沈阳地区2288例骨密度测定及骨质疏松症发病率分析

目的：观察沈阳地区健康人群骨密度（BMD）的变化规律及骨质疏松症的发病率，为骨质疏松症的防治提供参考依据。方法：采用GE，LUNAR公司生产的DEXA双能X线骨密度仪对沈阳地区2001～2005年来我院体检的2288例健康受试者进行BMD测定，以同部位、同性别峰值BMD减低2SD为诊断骨质疏松标准，按性别、年龄分组进行统计学分析。结果：沈阳地区男性BMD峰值在30～35岁，女性则在30岁左右，之后BMD开始下降，女性50岁后由于雌激素水平的下降，骨量快速丢失，致使此期男女BMD值差异更大（P〈0．05）。骨质疏松发病率女性高于男性，Ward’s区骨质疏松发生率女性明显高于男性。结论：本分析为沈阳地区骨质疏松症的诊断、防治提供了参考依据。     

骨质疏松症药物治疗的研究进展

０引言目前骨质疏松症治疗药物主要有三大类：即抗骨吸收药物、促骨形成药物以及促进骨矿化的药物，应用免疫学、中药及中西医结合方法防治骨质疏松症的临床基础研究也取得了较大进展。１抗骨吸收药物的研究进展目前抗骨吸收的药物主要有雌激素、降钙素及双膦酸盐。雌激素有抑制骨转换，抗骨吸收，促进钙吸收的作用，同时促进肾合成１，２５（OH）２D３，而间接促进骨吸收犤１犦。妇女绝经后，雌激素的缺乏导致骨吸收迅速增加，骨大量流失，有报道绝经后骨质疏松时骨组织I型胶原较正常组织增加３倍，而基质金属蛋白酶（MM－９）表达均较…     

雌激素与辛伐他汀序贯法干预对去势大鼠骨质疏松的治疗作用

背景:Frost根据骨重建的概念创建了骨重建干预理论--序贯疗法,即在骨吸收抑制剂之后可给予刺激骨形成的药物.目的:基于骨重建干预理论,序贯应用雌激素与辛伐他汀干预骨重建吸收期和形成期,观察其对去势大鼠骨质疏松的治疗作用.方法:3月龄雄性SD大鼠40只,以随机数字表法分为去势组与正常对照组.去势组切除双侧卵巢,正常对照组只进行下腹部皮肤单纯切开术.大鼠去势后1个月,将去势组随机分为3组:序贯组、雌激素组、去势对照组,并开始药物干预:序贯组,皮下注射苯甲酸雌二醇0.1 mg/kg,3 d给药1次,2周后,灌胃给予辛伐他汀5 mg/(kg·d)2周,停药5周,再应用辛伐他汀5 mg/(kg·d)灌胃2周;雌激素组,皮下注射苯甲酸雌二醇0.1 mg/kg,每3 d给药1次,连续用药11周;去势对照组,单纯的饲料喂养,无药物干预.11周后,双能X射线骨密度仪测定股骨骨密度,放射免疫法检测血清白细胞介素6、骨钙素水平.结果与结论:各治疗组大鼠股骨骨密度、骨钙素水平高于去势对照组(P<0.05),并且序贯组明显高于雌激素组(P<0.05).各治疗组白细胞介素6水平低于去势对照组(P<0.05),并且序贯组低于雌激素组(P<0.05).说明雌激素和辛伐他汀序贯疗法可以通过抑制骨吸收,促进骨形成有效地治疗骨质疏松.     

男性骨质疏松症的病因及特征

男性骨质疏松(osteoporosis,OP)的病因、发病机理和诊断与女性OP不同,男性病因主要有汹洒、过量使用糖皮质激素、性腺功能减退。骨量峰值是决定患OP危险的主要因素,雄激素在男性获得骨量峰值和维持骨质量起重要的作用,抗雌激素或雌激素缺乏也会影响男性获得适度骨峰值。男性OP的主要症状通常是骨质疏松性骨折和背部疼痛。雄激素、生长激素缺乏是男性OP的最主要病因;作为旁分泌激素,骨组织中产生的胰岛素样生长因子(insulinh-likegrowthfactorI,IGFI)受生长激素、1,25(OH)2维生素D的调节,且与血中睾酮和雌激素正相关;还有细胞自分泌和旁分泌IGFs/IGF结合蛋白调节骨的形成和吸收。治疗男性OP的关键仍然强调青春期获得较高的骨量峰值,老年人锻炼时强调适当的负重运动,合理使用抗骨吸收和促骨形成药物,因其发病机理复杂,需要明确病因的情况下作针对性的治疗,从而获取确切的疗效。     

