骨胶原肽对老年骨质疏松症患者骨密度和骨代谢指标的影响

目的观察骨胶原肽对老年骨质疏松症患者的骨密度和血清骨代谢指标水平的影响。方法 138例老年骨质疏松症患者纳入本研究,将其随机分为治疗组和对照组,每组各69例。对照组患者应用阿仑膦酸钠治疗,治疗组患者给予骨胶原肽联合阿仑膦酸钠治疗,治疗为期12个月。检测治疗前和治疗12个月后两组患者腰椎正位(L1-L4)、左股骨颈的骨密度、血清血钙、血磷、骨碱性磷酸酶(bone alkaline phosphatase,BALP)和抗酒石酸酸性磷酸酶-5b(tartrate-resistant acid phosphatase-5b,TRAP-5b)水平变化情况以及治疗有效率和不良反应。结果治疗12个月后,治疗组腰椎正位、左股骨颈的骨密度患者均明显高于对照组,差异均有统计学意义(P0.05);治疗12个月后,两组患者血清BALP及血磷水平较治疗前明显降低,血清TRAP-5b及血钙水平均较治疗前明显升高,和治疗前比较差异均有统计意义(P0.05);而治疗组较对照组改善更为明显(P0.05)。治疗组的患者治疗有效率优于对照组(P0.05),而不良反应无明显差异(P0.05)。结论骨胶原肽联合阿仑膦酸钠能安全有效提高老年骨质疏松症患者的骨密度,改善骨代谢。     

胶原肽联合钙尔奇D治疗绝经后骨质疏松患者疗效分析

目的 研究胶原肽联合钙尔奇D对绝经后骨质疏松患者的疗效分析。方法 202例绝经后骨质疏松症患者随机分为试验组(每天口服胶原肽10 g联合钙尔奇D 600 mg)和对照组（口服钙尔奇D 600 mg）,进行为期6个月的治疗。利用化学发光法检测血清总骨1型前胶原N端肽(N-propeptide of type 1 collagen,PINP）、β-I型胶原交联羧基末端肽（C-terminal crosslinked telopeptides of type 1 collagen,β-CTX）、血清骨钙素（osteocalcin,OC）、25-羟维生素D3[25 hydroxy vitamine D3,25(OH)D3]、甲状旁腺素(parathyroid hormone,PTH)。利用双能X线(dual energy X-ray absorptiometry,DXA)吸收法进行腰椎、股骨骨密度(bone mineral density,BMD)检测。结果 治疗6个月后,口服胶原肽联合钙尔奇D能够更有效地缓解骨质疏松导致的骨痛。试验组患者血清PTH、25(OH)D3及OC水平明显高于治疗前(P＜0.01)及对照组（P＜0.01）。对照组患者治疗后血清PINP水平明显低于治疗前(P＜0.01）,而PTH、25(OH)D3、β-CTX水平明显高于治疗前(P＜0.01)。试验组患者治疗后血清PINP水平明显高于对照组（P＜0.01）,而β-CTX水平低于对照组（P＜0.05）。试验组患者腰椎L2、L4及股骨颈、粗隆间BMD明显高于治疗前(P＜0.01）及对照组(P＜0.05）。试验组患者各部位BMD均显著高于治疗前(P＜0.01）;而对照组患者治疗后上述各指标差异无统计学意义(P＞0.05)。结论 口服胶原肽联合钙尔奇D既能促进骨形成,又能抑制骨吸收,进一步增加BMD,并且可以缓解骨质疏松引起的疼痛。     

