中国人原发性骨质疏松症诊断标准探讨

本文通过中国人上万倒髋部、腰椎及前臂骨密度值数据，对WHO推荐的女性骨质疏松诊断标准及西方国家推荐的男性骨质疏松诊断标准进行研究，发现WHO及西方国家推荐的男女性骨质疏松谚断标准并不完全适合于中国人，因而提出国人女性骨质疏松诊断标准为峰值骨密度-20OSD更适合于临床，但男性骨质疏松诊断标准有待进一步的研究。     

中国人原发性骨质疏松症诊断标准（试行）

一、诊断原则诊断骨质疏松以骨密度减少为基本依据，在鉴别继发性骨质疏松的同时，诊断原发性骨质疏橙，可参考病史、生化和骨折进行综合考虑，     

中国人原发性骨质疏松症诊断标准(试行）

主件一、诊断原则诊断骨质疏松以骨密度减少为基本依据,在鉴别继发性骨质疏松的同时,诊断原发性骨质疏松,可参考病史、生化和骨折进行综合考虑。二、基本手段１．判断骨密度减少尽可能以骨矿含量和脊椎Ｘ线片相结合,本标准目前主要以ＤＸＡ（双能Ｘ线吸收法）为手段制...     

骨质疏松症的诊断标准

应本刊主编刘忠厚教授的邀请，福永仁夫教授在第四届骨质疏松研讨会上做了骨质疏松诊断标准的特邀演讲     

建立原发性骨质疏松症诊断标准的原则和方法

建立骨质疏松症诊断标准的实质内容是建立骨密度正常参考值。１９６３年先进的高精度、无创伤的骨密度测量方法问世以来,国外经历了３０年制订一个诊断标准的艰辛历程,证明其难点是认识“把成人一生的骨量当成一个变量的问题”;在此基础上建立的诊断标准应遵守选择对象的同质性、骨密度正常参考值定界的合理性,建立骨密度诊断标准特殊性及流调峰值骨密度的问卷和方法等一系列要求。Ｋａｎｉｓ１９９４年的诊断标准是针对白人妇女的,本文为推动建立适合中国人的骨质疏松诊断标准而作。     

原发性骨质疏松症的诊断技术进展

骨质疏松症是Pommer L在1885年提出来的,在早期对骨质疏松的定义一直没有明确的概念,直到1990年在丹麦举行的第三届国际骨质疏松研讨会以及在1993年香港举行的第四届国际骨质疏松研讨会上明确了原发性骨质疏松症:(1)骨量减少(包括骨矿物质和骨基质等比例的减少);(2)骨的微观结构退化(由骨的吸收所致,表现为骨小梁变细、变稀乃至断裂。这实际是一种微骨折,致使周身骨骼疼痛);(3)骨的脆性增高、骨力学强度下降,骨折危险性增加,对载荷承受能力降低而易于发生微细骨折或完全骨折。可悄然发     

中国原发性骨质疏松症流行病学

中国是世界上老年人口最多的国家。目前60岁以上老人有一亿两千万，到2050年将达四亿五千万。由于中国人不同部位峰值骨量比白种人低5%～15%，标准差也比西方国家的测量值高，所以Kanis诊断标准不适合中国人。根据骨的生长发育和衰老规律及大样本骨矿测量结果，我们制定了适合中国人的诊断标准和诊断程序。预测目前我国有骨质疏松患者(包括骨量减少)八千四百万，占总人口的6．6%。到2050年将成倍增加达两亿一千二百万．占总人口的13．2%。回顾性的研究认为中国城市50岁以上的老年妇女脊椎骨折发生率为15%；南部城市50岁以上老人髋部骨折的发生率为11．26／10．0000；方地区50岁以上老人髋部骨折的总发病率为74．6／10，0000，(女性为67．2／10，0000，男性为80．8／10，0000)，男女发生率比为1.2。其原因在于女性以非重创性股骨颈骨折为多，而男性在非重创性骨折与女性相仿的同时，重创性骨折远远多于女性。髋部骨折的平均发病年龄为67．2岁。     

