六味地黄丸治疗绝经后骨质疏松症疗效的系统评价和Meta分析

目的系统评价六味地黄丸治疗绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)的疗效。方法系统检索CNKI、CBM、VIP、WanFang、PubMed、Embase、Cochrane图书馆,对纳入研究进行方法学质量评价,并采用Review Manager 5.3软件进行Meta分析。共纳入12篇文献,14个研究。结果Meta分析得出:六味地黄丸+常规治疗方案在治疗PMOP的有效率[OR=1.22,95%CI(1.13~1.32),P<0.00001]、减轻患者疼痛方面[MD=-0.50,95%CI(-0.77^-0.22),P=0.0004]疗效较好,对髋关节骨密度[MD=0.55,95%CI(0.26~0.84),P=0.0002]的改善效果优于常规西药组。而单独使用六味地黄丸及联合单一常规干预措施对腰椎骨密度[MD=0.05,95%CI(0.03~0.07),P<0.0001]改善情况优于常规西药。单独使用六味地黄丸对桡骨骨密度[MD=0.02,95%CI(0.02~0.03),P<0.00001],尺骨骨密度[MD=0.02,95%CI(0.01~0.03),P<0.0001]改善有一定的临床优势。结论六味地黄丸可以提高髋关节、腰椎、尺骨、桡骨的骨密度,并且在提高临床治疗绝经后骨质疏松症的有效率及减轻骨质疏松所造成的疼痛方面具有良好的效果。但在提高股骨颈密度方面证据不足,可能受多种因素影响。同时,六味地黄丸与常规治疗联用具有增强的效果,但联合多种药物时是否对绝经后骨质疏松有明确增效尚待研究。     

仙灵骨葆胶囊治疗绝经后骨质疏松症有效性的系统评价和Meta分析

目的评价仙灵骨葆胶囊治疗绝经后骨质疏松症的有效性和安全性。方法电子检索中、英文数据库共7个(自建库时间至2017年11月),按照纳入标准和排除标准筛选文献,依据Cochrane Handbook for Systematic Reviews of Interventions(version 5.35)质量评估,并用RevMan 5.3软件进行Meta分析。结果检索到文献共1 779篇,筛选后纳入文献16篇(19项原始研究),总样本量1 492例。Meta分析得出单用仙灵骨葆胶囊对于提高腰椎骨密度疗效优于常规治疗[MD=0.08,95%CI(0.03,0.14),P=0.002];仙灵骨葆胶囊加常规干预对于提高临床有效率[OR=3.35,95%CI(1.86,6.05),P0.000 1]、改善疼痛[MD=-1.71,95%CI(-2.39,-1.03),P0.000 01]疗效优于常规治疗;在改善腰椎骨密度方面,仙灵骨葆胶囊+单一常规干预疗效明显优于单一常规干预[MD=0.06,95%CI(0.04,0.07),P0.000 01];仙灵骨葆胶囊联合常规干预在提高髋部骨密度疗效上可能优于常规干预[MD=0.08,95%CI(0.03,0.14),P=0.001]。结论仙灵骨葆胶囊在改善腰椎骨密度、提高临床有效率及改善疼痛方面疗效确切;但在改善髋部骨密度方面证据不足,总疗程可能是其重要影响因素;仙灵骨葆胶囊联合单一抗骨质疏松药物具有增效作用,与两种或以上抗骨质疏松药物联用叠加增效作用尚待研究。     

