小剂量生长激素补充在中老年男性中的应用研究

目的 :探讨小剂量生长激素补充在中老年男性中应用的疗效和安全性。　方法 :从门诊患者中选择 30例4 2～ 77岁有更年期症状、血睾酮水平正常的中老年男性参加本试验 ,每例患者均接受连续 6个月的生长激素补充 ,0 .0 4U/ (kg·次 ) ,每周 3次 ,皮下注射。治疗前、后均检查血脂、血糖、血睾酮、血胰岛素样生长因子 (IGF 1 )、血前列腺特异性抗原 (PSA)、男性更年期症状评分、腹围、体重、握力、尿流率、国际前列腺症状评分 (IPSS)、前列腺体积以及治疗中的不良反应。　结果 :治疗后 ,血IGF 1水平显著上升 ;血睾酮水平无明显变化 ;血总胆固醇在用药 6个月后显著下降 ;男性更年期症状评分显著下降 ;握力增加 ,腹围减少 ,体重无明显变化 ;尿流率、IPSS、血PSA、甘油三酯、血糖以及前列腺体积在治疗前后均无明显变化。　结论 :短期小剂量生长激素补充可使部分中老年男性更年期症状得以改善 ,无明显不良反应     

小剂量生长激素补充对中老年男性性功能障碍患者的影响

目的 探讨小剂量生长激素补充对中老年男性性功能障碍患者的疗效和安全性。方法 30例42-77岁有性功能障碍、血睾酮水平正常的中老年男性随机分成A、B两组。A组病人按0.04U/Kg/次,每周3次,皮下注射rhGH,连续用药3个月;B组病人先给予安慰剂1个月,然后再按A组给药方案应用rhGH 3个月。记录治疗前、后各项有关指标。结果 A、B两组应用rhGH后,每月晨间勃起次数由10.25.3次增加到19.44.8次(P<0.01);成功阴道插入次数由1.61.1次增加到3.82.2次(P<0.01);男性更年期症状总评分及性功能症状评分显著下降;IIEF-5评分显著上升;而B组患者在应用安慰剂的第1个月,各项指标均无明显变化。结论 小剂量生长激素补充可使部分中老年男性性功能显著改善,无明显副作用,但由于其是一种促进全身代谢的激素,使用仍应谨慎。     

海口地区各年龄段人群骨密度变化及中老年骨质疏松患病率调查

目的分析海口地区常住居民各年龄段人群骨密度(bone mineral density,BMD)值变化情况,并调查分析中老年骨质疏松患病率。方法采用多阶段抽样法抽取海口地区常住居民2 176名,采用双能X线检测腰椎正位BMD、左髋部BMD,并根据性别、年龄分组对骨质疏松患病率进行分析,统计中老年(年龄≥46岁)骨质疏松患病率。结果 BMD值随年龄增加呈下降趋势,51岁以上男性BMD值同年龄段内女性,且组间差异有统计学意义(P0.05);男性在66～70岁年龄段BMD明显增加,其中L1～4最明显;女性51～55岁年龄段内BMD值下降最明显。海口地区城市女性Ward’s、Troch的BMD高于农村女性(P0.05)。海口地区中老年人骨质疏松总发生率为58.17%,中老年人骨质疏松发生率随年龄增加呈上升趋势;相同年龄段内,男性骨质疏松发生率低于女性,男性在66～70岁、76～80岁两个年龄段内骨质疏松发生率略下降。骨折发生率随年龄增加呈上升趋势,同年龄段内男性骨折发生率低于女性,女性76～80岁年龄段内骨折发生率最高;脊柱骨折发生率最高,81岁及以上年龄骨折发生率呈下降趋势。结论海口地区常住居民BMD随年龄增加下降,中老年骨质疏松发生率较高,且随年龄增加上升,女性骨质疏松发生率显著高于男性,因此应加强中老年群体干预与健康教育。     

