骨疏宁片联合阿托伐他汀对2型糖尿病合并绝经后骨质疏松症患者骨密度及骨代谢的影响

目的研究骨疏宁片联合阿托伐他汀对2型糖尿病合并绝经后骨质疏松症患者骨密度及骨代谢的影响。方法 124例2型糖尿病合并骨质疏松症妇女随机分为治疗组和对照组,治疗组进行骨疏宁片联合阿托伐他汀治疗,对照组单纯予以阿托伐他汀治疗。治疗前及治疗后12个月分别检测两组受试者腰椎1~4和左侧股骨颈骨密度、VAS疼痛评分以及骨代谢指标。结果治疗前,各组受试者骨密度、VAS疼痛评分以及骨代谢指标比较无统计学意义(P0.05)。治疗6个月及12个月,两组患者VAS评分不同程度降低,其中以治疗组骨痛的治疗效果要明显优于对照组(P0.05)。治疗12个月两组L1~4椎体、股骨颈的BMD明显升高(P0.05),而治疗组明显高于对照组(P0.05)。治疗12个月,两组血清I型胶原N端前肽(type 1 collagen N terminal peptide,P1NP)的水平明显升高,而I型胶原羧基末端肽(type I collagen carboxy-terminal peptide,CTX)水平明显下降,和对照组比较,治疗组血清P1NP及CTX水平改变更为明显(P0.05)。结论骨疏宁片联合阿托伐他汀可以显著提高2型糖尿病合并骨质疏松症女性骨密度及降低VAS评分,且能改善2型糖尿病合并绝经后骨质疏松症患者骨代谢异常,值得临床推广。     

甲状旁腺激素(1-34)联合伊班膦酸钠治疗严重骨质疏松症的临床研究

目的甲状旁腺激素(parathyroid hormone,PTH)(1-34)联合伊班膦酸钠治疗严重骨质疏松症效果临床观察。方法98例严重绝经后骨质疏松症合并骨骼疼痛患者随机分为治疗组和对照组,治疗组使用PTH联合伊班膦酸钠治疗,对照组单纯予以伊班膦酸钠治疗,为期12个月。分别检测两组受试者腰椎及髋部骨密度、血清骨代谢指标治疗前后的改变。结果药物治疗6个月后两组患者腰椎L1~4及股骨粗隆、左侧股骨颈、Ward三角区的骨密度明显增加,且12个月后骨密度进一步增加,显著高于对照组(P0.05);药物治疗12个月后两组血清及碱性磷酸酶(ALP)、血清Ⅰ型胶原C末端肽(s-CTX)、血清抗酒石酸酸性磷酸酶-5b(TRACP-5b)、血清骨源性碱性磷酸酶(BAP)及血清骨钙素(OC)水平均显著改变,且治疗组对ALP及s-CTX、BAP、OC及TRACP-5b影响更明显(P0.05),而两组血钙(Ca)及血磷(P)治疗前后无明显差异(P0.05)。结论PTH联合伊班膦酸钠使用能有效提高严重骨质疏松症患者髋部及腰椎骨密度,改善骨代谢。     

