• 제목/요약/키워드: Femoral Neck

검색결과 216건 처리시간 0.03초

Dosimetric Evaluation of Plans Converted with the DVH-Based Plan Converter

  • Chun, Minsoo;Choi, Chang Heon;Kim, Jung-in;Yoo, Jeongmin;Lee, Sung Young;Kwon, Ohyun;Son, Jaeman;An, Hyun Joon;Kang, Seong-Hee;Park, Jong Min
    • 한국의학물리학회지:의학물리
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    • 제29권4호
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    • pp.157-163
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    • 2018
  • Plans converted using dose-volume-histogram-based plan conversion (DPC) were evaluated by comparing them to the original plans. Changes in the dose volumetric (DV) parameters of five volumetric modulated arc therapy (VMAT) plans for head and neck (HN) cancer and five VMAT plans for prostate cancer were analyzed. For the HN plans, the homogeneity indices (HIs) of the three planning target volumes (PTV) increased by 0.03, 0.02, and 0.03, respectively, after DPC. The maximum doses to the PTVs increased by 1.20, 1.87, and 0.92 Gy, respectively, after DPC. The maximum doses to the optic chiasm, optic nerves, spinal cord, brain stem, lenses, and parotid glands increased after DPC by approximately 4.39, 3.62, 7.55, 7.96, 1.77, and 6.40 Gy, respectively. For the prostate plans after DPC, the HIs for the primary and boost PTVs increased by 0.05 and 0.03, respectively, and the maximum doses to each PTV increased by 1.84 and 0.19 Gy, respectively. After DPC, the mean doses to the rectum and femoral heads increased by approximately 6.19 and 2.79 Gy, respectively, and those to the bladder decreased by 0.20 Gy when summing the primary and boost plans. Because clinically unacceptable changes were sometimes observed after DPC, plans converted by DPC should be carefully reviewed before actual patient treatment.

Investigation of the Factors Affecting Bone Mineral Density in Children with Celiac Disease

  • Dehghani, Seyed Mohsen;Ilkhanipour, Homa;Samipour, Leila;Niknam, Ramin;Shahramian, Iraj;Parooie, Fateme;Salarzaei, Morteza;Tahani, Masoud
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • 제25권2호
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    • pp.138-146
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    • 2022
  • Purpose: Children with celiac disease (CD) are at an increased risk of low bone mineral density (BMD) owing to malabsorption of fat-soluble vitamins, inflammation, and malnutrition. This study aimed to determine the prevalence and risk factors for low BMD in Iranian children with CD. Methods: This prospective cohort study examined 149 Iranian children with CD between 2011 and 2018 at Zabol University of Medical Sciences. BMD was measured using dual-energy X-ray absorptiometry. Demographic, clinical, and laboratory data were collected from patients' medical records. Logistic regression analysis was performed to identify the factors associated with low areal BMD (BMD-Z <-2) in the lumbar spine and femoral neck. Descriptive data were analyzed using the mean, standard deviation, and relative frequency. Data were analyzed using the chi-square test, t-test, and analysis of variance. Results: Of the 149 children with CD, 27.5% had osteoporosis. The mean body mass index (BMI) Z score was -1.28±1.2. Lower BMI was associated with a higher likelihood of BMD-Z (odds ratio 2.17; p≤0.05). Conclusion: Overall, the findings of this study showed that there was no correlation among Marsh classification, presence of specific human leukocyte antigens, and low BMD in Iranian children with CD. BMI can be a predictor of bone density in children with CD and may be applied clinically in early screenings to evaluate the bone health status in these children.

척추의 중심점과 Modified U-Net을 활용한 딥러닝 기반 척추 자동 분할 (Deep Learning-based Spine Segmentation Technique Using the Center Point of the Spine and Modified U-Net)

  • 임성주;김휘영
    • 대한의용생체공학회:의공학회지
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    • 제44권2호
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    • pp.139-146
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    • 2023
  • Osteoporosis is a disease in which the risk of bone fractures increases due to a decrease in bone density caused by aging. Osteoporosis is diagnosed by measuring bone density in the total hip, femoral neck, and lumbar spine. To accurately measure bone density in the lumbar spine, the vertebral region must be segmented from the lumbar X-ray image. Deep learning-based automatic spinal segmentation methods can provide fast and precise information about the vertebral region. In this study, we used 695 lumbar spine images as training and test datasets for a deep learning segmentation model. We proposed a lumbar automatic segmentation model, CM-Net, which combines the center point of the spine and the modified U-Net network. As a result, the average Dice Similarity Coefficient(DSC) was 0.974, precision was 0.916, recall was 0.906, accuracy was 0.998, and Area under the Precision-Recall Curve (AUPRC) was 0.912. This study demonstrates a high-performance automatic segmentation model for lumbar X-ray images, which overcomes noise such as spinal fractures and implants. Furthermore, we can perform accurate measurement of bone density on lumbar X-ray images using an automatic segmentation methodology for the spine, which can prevent the risk of compression fractures at an early stage and improve the accuracy and efficiency of osteoporosis diagnosis.

