臨床婦人科産科70巻11号

2016年11月発行

今月の臨床 骨粗鬆症の最新トピックス─ガイドラインの大幅改訂を迎えて

原因ごとの病態

生活習慣病と骨粗鬆症

著者： 高橋一広¹

所属機関： ¹山形大学医学部産婦人科

ページ範囲：P.1001 - P.1006

文献概要

●閉経後女性における肥満は，大腿骨頸部骨折に対しては予防的に働くが，椎体骨折を増加させることから，身体部位によっては骨折のリスク因子となる．

●メタボリック症候群では大腿骨頸部や椎体骨の骨密度が低く，骨折の頻度が高くなるという報告がある一方，大腿骨頸部骨密度が高いという報告もあり一定していない．

●糖尿病を合併すると大腿骨頸部骨折が増加するが，骨密度が高くても骨折する例があり，この原因として悪玉架橋である終末糖化産物（AGEs）の増加が考えられている．

参考文献

1）Riggs BL : The mechanisms of estrogen regulation of bone resorption. J Clin Invest 10 : 1203─1204, 2000

2）Nakamura T, et al : Estrogen prevents bone loss via estrogen receptor alpha and induction of Fas ligand in osteoclasts. Cell 130 : 811─823, 2007

3）Trémollieres FA, et al : Relative influence of age and menopause on total and regional body composition changes in postmenopausal women. Am J Obstet Gynecol 175 : 1594─1600, 1996

4）Kotani K, et al : Sexual dimorphism of age-related changes in whole-body fat distribution in the obese. Int J Obes Relat Metab Disord 18 : 207─212, 1994

5）Maeda K, et al : cDNA cloning and expression of a novel adipose specific collagen-like factor, apM1（AdiPose Most abundant Gene transcript 1）. Biochem Biophys Res Commun 221 : 286─289, 1996

6）Kondo H, et al : Association of adiponectin mutation with type 2 diabetes : a candidate gene for the insulin resistance syndrome. Diabetes 51 : 2325─2328, 2002

7）Ouchi N, et al : Adipocyte-derived plasma protein, adiponectin, suppresses lipid accumulation and class A scavenger receptor expression in human monocyte-derived macrophages. Circulation 103 : 1057─1063, 2001

8）Arita Y, et al : Adipocyte-derived plasma protein adiponectin acts as a platelet-derived growth factor-BB-binding protein and regulates growth factor-induced common postreceptor signal in vascular smooth muscle cell. Circulation 105 : 2893─2898, 2002

9）Yamatani H, et al : Association of estrogen with glucocorticoid levels in visceral fat in postmenopausal women. Menopause 20 : 437─442, 2013

10）Compston JE, et al : Obesity is not protective against fracture in postmenopausal women : GLOW. Am J Med 124 : 1043─1050, 2011

11）Tanaka S, et al : Overweight/obesity and underweight are both risk factors for osteoporotic fractures at different sites in Japanese postmenopausal women. Osteoporos Int 24 : 69─76, 2013

12）von Muhlen D, et al : Associations between the metabolic syndrome and bone health in older men and women : the Rancho Bernardo Study. Osteoporos Int 18 : 1337─1344, 2007

13）Kim HY, et al : Negative association between metabolic syndrome and bone mineral density in Koreans, especially in men. Calcif Tissue Int 86 : 350─358, 2010

14）Hwang DK, et al : The relationship between low bone mass and metabolic syndrome in Korean women. Osteoporos Int 21 : 425─431, 2010

15）Wang D, et al : Association between metabolic syndrome and osteoporotic fracture in middle-aged and elderly Chinese peoples. Cell Biochem Biophys 70 : 1297─1303, 2014

16）Kinjo M, et al : Bone mineral density in adults with the metabolic syndrome : analysis in a population-based U.S. sample. J Clin Endocrinol Metab 92 : 4161─4164, 2007

17）Dytfeld J, et al : Type 2 diabetes and risk of low-energy fractures in postmenopausal women : meta-analysis of observational studies. Aging Clin Exp Res（in press）

18）Vestergaard P : Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes--a meta-analysis. Osteoporos Int 18 : 427─444, 2007

19）Yamamoto M, et al : Diabetic patients have an increased risk of vertebral fractures independent of BMD or diabetic complications. J Bone Miner Res 24 : 702─709, 2009

20）Saito M, et al : Collagen cross-links as a determinant of bone quality : a possible explanation for bone fragility in aging, osteoporosis, and diabetes mellitus. Osteoporos Int 21 : 195─214, 2010

21）Saito M, et al : Role of collagen enzymatic and glycation induced cross-links as a determinant of bone quality in spontaneously diabetic WBN/Kob rats. Osteoporos Int 17 : 1514─1523, 2006

22）骨粗鬆症の予防と治療ガイドライン作成委員会 : 骨粗鬆症の予防と治療ガイドライン2015年版．日本骨粗鬆症学会，2015