用皮膚皺紋猜測骨骼健康


  【24drs.com】根據發表於「ENDO 2011: 內分泌協會第93屆年會」中的研究,密切觀察剛停經婦女的皮膚,或許可以一窺她們的骨骼健康情況。
  
  這篇研究發現,對於停經後3年內、未使用任何荷爾蒙治療、未曾動過任何皮膚整容手術的女性,皮膚皺紋和骨密度(BMD)之間有顯著的反比關係。
  
  康乃狄克州紐哈芬耶魯大學醫學院副教授、生殖內分泌學家Lubna Pal醫師發表研究時表示,這些是身體發生急遽變化的一群人,而未曾有學者描述過此一關聯。
  
  Pal醫師解釋,骨骼和皮膚有共通性建構基礎:膠原蛋白;膠原蛋白的質量隨年紀改變,造成皮膚出現與年紀相關的改變,例如皺紋和鬆弛,或許也會造成BMD降低。
  
  Pal醫師表示,當看診年長病患時,她往往會擔心皮膚的變化,醫師擔心的卻是她的骨骼變化;因此,不禁可以問道:我可以微調病患的顧慮並使其了解骨骼健康嗎?
  
  Pal醫師等人進行了一個橫斷面分析,研究對象是納入「Kronos Early Estrogen Prevention Study (KEEPS)」這個縱向研究的114名剛停經的婦女(70%是白人)。
  
  皮膚研究的一部分,是使用Lemperle氏皺紋量表評估臉頸部11處皮膚皺紋的分布與深度;使用硬度計測量前額和臉頰皮膚的堅硬度,這種檢測方式在硬皮症患者身上證實有用;使用雙能量x光吸收儀測量腰椎、髖骨與全身骨密度。
  
  研究者觀察發現,皮膚皺紋和脊椎(r,–0.27;P< .01)、股骨頸(r,–0.29;P< .01)和全身(r,–0.26;P=.01)等之BMD有明顯的反向關係,與年紀、身體組成、已知與影響BMD有關的其他因素等無關。
  
  Pal醫師表示,基本上,我們發現的是,皺紋分數越高,骨密度越糟糕,因而藉此證明我們的假設。
  
  臉部及前額皮膚較硬與BMD較高有關。
  
  未參與研究的麻州綜合醫院與哈佛醫學院Madhusmita Misra醫師表示,需要後續研究加以證實,若證明為真,這是個有意義的關聯。
  
  Misra醫師表示,我們有各種已經證實與個人骨折風險有關的臨床風險因素,這或許是另一個有助於整體預測力的方式,這是有力的潛在關聯,不過尚待證實。
  
  Pal醫師表示,最後,我們想知道,皮膚皺紋密度是否可分辨出哪些婦女比較可能發生骨折,特別是股骨頸或髖骨。若真如此,那麼,探討皮膚皺紋加上其他臨床風險因素,將可不用增加花費即可辨識有骨折風險者。
  
  Pal醫師同意Misra醫師的看法,但認為需要更多研究;他表示,這只是冰山一角,這是個引人注意的關聯,需要以長期研究追蹤,藉以證實皺紋與骨折風險之間的關聯。
  
  Pal醫師指出,這篇研究是縱向追蹤這些婦女,值得探討後續幾年之後,觀察那些皺紋較深的婦女是否骨質流失較快。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_logon=W&x_idno=6538&x_classno=0
  

Skin Wrinkles May Provide a Glimpse Into Bone Health

By Megan Brooks
Medscape Medical News

June 6, 2011 (Boston, Massachusetts) — A close look at the skin of early postmenopausal women might provide a glimpse into their skeletal health, according to a study presented here at ENDO 2011: The Endocrine Society 93rd Annual Meeting.

The study found a significant inverse association between skin wrinkles and bone mineral density (BMD) in a population of women within 3 years of menopause who were not on any hormone therapy and who had not had any cosmetic skin procedures.

"It's a unique population when changes are happening in a dynamic fashion." This is a relation "not previously described," said study presenter Lubna Pal, MBBS, MRCOG, MSc, a reproductive endocrinologist and associate professor at Yale University School of Medicine in New Haven, Connecticut.

Common Building Block

The architecture of the skeleton and the skin share a common building block: collagen, Dr. Pal explained. Age-related changes in collagen contribute to age-related skin changes like wrinkles and sagging, and might also contribute to reduced BMD.

"When I am seeing an older patient, her bigger concern is what is happening to her skin; the clinician's concern is what is happening to her bones," Dr. Pal said. "So part of the question was: Can I fine tune to the patient's concern and get a sense of the bone health?"

Dr. Pal and colleagues performed a cross-sectional analysis of baseline data on 114 early postmenopausal women (70% white) enrolled in the longitudinal Kronos Early Estrogen Prevention Study (KEEPS).

As part of an ancillary study of the skin, the distribution and depth of skin wrinkles were assessed at 11 sites on the face and neck using the Lemperle wrinkle scale. Skin firmness was assessed at the forehead and cheek using a durometer, which has been validated in patients with scleroderma, and bone density was assessed with dual x-ray absorptiometry at the lumbar spine, hip, and total body.

The researchers observed a clear inverse correlation between skin wrinkling and BMD at the spine (r, –0.27; P < .01), femoral neck (r, –0.29; P < .01), and total body (r, –0.26; P =.01), independent of age, body composition, or other factors known to influence BMD.

"Basically, what we found was that the higher the wrinkle score, the worse the bone mineral density," Dr. Pal said, "so our hypothesis was substantiated by these associations."

Firmer skin of the face and forehead was associated with higher BMD.

"Powerful Potential Relevance"

Madhusmita Misra, MD, MPH, from Massachusetts General Hospital and Harvard Medical School, in Boston, who was not involved in this study, said: "This is a meaningful association if, indeed, it is real; we need future data to confirm that."

"We have multiple clinical risk factors that are already available that identify an individual's fracture risk; this may be yet another piece that would enhance the overall predictability. I think it is of powerful potential relevance, but it needs to be substantiated," Dr. Misra added.

"Ultimately," Dr. Pal said, "we want to know if the intensity of skin wrinkles can allow the identification of women who are more likely to fracture a bone, especially the femoral neck or hip." If this is the case, then looking at skin wrinkles plus other clinical risk factors "may allow the identification of fracture risk in populations that do not have access to more costly technology."

But Dr. Pal agrees with Dr. Misra that much more study is needed.

"This is just the tip of the iceberg," Dr. Pal said. "It's a tantalizing association" that needs to be followed-up in long-term studies to substantiate a relation between wrinkles and the risk for bone fracture.

Dr. Pal noted that the women in the study are being followed longitudinally, and that it will be "interesting to see in the coming years whether women with deeper wrinkles are losing bone at a faster rate than other women."

The study was funded by Aurora Foundation to the Kronos Longevity Research Institute in Phoenix, Arizona. Dr. Pal and Dr. Misra have disclosed no relevant financial relationships.

ENDO 2011: The Endocrine Society 93rd Annual Meeting: Abstract P3-126. Presented June 4, 2011.

    
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