微营养素对中老年男性部分雄激素缺乏综合征的作用研究

随着我国人口老龄化进程的加快,中老年人口的增加以及生活水平的提高,我国已进入老龄社会,对中老年男性健康和生活质量问题的研究已经逐渐受到重视。中老年男性部分雄激素缺乏综合征(PADAM)作为影响中老年男性健康的一种综合征,目前国内外多采用睾酮补充治疗,但是雄激素补充治疗引起的红细胞增多、前列腺增生以及前列腺癌的潜在影响也引起人们的密切关注,影响了雄激素补充治疗的临床应用。一些研究发现,许多营养素与人体的生殖功能、精子发生、雄激素合成与分泌都有一定的关系,尤其是维生素A、维生素E、微量元素锌和硒。本文主要从微营养素对PADAM的作用方面进行综述。     

MTHFR基因C677T多态性与蒙古族中老年男性骨质疏松的相关性

目的 探讨本地区蒙古族中老年男性亚甲基四氢叶酸还原酶（methylenetetrahydrofolate reductase ,MTHFR ）基因的多态性位点C677T基因多态性与内蒙古地区蒙古族中老年男性骨质疏松症(osteoporosis,OP)遗传易感性的关系。方法 收集门诊及住院蒙古族骨质疏松（包括骨质疏松性骨折）男性患者135例。对照组为按年龄配比的门诊体检内蒙古籍蒙古族中老年男性180例。入选者全部行腰椎（L2-L4）及股骨近端股骨颈骨密度扫查,并排除骨代谢疾病的影响,并进行MTHFR基因多态性检测。结果 骨质疏松组MTHFR基因受体C677T基因型CC、CT、TT频率分别为CC 25.2％、CT 40.0％和TT 34.8％;对照组基因型CC、CT、TT频率分别为31.2%,54.5%和14.3%,两组差别有统计学意义（P<0.05）。骨松组中的T等位基因频率为54.8%,显著高于对照组(41.6%,P<0.05),提示T是骨质疏松发生的危险因素(OR=1.70,95% CI=1.24～2.34,P=0.001)。与CC基因型相比,TT基因型携带者的骨松发生风险增加至2.97倍(95％ CI=2.57～5.65,P=0.001)。 结论 MTHFR基因型分布频率均符合 Hardy-Weinberg定律,T等位基因可以增加蒙古族中老年人骨折发生风险,MTHFR C677T基因变异与内蒙古地区蒙古族中老年男性骨质疏松易感性明显相关。     

激素补充治疗抗衰老技术规范化指南

正激素补充治疗(hormone replacement therapy,HRT)抗衰老是指女性卵巢功能衰退,男性迟发性性腺功能减退症(1ate-onset hypogonadism,LOH),以及成年生长激素缺乏症(adult growth hormone deficiency,AGHD)等疾病,导致性激素和生长激素不足,引起机体健康问题而采用的临床医疗干预措施。它应在有适应证而无禁忌证的情况下应用。通过适当补充所缺乏的激素,有助于缓解围绝经期妇女的不适症状。中老年男性的机体和精神衰退,增加肌肉含量,减少脂肪组分,从而提高机体各个器官、系统的功能,改善生活质量,达到抗衰老目的。需要注意:     

骨质疏松性椎体压缩骨折PKP术后再发椎体骨折的原因及相关危险因素分析

<正>随着我国人口的日趋老龄化,骨质疏松性椎体压缩性骨折(OVCFs)已成为中老年人,特别是中老年女性的常见疾病,约占所有骨质疏松性骨折的45%~([1])。经皮椎体后凸成形术(percutaneous kyphplasty,PKP)可有效恢复压缩椎体高度,迅速缓解疼痛,明显减少骨水泥渗漏,降低并发症的发生率,是一种安全、有效、简便的治疗方法~([2])。然而,PKP术后再发骨折并不少见。对于PKP术后再发骨折的     