骨碎补总黄酮治疗绝经后骨质疏松症的Meta分析

目的系统评价骨碎补总黄酮(强骨胶囊)治疗绝经后骨质疏松症(PMOP)的疗效及安全性。方法计算机检索CNKI、CBM、VIP、万方数据库、PubMed、Embase、Cochrane图书馆,检索时间是自建库以来至2017年11月3日,按照纳排标准,收集强骨胶囊治疗PMOP的临床对照试验,依据Cochrane Handbook for Systematic Reviews of Interventions(version 5.35)质量评估,并使用RevMan5.3软件进行Meta分析。结果纳入6篇文献,8个研究。在有效率[RR=1.50,95%CI(1.04～2.17),P=0.03]和提高股骨骨密度[MD=0.04,95%CI(0.02～0.06),P=0.0002]方面,强骨胶囊联合常规治疗可能优于单独常规治疗;在提高腰椎骨密度[MD=0.02,95%CI(-0.01～0.05),P=0.28]、髋骨骨密度[MD=-0.05,95%CI(-0.09～0.00),P=0.05]、改善血钙[MD=0.01,95%CI(-0.06～0.08),P=0.77]、血磷[MD=0.02,95%CI(-0.05～0.09),P=0.58]、血碱性磷酸酶[MD=4.28,95%CI(-6.98～15.54),P=0.46]等指标方面,与常规治疗组相比,差异无统计学意义。强骨胶囊的不良反应包括便秘、口干、恶心、胃肠道反应,经对症处理后缓解,不需停药。结论强骨胶囊在改善患者症状及股骨骨密度方面,可能有一定的辅助治疗作用。而在改善血钙、血磷、血碱性磷酸酶、血骨钙素等客观指标方面,可能无明显优势,但具有较好的安全性。     

唑来膦酸与阿仑膦酸钠治疗原发性骨质疏松疗效及安全性的Meta分析

目的系统评价唑来膦酸与阿仑膦酸钠治疗原发性骨质疏松的有效性与安全性。方法计算机检索PubMed、Embase、Cochrane Library、CNKI、CBM、万方数据库,检索时间均为建库至2018年12月,采用改良Jadad量表及Cochrane风险偏倚评估工具评价纳入研究的方法学质量。使用Rev Man5.3及Stata15.0软件进行Meta分析。结果共纳入12篇文献,1 344例患者。Meta分析结果表明:在疗效方面,腰椎骨密度(bone mineral density,BMD)在治疗12个月后[SMD=0.96,95%CI(0.03,1.90),P=0.04]、24个月后[SMD=1.70,95%CI(0.30,3.11),P=0.02],股骨颈BMD在治疗12个月后[SMD=0.34,95%CI(0.19,0.50),P0.000 1],VAS评分[MD=-0.76,95%CI(-0.93,-0.58),P0.000 01],Oswestry功能障碍指数(ODI)[MD=-10.48,95%CI(-11.38,-9.58),P0.000 01],差异具有统计学意义(P0.05),唑来膦酸治疗效果优于阿仑膦酸钠。在安全性方面,不良反应[RR=1.79,95%CI(1.41,2.28),P0.000 01]差异具有统计学意义,唑来膦酸安全性小于阿仑膦酸钠。结论与阿仑膦酸钠相比,唑来膦酸在治疗后期能明显提高患者腰椎、股骨颈BMD,有效降低VAS评分、Oswestry功能障碍指数,进而显著提升患者的生活质量,但不良反应相对较多。     

