基于“治未病”思想探讨骨质疏松性脊柱骨折的防治策略

骨质疏松症属于骨科慢性、增龄性疾患，病变呈现渐进性的动态变化，后期极易发生脊柱骨折。针对这一发病特点，基于中医"治未病"思想，从"未病先防，降低骨折发生风险"、"已病防变，选择最佳治疗方案"、"后期巩固，提高患者生活质量"三方面探讨骨质疏松性脊柱骨折的防治，从而达到减少脊柱骨折的发生，减轻患者疼痛症状，降低致畸、致残率的目的。     

骨质疏松与认知障碍关系的研究进展

近年研究显示，在老年共病患者中，骨质疏松与认知障碍共病的发病率逐年上升，表现为跌倒发生率高，骨折风险增加，从而引起致残、致死率升高，严重危害共病患者的健康和生活质量，同时也给家庭和社会带来沉重的经济负担，成为目前社区慢性病管理中较为棘手的问题。本文对骨质疏松与认知障碍关系的进展进行综述。重点讨论骨质疏松与认知障碍的共病机制、共病临床危险因素及共病临床特征。发现骨质疏松与认知障碍关系密切，并严重危害老年人群健康。希望本文能为探索骨质疏松与认知障碍共病新的风险因素提供思路，为有效预防和管理骨质疏松与认知障碍共病提供帮助。     

绝经后骨质疏松症与血管紧张素II的相关因素分析

目的：探讨血管紧张素II对骨质疏松症患者与社区正常人群骨质疏松与骨质疏松性骨折风险的相关性。方法：对骨质疏松症患者与社区正常人群实施双能X线骨密度测定,并采用酶联免疫吸附试验进行血管紧张素II的测定。进一步通过统计学分析对相关性进行了验证。结果：骨质疏松患者骨密度水平与血25羟维生素D水平和血管紧张素II水平相关,骨质疏松患者骨密度低、且骨折风险高于对照组。单因素分析显示血管紧张素II影响骨质疏松患者的骨密度与骨折风险。结论：进一步深入研究肾素血管紧张素系统相关组分对骨质疏松发病机制中的作用对疾病预防和治疗有着深远意义。     

人工智能辅助诊断骨质疏松及预测骨折的研究进展

骨质疏松症是一种与年龄相关的全身代谢性骨病,以骨量下降及骨微结构改变为主要特点,其起病隐匿、早期缺乏明显症状,随疾病进展易发生脆性骨折等严重并发症,若不及时发现,将给个人、家庭及社会带来巨大负担。目前骨质疏松症早期筛查及骨折预防工作开展仍不充分,人工智能技术与影像学数据结合有助于早期筛查骨质疏松症,预测患者骨质疏松性骨折风险。本文论述了人工智能在骨质疏松症影像辅助诊断及预测骨质疏松性骨折中的研究新进展。     

住院患者骨质疏松知识知晓与需求状况调查

目的了解不同年龄段住院患者对骨质疏松知识知晓与需求状况,为开展针对性健康教育提供依据。方法对230例住院患者采用自行设计的与骨质疏松相关知识问卷,进行认知程度的调查。结果不同年龄段、性别患者对骨质疏松相关知识的知晓差异无统计学意义（P〉0.05）;患者对骨质疏松知识认知情况的调查显示,不知道骨质疏松症与某些疾病有关者占85.21%,不知道如何诊断骨质疏松症者占80.0%,不知道骨质疏松症与生育绝经有关者占77.39%。多数患者希望通过医务人员讲解、医院印制宣传单张的途径获取骨质疏松症资料。结论各年龄段患者均对骨质疏松知识认识不足,应加大对骨质疏松症诊断、与骨质疏松症有关疾病、绝经与骨质疏松症相关等知识的普及,对不同年龄段患者采用针对性健康教育,教育方式以医务人员讲解、医院印制宣传单张为主,会取得较好效果     