天津地区住院2型糖尿病女性患者骨量异常患病率分析

目的 分析天津2型糖尿病女性患者骨密度情况以及骨量减少、骨质疏松患病率情况,为骨质疏松的防治提供依据。方法 选取2012年6月至2020年1月在天津医科大学代谢病医院住院的2型糖尿病女性患者13 956名,排除继发性骨质疏松以及其他影响骨代谢的疾病。应用美国GE公司的LUNAR双能X线骨密度仪测定患者L₁～L₄、股骨颈、全髋部位的骨密度,分析其BMD以及骨量异常的患病率。应用SPSS 24.0进行统计学分析,P<0.05为差异有统计学意义。结果 天津地区女性2型糖尿病患者峰值骨量出现在30～39岁;随年龄增长,骨量异常患病率逐渐增加,50岁以上骨量异常患病率显著增加,其中女性腰椎L₁～L₄、股骨颈、全髋各部位的BMD在52～53、55～56岁有两个明显下降的阶段。绝经后女性髋部、股骨颈单部位骨量异常患病率高于腰椎。结论 2型糖尿病绝经后女性患者骨量异常患病率显著增高,尤其要重视髋部、股骨颈部位骨密度的检查。     

体重对成年女性骨矿含量及其标化的影响研究

目的分析不同体重组人群[小体重组(<45 kg)、标准体重组(45~60 kg)、大体重组(>60 kg)]的骨矿含量结果,探索体重对骨矿含量及其标化的影响。方法纳入290例50~80岁绝经后女性,按体重大小分为大体重组、标准体重组、小体重组。通对不同体重组人群的腰椎L_1~4、股骨的骨矿含量及骨密度进行测量,并对测量结果进行比较分析。同时将年龄、体重作为应变量,腰椎或股骨颈骨矿含量作为自变量,进行多重线性回归分析。结果低体重组的腰椎或股骨颈骨密度T值、骨矿含量均明显低于标准体重组和高体重组人群。随着年龄增长,L_1~4及股骨颈骨矿含量均下降,年龄每升高1岁,L_1~4骨矿含量下降0.364 g、股骨颈骨矿含量下降0.031 g;随着体重增长,L_1~4及股骨颈骨矿含量均升高,体重每增长1 kg,L_1~4骨矿含量升高0.548 g、股骨颈骨矿含量升高0.025 g。结论成年女性的体重与骨矿含量显著正相关,因此,体重是骨矿含量标化的重要指标之一,可以避免骨质疏松的漏误诊。     

围绝经期女性骨密度特点分析

目的总结并分析围绝经期女性腰椎1-4、股骨颈及髋关节部位的骨密度(bone mineral density,BMD)及其临床特点。方法收集2017年12月至2018年6月在我院住院部住院并进行双能X线吸收法骨密度检测的183例围绝经期女性,分别测定其腰椎1-4总体BMD、左侧股骨颈及左髋关节全部BMD,同时分析比较年龄、体质量指数(body mass index,BMI)与骨质疏松的关系。结果 183例患者中,检出骨质疏松39例(21.3%),其中腰椎1-4、左股骨颈和左髋关节BMD各检出骨质疏松33例(18.0%)、20例(10.9%)、13例(7.1%)。腰椎总体骨质情况与股骨颈、髋关节检查结果相符的各有129例(70.5%)、119例(65.0%),股骨颈总体骨质情况与髋关节检查结果相符的有137例(74.9%)。在骨质疏松组、骨量减少组和骨量正常组,同一组病人腰椎1-4骨密度>左髋关节骨密度>左侧股骨颈骨密度,组间差异均有统计学意义。年龄、BMI与骨质疏松的发生均相关。骨质疏松与年龄呈正相关,与BMI、腰椎1-4总BMD、左股骨颈BMD、左髋关节BMD负相关,腰椎1-4 BMD与骨质疏松相关程度最高。结论腰椎整体骨密度呈现虚假升高趋势,腰椎1-4 BMD诊断骨质疏松的敏感性和特异性分别为84.6%、100%,股骨颈分别为51.3%、100%,髋关节分别为33.3%、100%;年龄增长、BMI偏低会增加围绝经期妇女罹患骨质疏松的风险。     