唑来膦酸、伊班膦酸钠及阿伦膦酸钠防治绝经后骨质疏松症的疗效对比研究

目的对比研究唑来膦酸、伊班膦酸钠及阿伦膦酸钠对绝经后骨质疏松症的疗效。方法 180名绝经后妇女随机分为唑来膦酸治疗组(ZOL组)、伊班膦酸钠治疗组(IBA组)和阿伦膦酸钠治疗组(ALN组);ZOL组给予唑来膦酸治疗,IBA组给予伊班膦酸钠治疗,ALN组予以阿伦膦酸钠治疗。治疗前后分别检测3组受试者腰椎及髋部骨密度、血清骨代谢指标、视觉模拟评分(visual analogue scale,VAS)改变及研究期间药物不良反应和骨折发生率。结果药物治疗12个月后3组腰椎(L1~4)及左侧股骨颈骨密度明显增加,显著高于治疗前(P0.05),而3组间比较差异无统计学意义(P0.05),3组治疗有效率比较差异无统计学意义(P0.05)。药物治疗12个月后3组患者的VAS评分均显著降低,显著低于治疗前(P0.05),而3组间比较差异无统计学意义(P0.05)。干预12个月后两组血清I型胶原交联羧基末端肽和抗酒石酸酸性磷酸酶-5b水平均显著降低,显著低于治疗前(P0.05),而3组间比较差异无统计学意义(P0.05)。3组间药物不良反应发生率比较差异无统计学意义(P0.05)。结论唑来膦酸、伊班膦酸钠及阿伦膦酸钠对绝经后骨质疏松症的治疗安全有效,可以显著改善骨密度及骨代谢异常。     

运动疗法对绝经后骨质疏松症骨转换及炎性因子的影响

目的 观察运动疗法在常规抗骨质疏松药物治疗基础上对绝经后骨质疏松症(postmenopausal osteoporosis, PMOP)骨转换、炎性因子水平的影响及相关性分析。方法 筛选符合纳入标准的绝经后骨质疏松症患者72例，随机分为观察组和对照组。观察组36例，年龄52～59岁，平均(56.03±2.86)岁；对照组36例，年龄50～58岁，平均(55.36±2.88)岁。对照组予以常规抗骨质疏松药物(钙剂、膦酸盐类)治疗，观察组在对照组的基础上予以有氧运动和递增式抗阻训练的组合式运动疗法。分别于治疗前和治疗3个月后检测患者L_1～4骨密度(bone mineral density, BMD)、左侧股骨颈BMD、血清Ⅰ型原胶原N-端前肽(serum N-terminal peptide of typeⅠcollagen, S-PINP)、血清Ⅰ型胶原C-末端肽交联(serum C-terminal telopeptide of typeⅠcollagen, S-CTX)、白细胞介素(interleukin, IL)-6、肿瘤坏死因子(tumour necrosi...     

补肾壮骨中成药对绝经后骨质疏松症治疗机理初探

目的 观察补肾壮骨中成药对绝经后骨质疏松症的疗效,初步探索补肾壮骨中成药治疗绝经后骨质疏松症的作用机制.方法:134例患者随机分为钙剂+活性维生素D治疗组(对照组)及补肾壮骨中成药+钙剂+活性维生素D治疗组(中成药治疗组)两组治疗1年.在第0月、第3月、第6月留取清晨空腹2 h尿检测尿钙/肌酐(Ca/Cr)、尿I型胶原交联C末端肽/肌酐(CTX-I/Cr),第0月、第12月检测骨密度.结果:经治疗1年后,所有患者第0月、第3月、第6月尿Ca/Cr均无明显差异.但中成药治疗组在第3月时尿CTX-I/Cr明显降低(P＜0.01),第12月股骨颈骨密度较基线显著提高(P＜0.01),与对照组第12月股骨颈骨密度比较有显著差异(P＜0.01);腰椎1-4骨密度较基线无明显变化(P＞0.05).尿CTX-I/Cr的变化与股骨颈骨密度的变化呈明显负相关(P＜0.05).而对照组尿CTX-I/Cr、股骨颈/腰椎1-4骨密度变化均无统计学意义.结论:补肾壮骨中成药可以通过填补肾精,滋补肝肾等作用,降低骨吸收,提高骨密度,发挥对绝经后骨质疏松症的治疗作用.其机制可能与抑制破骨细胞骨吸收功能和促进其凋亡有关.     

