老年骨质疏松症现状及进展

老年性骨质疏松症以骨矿含量下降,骨微细结构破坏为病理特征。男性峰值骨量高于女性,出现骨丢失的年龄迟于女性,而且雄激素水平的下降是“渐进式”,而非“断崖式”,故老年男性骨丢失的量与速度都低于老年女性,老年男性骨质疏松的程度轻于女性。老年骨质疏松症的诊断基于全面的病史采集、体格检查、骨密度测定、影像学检查(X线及QCT)及必要的生化测定。在使用基础用药的基础上(钙剂和维生素D),治疗骨质疏松症的药物可分为抑制骨吸收药物和促骨形成药物。抑制骨吸收药物包括双膦酸盐、雌激素替代疗法、选择性雌激素受体调节剂(SERM)、地舒单抗、降钙素等等。促骨形成药物包括甲状旁腺激素(PTH)类似物和骨硬化蛋白抑制剂。序贯和组合使用抗骨质疏松药物,例如从促骨形成药物转换为抑制骨吸收药物,可能提高抗骨质疏松疗效。该文将总结老年性骨质疏松症的流行病特点、分子机制、诊断、目前治疗骨质疏松症的药物及联合或序贯用药策略。     

中药内治法治疗骨质疏松症研究进展

骨质疏松症(OP)是以骨的微观结构改变,致使骨的脆性增加并易于发生骨折的一种全身性骨骼疾病[1],其随着年龄的增长患病概率增高,是中老年人常见病、多发病,尤以女性为多[2]。目前,全世界约有2亿多患者,严重危害老年人的健康,也给社会带来了巨大负担。骨质疏松症的防治已成为骨科、风湿病和老年学科的重要课题。临床上西医多使用雌激素、钙剂、活性维生素D、降钙素和氟化物等药物治疗,     

骨质疏松治疗的新进展(二)

就促进骨形成药物、钙剂及维生素D、运动锻炼及外科手术治疗骨质疏松症的进展作一综述。     

替勃龙联合钙剂治疗老年女性骨质疏松症的临床观察

目的探讨替勃龙联合钙剂治疗老年女性骨质疏松症的临床疗效。方法选取我院2017年1月～2018年3月收治的老年女性骨质疏松症患者64例,随机分为对照组与观察组各32例,对照组采用钙剂治疗,观察组在对照组基础上联合替勃龙进行治疗,比较两组患者临床效果。结果两组骨密度水平在治疗后均得到明显改善,且观察组的改善程度较对照组明显,差异有统计学意义(P0.05);观察组骨代谢指标显著优于治疗前,差异有统计学意义(P0.05),对照组治疗前后骨代谢指标比较,差异不显著(P0.05);观察组临床总有效率为84.38%,显著高于对照组的56.25%,差异有统计学意义(P0.05)。结论替勃龙联合钙剂治疗老年女性骨质疏松症,临床疗效显著,可有效提高患者骨量,加强骨代谢调节作用,值得临床推广应用。     

钙剂在绝经后骨质疏松症防治中的作用

妇女绝经后骨吸收大于骨形成，骨密度以每年2％～3％的速度减少，最后形成骨质疏松。由于中国居民从膳食中得到的钙量严重不足，钙剂补充成为预防绝经后骨质疏松的必要条件，钙剂的预防作用主要包括提高骨峰值和减少骨丢失，在绝经前或绝经早期可单独补充钙剂，在绝经晚期必需加用维生素D以增加钙的吸收和利用。钙剂在绝经后骨质疏松治疗中是一线治疗药物的必需的辅助药物，但不是一线治疗药物。     

降钙素改善老年骨质疏松症及椎管狭窄症疼痛

对103例老年骨质疏松症及椎管狭窄症患者应用鲑鱼降钙素治疗4周,同时服用钙剂及活性维生素D,重症疼痛者辅助局部封闭及理疗及口服药物治疗。结果表明降钙素(本组均为鲑鱼降钙素)与钙剂等方法联合应用在治疗老年性骨质疏松症、椎管狭窄症中疼痛和延长神经性跛行的行走距离上疗效显著     