老年骨质疏松症诊断标准探讨

本文对老年骨质疏松症骨密度（ＢＭＤ）诊断标准进行深入探讨。以美国Ｌｕｎａｒ公司ＤＰＸ－Ｌ型双能Ｘ线ＢＭＤ测定仪，随机对北京市６０～９４岁７３４名老年人进行ＢＭＤ测定，并分别以同性别、同部位峰值减低２．０及２．５ＳＤ作为骨质疏松症诊断标准进行分析比较。结果：以减低２．５ＳＤ较减低２．５ＳＤ所得骨质疏松症患病率高１倍左右，如以Ｗａｒｄ’ｓ三角为例，男性６０～６９、７０～７９及８０岁以上组，以减低２．０ＳＤ为诊断标准，其患病率各为２５．５％、４７．６％及４８．２％；若以减低２．５ＳＤ为诊断标准其患病率则下降为１０．６％、１９．０％及２３．２％，两者相差１倍以上。结论：若以减低２．５ＳＤ为诊断标准很可能造成一部分骨质疏松症患者被误诊、漏诊。鉴于国人ＢＭＤ峰值较白人低０．５ＳＤ左右，应以峰值减低２．０ＳＤ作为诊断骨质疏松症的标准为宜。     

亚健康与原发性骨质疏松症

亚健康是一种介于健康与疾病之间的第三状态.骨质疏松是一种骨质代谢失衡的现象,它既是亚健康状态,又可以由亚健康进而发展成为疾病.本文通过分析原发性骨质疏松症发病前期的亚健康状态,正确认识其发生发展的因素,以期更好地预防原发性骨质疏松症.     

应用QCT探索骨质疏松症诊断及分级诊断标准

目的　应用QCT检测健康成年人腰椎骨密度 ,探索骨质疏松症的诊断及分级诊断标准。方法　采用日本东芝制造 60 0HQ的CT(单能 ) ,对 12个年龄段 (5年为 1段 ) 5 14名 (男 2 0 6人 ,女3 0 8人 )健康志愿者 (除外患有影响骨代谢疾病及严重腰椎疾病者 ) ,进行L3松质骨BMD检测。结果①峰值骨密度位于 3 0岁年龄段 ,男性 (2 2 7 8± 2 7 0 )mg/cm3;女性 (2 40 9± 2 9 0 )mg/cm3。②峰值骨量过后BMD随增龄而逐渐降低 (P <0 0 1) ,至 45岁年龄段时 ,男女均进入骨量减少期 :女性 5 0岁、男性5 5岁年龄段时BMD均值进入骨质疏松期。③骨质疏松诊断标准有二 ,第一 ,BMD测定值比同性别峰值BMD均值降低 2 5SD以上。第二 ,BMD测定值比同性别峰值BMD减少 3 0 %以上可做骨质疏松诊断标准。④首次提出骨质疏松分 4级 (Ⅰ、Ⅱ、Ⅲ、Ⅳ级 )诊断标准及诊断量化表。结论　①QCT诊断骨质疏松具有较高的敏感性、准确性及可重复性。②骨质疏松分级诊断标准 ,给临床诊断、疗效观察及科研提供具体客观指标。③诊断量化表能帮助临床医师直接、准确、快捷的做出骨质疏松症的分级诊断并易于推广应用     

Exercise vs Conventional Treatment for Treatment of Primary Osteoporosis: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

ObjectivePhysical exercise has obvious effects on bone loss, pain relief, and improvement of bone metabolism indexes in patients with osteoporosis, but currently lacks sufficient evidence. The aim of this systematic review and meta‐analysis was to synthesize and present the best available evidence on the effectiveness and safety of exercises in the treatment of primary osteoporosis.MethodsPublications pertaining to the effectiveness of exercise on bone mineral density (BMD), visual analog scores (VAS), and biochemical markers of bone metabolism in primary osteoporosis (POP) from PubMed, Cochrane Library, Embase, VIP, CNKI, and Wanfang Database were retrieved from their inception to April 2020.ResultsA total of 20 studies with 1824 participants were included. The results of the meta‐analysis revealed that exercise therapy for lumbar spine and femoral neck BMD is statistically different from conventional therapy (lumbar spine BMD: SMD = 0.78, 95%CI: 0.46, 1.10, P < 0.00001, I ² = 85%; femoral neck BMD (SMD = 0.80, 95%CI: 0.34, 1.27, P = 0.0007, I ² = 88%), exercise therapy can significantly increase the lumbar spine BMD of patients with OP, especially in lumbar spine2‐4 BMD (SMD = 0.47; 95%CI: 0.20, 0.75; P = 0.0008; I ² = 69%). Compared with conventional treatment, kinesitherapy also has significant differences in alleviating the pain of POP patients (SMD = −1.39, 95%CI: −2.47,−0.31, P = 0.01, I ² = 97%). Compared with conventional therapy, kinesitherapy has no significant difference in improving biochemical markers of bone metabolism such as bone glaprotein (BGP) (SMD = 2.59, 95%CI:0.90, 4.28, P = 0.003, I ² = 98%), N‐terminal pro peptide of type I procollagen (PINP) (SMD = 0.77, 95%CI: −0.44 to 1.98, P = 0.21, I ² = 95%), serum phosphorus (SMD = 0.04, 95%CI: −0.13, 0.22, P = 0.61, I ² = 30%), alkaline phosphatase (ALP) (SMD = −0.08, 95%CI: −0.44, 0.27, P = 0.64, I ² = 76%), and serum calcium (SMD = 0.12, 95%CI: −0.18, 0.43, P = 0.42, I ² = 63%) in POP patients.ConclusionsKinesitherapy significantly improved lumbar spine and femoral neck BMD, and relieve the pain of patients in the current low‐quality evidence. Additional high‐quality evidence is required to confirm the effect of exercise therapy on the biochemical markers of bone metabolism in POP patients.     