缺氧诱导因子抑制剂对去卵巢大鼠骨质疏松症治疗效果的研究

目的研究缺氧诱导因子抑制剂对卵巢切除(ovariectomized,OVX)雌性Sprague-Dawley大鼠的治疗效果,比较缺氧诱导因子抑制剂对骨密度的影响。方法在大鼠卵巢切除12周后,使用缺氧诱导因子抑制剂进行治疗。治疗8周后,在实验结束时将大鼠进行安乐死处理,获取大鼠血清、股骨和胫骨。通过生物力学测试,Micro-CT扫描和血清生化分析进行评估。结果与未给药的OVX大鼠相比,缺氧诱导因子抑制剂的全身给药显著降低了骨代谢指标Ⅰ型前胶原氨基末端前肽(type I collagen N terminal peptide,PINP)和Ⅰ型胶原羧基端肽(type I collagen carboxy-terminal peptide,CTX-I),增加了大鼠胫骨骨密度(bone mineral density, BMD),增强了股骨极限载荷、能量和刚度,差异比较有统计学意义(P0.05)。结论缺氧诱导因子抑制剂能有效改善OVX诱导的骨质疏松症。     

绝经后女性骨代谢生化指标与骨质疏松性腰椎骨折之间的相关性

目的探讨骨代谢标志物对预测绝经后骨质疏松患者合并腰椎骨折风险的诊断价值。方法采用双能X线骨密度仪、酶联免疫检测法(ELISA)和速率法对70例绝经后骨质疏松症腰椎无骨折患者和70例绝经后骨质疏松症腰椎骨折患者的髋部及腰椎骨密度、各项骨代谢生化指标进行检测,并分析骨代谢生化指标的变化与骨质疏松症、骨质疏松性腰椎骨折之间的相关性。结果绝经后骨质疏松性腰椎骨折的发生风险与年龄、体重、身高、体重指数、骨密度等一般指标和骨钙素N端中分子片段(N-MID osteocalcin,N-MID)、骨碱性磷酸酶(bone alkaline phospha,BAP)、钙离子(calcium ionic,Ca~(2+))、骨吸收标志物β-Ⅰ型胶原羧基端肽(β-C-terminal telopeptide of type I collagen,β-CTx)等生化指标之间无关联,而与血清I型原胶原氨基端延长肽(propeptide of type I procollagen,PINP)、抗酒石酸酸性磷酸酶5b(TRAP-5b)和25-羟维生素D(25-hydroxy vitamin,25-(OH)D)之间存在显著相关性(P=0.002、0.007、0.001),其中与PINP、TRAP-5b呈正相关,与25-(OH)D呈负相关。结论绝经后女性血清PINP、TRAP-5b和25-(OH)D与骨质疏松性骨折的发生存在显著的相关性,骨代谢标志物与骨密度的联合检测对预测绝经后骨质疏松腰椎骨折具有一定的临床意义。     

杜仲壮骨胶囊联合雷洛昔芬治疗绝经后骨质疏松症临床研究

目的探索杜仲壮骨胶囊联合雷洛昔芬治疗绝经后骨质疏松症临床疗效。方法 158例绝经后骨质疏松症患者随机分为治疗组(n=79)和对照组(n=79)。对照组给予雷洛昔芬治疗,治疗组给予杜仲壮骨胶囊联合雷洛昔芬治疗,为期治疗12个月。检测治疗前后两组患者股骨颈、腰椎及髋部的骨密度,同时测定血清骨代谢指标:骨碱性磷酸酶(BALP)、I型原胶原N-端前肽(PINP)和血清I型胶原交联C-末端肽(S-CTX)、碱性磷酸酶(ALP)、骨钙素(BGP)的水平,记录两组治疗总有效率和药物不良反应。结果治疗组的治疗总有效率为93.67%,而对照组的为78.48%,两组比较差异有统计学意义(P0.05)。治疗12个月,两组股骨颈、髋部及腰椎密度都有不同程度的升高,其中治疗组骨密度变化更明显,和对照组比较差异有明显的统计学意义(P0.05);同时各组血清S-CTX、PINP和ALP水平均降低,BALP和BGP水平均升高,而治疗组改变更明显,两组比较差异有明显的统计学意义(P0.05)。两组患者药物不良反应比较差异有明显的统计学意义(P0.05)。结论杜仲壮骨胶囊联合雷洛昔芬治疗绝经后骨质疏松症,安全有效,较雷洛昔芬单独治疗效果更佳。     