男性骨质疏松症的病因及特征

男性骨质疏松(osteoporosis，OP)的病因、发病机理和诊断与女性OP不同，男性病因主要有汹洒、过量使用糖皮质激素、性腺功能减退。骨量峰值是决定患OP危险的主要因素，雄激素在男性获得骨量峰值和维持骨质量起重要的作用，抗雌激素或雌激素缺乏也会影响男性获得适度骨峰值。男性OP的主要症状通常是骨质疏松性骨折和背部疼痛。雄激素、生长激素缺乏是男性OP的最主要病因；作为旁分泌激素，骨组织中产生的胰岛素样生长因子(insulinh-like growth factor I，IGFI)受生长激素、1，25（OH）2维生素D的调节，且与血中睾酮和雌激素正相关；还有细胞自分泌和旁分泌IGFs／IGF结合蛋白调节骨的形成和吸收。治疗男性OP的关键仍然强调青春期获得较高的骨量峰值，老年人锻炼时强调适当的负重运动，合理使用抗骨吸收和促骨形成药物，因其发病机理复杂，需要明确病因的情况下作针对性的治疗，从而获取确切的疗效。     

非骨水泥全髋关节置换术对老年骨质疏松症患者骨密度的影响

目的 探讨非骨水泥全髋置换关节手术(THA-CL)前后老年骨质疏松症患者的骨密度(BMD)变化情况.方法 采用双能X线骨密度仪(DEXA)对29例THA-CL老年患者进行术前1 d和术后3个月正位腰椎和健侧髋部的BMD检测,按照术前1 d的检测结果 将其分为骨质疏松组和非骨质疏松组.结果 THA-CL后腰椎及健侧髋部骨密度均有所下降.骨质疏松组的腰椎骨量丢失明显快于对照组(P<0.05),健侧髋部的骨量丢失差异无统计学意义.结论 THA-CL后骨质疏松症患者骨量丢失快于非骨质疏松者.术后应给予患者抗骨质疏松治疗及加强康复锻炼,以避免进一步骨量丢失.     

骨形成促进剂及其他防治骨质疏松症药物研究进展

骨质疏松症(osteoporosis,OP)是一种全身性骨病,以骨强度下降、骨折风险增加为特征。目前抗OP治疗药物主要有3类,一是促进骨矿化的药物,如维生素D及钙制剂等;二是抑制骨吸收的药物,如双膦酸盐、降钙素、雌激素类等;三是促进骨形成的药物,主要     

补肾中药对老年男性骨质疏松症的治疗作用

目的:观察补肾中药对老年男性骨质疏松症的治疗作用.方法:临床选取符合标准的老年男性病例30例,给予口服补肾中药;同时服用钙而奇片和活性维生素D作为基础用药.分别测定患者服药前及服药0.5 a后骨密度(BMD)、血清骨特异性碱性磷酸酶(BAP)、抗酒石酸酸性磷酸酶5b(TRAP5b),并将其作比较.结果:患者盼BMD及BAP较服药前升高明显(P<0.05),有统计学意义;TRA.P5b较服药前降低(P<0.05),有统计学意义.结论:补肾中药能抑制骨吸收,促进骨形成,减缓骨量丢失,提高骨密度,有效防治老年男性骨质疏松症.     

骨质疏松症的药物治疗新进展

生理条件下 ,紧密联系的骨形成和骨吸收两过程相互作用而使骨量得以维持 ;疾病状态下 ,如在绝经期雌激素水平的降低明显地引起了卵巢功能的下降 ,使这一平衡被打破 ,骨吸收大于骨形成而引起骨质疏松症 (ｏｓｔｅｏｐｏｒｏｓｉｓ ,ＯＰ)。当前骨质疏松症的药物治疗主要包括抗吸收疗法 (ａｎｔｉｒｅｓｏｒｐｔｉｖｅｔｈｅｒａｐｙ)和合成代谢疗法 (Ａｎａｂｏｌｉｃｔｈｅｒａｐｙ) ,钙和维生素Ｄ为基础用药。抗吸收疗法主要是基于对抗骨动态平衡中的再吸收作用 ,包括雌激素、选择性雌激素受体调节剂、降钙素和二磷酸盐等。合成代谢疗法主…     

