社區停經初期婦女骨質流失及危險因子之追蹤研究(第三年)

骨質疏鬆症是廿一世紀人類因人口老化所將面臨的重大問題，尤其是婦女在停經後快速的骨質流失更是造成低骨密度，乃至骨質疏鬆、骨折的主要因素。據統計在美國一年有150 萬例因骨質疏鬆導致的骨折，台灣在進入本世紀不久將會與歐美國家一樣走上人口高度老化的程度。 台灣地區目前雖已有學者提出的骨密度平均值表及標準差，但皆為橫斷面的研究，且皆沒有深入探討其相關的危險或保護因子。為探討相關危險及保護因子，並補正橫斷面研究可能的缺失，本研究計畫乃是以社區為範圍，為期三年的世代追蹤研究。以下報告研究進行的方式與成果。我們以台北市大安區及文山區為主， 收錄已停經的婦女，予以測量及調查其基本資料（年齡、身高、體重、腰臀比…等）及生活型態(有無抽煙、喝酒、日常運動量多寡…等)，並詳細詢問其月經生育史（初經及停經年齡、懷孕及生產次數、有無哺餵母乳…等）及相關疾病家族史。 每位受檢婦女皆接受DEXA（Dual Energy X-ray Absorptiometry）測量腰椎及左大腿股骨頭關節的骨質密度（BMD - bone mineral density）。每位受測婦女原則上於 二年後，再接受一次骨密度檢查的追蹤。收案時共完成395 位65 歲以上停經後婦女的骨密度及其相關資料之調查。由於原先研究設計尚稱周詳，故第一年剛開始研究之進行尚無碰到重大困難。唯一的問題是因2003 年上半年SARS 的肆虐，被抽中測量的社區民眾不敢到醫療院所，導致收案個數較原先計劃者為少。到2005 年7 月截止，共有303 位婦女完成追蹤檢查，其中有60 位於追蹤期間有服用過雙磷酸鹽、女性賀爾蒙、抑鈣素等會 影響骨密度的藥物。茲將所得資料分析列表於後。Osteoporosis is a major public health concern of the 21st century due to the rapidly increasing elderly population worldwide. Women especially will lose bone rapidly after the menopause, which can lead to osteopenia initially, with worsening to osteoporosis and an increased propensity to fracture. Statistics from the USA show approximately 1.5 million fractures occurring each year as a consequence of osteoporosis. The steep increase in the elderly population of Taiwan in recent decades, similar toWestern developed nations, will further emphasize the urgency of preventative strategy against osteoporosis. Although there have been studies on the bone mineral density (BMD) of Taiwanese women, these studies, however, were mainly cross-sectional in nature. In order to investigate reproductive and lifestyle risk factors or protective factors for bone loss in the postmenopausal years and avoid the shortcomings of a cross-sectional study design, this longitudinal community-based cohort study with a 2-year follow-up were carried out. We include 395 postmenopausal women who are older than 65 years as study subjects. Using a questionnaire, baseline characteristics (age, years of education, etc.), lifestyle characteristics (ever smoked, drink alcohol, physical activity level, etc.), reproductive history (age at menarche and menopause, parity and number of livebirths, breastfeeding, etc.), as well as pertinent medical and family history were recorded. Anthropometric measurements were taken of each subject (height, weight, BMI, waist-hip ratio (WHR), etc.). Every subject received dual energy X-ray absorptiometry (DEXA) measurements of BMD ( bone mineral density) for the lumbar spine and left hip . Up to now, totally 303 patient finished the follow-up examination. Sixty of than took antiresorptive drug during follow-up period. The data collected initially were used as baseline to compare with any weight, height, lifestyle and BMD changes 2 years later. The final data analyzed were listed as tables in the following. The only problem we encounter during the first and second year study is SARS episode, which hindered subjects from receiving DEXA exam at hospital. Hence the subject number enrolled is less than originally planned

社區停經初期婦女骨質流失及危險因子之追蹤研究(第二年)