促胰液素对去卵巢骨质疏松大鼠血清骨转换指标和骨密度的影响

目的 观察促胰液素(secretin,SCT)对去卵巢骨质疏松大鼠骨转换指标和骨密度的影响。方法 采用双侧卵巢去除法制备绝经后骨质疏松大鼠模型,将60只SD大鼠随机分为假手术组、模型对照组、雌激素治疗组和促胰液素治疗组,每组各15只。干预3个月后,测定腰椎骨密度(bone mineral density,BMD),采取ELISA法测定血清I型胶原N前端肽(procollagen I N-Terminal propeptide,PINP)和I型胶原C末端肽(collagen type I C-terminal cross-linked telopeptide,CTX),另使用STRING10.0蛋白相互作用网络分析工具分析骨质疏松相关差异蛋白。结果 与假手术组比较,模型对照组、雌激素治疗组、促胰液素治疗组的PINP含量升高（P＜0.05）,模型对照组的CTX含量升高（P＜0.05）,模型对照组的BMD下降（P＜0.05）,雌激素治疗组和促胰液素治疗组的CTX、BMD含量无显著差异（P＞0.05）;与模型对照组比较,雌激素治疗组、促胰液素治疗组PINP、CTX含量有所下降,而BMD含量升高（P＜0.05）;雌激素组与促胰液素组之间PINP、CTX、BMD含量无显著差异（P＞0.05）。结论 促胰液素能改善去卵巢骨质疏松大鼠的PINP和CTX含量,增加骨密度,抑制骨质丢失,具有较好的抗骨质疏松效果。     

运动联合利塞膦酸钠治疗绝经后女性骨质疏松症疗效分析

目的观察广场舞运动联合补充利塞膦酸钠防治绝经后骨质疏松症的疗效。方法 168名绝经后骨质疏松症妇女随机分为实验组和对照组,实验组进行广场舞锻炼联合补充利塞膦酸钠治疗,对照组单纯予以补充利塞膦酸钠治疗。实验前及实验干预后6个月和12个月分别检测两组受试者腰椎L1-4、股骨颈部及Ward区骨密度、VAS疼痛评分、骨代谢指标以及不良反应。结果治疗6个月及12个月,两组患者VAS评分不同程度降低,其中以治疗组骨痛的治疗效果要明显优于对照组(P0.05)。治疗12个月后两组腰椎L1-4、股骨颈部及Ward区骨密度明显升高(P0.05),而治疗组明显高于对照组(P0.05)。治疗后6个月及12月,两组血清OC及NTX I较治疗前比较改善明显(P0.05),和对照组比较,治疗组血清OC及NTX I水平改变更为明显(P0.05);而两组不良反应无明显差异(P0.05)。结论广场舞运动结合补充利塞膦酸钠可以有效改善绝经后骨质疏松症,是一种合适的治疗方案。     