呼和浩特地区中老年人腰椎和髋部骨密度测量值差异的比较

目的探讨呼和浩特地区中老年男性和女性依据腰椎和髋部骨密度值诊断骨质疏松的差异。方法 :选择50～85岁中老年人1000例作为研究对象,其中男性500例,女性500例,经双能X线骨密度仪(DEXA)测定腰椎(L2-L4)前后位和左髋部骨密度(若左髋部发生骨折或有明显病变改测右髋部),根据不同部位的T值得出相应的骨质疏松检出率,比较分析各部位检出率的差异。结果中老年女性各年龄组腰椎骨密度T值评分比髋部低(P0.05),中老年男性除50～59岁腰椎和髋部骨密度无显著差异性外,其余各年龄组髋部骨密度T值评分低于腰椎骨密度T值评分(P0.05)。结论 选取多部位最低的T值作为骨密度的测定值,能够更好地提高中老年人骨质疏松的检出率,减少漏诊率。     

中老年男性生长激素部分缺乏的研究进展

近年来的研究表明[1],随着年龄的增长,中老年男性体内的一些内分泌激素如:生长激素(GH),睾酮,褪黑素等会逐渐下降,而伴随这些激素改变的是中老年男性出现身体脂肪增加、骨质疏松症、睡眠和情绪障碍、性功能减退等,由于这些与增龄有关的身体变化和激素缺乏引起的症状和体征相似,因此人们推测中老年男性出现的一些衰退症状是由于这些激素的缺乏引起。目前有关中老年男性雄激素部分缺乏(PADAM)的报道较多,而有关生长激素部分缺乏对中老年男性影响的研究很少,对此我们作一综述。在老年动物和人类衰老过程中,机体组织合成蛋白质的能力普遍下降…     

重组人生长激素治疗大鼠卵巢切除后骨量丢失的研究

目的研究重组人生长激素对卵巢切除后大鼠骨量丢失的治疗作用。方法大鼠卵巢切除后３个月开始接受不同剂量生长激素治疗,８周后处死。采用骨密度测定,骨组织计量学分析,血清生化指标测定等观察生长激素对实验性骨质疏松症的治疗作用。结果生长激素使骨质疏松大鼠腰椎骨增加,股骨中段皮质骨显著增厚,腰椎体小梁骨体积增加而且小梁连结性明显改善。重组人生长激素可促进骨质疏松大鼠类胰岛素生长因子－１合成增加。结论重组人生长     

Intravenous Zoledronic Acid: What Are the Indications for Male Osteoporosis?

Osteoporosis and fractures are under-recognized and undertreated, both in men and women worldwide. Male osteoporosis is not the epidemic problem that female osteoporosis is; however, the National Osteoporosis Foundation estimates that over 14 million American men have osteoporosis or low bone mass, and approximately 25% to 30% of all hip fractures occur in male individuals who incur greater morbidity and mortality than their female counterparts. Until recently, alendronate, risedronate, and teriparatide were the only pharmacologic agents approved by the US Food and Drug Administration for treating male osteoporosis. In December 2008, zoledronic acid was approved for “treatment to increase bone mass in men with osteoporosis.” In 2009, zoledronic acid was also approved for “treatment and prevention of glucocorticoid-induced osteoporosis in patients (both men and women) expected to be on glucocorticoids for at least 12 months.”     

Epidemiology, costs, and burden of osteoporosis in Argentina, 2009

Summary

Osteoporosis is a major public health concern for elderly subjects. Old age is a risk factor for fragility fractures; countries with aging population face a heavy burden of fractures and their consequences.

Introduction

In 2009, the total population of Argentina was 40 million, with 10 million inhabitants aged >50 years. Population will grow 13% by 2050 and reach 53 million, but the elderly population will reach 19.5 million.

Discussion

Local bone mineral density studies reveal that two out of four postmenopausal women have osteopenia, one has osteoporosis, and one has a normal bone mineral density. Around 3.3 million women will suffer from osteopenia in 2025 and 5.24 million in 2050. Although the rate of fragility fractures is higher in patients with osteoporosis, the absolute number of fractures is higher in osteopenic patients. In Argentina, the mean annual rate of hip fractures is 488/100,000 inhabitants aged above 50 years, with a 2.6:1 F/M ratio. Thus, over 34,000 hip fractures occur every year among the aged populationwith an average 90 such fractures per day.