鲑鱼降钙素联合护理干预治疗老年骨质疏松症60例疗效分析

目的:探讨鲑鱼降钙素联合护理干预对老年骨质疏松症患者骨痛及骨密度(BMD)的影响.方法:将120例老年骨质疏松症患者随机分为观察组和对照组各60例,对照组给予钙剂及维生素D药物治疗,观察组在此基础上加用鲑鱼降钙素及护理干预.比较两组干预前骨痛程度及BMD、治疗1个月后骨痛程度及治疗6个月后BMD变化.结果:治疗1个月后观察组骨痛程度改善明显优于对照组(P＜0.05),治疗6个月后观察组骨密度较对照组明显提高(P＜0.05).结论:鲑鱼降钙素联合护理干预能明显提高老年骨质疏松症患者的BMD,明显改善骨痛症状.     

绝经期骨质疏松症的中西医结合治疗

随着全球人类年龄趋向老化，以及对绝经后妇女生理、病理改变的关注，人们对绝经期骨质疏松症越来越引起重视，因此就诊的此类病人增多，临床上发现绝经期骨质疏松症的发病率比同年龄男性高达6倍。由于雌激素的分泌不足是导致绝经期骨质疏松症的主要病因，钙的吸收不足及老年肾气不足是引起此症的重要原因。笔应用激素替代、补充钙剂和维生素D、抑制骨的吸收及中药补益肾气治疗此症20例，收到满意疗效。     

中药补肾活骨方对去势骨质疏松大鼠骨代谢的影响(英文)

背景:中药补肾活骨方可有效防治骨质疏松症,但其具体的药理学机制仍不是很清楚。25-羟基维生素D3和1,25-二羟基维生素D3是调节骨吸收与骨形成的重要的偶联因子。目的:观察补肾中药对去势骨质疏松大鼠骨密度、骨生物力学、血清及肝肾组织中25-羟基维生素D3和1,25-二羟基维生素D3水平的影响。方法:健康雌性SD大鼠108只随机等分为假手术组、模型组和治疗组。后2组摘除双侧卵巢,导致雌激素缺失,从而诱导骨质疏松症模型。治疗组大鼠造模后以中药补肾活骨方2mL灌胃,2次/d。结果与结论:与模型组相比,治疗组股骨头骨密度明显提高(P<0.05),最大应力和最大负荷指数明显增强(P<0.05),血液、肝脏和肾脏组织中25-羟基维生素D3和1,25二羟基维生素D3水平明显提高(P<0.05);且接近于假手术组(P<0.05)。提示补肾中药在雌激素缺失早期即可在分子水平上调节25-羟基维生素D3和1,25-二羟基维生素D3的表达水平,激活骨代谢提高骨密度增强骨质量达到预防骨质疏松的作用。     

老年2型糖尿病患者骨健康及跌倒风险因素分析

目的探讨老年2型糖尿病患者骨密度、下肢肌力、平衡能力与个体活动以及钙剂和维生素D补充治疗的相关性。方法采用超声骨密度仪对120例糖尿病患者（糖尿病组）和60例体检健康者（对照组）的骨密度进行检测;通过起立行走、站起坐下及直线行走步态实验评估糖尿病组患者下肢肌力和平衡力,以问卷方式调查个体活动及钙剂和/或维生素D补充情况,分析其与骨密度、肌力及平衡力的关系。结果糖尿病组患者骨密度（-1.9±0.7）较对照组（-1.1±0.4）降低（P〈0.05）,且骨密度随年龄增长而下降,糖尿病组下降更明显（P〈0.05）;糖尿病组患者下肢肌力（起步行走、站起坐下时间）（（12.0±4.3）s、（9.8±2.7）s）、平衡力（3/8）较对照组（（10.5±2.7）s、（8.3±2.4）s、7/8）降低（P〈0.05）,年龄≥65岁者下肢肌力（起步行走、站起坐下时间）、平衡力（（13.6±4.9）s、（12.4±4.2a）s、2/8）较〈65岁者（（11.6±3.5）s、（10.7±3.3）s、4/8））下降更明显（P〈0.05）;糖尿病组户外活动频率、钙剂和/或维生素D的补充与骨密度、下肢肌力、平衡力呈正相关（r=0.24,P=0.04;r=0.39,P=0.03）。结论户外活动与钙剂和/或维生素D补充治疗与老年2型糖尿病患者骨密度、下肢肌力和平衡能力有关;改善活动行为,补充钙剂和/或维生素D有助于降低该人群骨质疏松发病率及跌倒风险。     