甲磺酸去铁胺辅助治疗绝经后骨质疏松症的可行性和安全性研究

目的观察甲磺酸去铁胺辅助治疗绝经后骨质疏松的可行性和安全性研究。方法 178例绝经后骨质疏松症女性分为治疗组与对照组,对照组给予雷洛昔芬(60 mg/d)治疗,治疗组在给予雷洛昔芬治疗的基础上添加甲磺酸去铁胺辅助治疗。治疗为期6个月,比较治疗前后两组患者不良反应、骨密度、骨代谢指标的差异和临床疗效。结果截止治疗时间为止,治疗组患者的治疗总有效率为100%,明显高于对照组的84. 27%,差异有统计学意义(P0. 05);两组患者治疗后的腰椎正位、股骨颈骨密度较治疗前均显著上升,且治疗组BMD升高较对照组更为显著,差异均有统计学意义(P0. 05);治疗组的血清骨钙素(OC)、甲状旁腺素(PTH)、血清I型胶原C端肽(CTX-I)、血清铁蛋白水平较治疗前明显改变且改变幅度均明显大于对照组,差异均有统计学意义(P0. 05)。治疗期间两组患者均无明显不良反应发生。结论甲磺酸去铁胺辅助雷洛昔芬治疗能明显提高绝经后骨质疏松患者的骨密度,改善骨代谢指标,且不增加不良反应的基础上增加治疗有效率。     

Comparative effects of teriparatide and ibandronate on spine bone mineral density (BMD) and microarchitecture (TBS) in postmenopausal women with osteoporosis: a 2-year open-label study

Summary

Treatment effects over 2 years of teriparatide vs. ibandronate in postmenopausal women with osteoporosis were compared using lumbar spine bone mineral density (BMD) and trabecular bone score (TBS). Teriparatide induced larger increases in BMD and TBS compared to ibandronate, suggesting a more pronounced effect on bone microarchitecture of the bone anabolic drug.

Introduction

The trabecular bone score (TBS) is an index of bone microarchitecture, independent of bone mineral density (BMD), calculated from anteroposterior spine dual X-ray absorptiometry (DXA) scans. The potential role of TBS for monitoring treatment response with bone-active substances is not established. The aim of this study was to compare the effects of recombinant human 1–34 parathyroid hormone (teriparatide) and the bisphosphonate ibandronate (IBN), on lumbar spine (LS) BMD and TBS in postmenopausal women with osteoporosis.

Methods

Two patient groups with matched age, body mass index (BMI), and baseline LS BMD, treated with either daily subcutaneous teriparatide (N?=?65) or quarterly intravenous IBN (N?=?122) during 2 years and with available LS BMD measurements at baseline and 2 years after treatment initiation were compared.

Results

Baseline characteristics (overall mean ± SD) were similar between groups in terms of age 67.9?±?7.4 years, body mass index 23.8?±?3.8 kg/m², BMD L1–L4 0.741?±?0.100 g/cm², and TBS 1.208?±?0.100. Over 24 months, teriparatide induced a significantly larger increase in LS BMD and TBS than IBN (+7.6 %?±?6.3 vs. +2.9 %?±?3.3 and +4.3 %?±?6.6 vs. +0.3 %?±?4.1, respectively; P?<?0.0001 for both). LS BMD and TBS were only weakly correlated at baseline (r ²?=?0.04) with no correlation between the changes in BMD and TBS over 24 months.

Conclusions

In postmenopausal women with osteoporosis, a 2-year treatment with teriparatide led to a significantly larger increase in LS BMD and TBS than IBN, suggesting that teriparatide had more pronounced effects on bone microarchitecture than IBN.     

骨愈灵胶囊对绝经后骨质疏松症的疗效及骨代谢指标的影响

目的观察骨愈灵胶囊对绝经后骨质疏松症的疗效及骨代谢指标的影响。方法 148例绝经后骨质疏松症患者纳入本研究并随机分为治疗组和对照组。治疗组患者给予骨愈灵胶囊治疗,对照组患者给予雷洛昔芬治疗,两组患者治疗期限为12个月。检测治疗前和治疗12个月后2组患者腰椎正位(L_(1-4))、左股骨颈的骨密度、血清血钙、血磷、骨碱性磷酸酶(BALP)和抗酒石酸酸性磷酸酶-5b(TRAP-5b)水平变化情况以及治疗有效率和不良反应。结果治疗12个月后,两组患者腰椎正位(L_(1-4))、左股骨颈的骨密度患者均明显高于对照组,差异均有统计学意义(P0. 05);治疗12个月后,两组患者血清BALP水平较治疗前明显降低(P0. 05),血清TRAP-5b均较治疗前明显升高(P0. 05);而治疗组较对照组改善更为明显(P0. 05)。治疗组的患者治疗有效率优于对照组(P0. 05),而不良反应差异无统计学意义(P0. 05)。结论骨愈灵胶囊对绝经后骨质疏松症患者骨密度和骨代谢影响显著。     