经皮椎体成形术结合补肾壮骨汤治疗骨质疏松性胸腰椎压缩骨折的Meta分析

目的系统评价经皮椎体成形术(PVP)结合补肾壮骨汤与单纯经皮椎体成形术(PVP)治疗骨质疏松性胸腰椎压缩骨折的疗效与安全性,为骨质疏松性胸腰椎压缩骨折的治疗提供更好的科学依据。方法计算机检索Pubmed、Embase、Cochrane图书馆、CNKI、中国生物医学文献数据库(CBM)、万方医学网等数据库,人工检索Spine等期刊,收集比较经皮椎体成形术(PVP)结合补肾壮骨汤与单纯经皮椎体成形术(PVP)治疗骨质疏松性胸腰椎压缩骨折的临床随机对照试验,并评价纳入研究的方法学质量。使用Review Manager 5.3软件对数据进行Meta分析,观察指标包括术后椎体高度恢复情况、治疗有效率、Cobb角、骨密度(BMD)、VAS评分、Oswestry功能障碍指数(ODI)及新发骨折率。结果最终纳入9项随机对照试验(randomized controlled trial,RCT),共745例患者,其中PVP结合补肾壮骨汤组381例,单纯PVP组364例。Meta分析结果示,与单纯PVP组相比,PVP结合补肾壮骨汤组治疗有效率高[OR=5.11,95%CI(2.51～10.40),P0.00001],骨密度(BMD)提高程度大[MD=0.09,95%CI(0.01～0.16),P=0.04],VAS评分低[MD=-1.03,95%CI(-1.51～-0.55),P0.0001],Oswestry功能障碍指数(ODI)低[MD=-4.90,95%CI(-6.93～-2.86),P0.00001],新发骨折率低[OR=0.10,95%CI(0.02～0.55),P=0.008],而两者在Cobb角改善[MD=-0.46,95%CI(-2.39～1.48),P=0.64]方面,差异无统计学意义。结论与单纯PVP相比,PVP结合补肾壮骨汤能明显提高骨密度及治疗有效率,有效降低VAS评分、Oswestry功能障碍指数及新发骨折率,进而显著提升患者的生活质量。     

补肾活血法治疗绝经后骨质疏松症的Meta分析

目的系统评估补益肝肾方治疗绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)的有效性和安全性,为临床治疗提供参考依据。方法计算机检索中国知网、万方数据库、维普中文科技期刊数据库、Medline、PubMed、Web of Science、Ovid,检索时限截至2018年5月。纳入补益肝肾方(试验组)对比其他方式(西药及非补益肝肾方,对照组)治疗PMOP的临床随机对照试验,使用Jadad评定量表提取数据并对相关数据进行评分,采用国际Cochrane协作网提供的Rev Man5. 3统计软件进行Meta分析。结果共纳入19项随机对照试验,合计1 480例患者。Meta分析显示,试验组在改善腰椎骨密度水平[MD=0. 20,95%CI(-0. 16,0. 56),P=0. 28]、雌二醇水平[MD=9. 53,95%CI (-2. 71,21. 78),P=0. 13]以及血清钙水平[MD=0. 07,95%CI(-0. 05,0. 19),P=0. 23]与对照组相比无明显差异;试验组在改善疼痛[MD=-0. 92,95%CI(-1. 03,-0. 82),P0. 01]、骨钙素水平[MD=3. 49,95%CI(2. 04,4. 93),P0. 01]以及临床疗效[OR=2. 47,95%CI(1. 35,4. 50),P=0. 003]方面优于对照组。补益肝肾方配合西药在改善临床疗效[OR=4. 47,95%CI(3. 09,6. 44),P0. 01]、腰椎骨密度[MD=0. 10,95%CI(0. 06,0. 15),P0. 01]、骨钙素[MD=1. 51,95%CI(0. 77,2. 24),P0. 01]以及E2水平[MD=6. 57,95%CI(1. 97,11. 23),P=0. 006]等方面疗效优于西药组或非补益肝肾方组。结论补益肝肾方能有效治疗PMOP,并可与西药协同增效,促进机体骨质生成,降低骨质吸收,从而缓解临床症状,但因纳入文献质与量的限制,更深入的研究有待进行。     