Conclusion

The Latin American Vertebral Osteoporosis Study found an overall 16.2% prevalence of vertebral fractures in Argentinean women aged 50 years or over. Hospitalization costs of hip and vertebral fractures in Argentina exceed 190 million USD per year. Consequently, the costs of osteoporosis for the public health system are staggering; however, the federal or the provincial governments of Argentina do not give the disease a high priority. To conclude, efforts for the prevention and management of osteoporosis are urgently needed.     

Direct clinical and welfare costs of osteoporotic fractures in elderly men and women

Osteoporosis is an increasing health care problem in all aging populations, but overall direct costs associated with the total fracture burden of osteoporosis remain uncertain. We have examined direct costs associated with 151 osteoporotic fractures occurring between 1989 and 1992 in a large cohort of elderly men and women followed prospectively as part of the Dubbo Osteoporosis Epidemiology Study. The median cost of hospital treated fractures was $A10 511 per fracture and for fractures treated on an outpatient basis $A455 in 1992 Australian dollars. Femoral neck fractures were the most expensive fractures ($15984 median cost). There was no significant difference in costs between men and women for either hospital- or outpatient-treated fractures. Rehabilitation hospital costs comprised the largest proportion of costs (49%) for hospital-treated fractures. Community services comprised the major cost (40%) of outpatient-treated fractures. Univariate predictors of costs were quadriceps strength and bone density, although multivariate analysis showed quadriceps strength to be the best overall predictor of costs. The predicted annual treatment costs in Australia for atraumatic fractures occurring in subjects 60 years was $A779 million or approximately $A44 million per million of population per annum. Estimated total osteoporotic fracture-related costs for the Australian population were much higher than previously reported. The majority of direct costs (95%) were incurred by hospitalized patients and related to hospital and rehabilitation costs. Extrapolation of these data suggests that the direct costs for hip fracture alone will increase approximately twofold in most Western countries by 2025. Improving the cost-effectiveness of treating osteoporotic fractures should involve reduced hospitalization and/or greater efficiency in community rehabilitation services. The costs of various approaches to osteoporosis prevention must be placed into the context of these direct costs and prevention should target men as well as women.     

Burden of osteoporosis and fractures

Osteoporosis currently affects up to one in three women and one in 12 men. In 1990, there were 1.6 million hip fractures per annum worldwide and this number is estimated to reach 6 million by 2050. This increase in the number of fractures is due to an increase in the number of elderly people in the population, improved survival, and an increase in the age-specific fracture rates of unknown etiology. The rising number of osteoporotic fractures and their associated morbidity will place a heavy burden on future health care resources. In the United States, the cost for the management of osteoporosis has been estimated at $17 billion. The majority of this cost is spent on the acute surgical and medical management following hip fracture, and the subsequent rehabilitation. Currently, only minimal costs are utilized for treatment and prevention of osteoporosis. Hopefully, however, an accurate assessment of the burden of osteoporosis on the individual and the health care system will enable the targeting of resources to tackle this growing problem. With an increasing number of effective pharmaceutical interventions, it is critical that these agents are targeted to those at greatest risk for future fracture. This will ultimately reduce the burden of osteoporosis in future years.     