Alendronate Treatment in Men With Primary Osteoporosis: A Three-Year Longitudinal Study

Bisphosphonates have been widely used in the treatment of osteoporosis in women, whereas until now there have been few data on their use in men. The aim of this study was to evaluate the effect of a 3-year alendronate treatment on bone mineral density (BMD) and quantitative ultrasound (QUS) in men with primary osteoporosis. We studied 77 osteoporotic men (aged 57.1 ± 10.8 yrs) who completed a 3-year treatment with alendronate (10 mg/day) plus calcium (1000 mg/day) (n = 39), or calcium alone (n = 38). At baseline and at a 12-month interval, we measured BMD at the lumbar spine and femur (femoral neck and total hip) by DXA (Hologic) and speed of sound (SOS), broadband ultrasound attenuation (BUA) and Stiffness (S) at the os calcis by Achilles plus (Lunar). Alendronate treatment had significantly increased lumbar spine BMD by 4.2% at year 1, by 6.3% at year 2, and 8.8% at year 3. BMD at the femoral neck and total hip had increased by 2.1% and 1.6% at year 1, by 3.2% and 2.9% at year 2, and by 4.2% and 3.9% at year 3, respectively. BUA and Stiffness showed a significant increase in the alendronate-treated group at year 2 (3.2% and 4.9%, respectively) and at year 3 (3.8% and 6%, respectively). BMD at the lumbar spine showed the best longitudinal sensitivity whereas longitudinal sensitivity of both QUS at the heel and femur BMD were similar. In conclusion, this study confirms that alendronate represents an important therapeutic advance in the management of male osteoporosis. BMD at the lumbar spine appears to be the best method for monitoring the effect of alendronate on bone mass in osteoporotic men.     

原发性骨质疏松症患者骨密度和骨代谢指标的对比研究

目的探讨骨密度（BMD）和骨代谢指标在原发性骨质疏松症的诊治过程中的临床意义.方法采用XR-36型双能X线骨密度仪和放射免疫方法,对252例中老年志愿者不同部位的BMD及血清骨钙素（BGP）、Ⅰ型前胶原氨基端前肽、Ⅰ型胶原交联羧基末端肽的含量进行测定.结果①无论是对照组还是骨质疏松组（OP）,老年男性BMD均明显高于老年女性BMD,其差异具有非常显著性（P＜0.01）;②OP组的BGP值明显低于对照组,其差异具有显著性（P＜0.05）;OP组的血清Ⅰ型前胶原氨基端前肽（PINP）值均明显低于对照组,而血清Ⅰ型胶原交联羧基末端肽（ICTP）值均明显高于对照组,其差异具有显著性（P＜0.05）.结论联合检测BGP、HNP和ICTP水平可直接反映骨胶原合成和降解状态,对于判断老年OP的进程以及指导OP的用药有着重要的意义.     