骨胶原肽对老年骨质疏松症患者骨密度和骨代谢指标的影响

目的观察骨胶原肽对老年骨质疏松症患者的骨密度和血清骨代谢指标水平的影响。方法 138例老年骨质疏松症患者纳入本研究,将其随机分为治疗组和对照组,每组各69例。对照组患者应用阿仑膦酸钠治疗,治疗组患者给予骨胶原肽联合阿仑膦酸钠治疗,治疗为期12个月。检测治疗前和治疗12个月后两组患者腰椎正位(L1-L4)、左股骨颈的骨密度、血清血钙、血磷、骨碱性磷酸酶(bone alkaline phosphatase,BALP)和抗酒石酸酸性磷酸酶-5b(tartrate-resistant acid phosphatase-5b,TRAP-5b)水平变化情况以及治疗有效率和不良反应。结果治疗12个月后,治疗组腰椎正位、左股骨颈的骨密度患者均明显高于对照组,差异均有统计学意义(P0.05);治疗12个月后,两组患者血清BALP及血磷水平较治疗前明显降低,血清TRAP-5b及血钙水平均较治疗前明显升高,和治疗前比较差异均有统计意义(P0.05);而治疗组较对照组改善更为明显(P0.05)。治疗组的患者治疗有效率优于对照组(P0.05),而不良反应无明显差异(P0.05)。结论骨胶原肽联合阿仑膦酸钠能安全有效提高老年骨质疏松症患者的骨密度,改善骨代谢。     

Effect of alendronate on bone mineral density and bone turnover in Thai postmenopausal osteoporosis

Alendronate has recently been approved for the prevention and treatment of postmenopausal osteoporosis, and its efficacy has been demonstrated in many Western countries. Our present study was performed to evaluate the effect of alendronate on bone mineral density (BMD) and its tolerability in Thais. Eighty postmenopausal women with osteoporosis participated in this study. After giving informed consent, the subjects were randomly allocated either 10mg alendronate or placebo in a double-blind fashion. All patients received a supplement of 500mg elemental calcium daily. BMD at the lumbar spine, femoral neck, and distal forearm was measured at baseline and 6 and 12 months after treatment. Biochemical markers of bone resorption were determined at baseline and 6 months after treatment. Baseline characteristics were similar in both alendronate- and placebo-treated groups. Ten subjects discontinued the study. Of 70 subjects, 32 received 10mg alendronate daily and the remaining subjects received placebo. At 1 year, BMD in the alendronate-treated group had increased from baseline by 9.2%, 4.6%, and 3.1% at lumbar spine, femoral neck, and distal forearm, respectively. These percentages were greater than those in controls (4.1%, 0.6%, and 1.0%, respectively). Urinary N-terminal telopeptide (NTx)-I and serum C-terminal telopeptide (CTx)-I levels decreased in both groups after 6 months of treatment. However, more reduction was demonstrated in the alendronate-treated group (71.9% vs. 28.4%, P 0.01, and 84.7% vs. 33.1%, P 0.01, respectively). Compliance with treatment and drug tolerability were good in both alendronate and placebo groups. We concluded that treatment with alendronate 10mg daily for Thai postmenopausal women with osteoporosis significantly increased BMD at all skeletal sites and reduced biochemical markers of bone resorption. It was well tolerated without any serious side effects.     