Major osteoporotic fragility fractures: Risk factor updates and societal impact

Osteoporosis is a silent disease without any evidence of disease until a fracture occurs. Approximately 200 million people in the world are affected by osteoporosis and 8.9 million fractures occur each year worldwide. Fractures of the hip are a major public health burden, by means of both social cost and health condition of the elderly because these fractures are one of the main causes of morbidity, impairment, decreased quality of life and mortality in women and men. The aim of this review is to analyze the most important factors related to the enormous impact of osteoporotic fractures on population. Among the most common risk factors, low body mass index; history of fragility fracture, environmental risk, early menopause, smoking, lack of vitamin D, endocrine disorders(for example insulin-dependent diabetes mellitus), use of glucocorticoids, excessive alcohol intake, immobility and others represented the main clinical risk factors associated with augmented risk of fragility fracture. The increasing trend of osteoporosis is accompanied by an underutilization of the available preventive strategies and only a small number of patients at high fracture risk are recognized and successively referred for therapy. This report provides analytic evidences to assess the best practices in osteoporosis management and indications for the adoption of a correct healthcare strategy to significantly reduce the osteoporosis burden. Early diagnosis is the key to resize the impact of osteoporosis on healthcare system. In this context, attention must be focused on the identification of high fracture risk among osteoporotic patients. It is necessary to increase national awareness campaigns across countries in order to reduce the osteoporotic fractures incidence.     

雌激素与老年男性骨质疏松的研究进展

骨质疏松是老年人的一种常见病,严重影响着老年人的健康和生活质量。骨质疏松原因有很 多,其中老年人性激素分泌减少是导致骨质疏松的重要原因之一,目前有研究显示雌激素与老年男性 骨质疏松有一定的关系。现就雌激素与老年男性骨质疏松的关系及其可能的作用机制作一综述。     

血脂紊乱与骨质疏松关系的研究进展

骨质疏松是一种常见的老年病,血脂紊乱常与其伴随出现。越来越多的研究显示二者之间可能存在一定的关系,不同类型的血脂紊乱对骨质疏松影响不一。高甘油三酯对男女性腰椎、股骨骨密度有不同的影响;低密度脂蛋白胆固醇影响骨细胞分化,低密度脂蛋白胆固醇增高可抑制成骨细胞活性,同时使破骨细胞活性增强从而引起骨质疏松;高密度脂蛋白胆固醇与骨质疏松的关系结论尚不一致。此外,他汀类药物可以促进成骨细胞分化,抑制破骨细胞活性从而增加骨密度,降低骨折风险;双膦酸盐在治疗骨质疏松的同时对血脂紊乱也有一定的影响。因此,研究血脂紊乱与骨质疏松之间的关系对于骨质疏松的防治具有一定的临床指导意义。     

酪酸梭菌治疗骨质疏松症的研究进展

骨质疏松症是以骨量减少,导致骨脆性增高及骨折危险性增加的一种全身性骨病。随着社会人口老龄化骨质疏松性骨折越来越多见,显著增加了老年人死亡率以及社会经济负担。炎性肠病患者存在骨质丢失现象,与骨质疏松的发生密切相关,临床上常用酪酸梭菌辅助治疗炎性肠病,因而酪酸梭菌对骨质的影响应引起关注。本文通过联系炎性肠病引发骨质疏松、酪酸梭菌治疗炎性肠病的相关作用机制,以初步探讨酪酸梭菌可能具有治疗骨质疏松症的作用。     

消化系统疾病并发骨质疏松症与肠道菌群的关系探讨

随着全球人口老龄化,骨质疏松症的发病率逐年增高,在我国,50岁以上人群中骨质疏松症总患病率达15.7%,预计到2020年,我国骨质疏松和低骨量患者将增加至2.8亿,骨质疏松症已经成为影响我国老年人口生活质量的重大公共卫生问题。消化系统疾病并发骨质疏松症,其发生机制较复杂,目前仍未彻底阐明,常常并发骨质疏松症的消化系统疾病有胃切除术后、慢性肝脏疾病、炎症性肠病等。研究发现,消化系统疾病伴随着肠道菌群的失调,而肠道菌群与骨质疏松症从发病、发展及治疗等方面关系密切,越来越多的研究表明肠道菌群失衡与多种代谢性疾病的发生发展紧密相关,因此,骨质疏松症作为一种全身性骨代谢疾病,其与肠道菌群失衡之间的关系近年来逐渐受到关注。从肠道菌群的视角探讨消化系统疾病并发骨质疏松症的机制,对于开拓该类合并症的防治思路具有启示意义。