Romosozumab의 효과 및 심혈관계 안전성: 체계적 문헌고찰 및 메타분석 (Efficacy and Cardiovascular Safety of Romosozumab: A Meta-analysis and Systematic Review)

  • 최서용;김정민;오상현;천승현;정지은
    • 한국임상약학회지
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    • 제33권2호
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    • pp.128-134
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    • 2023
  • Background: This systematic review and meta-analysis aimed to evaluate the efficacy and cardiovascular safety of romosozumab compared with placebo. Methods: Randomized controlled trials (RCTs) were searched from Medline, EMBASE, Cochrane Central, and Web of Science until July 2022. Primary outcomes included the change in bone mineral density (BMD) from baseline at month 6. The secondary outcomes were the change of bone turnover markers (N-terminal propeptide of type 1 procollagen (P1NP); C-terminal telopeptide of type 1 collagen (CTX)) from baseline at month 3, and the incidence of cardiovascular adverse events for the total follow-up period. Results: A total of 7 RCTs on 8,370patients were included. Romosozumab showed better effects in improving BMD in both lumbar spine and femoral neck at month 6 (standardized mean difference, SMD 2.20 [95% CI: 1.89-2.52], SMD 0.63 [95% CI: 0.41-0.86]). In contrast to placebo, romosozumab significantly increased PINP levels and reduced CTX levels at month 3 (SMD 0.93 [95% CI: 0.65-1.22], SMD -1.03 [95% CI: -1.23~ -0.82]. However, there was no significant difference in the composite incidence of cardiovascular adverse events and major adverse cardiovascular events (OR 1.16 [95% CI: 0.82-1.65], OR 1.08 [95% CI: 0.75-1.56]). Conclusion: This analysis showed that romosozumab significantly improved BMD compared to placebo and was beneficial for change in bone turnover markers. There is no significant difference in the incidence of cardiovascular adverse events compared to placebo.

High-Fidelity Perforator Visualization for Cadaver Dissection in Surgical Training

  • AllenWei Jiat Wong;Yee Onn Kok;Khong Yik Chew;Bien Keem Tan
    • Archives of Plastic Surgery
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    • 제50권6호
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    • pp.621-626
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    • 2023
  • In the first half of the third century B.C., Herophilus and Erasistratus performed the first systematic dissection of the human body. For subsequent centuries, these cadaveric dissections were key to the advancement of anatomical knowledge and surgical techniques. To this day, despite various instructional methods, cadaver dissection remained the best way for surgical training. To improve the quality of education and research through cadaveric dissection, our institution has developed a unique method of perforator-preserving cadaver injection, allowing us to achieve high-fidelity perforator visualization for dissection studies, at low cost and high efficacy. Ten full body cadavers were sectioned through the base of neck, bilateral shoulder, and hip joints. The key was to dissect multiple perfusing arteries and draining veins for each section, to increase "capture" of vascular territories. The vessels were carefully flushed, insufflated, and then filled with latex dye. Our injection dye comprised of liquid latex, formalin, and acrylic paint in the ratio of 1:2:1. Different endpoints were used to assess adequacy of injection, such as reconstitution of eyeball volume, skin turgor, visible dye in subcutaneous veins, and seepage of dye through stab incisions in digital pulps. Dissections demonstrated the effectiveness of the dye, outlining even the small osseous perforators of the medial femoral condyle flap and subconjunctival plexuses. Our technique emphasized atraumatic preparation, recreation of luminal space through insufflation, and finally careful injection of latex dye with adequate curing. This has allowed high-fidelity perforator visualization for dissection studies.