太极拳锻炼防治骨质疏松症效果的Meta 分析

目的系统评价太极拳预防和治疗骨质疏松症的有效性及安全性。方法计算机检索所有关于太极拳治疗和预防骨质疏松症的国内外随机对照试验。由2名研究人员独立进行文献筛选、数据提取和纳入文献评价,用Cochrane协作网提供的偏倚风险评估工具进行质量评价,使用RevMan 5.3软件进行Meta分析。结果共纳入18篇文献,涉及1 664例研究。分析结果显示:在改善腰椎和股骨颈骨密度方面,进行太极拳锻炼干预优于无太极拳干预[SMD=0.16, 95%CI(0.01,0.30),P=0.03]、[SMD=0.18, 95%CI(0,0.36),P=0.05];但尚不能确定太极拳是否能改善股骨大转子和Ward三角的骨密度[SMD=0.30, 95%CI(-0.23,0.83),P=0.27]、[SMD=0.25, 95%CI(-0.03,0.53,P=0.07];在临床有效率方面,太极拳锻炼优于未行太极拳锻炼[RR=1.53, 95%CI(1.28,1.83),P0.0001];对于骨代谢标志物血钙的影响,太极拳锻炼是有效的[SMD=-0.32, 95%CI(-0.60,-0.04),P=0.03]。但血磷和碱性磷酸酶方面,尚不能确定太极拳的有效性[SMD=0.10, 95%CI(-0.18,0.37),P=0.49]、[SMD=0.04, 95%CI(-0.24,0.32),P=0.78];在安全性方面,太极拳锻炼具有很好的安全性。结论太极拳锻炼可以有效地改善腰椎和股骨颈的骨密度,提高临床有效率,降低血钙,安全性高,但仍需大量高质量的研究以提供更充足的证据。     

成人阻塞性睡眠呼吸暂停低通气综合征与骨密度降低及骨质疏松相关性的Meta分析

目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)与骨密度降低及骨质疏松之间的相关性。方法从PubMed、EMBASE、Web of Science、the Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库(Wanfang data)和维普数据库(VIP)检索OSAHS与骨密度及骨质疏松相关性的研究。采用纽卡斯尔-渥太华量表(the Newcastle-Ottawa scale,NOS)对纳入研究进行质量评价。所有数据的合并、亚组分析采用Review manager 5.3软件,敏感性分析和发表偏倚检测采用Stata 15.1软件。结果检索到1091篇文献,1074篇文献被排除,17篇全文文献里的17项研究所包含的113460位研究对象的数据被提取。OSAHS组与对照组相比,骨质疏松症的发生率高(OR=1.74,95%CI:1.43~2.13,P<0.00001);性别、年龄的亚组分析显示,男性(OR=1.90,95%CI:1.33~2.72,P=0.0004)、女性(OR=2.56,95%CI:1.96~3.34,P<0.00001)、大于65岁老年人(OR=2.62,95%CI:1.86~3.71,P<0.00001)、40~65岁中年人(OR=1.73,95%CI:1.31~2.28,P=0.0001)骨质疏松症的发生率均高。OSAHS组与对照组相比,腰椎骨密度显著降低(MD=-0.12,95%CI:-0.18~-0.06,P=0.0001)。性别的亚组分析显示,男性腰椎骨密度显著降低(一般人群:MD=-0.08,95%CI:-0.15~-0.01,P=0.02;无伴随疾病人群:MD=-0.12,95%CI:-0.19~-0.05,P=0.0008);女性腰椎骨密度略低(MD=-0.08,95%CI:-0.21~0.06,P=0.27),但差异无统计学意义。OSAHS组与对照组相比,股骨颈骨密度显著降低(MD=-0.12,95%CI:-0.19~-0.05,P=0.0007)。男性亚组股骨颈骨密度显著降低(一般人群:MD=-0.09,95%CI:-0.17~-0.02,P=0.02,无伴随疾病人群:MD=-0.11,95%CI:-0.19~-0.03,P=0.006);女性亚组股骨颈骨密度略低(MD=-0.10,95%CI:-0.33~0.12,P=0.37),但差异无统计学意义。各项分析纳入的研究无明显发表偏倚。结论OSAHS组与对照组相比,骨质疏松症的发生率高,腰椎骨密度、股骨颈骨密度均有所降低。     