The efficacy and tolerability of risedronate on bone mineral density and bone turnover markers in osteoporotic Chinese women: a randomized placebo-controlled study

Osteoporosis has become an important health problem in postmenopausal Asian populations as the prevalence of hip and vertebral fractures in some Asian countries has risen to approach that of Caucasian populations. Risedronate, a pyridinyl-bisphosphonate agent, is a potent inhibitor of bone resorption. Risedronate increases bone mineral density (BMD), reduces markers of bone turnover, and reduces the risk of fractures in Caucasian postmenopausal women. To determine the efficacy and tolerability of risedronate in Chinese, a multicenter, randomized, double blind, placebo controlled study was performed in Hong Kong. Sixty-five (65) postmenopausal osteoporotic Southern Chinese women, aged 67+/-6 years, were randomly assigned to receive either risedronate 5 mg daily (n=31) or placebo (n=34) for 12 months. All women received calcium carbonate 500 mg daily and vitamin D 400 IU daily. Mean baseline BMD T-score at the spine and total hip was -3.4 and -2.6, respectively. A significant increase in spine BMD was already evident at month 3 of risedronate treatment (P<0.001). Risedronate significantly increased BMD and reduced bone turnover markers as compared with placebo. The risedronate group had significant increase in BMD at 12 months at both the spine and hip when compared with the placebo group (L1-4 6.6% vs. 0.4%, P<0.001; total hip 2.7% vs. 0.3, P<0.0001; femoral neck 1.8% vs. 1.1%, P<0.02; trochanter 4% vs. 1.1%, P<0.0001, respectively). Significant changes in urine N-telopeptide (NTx) and serum osteocalcin were evident as early as 1 and 3 months, respectively, with risedronate treatment. No significant changes were seen in both BMD and bone markers in the placebo group. Risedronate was well tolerated without major adverse effects. We conclude that risedronate is an effective and well-tolerated agent for the treatment of postmenopausal osteoporosis in Asian population.     

Effect of walking exercise on bone metabolism in postmenopausal women with osteopenia/osteoporosis

The purpose of this prospective study was to determine whether moderate walking exercise in postmenopausal women with osteopenia/osteoporosis would affect bone metabolism. Fifty postmenopausal women, aged 49–75 years, with osteopenia/osteoporosis were recruited: 32 women entered the exercise program (the exercise group) and 18 served as controls (the control group). The exercise consisted of daily outdoor walking, the intensity of which was 50% of maximum oxygen consumption, with a duration of at least 1h with more than 8000 steps, at a frequency of 4 days a week, over a 12-month period. Lumbar (L2–L4) bone mineral density (BMD) was measured at the baseline and every 6 months with dual-energy X-ray absorptiometry (DXA) in both groups. Serum bone-specific alkaline phosphatase (BAP) and urinary cross-linked N-terminal telopeptides of type I collagen (NTX) levels were measured at baseline and at months 1, 3, 6, 9, and 12 by EIA and ELISA, respectively, in the exercise group, and urinary NTX level was measured at the baseline and every 6 months in the control group. There were no significant differences in baseline characteristics including age, height, body weight, bone mass index, years since menopause, lumbar BMD, and urinary NTX level between the two groups. Although no significant changes were observed in lumbar BMD and the urinary NTX level in the control group, lumbar BMD in the exercise group was increased as compared with the control group, but was sustained from the baseline. In the exercise group, the urinary NTX level rapidly responded to walking exercise from month 3, and this reduction was sustained until month 12, followed by reduction in the serum BAP level. A moderately negative correlation was found between the percent change in the urinary NTX level at month 3 and that in lumbar BMD at month 12 in the exercise group. This study clearly demonstrates that the mechanism for the positive response of lumbar BMD to moderate walking exercise in postmenopausal women with osteopenia/osteoporosis appears to be the suppression of bone turnover, and that an early change in the urinary NTX level may be useful to predict the long-term response of increasing lumbar BMD to exercise, although its efficacy for lumbar BMD may be quite modest.     