体检人群血脂水平及血脂异常分型与骨密度的相关性研究

目的探讨基于体检人群血脂各项指标及不同血脂异常分型与骨密度的关系。方法收集2018年1月至2019年6月在四川省人民医院健康管理中心进行健康体检,骨密度和血脂相关指标完整且年龄18周岁的体检者28 174例,收集体检者的基本信息、各项血脂指标及平均骨密度与T值等资料,按照血脂异常分型进一步将患者分为高胆固醇血症组、高三酰甘油血症组、混合型高脂血症组和血脂正常组,比较各组间骨密度的差异,采用多元线性回归模型分析各血脂指标对骨密度的影响。结果 28 174例体检者中,高胆固醇血症914例(3.2%)、高三酰甘油血症2 266例(8.0%)、混合型高脂血症819例(2.9%)、血脂正常24 175例(85.8%);骨密度正常16 594例(58.9%)、骨量减少或骨质流失8 511例(30.2%)、骨质疏松3 069例(10.9%)。不同血脂异常分型体检者的性别构成、平均年龄、BMI水平、TC、TG、LDL-C、HDL-C水平之间存在差异(P均0.05)。不同血脂异常分型体检者的骨量异常者构成、骨密度和T值的平均水平之间存在差异(P均0.05),高胆固醇血症组和混合型高脂血症组的骨密度水平明显低于对照组及高三酰甘油血症组(P均0.05),而骨量异常者的占比为高胆固醇血症组和混合型高脂血症组的构成比高于对照组及高三酰甘油血症组(P均0.05)。结论加强体检人群高胆固醇血症和混合型高脂血症的骨密度筛查,骨量异常患者应重视血脂水平的监测。     

基于PI3K/Akt通路研究利拉鲁肽对2型糖尿病骨质疏松大鼠的作用

目的 基于磷脂酰肌醇-3-激酶/丝苏氨酸蛋白激酶(phosphateidylinositol-3 kinase/serine-threonine kinase,PI3K/Akt)通路研究利拉鲁肽对2型糖尿病性骨质疏松(type 2 diabetic osteoporosis,T2DOP)大鼠的影响.方法 高脂高糖、腹腔...     

2型糖尿病患者促甲状腺激素与骨质疏松关系的研究

目的研究2型糖尿病患者中骨密度(BMD)与促甲状腺激素水平的关系,探讨2型糖尿病中骨质疏松的可能危险因素。方法收集西安市中心医院内分泌科2017年1月至2018年5月住院的2型糖尿病患者151例,其中男性79例,女性72例。测定一般生化指标、甲状腺功能及骨代谢指标,双能X线骨密度仪测定BMD。对比不同性别之间非骨质疏松(non-OP)及骨质疏松(OP)患者上述指标的差异;Pearson相关分析法分析腰椎及股骨颈BMD与各临床指标之间的关系,多因素logistic回归分析方法探索不同性别组2型糖尿病患者骨质疏松的可能危险因素。结果 1.男性2型糖尿病患者中,non-OP组FT_3较OP组明显升高,女性2型糖尿病患者组OP患者TSH明显高于对照组,BMI明显低于对照组(P0.05);2.女性腰椎及股骨颈BMD均与TSH负相关(r=-0.290及-0.239 P0.05),男性BMD与TSH无相关性,无论男女,股骨颈BMD与年龄呈负相关(r=-0.242及-0.363 P0.05)、与BMI呈正相关(r=0.263及0.469 P0.05); 3.多因素logistic回归分析示,TSH是女性2型糖尿病患者骨质疏松的主要影响因素(OR=2.581, 95%CI 1.210-5.504,P=0.014。结论 2型糖尿病患者中,随着年龄的增大和BMI的降低骨质疏松发生的风险增高;女性2型糖尿病患者中TSH升高是OP发生的主要危险因素。     

