정상 소아청소년의 골밀도와 연관인자
Bone Mineral Density and Correlation Factors in Normal Children and Adolescence
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목적:최근 우리나라 소아청소년의 성장 변화에 따라 2007년 소아청소년의 신체 발육 표준치가 개정되었으나 정상 소아의 골밀도 참고치는 과거 몇몇 보고가 있었을 뿐 아직 확립되어 있지 않다. 이에 저자들은 우리나라 정상 소아를 대상으로 골밀도의 평균치를 구하고 골밀도와 연관 있는 인자들의 상관관계에 대하여 알아보고자 하였다. 방법:고려대학교 안암병원 소아청소년과를 방문한 소아 중 정상 발육 상태를 보이며, 만성질환이나 약을 복용한 적이 없는 만 6-14세의 남아 69명과 여아 66명, 총 135명을 대상으로 DEXA를 이용하여 성별, 나이별로 L1에서 L4까지 요추골과 대퇴골경의 평균 골밀도와 골 무기질 함량을 구하였다. 사춘기 발달에 따른 골밀도와 골 무기질 함량의 변화를 알아보고 신체 계측치와 혈중 골 알칼리인산분해효소, IGF-I의 농도, 남아는 테스토스테론, 여아는 에스트라디올의 농도를 측정하여 골밀도와의 상관관계를 분석하였다. 결과:남녀 모두 요추골과 대퇴골경의 골밀도는 나이에 따라 증가하는 경향을 보였고 골밀도의 가장 큰 증가세를 보이는 나이는 여아 10세에서 11세, 남아 12세에서 13세로 여아에서 2년 앞서 나타났다. 사춘기 발달에 따른 골밀도의 변화는 남녀 모두 요추골과 대퇴골경에서 사춘기 시작과 함께 골밀도가 증가하였고 특히 후기 사춘기에서 급격한 증가세를 보였다. 요추골의 골밀도는 여러 관련 인자 중 골연령, IGF-I과 가장 의미 있는 관계를 보였다(P<0.05). 결론:본 연구를 통해 우리나라 정상 소아 골밀도치의 기초 자료로 활용될 수 있을 것으로 생각되며 향후 보다 많은 수의 소아청소년을 대상으로 한 대규모의 연구가 필요하다.
Abstract
Purpose:The mean height of Korean children has been increased recently, and new version of growth chart was made in 2007. Nevertheless, the reference value on bone mineral density (BMD) of normal children has not been established yet. The aims of this study were to obtain mean values of BMD in normal children and to investigate correlation between BMD and their relating factors. Methods:One hundred thirty five normal children from 6 to 14 years old were included, who were 69 boys and 66 girls. Bone density was measured at the lumbar spine and the proximal femur by dual energy x-ray absorptiometry (Discovery A, Hologic, 2004). We assessed bone age, body mass index, bone alkaline phosphatase, insulin-like growth factor I (IGF-I), sex steroid level and analyzed their correlation with BMD. Results:The result showed a trend of an increase in BMD according to the age in both boys and girls. The mean value of BMD showed the greatest increase during age of 10 to 11 in girls and 12 to 13 in boys. A sudden increase of BMD in both boys and girls occurred during the overt puberty. Bone age and IGF-I level indicated the most significant relating factors of BMD of lumbar spine. The mean values of BMD of this study were similar to the previous studies about BMD of Korean children. Conclusion:The results could be utilized as fundamental data for normal BMD value of Korean children and larger population study is needed.
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