骨質疏鬆症是廿一世紀人類因人口老化所將面臨的重大問題，尤其是婦女在停經後快速的骨質流失更是造成低骨密度，乃至骨質疏鬆、骨折的主要因素。據統計在美國一年有150 萬例因骨質疏鬆導致的骨折，台灣在進入本世紀不久將會與歐美國家一樣走上人口高度老化的程度。 台灣地區目前雖已有學者提出的骨密度平均值表及標準差，但皆為橫斷面的研究，且皆沒有深入探討其相關的危險或保護因子。為探討相關危險及保護因子，並補正橫斷面研究可能的缺失，本研究計畫乃是以社區為範圍，為期三年的世代追蹤研究。以下報告研究進行的方式與到第二年結束時的成果。我們以台北市為 主，收錄已停經的婦女，予以測量及調查其基本資料（年齡、身高、體重、腰臀比…等）及生活型態(有無抽煙、喝酒、日常運動量多寡…等)，並詳細詢問其月經生育史（初經及停經年齡、懷孕及生產次數、有無哺餵母乳…等）及相關疾病家族史。每位受檢婦女皆接受DEXA（Dual Energy X-ray Absorptiometry）測量腰椎及左大腿股骨頭關節的骨質密度（BMD - bone mineral density）及全身脂肪分布。這第二年的工作主要是維繫已受試婦女以做為以後第三年的世代追蹤。 從2002 年9 月起截至2004 年7 月底共完成395 位停經後婦女的骨密度及其相關資料之調查。其骨密度及基本資料結果如後面附錄所示。由於原先研究設計尚稱周詳，故第一年研究之進行尚無碰到重大困難。唯一的問題是因2003 年上半年SARS 的肆虐，被抽中測量的社區民眾不敢到醫療院所，導致收案個數較原先計劃者為少。第二年的追蹤率亦高達九成，將待第三年全部受測人數完成滿二年的追蹤後，再予以統計分析。Osteoporosis is a major public health concern of the 21st century due to the rapidly increasing elderly population worldwide. Women especially will lose bone rapidly after the menopause, which can lead to osteopenia initially, with worsening to osteoporosis and an increased propensity to fracture. Statistics from the USA show approximately 1.5 million fractures occurring each year as a consequence of osteoporosis. The steep increase in the elderly population of Taiwan in recent decades, similar to Western developed nations, will further emphasize the urgency of preventative strategy against osteoporosis. Although there have been studies on the bone mineral density (BMD) of Taiwanese women, these studies, however, were mainly cross-sectional in nature. In order to investigate reproductive and lifestyle risk factors or protective factors for bone loss in the postmenopausal years and avoid the shortcomings of a cross-sectional study design, this longitudinal community-based cohort study with a 2-year follow-up were carried out. We include 397 postmenopausal women as study subjects until the end of the second year. Using a questionnaire, baseline characteristics (age, years of education, etc.), lifestyle characteristics (ever smoked, drink alcohol, physical activity level, etc.), reproductive history (age at menarche and menopause, parity and number of livebirths, breastfeeding, etc.), as well as pertinent medical and family history were recorded. Anthropometric measurements were taken of each subject (height, weight, BMI, waist-hip ratio (WHR), etc.). Every subject received dual energy X-ray absorptiometry (DEXA) measurements of BMD ( bone mineral density) for the lumbar spine and left hip and total body fat distribution. The data collected during the first year here will be used as baseline to compare with any weight, height, lifestyle and BMD changes 1 and 2 years later. Part of these original data were shown in appendix. The only problem we encounter during the first and second year study is SARS episode, which hindered subjects from receiving DEXA exam at hospital. Hence the subject number enrolled is less than originally planned

社區停經初期婦女骨質流失及危險因子之追蹤研究(第一年)

骨質疏鬆症是廿一世紀人類因人口老化所將面臨的重大問題，尤其是婦女在停經後快速的骨質流失更是造成低骨密度，乃至骨質疏鬆、骨折的主要因素。據統計在美國一年有150 萬例因骨質疏鬆導致的骨折，台灣在進入本世紀不久將會與歐美國家一樣走上人口高度老化的程度。 台灣地區目前雖已有學者提出的骨密度平均值表及標準差，但皆為橫斷面的研究，且皆沒有深入探討其相關的危險或保護因子。為探討相關危險及保護因子，並補正橫斷面研究可能的缺失，本研究計畫乃是以社區為範圍，為期三年的世代追蹤研究。以下報告研究進行的方式與第一年的成果。我們以台北市為主，收錄已停經的婦女，予以測量及調查其基本資料（年齡、身高、體重、腰臀比…等）及生活型態(有無抽煙、喝酒、日常運動量多寡…等)，並詳細詢問其月經生育史（初經及停經年齡、懷孕及生產次數、有無哺餵母乳…等）及相關疾病家族史。每位受檢婦女皆接受DEXA（Dual Energy X-ray Absorptiometry）測量腰椎及左大腿股骨頭關節的骨質密度（BMD - bone mineral density）及全身脂肪分布，並驗尿抽血檢驗骨代謝指標Dpd / Cre（Deoxypyridinoline / Creatinine）。這第一年的資 料主要是做為以後第二年及第三年世代追蹤的基準值。 從2002 年9 月起截至2003 年7 月底共完成280 位停經後婦女的骨密度及其相關資料之調查。其骨密度及基本資料結果如後面附錄所示。將待第二年及第三年全部受測人數完成滿二年的追蹤後，再予以統計分析。由於原先研究設計尚稱周詳，故第一年研究之進行尚無碰到重大困難。唯一的問題是因2003 年上半年SARS 的肆虐，被抽中測量的社區民眾不敢到醫療院所，導致收案個數較原先計劃者為少。Osteoporosis is a major public health concern of the 21st century due to the rapidly increasing elderly population worldwide. Women especially will lose bone rapidly after the menopause, which can lead to osteopenia initially, with worsening to osteoporosis and an increased propensity to fracture. Statistics from the USA show approximately 1.5 million fractures occurring each year as a consequence of osteoporosis. The steep increase in the elderly population of Taiwan in recent decades, similar to Western developed nations, will further emphasize the urgency of preventative strategy against osteoporosis. Although there have been studies on the bone mineral density (BMD) of Taiwanese women, these studies, however, were mainly cross-sectional in nature. In order to investigate reproductive and lifestyle risk factors or protective factors for bone loss in the postmenopausal years and avoid the shortcomings of a cross-sectional study design, this longitudinal community-based cohort study with a 2-year follow-up were carried out. We include 280 postmenopausal women as study subjects in the first year. Using a questionnaire, baseline characteristics (age, years of education, etc.), lifestyle characteristics (ever smoked, drink alcohol, physical activity level, etc.), reproductive history (age at menarche and menopause, parity and number of livebirths, breastfeeding, etc.), as well as pertinent medical and family history were recorded. Anthropometric measurements were taken of each subject (height, weight, BMI, waist-hip ratio (WHR), etc.). Every subject received dual energy X-ray absorptiometry (DEXA) measurements of BMD ( bone mineral density) for the lumbar spine and left hip and total body fat distribution. Urine sampling and blood drawing were done to test the bone turnover marker deoxypyridinoline (Dpd). The data collected during the first year here will be used as baseline to compare with any weight, height, lifestyle and BMD changes 1 and 2 years later. Part of these original data were shown in appendix. The only problem we encounter during the first - year study is SARS episode, which hindered subjects from receiving DEXA exam at hospital. Hence the subject number enrolled is less than planned