全身振动训练对骨质疏松患者治疗效果的Meta分析

目的系统评价全身振动训练对骨质疏松患者的治疗效果。方法计算机检索Pub Med、EMbase、The Cochrane Library(2017年1期)、CBM、Wan Fang Data和CNKI数据库,收集关于全身振动训练对骨质疏松患者效果的随机对照试验,检索时限均从建库至2017年1月31日。2名研究人员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入文献8篇,657例患者。Meta分析结果显示,与对照组相比,全身振动训练对骨质疏松患者的腰椎骨密度[MD=0.00,95%CI(-0.01~0.01),P=0.92]、桡骨松质骨体积骨密度[MD=-0.87,95%CI(-2.93~1.20),P=0.41]、胫骨松质骨体积骨密度[MD=0.34,95%CI(-0.69~1.38),P=0.52]没有影响;但可以减轻患者的疼痛[MD=-0.67,95%CI(-1.12~-0.22),P=0.003]、降低跌倒发生率[MD=0.50,95%CI(0.29~0.86),P=0.01]。结论全身振动训练并不能改善骨质疏松患者的腰椎骨密度、胫骨和桡骨松质骨体积骨密度,但可以减轻疼痛,而预防跌倒的效果及其安全性还有待进一步的证实。     

双膦酸盐对骨质疏松症患者腰椎融合影响的系统评价和Meta分析

目的通过Meta分析系统评价双膦酸盐对骨质疏松症患者腰椎融合的影响。方法系统检索Pub Med、Science Direct、Google Scholar、CNKI、VIP和Wan Fang Data自建库以来到2017年1月的文献,运用Stata11.0定量分析纳入的文献。结果最终有9篇研究符合纳入标准,Meta分析结果显示:双膦酸盐组与对照组的对比中,植骨融合情况[RR=1.138,95%CI(1.064,1.217)]、终末随访骨密度T值[MD=0.038,95%CI(0.025,0.052)]、ODI指数[MD=-4.36,95%CI(-6.372,-2.348)]、骨吸收生化标志物CTX值[MD=-0.401,95%CI(-0.511,-0.291)]、VAS评分[MD=0.940,95%CI(0.548,1.332)]之间差异均有统计学意义(P0.01);终末随访术后骨形成生化标志物PINP值[MD=-4.328,95%CI(-8.954,0.298)]、不良反应情况[RR=0.725,95%CI(0.420,1.251)]之间差异无统计学意义(P=0.067和P=0.248)。结论腰椎术后应用双膦酸盐并不影响骨质疏松症患者的骨融合结果,而且通过治疗能有效抑制骨吸收代谢,改善其骨量和术后功能恢复程度,且与对照组安全性相近。     

双能X线骨密度测定腰椎和股骨颈对诊断骨质疏松检出率的比较

目的探讨双能X线吸收法测量腰椎及股骨颈两个不同部位骨密度对骨质疏松诊断的检出率,寻找灵敏度高、更经济实用的筛查骨质疏松的有效方法方法 2011年1月至2012年12月在我院妇科及老年病科住院的女性患者共732人,分别测量腰椎及股骨颈的骨密度T值,进行SPSS统计研究。结果对同一人群通过股骨颈和腰椎不同部位检测发现骨质疏松的检出率分别为25.4%,32.0%;严重骨质疏松的检出率分别为9.0%,27.9%;两者之间差异有统计学意义(P=0.001),腰椎骨密度测量对骨质疏松诊断检出率明显优于股骨颈。根据4个年龄组的股骨颈和腰椎的骨密度T值比较差异均有统计学意义(P均0.01)。结论采用双能X线骨密度测定对诊断骨质疏松腰椎明显优于股骨颈。     