原发性骨质疏松与腰腿痛40例报告

研究腰腿痛与原发性骨质疏松的关系。方法采用骨密度测量对临床４０例中,老年腰椎病人以及同年龄段健康人骨密度值进行对比的分析。结果中老年腰痛病人中有相当一部分的骨密度值低于同年龄健康人,其发病率男女比为１：３．４４,骨折发生率约为２２．５％。结论原发性骨质疏松是引起中老年性腰腿痛的原因之一。     

谷慷太林对骨质疏松症患者骨密度和血清酶学的影响

目的：观察谷慷太林注射液对原发性骨质疏松症患者骨密度和血清酶学的影响。方法：58例患者配伍分为2组，A组28例每天静滴谷慷太林骨肽注射液5ml，B组30例每天静滴谷慷太林骨肽注射液10ml，2组均以20d为1疗程，共3疗程。测量治疗前后患者的骨密度及血清Ca、P、BGP、ALP及TRAP含量。结果：骨质疏松患者谷慷太林治疗后骨密度及血清学指标和治疗前相比变化显著，骨密度和血清ALP、BGP明显升简，血清TRAP活性显著下降，疼痛得到有效缓解；10ml组骨密度及血清学指标的变化较5ml组明显。结论：谷慷太林骨肽注射液可促进成骨、抑制破骨细胞的骨吸收，增加骨量，改善骨质疏松，且大剂量治疗效果优于小剂量。     

Nonresponders to Osteoporosis Therapy

The goal of osteoporosis therapy is reduction of fracture risk. In randomized controlled trials, relative risk of fracture is determined by comparing the absolute fracture rate of a treatment group to a control group. Fracture risk cannot be measured in individual patients being treated for osteoporosis. Since osteoporosis is a silent disease, and some patients may not respond to therapy, a surrogate test for reduction of fracture risk is often used-most commonly a bone density test. A proposed definition of nonresponse is: A decrease in bone mineral density greater than the Least Significant Change at the 95% level of confidence. The Least Significant Change is a value based on bone density measurements in patients and calculated according to well-established standards. There are other candidates for measuring responsiveness to therapy, most notably biochemical markers of bone metabolism, but none is as well validated or standardized as bone density testing. Causes of nonresponse include poor adherence, co-morbid conditions, calcium and vitamin D deficiency, malabsorption, metabolic factors, wrong dose, wrong dosing interval, and lack of efficacy. A bone density increase or stability of bone density is associated with fracture risk reduction in approved osteoporosis therapies, while a bone density decrease is cause for clinical concern. The proposed definition of nonresponse identifies a subset of patients who may require a change of therapy and/or additional medical intervention. More data are needed to develop guidelines for clinicians. Further study is suggested.     

A Comparison of Calcaneal Dual-Energy X-Ray Absorptiometry and Calcaneal Ultrasound for Predicting the Diagnosis of Osteoporosis From Hip and Spine Bone Densitometry

Peripheral densitometry is increasingly being used in the management of osteoporosis, but the optimal diagnostic thresholds have not been defined. The aim of this study was to determine the optimal T-score for peripheral dual-energy X-ray absorptiometry (pDXA) of the heel using a GE Lunar PIXI and quantitative ultrasound (QUS) of the heel using a GE Lunar Achilles Plus when compared with dual-energy X-ray absorptiometry (DXA) of central sites (spine, femoral neck, or total hip). Ninety-nine women (mean age 69 +/- 8, range 33-86 yr) referred from the metabolic bone clinic were studied. The optimal T-score for pDXA from ROC analysis was -1.7 and for QUS was -2.5. The pDXA T-score that defined the same prevalence of osteoporosis at any central site was also -1.7 and for QUS was -2.4. These results are similar to the manufacturer's recommendations. There is no significant difference in performance between the PIXI and QUS.     

不同区域骨密度值对原发性骨质疏松症诊断的影响

目的 分析受检区域骨密度（ｂｏｎｅ ｍｉｎｅｒａｌ ｄｅｎｓｉｔｙ,ＢＭＤ）值的差异对原发性骨质疏松症（ｏｓｔｅｏｐｏｒｏｓｉｓ,ＯＰ）诊断的影响。方法 回顾在我院进行ＢＭＤ检查的１２３３例患者,男４１４例,女８１９例;年龄２０￣８９岁;除外内分泌、肿瘤等疾病及皮质激素治疗史人群。用比能Ｘ线骨密度仪（ＤＥＸＡ）对腰椎、髋部及全身进行扫描,测量不同部位的ＢＭＤ值,采用计算机ＥＸＣＥＬ软件进行统计学分