中医治未病原理在骨质疏松防治中的应用

目的 探讨利用中医治未病原理,采取事先干预的方法对老年人骨质疏松症的认知情况以及进行骨密度筛查行为的影响。方法 将300名研究对象随机分为对照组和实验组,每组150名,对照组采用常规措施进行干预；实验组采用中医治未病方法进行干预,重点评估中医治未病对老年人(被教育者)骨质疏松相关知识的知晓情况以及进行骨密度筛查行为的影响。结果 实验组人员对骨质疏松的认知情况以及进行骨密度筛查行为的比例明显优于对照组。 结论 采用中医治未病方法干预能显著提高老年人对骨质疏松的认知情况,从而规范地进行骨密度检测,做到早防早治。     

骨质疏松症与痴呆关系的研究进展

近年来研究显示骨质疏松症与痴呆密切相关。骨质疏松症人群痴呆发病风险高、发病率高;另一方面,痴呆人群骨质疏松症发病率高,发生骨质疏松性骨折风险大,致残、致死率高。骨质疏松症和痴呆在危害患者健康的同时,也给照护家庭及社会带来很大负担,成为世界范围内的慢性病研究热点问题。该文对骨质疏松症与痴呆关系的研究进展进行综述,重点讨论痴呆对骨质疏松症及骨质疏松性骨折的影响,也对相关骨-脑轴的病理生理机制进行综述,希望能为骨质疏松症伴痴呆的研究提供新思路。     

阿仑膦酸钠治疗糖尿病合并骨质疏松40例临床疗效分析

目的分析阿仑膦酸钠治疗糖尿病合并骨质疏松患者的临床疗效。方法对本院收治的40例糖尿病合并骨质疏松患者进行对症治疗,以阿仑膦酸钠治疗骨质疏松症状,6个月后,观察药物治疗患者骨质疏松的临床疗效。结果经对症治疗后,40例患者的疼痛症状明显改善(P<0.01),骨密度检测结果显示腰椎、股骨颈、股骨粗隆、化石三角区的骨密度值增加(P<0.05),且无严重不良反应。结论对于合并骨质疏松的糖尿病患者,积极采取对症治疗措施,能够明显改善骨质疏松症状,有效预防因骨质疏松导致的其他骨科疾病。     

成都地区女性骨质疏松性骨折的相关危险因素研究

目的骨质疏松症是一种最常见的骨骼疾病,骨折是骨质疏松最严重的后果,了解女性骨质疏松性骨折的危险因素,对于女性骨质疏松的预防有重要的意义。方法通过调查在成都市第二人民医院及四川大学华西附四院等三甲医院就诊经DXA或X线确诊的非骨折骨质疏松症(174例)及骨质疏松性骨折(222例)女性患者的生活习惯,共396例,进行分析。结果获取问卷396份,有效问卷396份,有效回收率100%。年龄44～97岁,平均(70.58±8.715)岁。年龄、膳食情况、起床时间、牙齿松动脱落、职业的体力要求、经常腰背部疼痛、舞蹈对于骨质疏松骨折有统计学意义(P<0.05)。结论成都地区女性骨质疏松骨折与年龄、职业、饮食情况等生活方式有关,提倡早起,正确体育方式,均衡饮食、保持牙齿的健康有重要意义。     

骨质疏松患者骨折后再骨折的风险因素临床分析

目的：研究分析骨质疏松患者骨折后再骨折的风险因素,旨在为临床防治骨质疏松患者再骨折风险提供依据。方法：取我院收治的74例老年骨质疏松症患者为本次研究对象,根据骨折类型将其分为对照组（常规骨折40例）与实验组（再骨折34例）,回顾性分析患者一般资料以及临床资料,综合分析其发生再骨折的相关影响因素。结果：BMD-T值、既往脊柱或者髋部骨折病史、女性、高龄、平卧至站位转换时间＞20秒为骨质疏松患者再骨折的风险相关因素。结论：骨质疏松骨折初次发病患者仍然具有较高的再骨折发生率,应告知患者定期接受复查以评估骨密度,并做好相应的预防措施,特别是既往有脊柱或者髋部骨折病史的高龄女性患者,应积极服用药物,进行骨质疏松治疗,并开展针对性的运动协调技能以及防跌倒训练,有效预防再骨折。     

Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 3. Effects of ovarian hormone therapy on skeletal and extraskeletal tissues in women.

