长沙地区男性BMD参考数据库的建立

目的建立男性多骨骼部位骨密度（BMD）参考数据库。方法采用双能X线吸收法（DXA）骨密度仪,测量1537例长沙地区男性健康志愿者（年龄15～85岁）正位腰椎、侧位腰椎、股骨近端（髋部）和前臂远端的BMD。结果腰椎和股骨近端的BMD随年龄变化采用二次回归模型拟合优度最佳,前臂远端的BMD与年龄之间的关系采用三次回归模型拟合优度最佳。腰椎、股骨颈和总体髋部的峰值BMD（PBMD）发生在15-19岁,前臂远端的PBMD则发生在40～44岁。结论该研究建立的男性多骨骼部位BMD参考数据库,为南方地区男性诊断骨质疏松提供了可靠的参考标准。     

女性随年龄增长不同骨骼部位的骨丢失

目的 评价健康女性随增龄，不同骨骼部位的骨丢失。方法 用ＤＸＡ ＱＤＲ４５００Ａ型扇形束骨密度仪测量１６６４例１５￣９６岁健康女性不同骨骼部位（腰椎正位和侧位、髋部和前臂）的骨密度（ＢＭＤ）。结果 横断面分析显示，绝经时所有部位骨丢失显著（Ｐ〈０．０１￣０．００１），其中松质骨占优势的部位（腰椎侧位和Ｗａｒｄ’ｓ三角）丢失最多（－１３％￣－１９％，Ｐ〈０．００１）。所有部位绝经１５年内（〈６５岁）     

长沙地区男性BMD参考数据库的建立

目的 建立男性多骨骼部位骨密度(BHD)参考数据库.方法 采用双能X线吸收法(DXA)骨密度仪,测量1537例长沙地区男性健康志愿者(年龄15～85岁)正位腰椎、侧位腰椎、股骨近端(髋部)和前臂远端的BMD.结果 腰椎和股骨近端的BMD随年龄变化采用二次回归模型拟合优度最佳,前臂远端的BMD与年龄之间的关系采用三次回归模型拟合优度最佳.腰椎、股骨颈和总体髋部的峰值BMD(PBMD)发生在15～19岁,前臂远端的PBMD则发生在40～44岁.结论 该研究建立的男性多骨骼部位BMD参考数据库,为南方地区男性诊断骨质疏松提供了可靠的参考标准.     

老年人腰椎和髋部骨密度测定T评分的一致性比较

目的 探讨老年人腰椎和髋部双能X线骨密度(DEXA)测定T评分的一致性及髋部骨密度(BMD)T评分在骨质疏松诊断中的意义。方法 在排除患有影响骨量的疾病及使用影响骨代谢药物者后，选择60-89岁老年人260(其中男123人，女137人)例作为为研究对象。受检者均接受问卷调查、胸腰段脊椎正侧位X线摄片，DEXA测定2-4腰椎(L2-4)椎体前后位和左髋部BMD(若左髋部发生过骨折或存有明显病变则改测右髋部)，并进行有关统计分析。结果 老年男性各年龄组L2-4 BMD T评分比髋部要高(P＜0．01或P＜0.05)；老年女性除在65—69岁、85—89岁年龄组腰椎BMD T评分比髋部要高(P＜0．01和P＜0.05)外，其余各组则差异无显著性。按照WHO标准，以髋部、腰椎和同时以髋部、腰椎BMD T评分为依据，在123例男性中，分别有19、6、5人被诊断为骨质疏松症；在137例女性中，则分别有35、17、14人被诊断为骨质疏松症；单以腰椎和同时以髋部、腰椎BMD T评分为依据所检出的骨质疏松症患者人数均少于单以髋部BMD T评分为依据者(P＜0．01)。结论 在老年人尤其是老年男性，其腰椎BMD T评分明显高于髋部，腰部BMD T评分在骨质疏松诊断中的意义更为重要。     

女性随年龄增长不同骨胳部位的骨丢失

目的评价健康女性随增龄，不同骨胳部位的骨丢失。方法用ＤＸＡＱＤＲ４５００Ａ型扇形束骨密度仪测量１６６４例１５～９６岁健康女性不同骨胳部位（腰椎正位和侧位、髋部和前臂）的骨密度（ＢＭＤ）。结果横断面分析显示，绝经时所有部位骨丢失显著（Ｐ＜０．０１～０．００１），其中松质骨占优势的部位（腰椎侧位和Ｗａｒｄ’ｓ三角）丢失最多（－１３％～－１９％，Ｐ＜０．００１）。所有部位绝经１５年内（＜６５岁）及２５年后（≥７５岁）呈快速丢失。预期寿命（≥７２岁）与峰值年龄比较，各部位ＢＭＤ减少３１％～５９％（平均３８．７％±７．７％），Ｗａｒｄ’ｓ区减少最多（－５９％）。骨质疏松（ＯＰ）检出率腰椎侧位（４１％～５８％）、桡骨（４３％～５８％）和Ｗａｒｄ’ｓ区（４６％）较高，腰椎正位（２９％）和股骨颈（１９％）较低。结论绝经早期腰椎侧位是诊断ＯＰ的最敏感部位。不同骨胳部位峰值骨量的变异度较高，致绝经后ＯＰ检出率随测量部位不同而显示较大差异。     