单一钙制剂与钙制剂联合维生素D干预治疗老年男性骨质疏松症疗效的随机对照临床研究

目的探讨单一钙制剂和钙制剂联合维生素D(Vd)治疗老年骨质疏松的疗效。方法共纳入380例男性老年骨质疏松症患者,随机分为单纯补钙组(单一钙制剂)和联合补钙组(钙制剂+Vd),各190例,观察治疗前和治疗后个体的骨密度和骨质疏松各项指标。结果在治疗3个月后,两组老年患者中全身腰椎2~4、股骨颈和大转子部位的骨密度(BMD)均有所增加,其中Vd+钙制剂组中各BMD与干预前相比有显著性差异(P0.05)。在6个月末两组之间BMD无显著差异,血清羟脯氨酸水平在Vd+钙组中显著降低(P0.05)。结论补充适宜的钙和Vd对于按男性老年骨质疏松的预防有一定作用,单纯补钙不如同时补充钙和Vd对体成分和BMD的改善效果明显。补钙的同时服用Vd可以显著提升体内的Vd水平和短期内骨组织的密度,预防老年人的骨钙流失。     

老年脑梗塞患者骨质疏松相关骨生化与骨转换指标的研究

目的研究老年脑梗塞患者骨质疏松相关骨密度、骨生化与骨转换等指标变化。方法应用骨密度仪对受试者足踝部进行骨密度（BMD）测定。应用偶氮胂Ⅲ法检测血钙与钼酸盐法检测血磷,应用双抗体夹心法检测血清25羟基维生素D3（25（OH）D3）、甲状旁腺素（PTH）、骨钙素（BGP）、1型胶原羧基末端肽（β-CTX）、1型前胶原氨基端肽（P1NP）和骨源性碱性磷酸酶（BALP）。结果 85例老年脑梗塞患者骨质疏松自我筛查（OSTA）指数属高风险22例,女性老年脑梗塞患者OSTA指数与男性比较差异有统计学意义（P〈0.05）,OSTA指数风险分组与骨密度相关（P=0.01）。另外,男性与女性老年脑梗塞患者血清25（OH）D含量与骨形成指标（PTH、BGP、P1NP和BALP）均具有相关性（P〈0.01）,女性患者血Ca2＋、血P3＋、25（OH）D3、PTH、BGP和P1NP高于男性,差异有统计学意义（P〈0.05-0.01）。结论老年脑梗塞患者普遍存在骨质疏松现象,且女性患者尤为严重,有必要进行骨质疏松综合干预治疗。     