Management of male osteoporosis

The objective of this study was to evaluate the efficacy of treatments for male osteoporosis selected based on the cause of the disease. METHODS: Sixty-three men with osteoporosis (T-score at the lumbar spine and/or femoral neck lower than -2.5) with a mean age of 53+/-11 years were studied. Forty-three (68.3%) had a history of fracturing without trauma (vertebral fractures, 37 patients, 57%). Treatments were as follows: idiopathic osteoporosis: calcium and vitamin D supplements (N = 10) or cyclical etidronate for 2 weeks followed by calcium and vitamin D supplements for 76 days (N = 29); moderate idiopathic phosphate diabetes: calcitriol and phosphate (N = 15); idiopathic hypercalciuria: hydrochlorothiazide (N = 6); and hypogonadism: testosterone (N = 3). RESULTS: Percentage change in bone mineral density (mean +/- standard error of the mean) after 18 months: calcium and vitamin D (lumbar spine: 0.6+/-2; femoral neck: 2.2+/-2.2); etidronate (lumbar spine: 3.6+/-1.4*; femoral neck: 0.5+/-1); calcitriol (lumbar spine: 7.0+/-3.5*; femoral neck: 0.0+/-1.4); thiazide diuretic (lumbar spine: 1+/-3.2; femoral neck: -2.3+/-3.7); and testosterone (lumbar spine: 6.8+/-6.4; femoral neck: 2.5+/-2.7), where *P < 0.05 versus baseline. Gastrointestinal side effects occurred in three patients (4.8%), including two on calcitriol-phosphate therapy and one on etidronate therapy. Of the six (9.5%) patients who experienced incident fractures, four were on etidronate, one on calcitriol-phosphate, and one on calcium-vitamin D. No patients discontinued their treatment because of side effects. CONCLUSION: Etidronate and the combination of calcitriol-phosphate produce a significant increase in lumbar spine bone mass in men with idiopathic osteoporosis or moderate idiopathic phosphate diabetes.     

唑来膦酸治疗绝经后骨质疏松的Meta分析

目的系统评价唑来膦酸治疗绝经后骨质疏松症的疗效和安全性。方法系统检索CNKI、CBM、VIP、Wan Fang、PubMed、Embase、Cochrane图书馆,对关于唑来膦酸治疗绝经后骨质疏松的临床随机对照研究(RCT),纳入研究开展方法学质量评估,同时借助软件Stata 16.0和Review Manager 5.3进行疗效和安全性的系统评价。结果所纳入文献量合计10篇,涉及研究为16个,包括1 277例患者。结果表明唑来膦酸联合钙剂能有效提高绝经后骨质疏松患者的腰椎骨密度[MD=0.021,95%CI(0.009,0.033),P0.05]。并对腰椎BMD进行亚组分析,表明治疗方法亚组分析中,唑来膦酸联合钙剂的疗效最好[MD=0.037,95%CI(0.009,0.065),P=0.009];按照疗程分组,疗程小于1年的疗效相对较差[MD=0.017,95%CI(-0.034,0.069),P=0.506];按患者所在国家分组,中国[MD=0.02,95%CI (0.006,0.035),P=0.005]和印度[MD=0.03,95%CI(0.002,0.058),P=0.005]疗效好。网状Meta分析结果表明唑来膦酸联合钙剂对于提高腰椎BMD的效果最好。唑来膦酸治疗普通不良反应(流感样症状、发热、头痛、肌痛及关节痛、骨折等)较少,更极少发生严重不良反应。结论唑来膦酸联合钙剂对绝经后骨质疏松的治疗具有积极意义,显著改善了患者的骨密度;降低血清生化标志物;不良反应发生率较低,安全性高。     

Association of plasma folate, plasma total homocysteine, but not methylenetetrahydrofolate reductase C667T polymorphism, with bone mineral density in postmenopausal Iranian women: a cross-sectional study