The Effects of COVID-19 Pandemic on the Recovery of Hip Fracture Patients

  • Young Yool Chung;Sung Nyun Baek;Tae Gyu Park;Min Young Kim
    • Hip & pelvis
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    • 제35권4호
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    • pp.253-258
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    • 2023
  • Purpose: To figure out how complete control of family visits to prevent infection of coronavirus disease 2019 (COVID-19) affected the activity recovery of hip fracture patients admitted to nursing hospitals. Materials and Methods: Eighty-one patients with hip surgery in the two years prior to COVID-19 pandemic were classified as Group A, and 103 patients in the next two years were designated as Group B. The subjects' walking ability was evaluated by using the modified Koval index (MKI). In order to analyze the impact of the family visit control to the subjects, each group was classified into two different groups: (1) inpatients group who admitted to nursing hospitals and (2) home-treated patients. Additionally, statistical elements were processed in consideration of other factors that may affect the results of the experiment. Results: The MKI evaluated at 6 months postoperative was 3.31±1.79 in Group A and 2.77±1.91 in Group B, and it was meaningfully low after the pandemic (P=0.04). There was significantly low among both of Group A 2.74±1.76 and Group B 1.93±1.81 after the pandemic (P=0.03) among those treated at the nursing hospital. The rate of deterioration of the MKI was 35 (43.2%) in Group A and 57 (55.3%) in Group B, which increased by 12.1% after the pandemic. Conclusion: The pandemic had a negative effect on the recovery of postoperative activities of elderly hip fracture patients who admitted to nursing hospitals when family access was completely restricted to prevent infection.

대퇴경부 골절 환자의 입원 생활 (The Hospital Life of the Patient with Femoral Neck Fracture)

  • 김경자;지성애
    • 간호행정학회지
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    • 제2권1호
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    • pp.35-56
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    • 1996
  • Nowerdays, the increase of traffic accidents and old age population make the Femoral Neck Fracture(FNF) patients increase. By the improvement of education and standard of living the patients demand better medical service than before. This study is designed to give practical help for the FNF patients by observing their hospital life and establish practical nursing strategies for the FNF patients. For these purposes the Ethnographic Participant Observation was adopted. By this study is focused on the hospital life patient's view. For this end, the field study adopted orthopedic ward in the C University Hospital with 400 beds in Seoul. The object patients of the study were twelve patients. The patients experienced five stages : Embarrassment, Conflict, Stability, Independent, and Extension Stage. The findings and prepared nursing strategies are stated as follows. First, in the Embarrassment Stage they suffered embarrassment, anxiety, pain, they could not do ordinary things. The patients who accidental fractures had anxiety from unfamiliar tests and from hospitalization itself. They lamented that they could not ordinary things, and do nothing but obeying the hospital, and endure the pain. They recognized the changed environment and resigned themselves to life in the ward. In this stage, full openness by the nurses is needed. Second, the attribute of the Conflict Stage were conflict, fear, curiosity, belief, reflection. When they sign the consentment form, they experience conflicts about the possibility of complication, fear of recovery from anesthesia, curiosity about the operation procedure, post - operation state, reflection on their past life, and promise to care for their family members after discharge and keep their religious life faithfully. And they accepted the operation depending on God, believing in modern medicine, and the surgeon. Asking for their changed informations, they expected positive results from the operation. In this stage, an empathic attitude by the nurses is needed. Third, the attribute of the Stability Stage were relief, gratitude, difficulty with excretion, and pain. When they awoke from anesthesia, they felt relief because of a the end of the operation, but they experienced extreme pain, difficulty of excretion in bed. They accepted the changed environment and expected recovery. In this stage, support by the nurses is needed. Fourth, the attributes of the Independence Stage were freedom, exercise, nurturing, anxiety, and discomfort. When they ambulated and exercised, they experienced freedom. They showed exhibited weakness of the digestive organs and discomfort hospital's space, structure, and facilities, the delay of medical certificate issue the lack of prompt response by the medical agents. They ate nurturious food and felt anxiety on the end of hospital life and returning to their ordinary life. They showed the independence of overcoming their environment by increasing exercise and expected their discharges. In this stage, respect by the nurses is needed for the patients to, overcome their environment and prepare for their independence. Fifth, the attributes of the Extension Stage were pessimism, isolation, dissatisfaction, and pain. Accompanied injury and old age made their ward life extend to over seven weeks. They exhibited weariness, melancholy, skeptisis, general pessimistic feeling, and desperation caused by their isolated life. They experienced the digestive discomfort caused by the prolonged medication and psycological pain caused by long-time hospitalization. As a, result, their dissatisfaction on the human, physical, and systematic environments had been increased. They acquired critical power and sought for something to do spending their time. They expected vaguely about the returning of their ordinary life. In this stage, counseling is needed by the nurse to overcome positively their psychological, social, and physical problems. The process of the FNF patient's ward life starts from the dependent state, when they are hospitalized, and gradually progresses to self-fulfillment in order to keep independent life. As a result, the FNF patients showed "Response in Challenge" or "Adaptation in Conflict" through their experiences of social, physical, and psychological difficulties.