骨质疏松症患者的饮食干预与护理措施

骨质疏松(OP)是以骨量减少、骨的微观结构退化为特征,致使骨的脆性增加,引起骨痛、畸形及易发生骨折的一种全身性骨骼疾病.临床分为原发性和继发性骨质疏松症2种,常见有绝经后骨质疏松症、老年性骨质疏松症和继发性骨质疏松症.主要症状是骨痛、易骨折、生长停止或身高下降.在我国60岁以上骨质疏松患者约为1.3亿人,男性在55岁以上,女性在绝经后易发生老年性骨质疏松,女性发病率是男性发病率的4倍.骨质疏松的治疗方法主要包括饮食调节、运动治疗、药物治疗等措施.本文回顾分析25例OP患者的临床资料、饮食干预与护理措施.     

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。     

钙剂和维生素D在老年骨质疏松症中的应用

随着人口老龄化日趋严重,骨质疏松症已经成为我国面临的重要公共健康问题。骨质疏松症是一种多见于绝经后女性和老年男性,以骨量低下、骨组织微结构损坏,导致骨脆性增加,易发生骨折为特征的全身性代谢性骨病。钙剂和维生素D作为骨健康基本补充剂,在骨质疏松症的防治中具有重要作用。该文就老年骨质疏松症患者钙剂和维生素D应用中的相关问题进行阐述。     

类风湿关节炎患者骨密度横断面研究

目的调查类风湿关节炎（RA）患者骨密度（BMD）,并探讨骨流失的相关危险因素。方法采用横断面方法调查102例绝经后女性、50岁以上男性RA患者及经年龄、性别匹配的47例对照人群腰椎、前臂、股骨颈、全髋关节四个部位的BMD,记录患者基本资料及用药情况。根据病程分为早期RA组（≤6个月）及非早期RA组（〉6个月）,比较对照组、总RA患者、早期RA、非早期RA各部位BMD的变化情况及各组间骨质疏松症、骨量低下的发病率,并分析与之相关的危险因素。结果（1）早期RA患者ESR、DAS28评分、糖皮质激素使用率、使用量等明显高于非早期RA患者组,而抗骨质疏松药物的使用率等则显著低于病史长者（P〈0．05）。（2）除对照组与早期RA患者OP率、骨量低下率和早期RA与非早期RA患者OP率差异不显著外,其余各组数据均有显著性差异（P〈0．05）。（3）RA总体及非早期RA患者各部位BMD较对照组均明显下降;而早期RA与对照组相比,仅前臂BMD下降明显;两组RA患者除前臂差异不显著外,其余各部位BMD差异均有统计学意义（P〈0．05）。（4）病程、绝经年限、ESR、CI心、活性维生素D及骨吸收抑制剂的应用与各部位BMD变化相关,DAS28与股骨颈、髋关节BMD变化相关,而糖皮质激素、DMARDs使用等因素与BMD变化无显著相关。结论RA是继发性骨质疏松症的重要原因,开始于四肢骨逐渐发展至全身,疾病活动度和关节功能障碍造成的活动障碍等是骨流失的危险因素,应用骨营养剂及骨吸收抑制剂能有效防治骨破坏。     