新疆绝经后2型糖尿病女性SOST蛋白表达在骨质疏松中诊断价值的研究

目的探讨SOST蛋白表达水平与骨代谢的关系及其在骨质疏松(osteoporosis,OP)中的诊断价值,为预防绝经后2型糖尿病(type 2 diabetes mellitus,T2DM)女性合并OP的发生提供依据。方法纳入对象为135例新疆绝经后女性,记录其年龄等一般基线资料;全自动生化分析仪测定空腹血糖(FPG)、碱性磷酸酶(ALP)等生化指标;双能X线吸收检测法(dual energy X-ray absorptiometry,DXA)测定股骨颈及腰椎(L1~4)骨密度(BMD);酶联免疫吸附法(ELISA)测定SOST蛋白的表达水平。结果(1)与A组(277.261±251.144)相比,B组(785.507±366.941)和D组(884.056±631.041)的SOST蛋白表达水平高于A组,差异具有统计学意义(P<0.01)。(2)通过绘制ROC曲线显示,SOST蛋白表达水平诊断OP的最佳临界点为0.479,其对应的SOST蛋白水平为851.31 pg/mL,敏感度为61.4%,特异性为86.5%,曲线下面积(AUC)为0.741(95%可信区间:0.656~0.827);(3)Pearson相关性分析显示,新疆绝经后T2DM女性SOST蛋白表达水平与BMD(L1~4)呈负相关(r=-0.239,P=0.005)。结论(1)新疆绝经后T2DM女性SOST蛋白表达水平与骨代谢有关,且SOST蛋白高表达是腰椎BMD(L1~4)降低的危险因素。(2)以SOST蛋白表达水平≥851.31 pg/mL为0P的诊断标准,有较大的AUC和更高的敏感性。     

Correlates of trabecular and cortical volumetric bone mineral density at the femoral neck and lumbar spine: The osteoporotic fractures in men study (MrOS)

The objective of this cross‐sectional analysis was to examine the correlates of trabecular and cortical volumetric bone mineral density (vBMD) in 3670 community‐dwelling men, mean age 73.6 ± 5.9 years. vBMD was measured by quantitative computed tomography (QCT) and areal BMD by dual‐energy X‐ray absorptiometry (DXA). Demographic, historical, and lifestyle information was obtained by interview, and height, weight, and neuromuscular function were determined by examination. To express the strength of the associations, percent differences (95% confidence interval) were calculated from multivariable linear regression models using the formula 100 (β × unit/mean BMD). Units for continuous variables were chosen to approximate 1 standard deviation (SD). The multivariable linear regression models predicted 15%, 21%, and 20% of the overall variance in trabecular and cortical vBMD of the femoral neck and vBMD of the lumbar spine, respectively. Diabetes was associated with a 16.5% greater trabecular vBMD at the femoral neck and 11% at the lumbar spine but less than 2% for cortical vBMD. For femoral neck trabecular vBMD, the strongest negative correlates were past smoking (?9%), fracture history (?15%), kidney stones (?7%), corticosteroids (?11%), and insulin therapy (?26%). For cortical vBMD, the strongest negative correlate was use of thyroid medication (?2.8%). The strongest negative correlates for lumbar spine trabecular vBMD were fracture history (?5%), antiandrogen use (?19%), height (?8%), and thiazoliainedione use (?22%). Bioavailable estradiol and testosterone levels were positively related and sex hormone–binding globulin was negatively related to trabecular vBMD of the spine. There was no relationship between sex hormones and femoral neck trabecular vBMD. Our conclusion is that correlates of trabecular vBMD and cortical vBMD appear to differ in older men. © 2010 American Society for Bone and Mineral Research     

体积骨密度评价骨质疏松症的价值和前景

20多年来面积骨密度(areal bone mineral density,aBMD)在骨质疏松症(osteoporosis,OP)的临床和科研中发挥了重要作用,但是骨矿含量(bone mineral content,BMC)的不完全标准化及与骨生物力学负荷原则的不适应,导致漏、误诊增多.因此,骨生物力学研究中提出了更...     

GYY4137对去卵巢诱导的骨质疏松大鼠的实验研究

目的 探讨GYY4137对去卵巢诱导的骨质疏松大鼠的影响.方法 将80只大鼠随机分为4组,采用雌性SD大鼠双侧卵巢全切除术(OVX)或假手术(Sham),建立骨质疏松模型,通过骨密度的检测确认模型建立成功,随后OVX大鼠给予腹腔注射GYY4137和阿仑膦酸钠治疗.测定血浆硫化氢(H2S)、血清碱性磷酸酶(ALP)活性、...     