OBJECTIVE: To present recent evidence on the use of ovarian hormone therapy (OHT) for osteoporosis and outline safe and effective regimens. OPTIONS: Estrogen alone, estrogen and progestins, progestins alone; various treatment regimens. OUTCOMES: Fracture and loss of bone mineral density in osteoporosis; increased bone mass, prevention of fractures and improved quality of life associated with OHT. EVIDENCE: Relevant clinical studies and reports, including the Nurses' Health Study and the Post-menopausal Estrogen/Progestin Interventions (PEPI) Trial, were studied with emphasis on recent prospective, randomized, controlled trials. Current clinical practice was determined by survey. VALUES: Reducing fractures, increasing bone mineral density and minimizing side effects of treatment were given a high value. BENEFITS, HARMS AND COSTS: Proper management of osteoporosis minimizes injury and disability, improves quality of life and reduces the personal and social costs associated with the condition. OHT is the front-line pharmaceutical therapy for prevention and treatment of osteoporosis in post-menopausal women. In those who are able and willing to comply with therapy, OHT prevents bone loss and fractures. Hormone therapy may also decrease risk of coronary artery disease. Cyclic progestin protects against endometrial cancer in patients receiving estrogen. Potential harms include breast cancer and endometrial cancer related to dosage and duration of therapy. Mastalgia and especially resumption of menstrual bleeding affect compliance. RECOMMENDATIONS: Use of OHT should be considered as early as possible in the perimenopausal period for women at increased risk of osteoporosis. Guidelines are provided for assessment of osteoporosis risk. Physicians and their patients should take into account the absolute and relative contraindications to OHT. Women with a uterus should be given estrogen in combination with a progestin. Ideally, therapy would be continued for a minimum of 10 years beyond menopause for maximum bone protection. Women using OHT should be carefully monitored and evaluated for possible adverse events. This should include regular screening mammography, breast examination and, for some, endometrial surveillance. Specific dosages and treatment regimens are outlined.     

Clinical practice guidelines for the diagnosis and management of osteoporosis. Scientific Advisory Board, Osteoporosis Society of Canada.

OBJECTIVE: To recommend clinical practice guidelines for the assessment of people at risk for osteoporosis, and for effective diagnosis and management of the condition. OPTIONS: Screening and diagnostic methods: risk-factor assessment, clinical evaluation, measurement of bone mineral density, laboratory investigations. Prophylactic and corrective therapies: calcium and vitamin D nutritional supplementation, physical activity and fall-avoidance techniques, ovarian hormone therapy, bisphosphonate drugs, other drug therapies. Pain-management medications and techniques. OUTCOMES: Prevention of loss of bone mineral density and fracture; increased bone mass; and improved quality of life. EVIDENCE: Epidemiologic and clinical studies and reports were examined, with emphasis on recent randomized controlled trials. Clinical practice in Canada and elsewhere was surveyed. Availability of treatment products and diagnostic equipment in Canada was considered. VALUES: Cost-effective methods and products that can be adopted across Canada were considered. A high value was given to accurate assessment of fracture risk and osteoporosis, and to increasing bone mineral density, reducing fractures and fracture risk and minimizing side effects of diagnosis and treatment. BENEFITS, HARMS AND COSTS: Proper diagnosis and management of osteoporosis minimize injury and disability, improve quality of life for patients and reduce costs to society. Rationally targeted methods of screening and diagnosis are safe and cost effective. Harmful side effects and costs of recommended therapies are minimal compared with the harms and costs of untreated osteoporosis. Alternative therapies provide a range of choices for physicians and patients. RECOMMENDATIONS: Population sets at high risk should be identified and then the diagnosis confirmed through bone densitometry. Dual-energy x-ray absorptiometry is the preferred measurement technique. Radiography can be adjunct when indicated. Calcium and vitamin D nutritional supplementation should be at currently recommended levels. Patients should be counselled in fall-avoidance techniques and exercises. Immobilization should be avoided. Guidelines for management of acute pain are listed. Ovarian hormone therapy is the therapy of choice for osteoporosis prevention and treatment in postmenopausal women. Bisphosphonates are an alternative therapy for women with established osteoporosis who cannot or prefer not to take ovarian hormone therapy.     

