唑来膦酸与替勃龙治疗绝经后骨质疏松疗效比较及对骨折的预防作用

目的比较唑来膦酸与替勃龙治疗绝经后骨质疏松的临床疗效及对骨折的预防作用。方法将本院诊治的128例绝经后骨质疏松患者随机分入唑来膦酸组与替勃龙组,两组患者均接受骨化三醇、钙剂治疗,唑来膦酸组患者同时接受唑来膦酸5 mg/年静脉注射,替勃龙组患者接受替勃龙2.5 mg/d,口服。用药后2年比较两组髋部及腰椎骨密度变化、血清Ⅰ型前胶原肽（CTX）、骨碱性磷酸酶（BALP）及不良反应发生情况。结果两组治疗后2年腰椎L1-L4和髋部区、股骨颈、大转子骨密度均显著增加（P〈0.05）,唑来膦酸组L1-L4骨密度增加显著优于替勃龙组（P〈0.05）;治疗后两组CTX及BALP均显著下降,唑来膦酸组CTX显著低于替勃龙组（P〈0.05）;唑来膦酸组与替勃龙组新发骨折发生率分别为4.5%和8.1%,两组比较差异无统计学意义（P〉0.05）;唑来膦酸组不良反应发生率为19.7%,替勃龙组为11.3%,两组均未发生严重不良反应。结论唑来膦酸与替勃龙治疗绝经后骨质疏松均可获得理想的临床疗效,唑来膦酸组腰椎骨质密度增加更为显著,患者治疗依从性好。     

The effect of 4-week aerobic exercise program on postural balance in postmenopausal women with osteoporosis

The aim of this study is to evaluate the effect of submaximal aerobic exercise program on postural balance in postmenopausal women with osteoporosis. Twenty-five postmenopausal women without osteoporosis and 28 postmenopausal women with osteoporosis enrolled in this study. Balance ability of all subjects was measured by timed up and go test (TUG), four square step test (FSS), Berg balance scale (BBS) and Kinesthetic ability trainer 3000. After completion of initial measurements of balance, postmenopausal women with osteoporosis attended the submaximal aerobic exercise program on treadmill. At the end of the exercise program, balance tests were repeated. Balance tests of postmenopausal women without osteoporosis were repeated approximately 4-weeks after the initial measurement. There was statistically significant improvement in all balance scores in the postmenopausal women with osteoporosis after exercise training whereas there were no statistically significant differences in the scores of postmenopausal women without osteoporosis who did not exercise. This study showed that a 4-week submaximal aerobic exercise program provided significant improvements in static and dynamic balances in postmenopausal osteoporotic women.     

补肾益髓中药复方对去卵巢骨质疏松症大鼠骨组织Runx2 mRNA及蛋白表达的影响

目的观察去卵巢骨质疏松症大鼠骨组织Runx2 mRNA及蛋白表达,探讨绝经后骨质疏松症(Postmenopausal Osteoporosis,PMOP)的发病机制以及补肾益髓中药复方的疗效机理。方法去卵巢复制骨质疏松症大鼠模型,实验设正常组、模型组、假手术组、补肾益髓中药复方组、钙尔奇D组、骨疏康组。术后7d开始灌胃给药12周。应用XR-36型双能X线骨密度仪测定股骨骨密度,应用OLYMPUS BX51显微镜观察股骨头石蜡切片HE染色显微形态结构,实时定量RT-PCR及Western Blot检测骨组织Runx2 mRNA及蛋白表达。结果 (1)与正常组、假手术组比较,模型组股骨骨密度明显降低(P0.001、P0.05),骨组织Runx2 mRNA及蛋白表达明显降低(P0.001)。(2)与模型组比较,补肾益髓中药复方组、骨疏康组股骨骨密度明显升高(P0.05),补肾益髓中药复方组(P0.001)、钙尔奇D组(P0.05)、骨疏康组(P0.01)骨组织Runx2 mRNA及蛋白表达明显上调。(3)与钙尔奇D组、骨疏康组比较,补肾益髓中药复方组骨组织Runx2 mRNA(P0.01、P0.05)及蛋白(P0.001)表达均明显升高。(4)股骨头石蜡切片HE染色显微形态结构:与正常组、假手术组比较,模型组骨小梁形态结构完整性差,有些部位破坏、断裂,余留骨重建空间较多;各给药组骨小梁形态结构均改善,结构较紧密,余留骨重建空间减少,其中以补肾益髓中药复方组改善最明显。结论骨组织Runx2 mRNA及蛋白表达降低可能是PMOP的发病机制之一;补肾益髓中药复方可能通过上调骨组织Runx2 mRNA及蛋白表达有效防治PMOP,其作用优于钙尔奇D、骨疏康。     

