摘要： 目的 探讨中老年妇女骨密度和骨生化指标的变化及其意义。方法 选择2010年1月至2013年6月我院门诊及住院40岁以上女性患者2446例，按年龄分成三组：① 40～49岁； ② 50～59岁；③ ≥60岁，采用超声定量骨密度测定仪，按常规方法测定骨密度；采用电化学发光法测定血清 I 型胶原氨基端肽原(PINP) 和血清β-异构C-端肽(β-CTx)；采用酶联免疫吸附法测定血清抗酒石酸酸性磷酸酶5b(TRACP-5b)和血清25羟基维生素D[ 25(OH)D]，进行统计分析。结果  骨密度值随着年龄的增长逐渐降低(P<0.01)。PINP值随着增龄而升高(P<0.05)，≥60岁组比40～49岁组升高更显著(P<0.05)。β-CTx值随着增龄而升高(P<0.01)，50～59岁和≥60岁两组比40～49岁组升高更显著(P<0.05)。TRACP-5b在40～49岁组值最低，≥60岁组次之，50～59岁组最高(P<0.01)，50～59岁和≥60岁两组比40～49岁组升高更显著(P<0.05)。骨吸收指标β-CTx和TRACP-5b值较骨形成指标PINP值升高更显著。25(OH)D的结果整体偏低，均属于缺乏状态(P<0.01)。结论 中老年妇女的维生素D营养状况普遍较差，老年妇女的骨量丢失更明显，更容易发生骨折。联合检测骨密度和骨代谢生化指标，为加强中老年妇女的保健工作提供依据，对降低骨质疏松的发病率具有一定的临床意义。

Abstract: Objective To investigate the change and the significance of bone mineral density and biochemical indexes of bone metabolism in middle-aged and elderly women. Methods 2446 cases of female inpatients and outpatients, aged 40 years or more had been enrolled from January 2010 to June 2013. They were divided into three groups according to age, 40 to 49years old, 50 to 59years old and ≥60years old groups. They received BMD scanning with quantitative ultrasonic bone density apparatus according to the conventional method; and serum procollagen type I -terminal propeptide (PINP) and beta-isomerized C-telopeptide (β-CTx) were measured by Roche ECLIA. The serum 25-hydroxyvitamin D (25(OH)D) and tartaric acid phosphatase-5b (TRACP-5b) were determined by enzyme linked immunosorbent assay. Results The bone mineral density were significantly reduced with age (P<0.01), while the serum level of PINP were increased observably with age (P<0.05). The bone mineral density in group less than 60 years old increased more obviously than group 40 to 49 years old (P<0.05). The serum level β-CTx were increased observably with age (P<0.01), The serum level β-CTx in group of 50 to 59 years old and over 60 years old increased more significantly than group of 40 to 49 years old (P<0.05). The TRACP-5b values in the group less than 40 to 49 years old were minimum, the group aged more than 60 came second，and the group aged 50 to 59 showed maximum. The bone resorption beta CTx and TRACP-5b value increased more obviously than bone formation PINP value. The serum concentrations of 25-hydroxyvitamin D showed low values as a whole, all in the lack of state (P<0.01). Conclusion Middle-aged and old women vitamin D nutritional status is generally poor. Elderly women's bone mass loss is more obvious, and bone fracture occurs more obvious. Combined detection of bone mineral density and bone metabolism biochemical indexes, which provide the basis to strengthen the health care work of middle-aged and old women, have certain clinical significance to reduce the incidence of osteoporosis.