Laparoscopic Cystectomy of a Twisted Benign Ovarian Teratoma in the First Trimester of Pregnancy

Adnexal torsion is an unusual, but serious complication in pregnancy. The treatment is surgical, but this may increase the risk of pregnancy loss in the first trimester. The use of laparoscopic surgery, which is less invasive than traditional laparotomy, has been limited by diagnostic and technical difficulties including determination of ovarian tumor nature and spillage of cyst contents intraoperatively. A 25-year-old woman in her 11 th week of pregnancy had acute severe left lower-abdominal pain, which was diagnosed as left ovarian teratoma with torsion. She underwent emergency laparoscopic surgery with unwinding of the twisted fallopian tube and ovary and cystectomy of the teratoma. The patient subsequently delivered a full-term baby, without complications. Accurate ultrasound and cytologic diagnoses along with copious intraoperative warm, normal saline irrigation were likely contributing factors to the successful outcome of this case

The critical role of ECM proteins within the human MSC niche in endothelial differentiation

Interactions between blood vessels and osteoblasts-bone-forming cells-are critical for successful bone development. We therefore investigated the endothelial differentiation capacity of mesenchymal stem cells (MSCs) derived from bone tissue. We found that fetal pre-osteoblast and adult trabecular bone-derived (TB) MSCs express similar surface markers as bone marrow (BM) MSCs and can differentiate into adipocytes, osteoblasts, and chondrocytes. However, when cultured in extracellular matrix (ECM) and endothelial differentiation conditions, bone-derived MSCs (B-MSCs) more readily form tubular structures and uptake acetylated low-density lipoproteins, fulfilling the functional criteria for endothelial cells (ECs). Moreover, addition of B-MSCs but not other cells significantly enhanced vessel formation in the in vivo chick chorioallantoic membrane assay. Mechanistically, this appears to be due to the upregulation of the endothelial transcription factor forkhead box protein C2 (FOXC2) and its downstream gene alpha v beta 3 integrin/CD61 in B-MSCs but not BMMSCs by laminin, a component protein of the ECM. Our findings not only reveal discrepant differentiation capacity for various tissue-specific MSCs, but also highlight the critical role of the niche in this case, the ECM and its component proteins in determining lineage commitment of stem cells. (C) 2013 Elsevier Ltd. All rights reserved

Effects of Alendronate on Osteopenic Postmenopausal Chinese Women

To evaluate the effects of alendronate on postmenopausal Chinese women with osteopenia, we treated 46 subjects daily with either 10 mg alendronate (N = 24) or placebo plus 500 mg calcium supplement (N = 22), and measured their bone mineral density (BMD) at the lumbar spine and hip, and urinary bone resorption markers before, during, and after the 1 year treatment period. The bone markers included N- telopeptide of type I collagen (NTx) and deoxypyridinoline ( Dpd); both were corrected by the concentration of creatinine in the same sample (NTx/Cr and Dpd/Cr). Both NTx/ Cr and Dpd/Cr decreased significantly by 44% and 28%, respectively (p < 0.05 for both), in 1 month in the active treatment group but did not change in the placebo group. BMD at the spine, femoral neck, trochanter, and Ward's triangle increased significantly by 6 months and showed a further increase through month 12 at the spine in the alendronate- treated group. Relative to the placebo group, BMD changes at various sites in the alendronate-treated group were higher at 12 months by 6%-11%. Thus, our data suggest that 10 mg alendronate daily resulted in significant increases in spine and hip BMD, and decreases of urinary resorption markers in the osteopenic postmenopausal Chinese women studied. The amplitude of responses was higher than in previous reports in the USA and Europe