骨质疏松症的最新预防措施

骨质疏松症是一个重要的初级护理健康问题,是全球性的一个庞大且不断增长的医疗负担,临床医师对此疾病采取的有效治疗措施不一致。有一些专家对患者是否需要进行骨密度的测量持不同的意见。本文在大量阅读最新外文文献的基础上对骨质疏松症的预防措施进行了系统的归纳和总结。对骨质疏松症实施早期有效的干预措施和预防还尚未得到普遍推广,我们应对那些具有高风险性骨折的患者提高关注度,特别是那些发生脆性骨折的患者。在生活方式层面上,骨骼健康与其他方面的健康具有协同作用,因此应尽可能彻底解决这些生活方式上面的问题。     

Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 2. The use of bone density measurement in the diagnosis and management of osteoporosis.

OBJECTIVE: To determine the best method of diagnosing osteoporosis and determining fracture risk and to promote standards in the use of bone densitometry and the reporting of results. OPTIONS: Methods of bone mineral density measurement: dual-energy x-ray absorptiometry (DXA), radiographic absorptiometry, single-photon absorptiometry, dual-photon absorptiometry, quantitative computed tomography, quantitative ultrasound, neutron activation analysis. The options of using bone densitometry in individual patient management and as a mass screening tool are also considered. OUTCOMES: Appropriate use of densitometry to promote accurate diagnosis and assessment of fracture risk and timely, appropriate treatment. EVIDENCE: Relevant clinical studies and reports were examined. Clinical practice in Canada was also considered. VALUES: Accurate assessment of osteoporotic fracture risk and diagnosis of osteoporosis and assuring low exposure to medical radiation were given a high value. BENEFITS, HARMS AND COSTS: Early diagnosis through bone density measurement allows proper management of osteoporosis to minimize injury and disability, improve quality of life and reduce the personal and social costs associated with the condition. Potential harms include radiation exposure and cost. The harms and costs of appropriate use of DXA are minimal compared with the harms and costs associated with osteoporosis. RECOMMENDATIONS: Bone mineral density should be measured only to assist in making a clinical management choice. DXA is the best method of measuring bone density and, thus, the best available indicator of osteoporotic fracture risk. Plain radiographs may supplement DXA if there is a specific reason for their use. Measurement of the lumbar spine and femoral neck is standard, but a different site or a single measurement is recommended in specific cases. Unless accelerated bone loss is suspected, DXA should be repeated every 2 to 4 years for patients receiving ovarian hormone therapy and 1 to 2 years for patients undergoing bisphosphonate therapy. Measurements and reporting of results must be standardized. Reports should refer to the World Health Organization's recommended definitions of osteopenia and osteoporosis and provide actual measurement and its relation to peak bone mass.     