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골절의 절대위험도 평가방법에서 GE Prodigy와 FRAX Tool의 비교분석에 관한 고찰 (Studies on the Comparative Analysis Between GE Prodigy and $FRAX^{TM}$ Tool in Absolute Fracture Risk Assessment Tool)

  • 이화진;이효영;윤종준;이무석;송현석;박세윤;정지욱
    • 핵의학기술
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    • 제13권3호
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    • pp.137-142
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    • 2009
  • 목적: WHO (world health organization)에서는 골밀도뿐만 아니라 대규모 역학연구에서 정리된 골절의 위험인자 분석을 통하여 10년 내 골절위험도(10-year fracture probability)를 실제적으로 임상에 적용시킬 수 있는 소프트웨어 프로그램인 FRAX Tool (fracture risk assessment)이 2008년에 공개되었다. 본 연구는 기존에 사용하고 있는 GE Prodigy사의 골절위험도평가와 $FRAX^{TM}$를 이용한 골절위험도평가를 비교분석하고자 한다. 검사방법: 본원에 골밀도 검사를 시행한 201명($55{\pm}3.5$세)의 여자를 대상으로 GE Prodigy를 이용하여 Femur를 측정하였다. 측정한 Femoral Neck의 BMD (bone mineral density)를 구하여 GE Prodigy의 T-값과 골절위험인자를 고려하지 않은 $FRAX^{TM}$의 T-값를 사용하여 10년 내 대퇴골 골절위험도와 주요한 골다공증성 골절 위험도를 계산하여 SPSS통계프로그램으로 GE Prodigy의 골절위험도 평가와 $FRAX^{TM}$의 골절위험도 평가를 비교분석하였다. 결과: GE Prodigy의 T-값($-0.52{\pm}0.97$)과 $FRAX^{TM}$의 T-값 ($-1.45{\pm}0.81$)은 통계적으로 유의한 차이가 있었으며(p=0.000), GE Prodigy의 주요한 골다공증성 골절위험도($9.15{\pm}3.71$)와 $FRAX^{TM}$의 주요한 골다공증성 골절위험도($4.87{\pm}1.51$)도 또한 통계적으로 유의한 차이가 있었다(p=0.000). 그리고 GE Prodigy의 10년내 대퇴골 골절위험도($1.56{\pm}1.48$)와 $FRAX^{TM}$의 10년 내 대퇴골골절위험도($0.53{\pm}0.61$)도 통계적으로 유의한 차이를 보였다(p=0.000). 결론: GE Prodigy와 $FRAX^{TM}$에서 측정한 골절의 절대위험도는 통계적으로 유의한 차이를 보였다. 특히 GE Prodigy의 T-값, 주요한 골다공증성 골절위험도, 10년 내 대퇴골 골절위험도가 높게 측정되었다. 향후 $FRAX^{TM}$에 대한 평가 및 적용에 관한 연구가 필요할 것으로 생각된다.

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생리적 요인과 생활습관이 폐경 후 여성의 골밀도에 미치는 영향 (Effects of Physiological Factors and Lifestyles on Bone Mineral Density in Postmenopausal Women)