白藜芦醇抗切除卵巢大鼠发生骨质疏松的作用研究

目的研究白藜芦醇(resveratrol,R)抗切除卵巢大鼠发生骨质疏松的作用。方法 6月龄Wistar雌性大鼠40只,随机数字表法分为假手术组(Sham)、去卵巢组(OVX)、淫羊藿苷组(I)和白藜芦醇组(R)。I组给予25 mg/(kg·d)的淫羊藿苷灌胃,R组给予8.4 mg/(kg·d)的白藜芦醇灌胃,Sham和OVX组灌胃等体积蒸馏水。根据体质量每两周进行一次灌胃剂量调整。8周后待各组间骨密度出现显著性差异后立即处死,统计大鼠体质量并计算大鼠器官指数,检测离体骨密度、骨生物力学、血清生化指标,观察骨组织形态并测量分析骨小梁相关静态参数。结果各组大鼠体质量并未出现统计学差异,除子宫系数外其他器官指数无统计学差异(P0.05),但OVX组的子宫指数显著低于Sham组(P0.05),I组和R组子宫指数显著高于OVX组(P0.05);与OVX组相比,I组和R组的骨密度、最大载荷、弹性模量、骨形成指标OC以及Tb.N、BV/TV均显著升高(P0.05),而骨吸收指标TRACP-5b含量和Tb.SP均显著降低(P0.01);骨组织形态观察结果也显示I组和R组骨小梁网状结构呈致密性增加,骨小梁数目明显变多。R组与I组相比,其各指标平均值略低于I组,差异均无统计学意义(P0.05)。结论白藜芦醇可能通过增加骨密度、提高骨强度、促进骨形成、抑制骨吸收、改善骨质量从而发挥抗骨质疏松的作用。     

Which vertebrae should be assessed in diagnosing osteoporosis by plain radiography? Comparative study of radiographic findings and bone mineral density measured by dual energy X-ray absorptiometry

In 1990, the Ministry of Health and Welfare of Japan advocated a criterion for the diagnosis radiographic bone atrophy in lumbar vertebrae. We carried out a comparative study of this criterion (i.e., radiographic bone atrophy grading) and bone mineral density measured by posteroanterior and lateral dual energy X-ray absorptiometry. We investigated the second to fourth lumbar vertebrae of 47 postmenopausal women (mean age, 67.2 years; range, 57–82 years), to determine which vertebra would most accurately indicate osteoporosis. A significant difference in bone mineral density (P < 0.01) was found between each grade of radiographic bone atrophy in all of the second, third, and fourth vertebrae examined. The highest correlation (r = 0.714) was found between the radiographic grades and the bone mineral density on lateral dual energy X-ray absorptiometry of the third lumbar vertebrae. Our visual determinations were dependable, radiographic and a examination of the third lumbar vertebra rather than that of other lumbar vertebrae was more helpful for the detection of radiographic bone atrophy. Plain radiographic film can provide a rough estimation of bone atrophy. Received for publication on Oct. 1, 1997; accepted on April 9, 1998     

注射甲状旁腺素相关肽6个月后停药18个月骨密度随访

目的研究重组人甲状旁腺素相关肽注射6个月治疗绝经后骨质疏松,随后停药18个月时,对于骨密度是否仍存在作用。方法以采用甲状旁腺素相关肽注射6个月的32例绝经后骨质疏松患者作为研究对象,同时选取年龄匹配的绝经后骨质疏松患者26例作为对照组。比较治疗组和对照组在治疗6个月及停药18个月时的骨密度变化。结果 6个月后治疗组腰椎骨密度平均增加(1.115±3.711)%,全髋骨密度下降(0.498±2.871)%,股骨颈骨密度增加(0.127±4.912)%;对照组在腰椎下降(1.773±2.626)%,全髋下降(1.255±3.02)%,股骨颈增加(1.959±4.065)%;除腰椎外,两组比较差异均无统计学意义(P0.05);停止治疗18个月时,治疗组腰椎骨密度增加(2.210±8.171)%,全髋下降(0.734±4.266)%,股骨颈下降(1.854±4.184)%;对照组腰椎下降(2.004±5.065)%,全髋下降(3.271±3.003)%,与治疗组比较差异有统计学意义(P0.05),股骨颈下降(2.704±2.659)%,与治疗组比较差异无统计学意义(P0.05)。两组人群均未出现严重的不良反应。结论对于绝经后骨质疏松妇女应用甲状旁腺相关肽6个月,随后停药18个月时,对腰椎和全髋骨密度仍有一定的保护作用。     