中老年慢性肾病患者并发骨质疏松的相关因素分析

目的:分析慢性肾病并发骨质疏松的相关因素,为防治慢性肾病并发骨质疏松提供理论依据。方法:研究2016年7月至2017年7月我院收治的70例非透析慢性肾病患者的临床资料。采用双能X线骨密度仪测定患者骨密度值(BMD),并测定相关生化指标及骨代谢指标。根据慢性肾病患者的BMD,将其分为骨质疏松组(30例)和非骨质疏松组(40例)。比较两组患者的性别、年龄、病程、体重指数(BMI)、血钙、血磷、血清的骨碱性磷酸酶(BALP)、甲状旁腺激素(PTH)、维生素D、血肌酐、血清尿酸、肾小球滤过率(GFR)的差异并进行相关性分析。结果:根据WHO诊断标准,本研究中骨质疏松患者达42.86%,女性发病率为50.00%,而男性为32.14%。两组性别构成比无统计学差异(P>0.05)。两组比较,骨质疏松组年龄明显大于非骨质疏松组,病程显著长于非骨质疏松组,BMI低于非骨质疏松组,均具有统计学意义(P <0.05)。两组实验室指标比较,血钙、血磷、血肌酐、血清尿酸及GFR无显著差异(P>0.05);骨质疏松组BALP、PTH高于非骨质疏松组(P<0.05),而维生素D低于非骨质疏松组(P<0.05)。相关性分析显示, BMD与BMI、维生素D呈正相关(r=0.607,0.450,P<0.05);BMD与年龄、病程、BALP及PTH呈负相关(r=-0.581,-0.256,-0.383,-0.551,P<0.05);而BMD与与性别、血钙、血磷、血肌酐、血清尿酸及GFR无明显相关性(P>0.05)。结论:中老年慢性肾病患者具有较高的骨质疏松风险,女性骨质疏松发病率明显高于男性。年龄、病程、维生素D、BMI、 BALP及PTH是慢性肾病患者并发骨质疏松的相关因素,慢性肾病并发症与骨质疏松密切相关,临床中应引起重视。     

2型糖尿病患者骨密度与骨钙素变化研究

目的 :研究 2型糖尿病患者骨密度的变化以及与骨钙素和胰岛功能的关系。方法 :使用定量超声骨量 (QUS)分析系统测定 71例 2型糖尿病踝中部骨超声指数 (OSI) ,根据其测定结果将 2型糖尿病患者分为骨量正常组、骨量减低组和骨质疏松组 ,并与同年龄的正常对照组相比较。同时测定 2型糖尿病患者的血清骨钙素 (BGP)、C肽、血糖、血钙、血磷及血浆硷性磷酸酶等进行组间比较。结果 :2型糖尿病患者OSI低于对照组 ,差异显著 (P <0 .0 1)。 2型糖尿病BGP和C肽值三组间相比较差异显著 (P <0 .0 1)。结论 :2型糖尿病患者骨质疏松的发生比例高于正常人。骨密度降低者BGP和C肽呈同步降低 ,说明2型糖尿病患者的骨质疏松可能与胰岛功能降低有关。血浆骨钙素测定可以作为骨质疏松的监测指标之一。早期诊断糖尿病并及时予以有效的治疗 ,必要时早期使用胰岛素将可能会防止糖尿病患者骨质疏松的发生     

Non‐pharmacological means to prevent fractures among older adults

Bone fractures affecting elderly people are a true public health burden, because they represent one of the most important causes of long‐standing pain, functional impairment, disability, and death among this population. Compromised bone strength (osteoporosis) and falling, alone, or more frequently in combination, are the two independent and immediate risk factors of elderly people's fractures through which all the other, more distant risk factors, such as aging, inactivity, poor nutrition, smoking, use of alcohol, diseases, medications, functional impairments, and disabilities, operate. Of these two, falling, not osteoporosis, is the strongest single risk factor for a fracture. The most usual occurrence resulting in a fracture of an older adult is a ‘simple’ fall from standing height or less. Although in general terms this type of trauma is mild or moderate only (compared with, for example, motor vehicle collisions), to the specific injury site these traumas are high‐impact injuries often creating forces clearly exceeding the breaking strength of the bone. Therefore, fractures affecting elderly people should be called ‘fall‐induced high‐impact injuries’ instead of the commonly used, partly misleading terms of osteoporotic fractures or minimal‐trauma fractures. Prevention of elderly people's fractures consists of prevention of osteoporosis and of falling, and prevention of fractures using injury‐site protection. Concerning osteoporosis, maximizing peak bone mass and preventing bone loss by regular exercise, calcium, and vitamin D, and, treatment of established osteoporosis with bone‐specific drugs, have a strong scientific basis. In fall prevention, regular strength and balance training, reducing psychotropic medication, and diet supplementation with vitamin D and calcium have been shown to be effective. The multifaceted risk factor‐assessing and modifying interventions have also been successful in preventing falls among the older adults by simultaneously affecting many of the risk factors of falling. Finally, concerning injury‐site protection, padded strong‐shield hip protectors whose effectiveness is scientifically proven seem to be a promising option in preventing hip fractures.     