DXA影像评估绝经后女性椎体骨折

目的：做骨密度检测时,应用椎体骨折评估软件发现椎体骨折,提高椎体骨折诊断率。方法连续对217例≥50岁绝经后女性做股骨近端骨密度检测时,行胸腰椎侧位扫描,应用椎体骨折评估软件发现椎体骨折。根据骨密度T值分为T＞－2．5组和T≤－2．5组,年龄分为50～59岁组、60～69岁组和≥70岁组,绝经年限分为0～9年组、10～19年组和≥20年组,分析骨密度、年龄和绝经年限对椎体骨折率的影响,为了了解VFA对椎体骨折的评估的一致性,由同一位研究人员间隔2个月后再次对影像进行评估,采用Kappp统计方法行重复性检验。结果骨密度T＞－2．5患者椎体骨折率为21．6％,T≤－2．5患者椎体骨折率34．8％;各年龄组椎体骨折率：50－59岁为12．5％,60－69岁为25．6％,≥70岁为44．8％;绝经年限长的女性椎体骨折率显著升高。重复性检验提示一致性强度极强。结论对绝经后女性做骨密度检测时,同时进行椎体骨折评估有利于提高椎体骨折和骨质疏松诊断率。     

金天格胶囊对绝经后膝骨关节炎OPN和MMP3表达的影响

目的：探讨金天格胶囊对绝经后膝骨关节炎患者血清中骨桥蛋白（OPN）和基质金属蛋白酶3（MMP－3）表达的影响。方法2013年1月－12月将180例绝经后膝骨关节炎妇女随机分为金天格胶囊组（ A组）、盐酸氨基葡萄糖胶囊组（ B组）、仙灵骨葆胶囊组（C组）,每组60例,采用酶联免疫吸附试验测定各组血清MMP－3、OPN、雌二醇（E2）、Ⅰ型胶原C端肽（CTX）和Ⅰ型胶原N端前肽（PINP）水平。结果 A组和B组在治疗后4周和6周JOA和VAS评分明显优于C组（P＜0．05）,B组在治疗后4周的MMP－3表达改善明显（P＜0．05）,优于其他两组。治疗后6周,A组OPN和MMP－3表达水平改善明显（P＜0．05）,优于其他两组。同时,A组和C组CTX和PINP水平明显改善（P＜0．05）,优于B组。结论金天格胶囊能有效改善绝经后骨性关节炎的症状,可能通过调节OPN和MMP3的复合体表达,改善关节软骨的功能实现这一目的。     

Spanish Menopause Society position statement: Use of denosumab in postmenopausal women

Denosumab is a new drug developed for the treatment of osteoporosis. Moreover, increasing evidences link denosumab with benefits in cancer, an area of interest for those in charge of the postmenopausal health. Denosumab has shown efficacy in the control of bone loss associated with hypogonadic states created by chemotherapy in breast and other cancers. Moreover, some studies reveal efficacy in reducing the progression of metastases. A panel of experts from the Spanish Menopause Society has met to develop usage recommendations based on the best available evidence.     

Association between bone mineral density and lumbar disc degeneration

Objectives

Higher vertebral bone mineral density (BMD) has been found to be related with lumbar disc degeneration (LDD), while relationship between femoral neck BMD and LDD remains controversial. The aim of our research was to study the relationship between LDD and BMD of the lumbar spine and femoral neck.

Study design

The study population consisted of 168 postmenopausal women (aged 63.3–75.0 years, mean 68.6 years) from the prospective OSTPRE and OSTPRE-FPS study cohorts. The severity of LDD was graded from T2-weighted MRI images using the five-grade Pfirrmann classification. Four vertebral levels (L1-L4) were studied (total 672 discs). The association between lumbar BMD and Z-score and the severity of LDD was studied separately for each vertebral level with AN(C)OVA analysis, using potential confounders as covariates.

Results

Higher lumbar BMD and Z-score were associated with more severe LDD at all studied levels (L1-L4): between L4-L5 disc and L4 BMD (p = 0.044) and L4 Z-score (p = 0.052), between L2-L3 disc and L3 BMD (p = 0.001) and at all other levels (p < 0.001). The mean degeneration grade of the studied discs was associated with the mean L1-L4 BMD and Z-score (p < 0.001). Statistical significance of any result did not alter after controlling for confounding factors. There was no significant association between femoral neck BMD and LDD.

