass index[J].Europe Journal of Nutrition.2008,47:87-91.
[30]Anne-Thea McGill*1,4, Joanna M Stewart4, Fiona E Lithander1,2,3,Caroline M Strikl and Sally D Poppitt1'2 Relationships of low serum vitamin D3 with anthropometry and markers of the metabolic syndrome and diabetes in overweight and obesity[J]. Nutrition Journal 2008,7,4:10.1186/1475-2891-7-4.
[31]Marieke B. Snijder, Rob M. van Dam, Marjolein Visser, Dorly J. H. Deeg, Jacqueline M. Dekker,Lex M. Bouter, Jaap C. Seidell, and Paul Lips. Adiposity in Relation to Vitamin D Status andParathyroid Hormone Levels:A Population-Based Study in Older Men and Women[J]. Clin Endocrinol Metab, July 2005,90(7):4119-4123.
[32]Steinar,Konradsen, Harald, et al. Serum 1,25-dihydroxy vitamin D is inversely associated with body mass index[J]. Eur J Nutr.2008 47:87-91.
[33]Ensrud KE,Duong T, Cauley JA, et al. Low fractional calcium absorption increase the risk for hip fracture in women with low calcium intake. Study of Osteoporotic Fractuer Research Group[J]. Ann Intern Med,2000, 132:345-353.
[34]张川,符诗聪.人群中维生素D缺乏的研究.中国骨质疏松杂志,2007,13(7)：527-530.
[35]朱国英,王洪复,徐培康等.绝经后妇女骨丢失与1,25-二羟维生素D的相关性研究[J],2001,81(23)：1443-1446.
[36]梁桂山,陈阳生,刘晓霞.骨质疏松症的首选药物——骨化三醇[J].中国医药研究,2005,3(5)：384-385.
[37]Bischoff-Ferrari HA,Zhang Y, Kiel DP, Felson DT.Positive association between serum 25-hydroxyvitamin D level and bone density in osteoarthritis. Clinical Epidemiology Unit[J]. Arthritis Rheum.2005, Dec 15,53(6):821-6.
[38]Arya V, Bhambri R, Godbole MM, et al. Vitamin D status and its relationship with bone mineral density in healthy Asian Indians[J]. Osteoporos Int,2004, 15:56-61.
[39]Malavolta N, Pratelli L, Frigato M, et al. The relationship of vitamin D status to
bone mineral density in an Italian population of postnienopausal women[J]. Osteoporos Int,2005,16:1691-1697.
[40]Dawson-Hughes B, Dallal GE, Krall EA, et al. Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women[J]. Ann Intern Med,1991,115:505-12.
[41]刘华章,王海清.原发性骨质疏松症的流行病学研究进展[J].医学临床研究,2005,22(10)：1474-1476.
[42]Teegarden D. Calcium intake and reduction in weight for fat mass[J]. Nutr, 2003,133(suppl):249-251.
[43]Parikh SJ. Calcium intake and adiposity[J]. Am J Clin Nutr,2003,77(2): 281-287.
[44]Davis KM, Heaney RP, Recker RR, et al. Calcium intake and body weight[J]. Clin Endocrinol Metab,2000,85(12):4635-4638.
[45]Resnick LM. Calcium metabolism in hypertention and allied metabolic disorders[J]. Diabetes Care.1991,14:505-520.
[46]Zemel MB. Mechanisms of diary modulation of adiposity[J]. Nutr 2003, 133(suppl):252-256.
[47]Reid TA, Chowdhury HA. Calcium supplementation suppresses bone turnover during weight reduction in postmenopausal women[J]. Bone Miner Res.1998,13: 1045-1050.
[48]Ortega BR. The role of dietary calcium and other nutrients in moderating body fat in old women[J]. Int J Obet Relat Metab Disord.2001,25(4):559-566.
[49]McGill E. Intakes of calcium and vitamin D predict body mass index in the population of northen Norway[J]. Nutr,2003,133(1):102-106.
[50]张刚,赵文华,付萍等.不同钙摄入量对我国青年女性骨密度影响的研究[J].卫生研究,2005,6(34)：729-731.
[51]马蓓蕾,蔡美琴.钙需要量的影响因素与骨质疏松[J].中国临床营养杂志,2006,14(4)：265-269.
[52]Peacock M, Liu G, Carey M, et al. Effect of calcium or 25OH vitamin D3 dietary supplementation on bone loss at the hip in men and wemen over the age of 60[J]. Clin Endocrinol Metav,2000,85(3):3011-3019.
[53]Welten DC, Kenper HC, Post GB, et al. A meta-analysis of the effect of calcium intake on bone mass in young and middle aged females and males[J]. Nutr, 1995,125(11):2802-2813.
[54]Ushiroyama J. The role of calcium and vitamin D in menopausal women[J]. Nutr.2001,8(2):84-95.
[55]Schaafsma A, Muskiet FA, Storm H, et al. Vitamin D and vitamin K supplementation of Dutch postmenopausal women with normal and low bone mineral densities[J].European Journal of Clinical Nutrition,2000,54:626-631.
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[1]刘忠厚,杨定焯,朱汉民,等.中国人骨质疏松症建议诊断标准[J].中国骨质疏松杂志,2000,6(1)：1-3.
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