Osteoporosis in men: epidemiology, diagnosis, prevention, and treatment

BACKGROUND: Osteoporosis and fragility fractures in men account for substantial health care expenditures and decreased quality of life. OBJECTIVE: This article reviews the most current information about the epidemiology, diagnosis, prevention, and treatment of osteoporosis in men. METHODS: Relevant literature was identified through a search of MEDLINE (1966-June 2003) limited to English-language studies in men. The search terms included fractures, bone density, or osteoporosis plus either epidemiology, diagnosis, prevention, control, or therapy. Additional search terms included specific subtopics (eg, bisphosphonates, calcium, exercise, parathyroid hormone). The authors contributed additional relevant publications. RESULTS: Morbidity after fragility fracture is at least as high in men as in women, and the rate of fracture-related mortality 1 year hip fracture is approximately double in men compared with women. The bioavailable fraction of testosterone slowly declines into the ninth decade in men. There is evidence that the effect of estrogen on bone is greater than that of testosterone in men. Diagnosing osteoporosis in men is complicated by a lack of consensus on how it should be defined. Significant risk factors for osteoporosis or fracture include low bone mineral density, previous fragility fracture, maternal history of fracture, marked hypogonadism, smoking, heavy alcohol intake or alcoholism, low calcium intake, low body mass or body mass index, low physical activity, use of bone-resorbing medication such as glucocorticoids, and the presence of such conditions as hyperthyroidism, hyperparathyroidism, and hypercalciuria. Prevention is paramount and should begin in childhood. During adulthood, calcium (1000-1500 mg/d), vitamin D (400-800 IU/d), and adequate physical activity play crucial preventive roles. When treatment is indicated, the bisphosphonates are the first choice, whereas there is less support for the use of calcitonin or androgen therapy. Parathyroid hormone (1-34) is a promising anabolic therapy. There is also strong evidence for the use of bisphosphonates for the treatment of glucocorticoid-induced osteoporosis.     

Osteoporosis in men: prevalence and investigation

In the past, osteoporosis was thought to affect only women; however, in the last decade it has become apparent that osteoporosis is common in men, particularly elderly men. Osteoporosis affects as many as 2 million men in the United States. Osteoporosis most commonly affects the hip and the lumbar vertebrae, but other bones, such as the radius, tibia, and ribs, may also fracture. The main feature of the etiology of the disease is that low bone mineral density results in increased susceptibility to bone fracture. The World Health Organization has defined osteoporosis as a bone mineral density T-score value >2.5 SDs below the mean observed in young adult women. Although the validity of this score for evaluating men has been questioned and it is not clear whether a male or female reference database should be used, it is nonetheless often used in this way. The disease affects men differently than women in a number of respects. It manifests itself later in life in men than in women, probably because men initially have greater bone mass. Mortality and morbidity associated with hip fractures are high in all elderly individuals, but they are substantially higher in men than in women. Unlike in women, there is an underlying cause for the osteoporosis in almost half of affected men. Thus, for elderly men, a complete history and physical examination may reveal some remediable conditions; treating these may stop further progression of the disease and prevent further morbidity or mortality. Corticosteroid therapy for arthritis or asthma is a common cause of osteoporosis in elderly men. Hypogonadism is a recognized cause of osteoporosis in men treated for carcinoma of the prostate with androgen withdrawal therapy; treatments to modify the effects of these agents on bone are available. Consumption of large amounts of alcohol will eventually result in osteoporosis in some elderly men. Moreover, alcohol can predispose confused elderly patients to falls and to fracture bones that are already osteoporotic. Hyperthyroidism is associated with a reduction in bone mineral density and an increased likelihood of bony fracture. A careful search for undiagnosed hyperthyroidism in elderly osteoporotic men may prove worthwhile. Vitamin D deficiency is common among older men and could contribute to an increase in fractures. Routine analyses of blood and biochemistry should be carried out in any older male patient with newly diagnosed osteoporosis. Dual x-ray energy absorptiometry should be performed on every new patient with newly diagnosed osteoporosis.     

阿仑膦酸钠联合辛伐他汀对老年性骨质疏松伴高脂血症患者的疗效观察

目的观察阿仑膦酸钠片联合降血脂药物对伴有高脂血症的老年性骨质疏松患者的临床疗效。方法将42例老年性骨质疏松症伴高血脂患者分为三组,联合治疗组16例,口服阿仑膦酸钠片和辛伐他汀;阿仑膦酸钠片单独治疗组16例,仅服阿仑膦酸钠片;辛伐他汀单独治疗组10例,仅服辛伐他汀,观察6个月,观察治疗前后临床疗效、积分、腰椎及股骨颈的骨密度(BMD)和血脂等生化指标的变化。结果联合治疗组的总有效率为93.8%,明显高于阿仑膦酸钠片单独治疗组的86.7%(P<0.01)和辛伐他汀单独治疗组的0%(P<0.01)。三组治疗后BMD均有明显上升,但联合治疗组上升幅度大于单独治疗组(P<0.01)。联合治疗组和辛伐他汀治疗组的血脂下降明显,差异具有统计学意义(P<0.05),阿仑膦酸钠片单独治疗组的血脂也有下降,但无统计学意义。结论降血脂药物辛伐他汀对阿仑膦酸钠片治疗骨质疏松具有协同作用。     

