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출산 빈도수가 골대사에 미치는 영향 : 단면적 연구 A Cross-sectional Study
한인권,조남한,김효민 대한폐경학회 1998 대한폐경학회지 Vol.4 No.1
"Previous studies have contradicted the relationship between bone mineral density (BMD) and parity. Therefore, we evaluated the relationships between parity and bone metabolism in 3491 Korean menopausal women. All participants were recruited from the outpatient Climateric clinics of the Samsung Cheil General Hospital in Seoul. Most of the women were seeking a routine physical, or treatment for typical climacteric symptoms. At the first visit, we interviewed subjects for history of parity, and measured bone mineral density (BMD), biochemical markers for the bone tumover, and lipid profiles. BMD was measured using Dual Energy X-ray Absorptiometry. The mean age, age at menopause, and menarche were 51.9+-6.7 yrs, 47.4+-5.4 yrs, and 16.3+-1.73 yrs respectively. The mean body mass index was 23.2+-2.7 kg/m2. The mean BMD, osteocalcin, alkaline phosphatase, and Urine Ca/Cr level were 1.031+-0.163 g/cm3, 5.1+2.5 ng/ml, 77.5+29.3 IU/L, and 15,3+15.9 respectively. Parity was inversely correlated with BMD(r=-0.169, p<0.00l). However, this relationship no longer existed when age was controlled. Thus, we extended our analyses by arbitrarily stratifying parity into four groups; 0 parity, 1-3 parity, 4- 6, and 7+ parity. Mean levels of BMD were significantly different among the nulliparous, 1-3 parity, 4-6 parity, and 7+ parity groups(1.024+-0.162 g/cm3, 1.051+-0.158 g/cm3, 0.99+-0.167 g/cm3, and 0.901+-0.131 g/cm3 respectively), even after controlling for the confounding factors such as age, body mass index, age at menopause, age at menarche, and FSH level by ANCOVA(p<0.001). Moreover, this analysis further revealed significant negative trend among the parity groups(I.026 g/cm3, 1.013 g/cm3, 0.995 g/cm3, and 0.967 g/cm3 respectively) and BMD after adjusting for factors and covariates. Furthermore, when we analyzed the relationships between parity and these putative variables using multiple linear regression, we found a significant but independent relationship between parity(t= -3.4, p<0.001) and BMD(r=0.467, r2=0.218).In conclusion, this study revealed a significant negative relationship between parity and BMD. Although BMD was significantly higher in the nulliparous and 1-3 parity groups in all ages but BMD significantly declined respect to the number of parity. The declining pattern was more dramatic after at age 60 and older. Thus, these findings suggest that parity may exacerbate the natural, age-related decrease in BMD. "