老年妇女不同骨骼部位的骨丢失及其对诊断骨质疏松症的评价

目的评价老年妇女随增龄骨骼各部位骨丢失和骨质疏松症（ＯＰ）的发生率。方法采用扇形束双能Ｘ线骨密度仪测量３６１例老年妇女腰椎正侧位、股骨和桡骨的骨密度。结果６０～６４岁组各部位骨量比峰值骨量平均减少（２８．３±７．４）％,Ｗａｒｄ＇ｓ区和腰椎侧位中间区减少最多（分别减少４４．７％和３５．９％）,桡骨远端中段和股骨颈骨丢失率最少（分别丢失２０．６％和２１．６％）。７０岁以前的老年妇女腰椎侧位是诊断ＯＰ的敏感部位,随年龄增长股骨和桡骨的ＯＰ检出率迅速增高。结论老年妇女不同骨骼部位骨丢失方式和丢失率存在明显差别。测量的部位不同ＯＰ检出率不同,随年龄增长ＯＰ检出率也不同。     

绝经后妇女脊椎压缩性骨折与骨密度的关系

目的探讨绝经后妇女脊椎压缩性骨折与骨密度（BMD）的关系。方法为病例一对照研究，入选250例有脊椎压缩性骨折的绝经后妇女，另有250名无脊椎压缩性骨折的绝经后妇女作为对照组。两组均有胸腰椎正侧位X线摄片，并应用双能X线吸收仪检测腰椎1～4和左股骨近端各部位BMD。结果脊椎压缩性骨折组身高、体重、腰椎2～4和股骨近端各部位BMD值均显著低于对照组（均P〈0．01）。腰椎2～4BMD是发生脊柱骨折的预报因子（r=-0．416，P〈0．01）。身高和全髋部BMD与骨折次数和骨折椎体数目呈负相关（均P〈0．01）。按股骨颈和全髋部BMD值，骨折组骨质疏松检出率各为50．8％和50．4％；另外剔除在腰椎2～4发生椎体骨折53例，按腰椎2～4BMD检出骨质疏松占64．5％。同时，腰椎2～4、股骨颈或全髋部BMD值低于-2．5s者发生脊柱压缩性骨折的风险分别是BMD正常者的4．76、2．36和3．52倍。结论腰椎呈低骨量是发生脊椎压缩性骨折的重要危险因素。身高的下降和全髋部低BMD值是骨折发生次数和受累椎体数目的危险因子；对绝经后妇女在重视BMD测量的同时，应重视脊柱X线正侧位检查。     

青岛地区成年女性多部位骨密度数据库的建立及骨折风险预测

目的确立青岛地区正常成年女性骨密度(BMD)的正常参考范围,建立诊断成年女性骨质疏松的多骨骼部位BMD参考值,并预测骨折的风险性。方法用双能X线骨密度仪测量868名25～83岁女性参考人群和191例骨折患者的腰椎(L_2-L_4)和左侧髋部(股骨颈、大转子、Ward’s三角区)6个骨骼区域的BMD,用8种回归模型拟合健康成年女性人群BMD随年龄的变化,找出最佳拟合的方程和建立数据库,并对骨折患者的BMD进行分析,预测骨折的风险性。结果6个骨骼区域BMD随年龄变化,不同部位骨峰值出现的时间不同,腰椎在25～29岁,髋部在40～44岁。用三次回归模型拟合程度优于其他回归模型,拟合曲线的决定系数(R~2)为0.21±0.09(P＜0.01)。骨折患者BMD明显降低,与同地区同年龄正常女性相比,BMD下降幅度有限；而与同地区正常女性峰值骨量相比,BMD下降1.6～2.5s。结论女性在45岁以后骨丢失加速。50岁以后女性BMD低于同地区峰值BMD 1.6～2.5s,其骨折风险增加。     