Bone mineral density correlates strongly with basal metabolic rate in postmenopausal women

BACKGROUND: This study investigated the relationships of bone mineral density (BMD) with body composition, basal metabolic rate (BMR), and fat distribution. METHODS: We measured body mass index (BMI), anthropometrics, and BMD in 345 postmenopausal women and 224 elderly men. Total body fat (TBF), fat distribution, and BMR were assessed using a body composition analyzer. Lumbar spine and proximal femur BMDs were measured with dual-energy X-ray absorptiometry. RESULTS: Lumbar spine BMD was more strongly correlated with BMR (r=0.51, p<0.01) than with lean body mass (r=0.39, p<0.01) and waist hip ratio (r=-0.28, p<0.01) in postmenopausal women. The mean values of BMR in osteoporotic women were significantly lower than those for non-osteoporotic women (p<0.01). The prevalences of osteoporosis at the sites of lumbar spine and proximal femur were 32.1% and 23.3% in the women with BMR<1230 kcal, which were significantly higher than those of osteoporosis (5.4% and 7.7%) at the corresponding sites in the women with BMR> or =1230 kcal (p<0.01). In elderly men, the incidence of osteoporosis at the proximal femur was 29.5% in the subjects with BMR<1390 kcal, significantly higher than that (2.2%) in the subjects with BMR> or =1390 kcal (p<0.01). CONCLUSION: BMR is more closely associated with bone density in elderly persons, at least as compared to TBF, BMI, or lean body mass.     

骨质疏松症的药物治疗进展

骨质疏松症是一种常见的全身性骨骼疾病,该病的主要特征是骨组织微结构损坏和骨量减少,进而引起骨脆性及骨折风险的增加。随着人口老龄化进程,骨质疏松症的患病率逐年增高,如何防治骨质疏松症已成为全球重要的公共健康问题之一。目前临床上常用的抗骨质疏松症药物主要分为两大类:抑制骨吸收药物和促进骨形成的药物。该文就骨质疏松症的药物治疗进展做一综述。     

OSTEOPOROSIS AND THE EFFECTS OF AGEING ON BONE MASS IN ELDERLY MEN AND WOMEN1

A longitudinal study of the effects of ageing on bone mass,height, and body weight was made in random samples of a definedpopulation of elderly men and women. The observations were madetwice with an interval of 11 years between them. At initialsurvey ages ranged from 55 to 64 years. Bone mass was assessedfrom measurements of the second metacarpal cortex made directlyfrom radiographs. Loss of bone occurred in both sexes but thiswas not a universal phenomenon; some men and women lost littleor no bone over the period of study. In those persons in whombone loss did take place this happened at different rates; andthe women tended to lose more bone than the men.Change in bonemass in the metacarpal was not related to loss of heigh, changein body weight, the occurence of fracture, or the presence ofback pains. A separate population of persons with the clinicalsyndrome of senile osteoporosis was not identified.     

凉山彝族地区中老年人骨密度影响因素调查分析

目的 探讨凉山彝族地区中老年人骨密度(bone mineral density BMD)的现状及骨质疏松症的发病率,为骨质疏松症发病相关危险因素及骨质疏松防治提供科学依据.方法 长期居住在凉山彝族地区的50岁以上的中老年人群760例(男381例,女379例),准确记录性别、年龄及种族,采用双能X线骨密度仪进行腰椎(L1～5)前后位BMD测量,并按5岁为1个年龄组分组.以峰值BMD减低2.5倍标准差为诊断骨质疏松症标准.结果 随年龄增加BMD逐渐下降(P＜0.05),女性55岁后骨量下降较男性显著(P＜0.05),骨质疏松患病率随年龄增加而上升(P＜0.05),女性高于男性(P＜0.O1).结论 年龄及性别是骨量减少的主要危险因素:凉山彝族地区中老年人群随着年龄的增长,BMD逐渐降低,骨质疏松患病率明显增加,女性更为明显;运动是骨量减少的保护因子:彝族老年人骨质疏松较汉族老年人发病偏少(P＜0.05),可能与彝族人居住在高山地区,交通不便,多以步行及体力劳动较多有关.