Osteoporosis Prevention: Narrowing the Gap Between Knowledge and Application

Osteoporosis is the most prevalent bone health issue for the elderly in the United States, creating huge economic, social, and emotional burdens in our older population. Despite proven strategies to prevent osteoporosis, primary care providers do not provide adequate osteoporosis prevention education. To address this problem, an evidence-based osteoporosis prevention intervention project was implemented to increase osteoporosis prevention education by providers at an urban community clinic. A preintervention and 6-month postintervention chart review showed significant improvement in osteoporosis risk assessment with recommendations for calcium/vitamin D as well as small gains in education on lifestyle modification.     

Non-pharmacological means to prevent fractures among older adults

Bone fractures affecting elderly people are a true public health burden, because they represent one of the most important causes of long-standing pain, functional impairment, disability, and death among this population. Compromised bone strength (osteoporosis) and falling, alone, or more frequently in combination, are the two independent and immediate risk factors of elderly people's fractures through which all the other, more distant risk factors, such as aging, inactivity, poor nutrition, smoking, use of alcohol, diseases, medications, functional impairments, and disabilities, operate. Of these two, falling, not osteoporosis, is the strongest single risk factor for a fracture. The most usual occurrence resulting in a fracture of an older adult is a 'simple' fall from standing height or less. Although in general terms this type of trauma is mild or moderate only (compared with, for example, motor vehicle collisions), to the specific injury site these traumas are high-impact injuries often creating forces clearly exceeding the breaking strength of the bone. Therefore, fractures affecting elderly people should be called 'fall-induced high-impact injuries' instead of the commonly used, partly misleading terms of osteoporotic fractures or minimal-trauma fractures. Prevention of elderly people's fractures consists of prevention of osteoporosis and of falling, and prevention of fractures using injury-site protection. Concerning osteoporosis, maximizing peak bone mass and preventing bone loss by regular exercise, calcium, and vitamin D, and, treatment of established osteoporosis with bone-specific drugs, have a strong scientific basis. In fall prevention, regular strength and balance training, reducing psychotropic medication, and diet supplementation with vitamin D and calcium have been shown to be effective. The multifaceted risk factor-assessing and modifying interventions have also been successful in preventing falls among the older adults by simultaneously affecting many of the risk factors of falling. Finally, concerning injury-site protection, padded strong-shield hip protectors whose effectiveness is scientifically proven seem to be a promising option in preventing hip fractures.     

Osteoporosis as a lifestyle-related disease

Although genetic factors determine the limits of peak bone mass, environmental factors can modify the outcome. Relation between lifestyle and osteoporosis is discussed, in terms of nutrition and habits. Significant link between calcium intake and bone mass has been reported. Although recommended daily allowance of calcium is 600 mg/day for adults, 850 mg/day or more shall be recommended later in life. Vitamin D insufficiency may lead to secondary hyperparathyroidism in the elderly, the condition that facilitates bone loss. Other nutrients that affect bone turnover include vitamin K, vitamin C, protein, potassium, salt, magnesium and phosphorus. Too much intake of caffeine or alcohol, as well as smoking is a risk factor of osteoporosis. Mechanical loading on the skeleton increases bone mass, therefore weight-bearing activity is recommended to gain or preserve bone mass.