阿伦膦酸钠对老年女性2型糖尿病骨质疏松患者骨代谢标志物的影响

目的观察老年女性2型糖尿病（T2DM）骨质疏松患者应用阿伦膦酸钠（ALN）联合钙尔奇D治疗后骨密度（BMD）和骨代谢指标的变化。方法采用双能X线骨密度仪（DEXA）对34例老年女性糖尿病骨质疏松患者给予ALN联合钙尔奇D治疗6个月,对比治疗前后腰椎和髋部BMD及骨代谢标志物的变化。结果 ALN联合钙尔奇D治疗6个月后腰椎和髋部T值和BMD均增加,尤其L1、L3、L4及L总部位增加显著;血清抗酒石酸酸性磷酸酶5b、尿羟脯氨酸/肌酐比值和骨碱性磷酸酶水平较治疗前降低,血清降钙素水平较治疗前升高（P均〈0.05）。结论 ALN联合钙尔奇D治疗老年女性T2DM患者骨质疏松疗效明显,短时间内可显著改善骨代谢指标和提高腰椎BMD。     

老年2型糖尿病患者骨密度及骨超声改变的观察

目的：探讨老年2型糖尿病患者跟骨定量超声（QUS）和腰椎骨密度（BMD）的改变，方法：采用QUS骨量分析系统检测94例老年2型糖尿病患者和90例健康对照者的跟骨超声传导速度（SOS），超声振幅衰减（BUA）及骨强度指数（STI），用双能X线骨吸收测量仪（DXA）测定前后位腰椎BMD，并同时进行了骨生化指标的检测。结果：2型糖尿病患者BMD（g/cm^2)男性L2为0．863，低于对照组的0．931（P＜0．05）；女性L2，L2－4分别为0．826和0．841，均低于对照组0．903和0．905（P＜0．01）；2型糖尿病患者跟骨BUA（dB/MHz)男，女分别为64．63，51．05，均低于对照组71．38和61．76（P＜0．01），糖尿病组STI男，女分别为83．12％和67．64％，低于对照组91．24％和69．03％（P＜0．05）。糖尿病组女性SOS（m/s)为1487．28低于对照组1502．34（P＜0．05）。结论：老年2型糖尿病患者跟骨BUA、SOS和腰椎前后位BMD均较正常对照组降低，提示有骨量丢失。     

Histomorphometric analysis of bone in metabolic bone disease

Most of the tools necessary for a detailed study of bone remodeling are now available. These methods will enable us to substitute simple surface-based histomorphometry with pertinent derived variables that reveal more information about the processes going on. Because of the inherent variability of the methods, bone histomorphometry is less well suited for investigations in single individuals. However, in terms of basic investigations of cell and tissue activity in grouped materials of patients with metabolic bone disease and the evaluation of treatment regimens in these materials, bone histomorphometric investigations still yield the most detailed analyses.     

Aseptic bone/bone marrow necrosis in leukaemia

Aseptic (avascular) bone/bone marrow necrosis (ABN) was found in 21 leukaemic patients during a period of 14 yr, with a frequency of 6.5% in autopsied leukaemic patients, and with the highest frequency in ALL. 8 patients (38%) complained of bone pain. X-ray examination was carried out in 7 of these with a positive result in 3 (43%). Only 1 patient had elevated S-Alkaline phosphatase. Leucocytosis was found in 12 patients. Only 1 patient (ALL) received steroid in a rather high dose during 6 weeks. At autopsy ABN was found localized to the femur in all patients and 2 patients also had ABN in other bones. Post-mortem X-ray examination demonstrated changes in 8 of 15 cases (53%), with osteolysis in 6 and sclerosis in 2. 19 patients had had recent ABN with some fibroblast proliferation. In 4 of these, appositional bone formation had started. 2 patients had sclerosis as the only change. The pathogenesis of ABN is not known; an important factor, however, may be ischaemia due to vascular obstruction.     

骨填充材料在骨肿瘤缺损修复中的应用研究进展

骨填充材料既要满足骨缺损腔内充分植骨的需要,也要减少对骨膜及骨组织的损伤刺激。传统的自体骨和异体骨填充材料具有较好的临床疗效,但也具有一定的临床局限性。随着科技的不断进步创新,越来越多的骨填充材料被研究应用于骨肿瘤缺损修复。异种骨、生物陶瓷、骨水泥、高分子聚合物、胶原蛋白均是骨填充材料,不同的骨填充材料有着不同的优缺点。该文就骨填充材料在骨肿瘤缺损修复中的应用研究进展作一综述。     