Polymorphisms of methylenetetrahydrofolate reductase (MTHFR) have been well documented to cause hyperhomocysteinemia, and recent studies suggest an association of C677T mutation of methylenetetrahydrofolate reductase with low bone mineral density (BMD). In this study, the association of plasma total homocysteine (Hcy), plasma folate, and vitamin B12 as well as methylenetetrahydrofolate reductase C667T polymorphism with bone mineral density at neck of femur and lumbar spine in 271 postmenopausal Iranian women was investigated. Bone mineral density was measured by dual-energy X-ray absorptiometry. Restriction fragment length polymorphism was used for genotyping the methylenetetrahydrofolate reductase polymorphism. Plasma total homocysteine, plasma folate, and vitamin B12 were also determined. The bone mineral densities at the neck of femur and lumbar spine together with other clinical characteristics among methylenetetrahydrofolate reductase genotypes (CC, CT, and TT) were examined. Bone mineral densities at both neck of femur (r = -0.18, P = 0.003) and lumbar spine (r = -0.16, P = 0.01) were significantly and negatively correlated with the logarithm of plasma total homocysteine. Bone mineral density at the lumbar spine was also significantly and positively associated with plasma folate (r = 0.14, P = 0.02). However, no correlation between methylenetetrahydrofolate reductase polymorphism with bone mineral density at neck of femur (r = -0.01, P = 0.81) and lumbar spine (r = -0.04, P = 0.51) was observed. The negative association of plasma total homocysteine with bone mineral density was no longer significant when adjusted for folate and vitamin B12. Plasma folate and age were the main predictors of plasma total homocysteine explaining 15.3% and 5.2% of the variance of plasma total homocysteine, respectively. Methylenetetrahydrofolate reductase polymorphism, however, was not associated with plasma folate (r = 0.086, P = 0.17) or vitamin B12 (r = 0.05, P = 0.4). Plasma folate was one of the main predictors explaining 3.0% and 1.7% of variance of the bone mineral density at femoral neck and lumbar spine, respectively. Results from this study suggest hyperhomocysteinemia as a result of folate deficiency, but not methylenetetrahydrofolate reductase polymorphism, is independently associated with low bone mineral density and may contribute to the pathogenicity of osteoporosis in postmenopausal Iranian women.     

Clinical utility of spine bone density in elderly women.

It is common clinical practice to obtain a bone density measurement at both the hip and spine to evaluate osteoporosis. With aging, degenerative changes in the lumbar spine may elevate the bone mineral density (BMD) results giving false assurances that the fracture risk at the spine is low. We examined the association of spine osteoarthritis and bone mineral density in 1082 community-dwelling ambulatory older women aged 50-96 years who participated in a 1992-1996 osteoporosis research clinic visit. The BMD was measured at the hip and posteroanterior (PA) and lateral lumbar spine using dual energy X-ray absorptiometry (DXA). Spine osteoarthritis was identified on the PA lumbar spine DXA images by a musculoskeletal radiologist. Forty percent of women had evidence of spine osteoarthritis (OA). Women with spine OA had a mean age of 77.4 yr (95% confidence interval [CI]: 76.5-78.2), were significantly older than women without spine OA (mean age, 66.8 yr; 95% CI: 65.9-67.7), and were more likely to have prevalent radiographic fractures (14.2% vs. 9.5%; p<0.05). Age-adjusted BMD at the femoral neck, total hip, PA spine, and lateral spine was significantly higher in women with spine OA. Women with spine OA were more likely to have osteoporosis by the World Health Organization classification at the femoral neck and total hip than those without spine OA, but less likely based on the PA spine (14.4% vs. 24.5%). Despite higher BMD levels, women with OA of the lumbar spine had higher prevalence of osteoporosis at the hip and more radiographic vertebral fractures. In elderly women 65 yr and older who are likely to have spine OA, the DXA measurement of the spine may not be useful in assessing fracture risk, and DXA of the hip is recommended for identification of osteoporosis.     

青娥丸治疗绝经后骨质疏松症的系统评价及Meta分析

目的 系统评价青娥丸(包括古方青娥丸、加味青娥丸)治疗绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)的有效性及安全性.方法 计算机检索PubMed、the Cochrane Library、Embase、中国知网、中国生物医学数据库、万方、维普等中英文数据库.收集随机对照试验,依据...