  • 승정자;최윤희
    • Journal of Nutrition and Health
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    • 제40권6호
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    • pp.517-525
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    • 2007
  • 본 연구에서는 폐경 후 여성 64명중 골밀도 분류에 따라 골다공증군 (20명), 골감소군 (24명), 정상군 (20명)으로 분류한 뒤 신체계측, 골밀도 측정, 설문조사를 통하여 생리적 요인과 생활습관이 폐경 후 여성의 골밀도에 미치는 영향을 살펴보기 위하여 실시하였으며 그 결과를 요약하면 다음과 같다. 1) 연구 대상자들의 평균 연령은 62.09세, 평균 신장은 153.78 cm로, 골밀도에 따른 세 군간에 유의적인 차이가 없었다. 평균 체중은 56.09 kg, 체질량 지수 (BMI)는 23.7 $kg/m^2$로 정상군이 골감소군과 골다공증군에 비해 높아 유의적인 차이를 보였다 (p < 0.001). 2) 요추와 대퇴 경부의 평균 골밀도 T-값은 각각 -1.75, -2.15로 나타났으며, 평균 요추 골밀도는 0.84 $g/cm^2$, 대퇴경부 골밀도는 0.71 $g/cm^2$로 세 군간에 유의성 (p < 0.001)이 나타났다. 3) 평균 가임기간은 31.3년으로, 세 군 간에 유의적인 차이를 보여 정상군이 골다공증군과 골감소군에 비해 길었다(p < 0.05). 평균 폐경 후 기간은 14.2년으로 골다공증군이 골감소군과 정상군에 비해 길게 나타났다 (p < 0.05). 평균 최종 출산 연령은 33.67세로 골다공증군이 다른 두 군에 비해 늦게 나타났다 (p < 0.05). 4) 갱년기 증세는 전체 대상자의 43%가 경험 했다고 하였는데. 기타 (37.21%)가 가장 높은 비율을 차지했으며, 우울증 (27.91%), 불면 (18.60%), 발열 (9.30%), 안면홍조(6.98%) 순이었고 세 군 간에 유의성은 나타나지 않았다. 증세의 강도는 51.85%가 증세가 없었거나 약하게 경험하였다고 하였으며, 보통 수준은 38.89%, 심한 편은 9.26%로 대부분의 대상자들은 갱년기 증세를 약하게 경험한 것으로 나타났고 세 군 간에 유의적인 차이는 없었다. 5) 평균 운동시간은 하루에 1시간이었고, 정상군 (79.44분)의 운동시간이 골다공증군 (55.22분)과 골감소군 (68.33분)에 비해 긴 경향을 보였으나 유의적인 차이는 없었다. 마찬가지로 옥외 활동시간도 유의적인 차이는 나타나지 않았다. 6) 연령 보정 후 요추 및 대퇴 경부 골밀도는 체중, 체질량 지수와 유의적인 양의 상관관계가 나타났다 (p < 0.001). 연령과 BMI 보정 후 생리적 요인은 요추 및 대퇴 경부 골밀도는 유의적인 상관성이 나타나지 않았다. 7) 연령과 체질량지수를 보정 한 후 생활습관은 골밀도와 유의적인 상관성이 나타나지 않았다. 이상의 연구 결과를 종합해 볼 때 폐경 후 여성의 골밀도와 체중은 기존의 연구보고에서와 같이 밀접한 관련성이 있어, 폐경이후 정상체중 유지는 골다공증 예방에 중요한 보호인자로 나타났다.

폐경 전 성인여성의 골밀도 영향 요인 - 국민건강영양조사 자료를 이용하여 - (The Bone Mineral Density Impact Factors of Adult Women before the Menopause - based on the National Health and Nutrition Examination Survey -)

  • 김경희;이정희;여진동
    • 한국방사선학회논문지
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    • 제9권3호
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    • pp.147-168
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    • 2015
  • 본 연구는 폐경 전 성인여성의 일반적 특성, 생활습관, 식습관, 여성건강행태 및 신체조성에 따른 대퇴골전체, 대퇴골경부 및 요추의 골밀도 차이가 존재 하는지 규명하여 골밀도의 영향요인을 분석하였다. 연구는 제4기(2008년~2009년), 제5기(2010년~2011년)에 실시한 국민건강영양조사 자료를 활용하여 30세 이상 폐경 전 성인여성 3820명을 대상으로 실시되었으며 이 결과는 폐경 전 성인여성에서 골밀도 영향요인이 무엇인지 규명하여 치료하는데 필요한 권고사항이나 지침을 마련하고, 젊은 성인여성의 골밀도를 올바르게 평가하여 폐경 후 골다공증 예방을 위한 보건교육 자료의 개발을 위한 기초자료를 제공하고자 한다. 폐경 전 성인여성의 일반적 특성 중 연령은 대퇴골전체에서 40~44세, 요추에서 35~39세에 골밀도가 높았다. 교육수준은 고졸에서 골밀도가 높았고, 여성건강행태 중 초경연령이 낮을수록 골밀도가 높았다. 생활 습관은 흡연경험이 없고 걷는 시간 및 운동 빈도가 규칙적일수록 골밀도가 높았고, 식습관은 햄버거와 피자 섭취를 하지 않을 경우 골밀도가 높았다. 신체조성 중 비만유병여부는 비만일 때 골밀도가 높았고 저체중일 때 골밀도가 낮았다. 복부비만 및 체중조절경험이 있는 사람이 골밀도가 높았다. 총체지방률, 총지방량 및 총근육량은 제1사 분위(Q1)에서 제4사 분위(Q4)로 갈수록 골밀도가 높게 나타났다. 이 연구에서는 비만유병여부, 총지방량 및 근육량이 골밀도 간에는 매우 유의적인 상관관계를 보였으며, 젊은 여성들은 골밀도를 증가시키기 위해 자신의 체형에 맞는 적정한 체중을 유지해야하며 정상적인 BMI를 유지 할 필요가 있음을 알았다. 골다공증의 예방을 위해서는 성장기부터 규칙적인 운동과 금연 등의 올바른 생활습관과 젊은 시절부터 적절한 체중조절을 통해 최대 골질량에 도달할 수 있도록 노력해야 할 것이다.