Estrogen replacement may be an alternative to parathyroid surgery for the treatment of osteoporosis in elderly postmenopausal women presenting with primary hyperparathyroidism: A preliminary report

Parathyroid surgery is indicated in patients presenting with primary hyperparathyroidism (PHPT) and osteoporosis (defined as bone mineral density more than 2 standard deviations below normal). Many are elderly women with complex medical problems, either unwilling or considered unfit for surgery. Estrogen replacement therapy (ERT) may potentially be an alternative form of therapy in this group. We studied 15 consecutive postmenopausal women presenting with PHPT and osteoporosis. Group 1 comprised 5 women who elected to be treated with ERT (conjugated equine estrogen, 0.3–0.625 mg/day). The other 10 women underwent successful parathyroidectomy. These 10 patients were randomly subdivided into group 2 (5 patients who received calcitriol 0.25 µg b.i.d. for 12 months following surgery) and group 3 (5 patients who received elemental calcium 1 g/day for 12 months following surgery). Lumbar spine and femoral neck bone mineral density (BMD) were measured prior to and after 12 months of therapy, using a dual-energy X-ray absorptiometer (Lunar DPX-L). The three groups did not differ with respect to their ages (group mean 71.8 years), or baseline serum calcium (group mean 2.77 mmol/l), serum parathyroid hormone (group mean 11.0 pmol/l), lumbar spine BMD (group mean 0.93 g/cm²) and femoral neck BMD (group mean 0.73 g/cm²). Serum calcium normalized in all patients who underwent surgery and none developed hypoparathyroidism. A non-significant decrease in serum calcium was seen in patients treated with ERT only. Lumbar spine (+5.3% per year; 95% CI, 1.1% to 9.6%) and femoral neck BMD (+5.5% per year; 95% CI, –2.1% to 13.2%) increased significantly after 12 months of ERT (p<0.001 compared with pre-therapy values). These increases in BMD did not differ significantly from those in patients who underwent successful parathyroidectomy followed by either calcitriol therapy or calcium replacement (lumbar spine BMD increase of +6.2% per year, 95% CI 3.1% to 9.4%; and femoral neck BMD increase of +3% per year, 95% CI 0 to 6%). In summary, increases in lumbar spine and femoral neck BMD occur following treatment of PHPT. ERT appeared as effective as parathyroidectomy (combined with either calcitriol or calcium supplements) for the treatment of osteoporosis in elderly postmenopausal women presenting with PHPT.     

持续运动锻炼对绝经后女性骨密度影响的追踪研究

目的比较不同运动锻炼参与程度的绝经后女性骨密度差异及在12个月间的变化。方法对82名符合条件的社区绝经后女性骨密度进行12个月追踪。研究对象分为锻炼量达标组(n=42)和不达标组(n=40),不达标组进一步分为不锻炼和偶尔锻炼亚组。采用定量超声(QUS)法采集跟骨骨密度T值、Z值、超声传导声速(SOS)、超声宽带衰减(BUA),统计各组骨质疏松不同发生风险等级的人数比,测量时间点为基线、6个月和12个月。结果达标组骨密度各指标水平和骨质疏松高度风险人数比(16.7%)在12个月间基本维持稳定(P0.05);不达标组T值(F=11.877,P=0.000)、Z值(F=7.459,P=0.002)、BUA值(F=4.207,P=0.026)在12个月间均出现显著下降,骨质疏松高度风险人数比由20.0%上升至30.0%。达标组与不达标组T值变化具有明显的组间效应(F=4.268,P=0.042)和时间效应(F=6.378,P=0.004)。偶尔锻炼亚组骨密度各指标水平在12个月间下降幅度低于不锻炼亚组。结论不同运动锻炼参与水平可不同程度地维持绝经后女性骨密度水平或延缓其增龄性流失。持续规律的运动锻炼对绝经后女性骨密度水平具有积极的改善作用。