Conclusions

Higher lumbar BMD/Z-score were associated with more severe LDD. There was no significant association between femoral neck BMD and disc degeneration. Femoral neck BMD may be a more reliable measurement for diagnosing osteoporosis in postmenopausal women with degenerative changes in the lumbar spine.     

Qualitative cross-cultural exploration of vaginal bleeding/spotting symptoms and impacts associated with hormone therapy in post-menopausal women to inform the development of new patient-reported measurement tools

Objectives

To understand the vaginal bleeding/spotting experiences of postmenopausal (PM) women taking estrogen plus progestin therapies (EPT) and develop measures to assess these symptoms and their impact on women's daily lives in four countries.

Design

(1) Concept elicitation interviews were conducted with PM women in the US (n = 14), Italy (n = 15), Mexico (n = 15) and China (n = 15) to explore vaginal bleeding/spotting symptoms associated with EPT. The Post-Menopausal Bleeding Questionnaire (PMBQ) was also debriefed to evaluate understanding and comprehensiveness. (2) Based on concept elicitation, a single item electronic daily diary was developed and the PMBQ modified to form a 12-item impact measure. (3) The measures were pilot-tested and then cognitively debriefed with US women receiving EPT. All qualitative data was subject to thematic analysis.

Main outcome measures

The Vaginal Bleeding/Spotting Daily Diary, (VBS-DD) and Post-Menopausal Bleeding Impact Questionnaire (PMBIQ) were developed in this study.

Results

Concept elicitation identified vaginal bleeding and spotting as important symptoms for women taking EPT, impacting their emotional wellbeing, social life, ability to move freely, clothing and sexual activity. Based on pilot testing and cognitive debriefing, women demonstrated good understanding of the VBS-DD and the PMBQ was reduced to 10 items due to conceptual redundancy.

Conclusions

Women taking EPT in the US, China, Mexico and Italy reported vaginal bleeding/spotting symptoms that have a detrimental impact on their quality of life. Two new measures were developed to assess the severity and impact of vaginal bleeding/spotting specific to EPT. This work highlights the need for EPT-related symptoms to be a part of treatment decision-making.     

Feasibility and preliminary efficacy of a hypopressive exercise program on postmenopausal cancer survivors: A pilot study

BackgroundCancer-related fatigue (CRF) is a common symptom during and after cancer treatment that negatively affects the patient's quality of life. Exercise is one of the most effective non-pharmacological treatments for CRF. Multimodal exercise therapy programs that include hypopressive exercises, relaxation and myofascial release may be beneficial for CRF. The aim of this pilot study was to evaluate the feasibility and efficacy of a multimodal program on CRF and lower limb functional strength in postmenopausal women diagnosed with cancer.Methods7 postmenopausal women (age = 55.28 years; BMI = 26.05 kg/m2) who had a cancer diagnosis participated in a supervised and progressive 55-min class once per week for 12-weeks. CRF was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer Related Fatigue 12 and lower limb strength was assessed with the sit and stand test.ResultsNo adverse events were reported during the training period and all participants completed the exercise protocol. There was a significant increase (p = 0.01) in lower limb functional strength (pre: 19.60 (SD = 2.19) vs post: 24.60(SD = 2.19)) with an effect size of d = 2.28 and a decrease in CRF (p = 0.245) (pre: 29.36 ± 24.42; post: 17.85 ± 14.23) with a trivial effect size (d < 0.5).ConclusionsThese preliminary findings indicate that a supervised once per week multimodal program that includes hypopressive exercises for postmenopausal cancer survivors increased lower limb functional strength without exacerbating their CRF. These findings support further randomized trials of hypopressive training programs on patients with cancer.     

绝经对经皮冠状动脉介入治疗冠心病影响分析

目的探讨绝经对经皮冠状动脉介入治疗冠心病的影响。方法选取2010年1月至2014年12月首次行冠状动脉造影提示冠状动脉病变并行经皮冠状动脉介入治疗(PCI)的绝经女性患者10 746例,分为A组(绝经时间>5年,n=5 573)与B组(绝经时间≤5年,n=5 173)。记录随访期间的主要心脑血管不良事件、死亡、靶血管再次血运重建、出血事件等发生率。采用多因素Logistic回归分析患者死亡的影响因素。结果 A组随访30 d及1年的主要心脑血管不良事件、死亡发生率均高于B组(P<0.05)。多因素Logistic回归分析显示,病变血管支数、肾小球滤过率是影响A组患者死亡的独立危险因素。结论绝经时间>5年的女性患者行PCI治疗冠心病预后差于绝经时间≤5年的女性,病变血管支数、肾小球滤过率是其死亡的独立危险因素。