Bisphosphonates in bone cement inhibit PMMA particle induced bone resorption

OBJECTIVE—Wear particle induced bone resorption is thought to be one of the mechanisms that contribute to implant loosening. It has previously been shown that macrophages, in response to polymethylmethacrylate (PMMA) particles, differentiate into bone resorbing osteoclasts, and that this process is inhibited by a bisphosphonate, etidronate (EHDP). The aim of this study was to determine whether incorporating EHDP in bone cement could reduce PMMA associated bone resorption.
METHODS—Two concentrations of EHDP were mixed with PMMA monomer before polymerisation. Particles of PMMA (1-10 µm) were generated then added to mouse monocytes cocultured with UMR106 rat osteoblast-like cells and the extent of osteoclast differentiation was determined by assessing the extent of tartrate resistant acid phosphatase (TRAP) staining and measuring the amount of lacunar bone resorption.
RESULTS—The addition of PMMA to monocyte-UMR106 cocultures resulted in a marked increase in the number of TRAP positive osteoclast-like cells and a significant increase in the number of lacunar resorption pits compared with control cultures to which no particles had been added. After the addition of particles of PMMA + 20 mg EHDP, significantly fewer lacunar pits (p=0.00006) and fewer TRAP positive cells were noted compared with cocultures containing PMMA particles alone.
CONCLUSIONS—These results indicate that by mixing a bisphosphonate with bone cement, it is possible to inhibit PMMA particle induced bone resorption. This bisphosphonate inhibition of PMMA biomaterial wear particle containing macrophage-osteoclast differentiation and bone resorption may provide a possible therapeutic strategy to prevent or to control the osteolysis of aseptic loosening.

Keywords: bisphosphonate; bone resorption; aseptic loosening; macrophages     

Mechanisms of bone resorption and new bone formation in spondyloarthropathies

Spondyloarthropathies (SpA) share clinical features such as sacroiliitis, axial immobility, and peripheral arthropathies. They also share a strong association with human leukocyte antigen-B27, implicating T cells and antigen-presenting cells in the disease process. Inflammation seems to underlie the pathogenesis of SpA, particularly in the axial skeleton and entheses. Pathologic bone loss and formation occur simultaneously in inflamed regions, suggesting an inflammation-induced dysregulation of osteoclast and osteoblast activity. Pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNFα) appear to be central to the disease, because TNFα blockade has been shown to effectively improve clinical outcome. Other cytokines such as transforming growth factor-beta, interferon-gamma (IFNγ), and interleukin-18 are also likely to be important in SpA. Activated T cells have been shown to produce cytokines such as IFNγ and receptor activator of nuclear-factorkappaB ligand, with direct effects on osteoclastogenesis. The dual role of T cells in immunobiology and skeletal biology provides a possible link between human leukocyte antigen-B27, pro-inflammatory cytokines, and bone cells in SpA.     

Retardation in bone resorption after bone marrow ablation in klotho mutant mice

The klotho gene mutant mice exhibit both osteopetrotic phenotype, including elongation of trabeculae in the epiphyses of long bones and vertebral bodies, and osteopenic phenotype, such as thin cortical bones in the diaphyses of these bones. These diverse features raise the question of whether the klotho gene defect results in alteration in bone resorption in vivo. Therefore, we examined the effect of the klotho gene defect on bone resorption by using bone marrow ablation model. At 1 week after bone marrow ablation, trabecular bones were formed in the ablated marrow cavity to levels higher than those in unablated bones in both klotho mutant and wild-type mice. At 2 weeks postsurgery, newly formed trabecular bones were resorbed in wild-type mice to resume normal bone marrow and trabecular bone volume fraction as reported previously. In contrast, the newly formed trabecular bones in the ablated marrow in klotho mutant mice remained at levels similar to those at 1 week. The defect in the bone resorption phase in klotho mutant mice is associated with site-specific reduction of the number and size of osteoclasts in klotho mutant mice. Moreover, the expression levels of osteoprotegerin messenger RNA in the ablated femora of klotho mutant mice were higher than those in wild-type mice. These results indicate that lack of klotho gene expression suppressed bone resorption that should normally take place 2 weeks after bone marrow ablation.     

Multiplicity in bone fragility

Relative risk (RR) of vertebral fracture in anti-resorptive treatments has 25% reduction as the offset and then decreases 3% by every 1% increase in BMD. RR in non-vertebral fracture does not show the offset, but decreases 8 - 27% by every 1% increase in BMD. These reductions in fracture risk seem to be due to stabilization of trabecular bone structure by refilling of resorption pits and improvement of the material strength of bone tissue by the progress of secondary mineralization.     

Sex differences in cancellous and cortical bone strength, bone mineral content and bone density.

The purpose of this study was to examine sex differences in cancellous and cortical bone strength, bone mineral content (BMC) and bone density of excised cadaver vertebral and phalangeal bones. The samples were age-matched. Bone strength was measured as the mechanical force required to crush or break the bones. Two parameters of bone strength were used on the vertebrae; the force at the first deviation from linearity and the mean force during the consolidation before final failure. The force at first deviation from linearity was not significantly different between the sexes, but there was a significant difference in the consolidation force. The mean men's phalangeal strength was twice that of the women's. BMC and BMC/BW of both types of bone were statistically different between the sexes. Radiographic photodensity measures on the vertebrae showed no sex differences. Cortical diameters of the finger bones were significantly greater in males.