质子泵抑制剂引发骨质疏松的病变机制和治疗策略

质子泵抑制剂的长期使用会抑制机体对钙的吸收,从而干扰骨代谢、导致骨质疏松或骨折,对老年患者尤其明显。长期使用质子泵抑制剂导致骨折的风险可能与用药剂量和时间相关。目前对预防和治疗质子泵抑制剂引起的骨质疏松主要根据原发性骨质疏松的治疗原则而采取措施,对长期使用质子泵抑制剂的患者应补充钙剂和维生素D以预防骨质疏松,对于已导致的骨质疏松的患者可根据具体病情选择双膦酸盐、降钙素、雌激素和甲状旁腺类似物等治疗。本文对质子泵抑制剂引发骨质疏松的机制及预防和治疗策略的研究进展进行综述。     

The clinical role of quantitative ultrasound in assessing fracture risk and bone status

Quantitative ultrasound (QUS) analysis of calcaneal bone is useful to quantify fracture risk, and in monitoring response to treatment and identifying bone changes associated with disease and medication. However, diagnosis of osteoporosis by QUS measurements remains contentious, but the problems are due to the limitations of the present T-scores rather than the technique. QUS offers the potential for the widespread detection of low bone mass and subsequent management and prevention of fracture.     

What is osteoporosis?

Osteoporosis is a very common disorder, which results in an increase in fracture risk. The annual cost attributable to hip, vertebral, and wrist fractures in England and Wales is pound 1.7 billion. Significant mortality and morbidity are associated with osteoporotic fractures. The method that is most widely used for the diagnosis of osteoporosis is dual energy x-ray absorptiometry. The aim of prevention and treatment of osteoporosis is to prevent the occurrence of future fractures. Lifestyle changes should be encouraged in high risk patients. Pharmacological treatments include the bisphosphonates, hormone replacement therapy, selective oestrogen receptor modulators, calcitonin, the 1-34 fragment of parathyroid hormone, calcium and vitamin D supplements, and calcitriol.     

骨质疏松的健康管理发展现状及挑战

骨质疏松是引起老年人骨质疏松性骨折的主要原因,严重影响患者的生活质量、增加经济负担。引起骨质疏松的主要原因包括骨密度下降、骨组织显微结构的破坏及骨强度减弱等。目前针对骨密度下降这一原因的主要治疗手段是使用抗骨吸收药物(如双膦酸盐类药物、降钙素)、促进骨形成药物(甲状旁腺激素)以及某些中药等,然而药物治疗效果并不理想。尽管可以通过手术进行干预,但依旧存在诸多术后并发症。近年来随着三级预防思想的树立,从一级预防的角度针对高危人群来进行骨质疏松的健康管理成为当前预防骨质疏松症及相关骨折的主流方法。本文主要从骨质疏松健康管理的来源与患者和医务人员的相互关系2个方面简要介绍骨质疏松健康管理的一些措施及其在当前发展中所遇到的挑战。此外,绝经后女性的骨质疏松症主要是由于雌激素减少导致骨密度下降,因而在预防措施上与老年性骨质疏松有所不同,予以分开阐述。进一步的发展目前需要解决我国三级诊疗体系尚不完善的现状并制定出更科学的骨质疏松评定标准以及加强患者对健康管理方案中饮食和生活习惯的依从性等。此外,从雌激素的类型、剂量、持续使用时间以及个体情况等方面改善并发展雌激素在围绝经期女性骨质疏松健康管理中的应用,最终发挥健康管理在骨质疏松症及相关骨折中的一级预防作用。      

老年骨质疏松症病因病机及防治概述

随着中国社会人口老龄化情况加剧,老年骨质疏松症的防治已经成为亟待解决的问题。文章系统、全面地阐述了中医对老年骨质疏松症的认识,包括病名、病因病机、辨证分型等多个方面,该病在中医属于“骨痹”“骨痿”“骨枯”等范畴,是指随着年龄增长,肢体筋脉痹阻萎软,骨量减少,骨骼空虚而发生的疾病,是内外因综合作用的结果。通过查阅相关文献,文章总结了近年来中医药防治老年骨质疏松症的研究概况,认为中医药在老年骨质疏松症的防治方面具有独特优势,能够改善患者临床症状,增加骨量,降低骨折风险,提高老年人的生活质量,并为现代中医药防治老年骨质疏松症提供更多的理论依据。