纳豆提取物对预防骨质疏松作用的研究

目的 探讨纳豆提取物对骨质疏松症的预防作用,为进一步研究纳豆提取物对骨质疏松的预防和治疗提供理论依据.方法 通过大鼠实验研究纳豆提取物对低钙饲料喂养大鼠体重、身长、钙吸收率、股骨质量、骨密度和骨钙含量的影响.结果 (1)高剂量组(P<0.05)、碳酸钙组(P<0.05)的体重显著大于低钙对照组.高剂量组(P<0.05)...     

骨密度与体积骨密度诊断腰椎、股骨颈骨质疏松效果比较研究

目的通过流行病学调查比较面积骨密度(areal bone mineral density,aBMD)和体积骨密度(volumetric BMD,vBMD)对骨质疏松的检出率,从而探索出针对大骨骼和小骨骼人群骨质疏松诊断的校正诊断方法。方法采用GE-Lunar DPX双能X线吸收法骨密度测量仪测量腰椎和股骨颈骨密度,将仪器给的投影面积(cm~2)通过正方体数学模式(腰椎)和圆柱体数学模式(股骨颈)分别获得骨体积和vBMD(vBMD=骨矿物含量/骨体积),按世界卫生组织推荐20～39岁的aBMD和vBMD的标准差生成的T值定义正常、骨量减低和骨质疏松,骨质疏松诊断用世界卫生组织确立的T值诊断法。结果腰椎和股骨颈vBMD诊断骨质疏松症避免了aBMD引起的小骨误诊两部位分别为16%和11.6%,大骨漏诊在两部位分别为7%和18%。腰椎骨体积每小于均值10 cm~3,其aBMD的误诊率为1%;每大于均值10 cm~3,漏诊率为0.44%。股骨颈骨体积每小于均值1.0 cm~3,aBMD的误诊率为2.6%;每大于均值1.0 cm~3,漏诊率为4%。结论诊断骨质疏松用vBMD可以避免aBMD引起的大骨漏诊和小骨误诊的弊病。     

The Effect of Drinking Water Fluoridation on the Fluoride Content,Strength and Mineral Density of Human Bone

The effect of drinking water fluoridation on the fluoride content of human bone, on cancellous bone strength and on the mineral density of bone was studied by analysing 158 autopsy samples of the anterior iliac crest from persons from two different areas. in the samples from the town of Kuopio, where drinking water has been fluoridated since 1959, the fluoride concentrations were considerably higher than in samples from the surrounding area where low—fluoride drinking water is used. the fluoride content of bones from Kuopio increased significantly with age, while considerably less change with age was found in samples from outside Kuopio. the highest fluoride content in bone ash was observed in women with severe osteoporosis.

Cancellous bone strength measured by a strain transducer was statistically significantly higher in women with chronic immobilizing disease from Kuopio, compared with the corresponding group from outside Kuopio. No statistically significant differences in bone strength were found in men. There were no statistically significant differences in bone mineral density, as measured by gamma ray attenuation, between the samples from the fluoridated and non—fluoridated areas.     

Measurement of bone mineral density by dual-energy X-ray absorptiometry around an uncemented knee prosthesis

Dual-energy x-ray absorptiometry allows the measurement of bone mineral density (BMD) around an uncemented hip prosthesis, but has not so far been widely used to measure BMD around a knee prosthesis. We studied 16 patients undergoing total knee replacement using a Miller-Galante uncemented prosthesis for either osteoarthritis or rheumatoid arthritis of the knee. The precision of the measurement was improved by using a leg brace. The pattern of bone loss differed in the lateral projection by region (P = .001). There was significant loss of bone from the distal femur but not from the patella or proximal tibia over the 6-month period after insertion of a knee prosthesis.