骨质疏松的运动疗法

骨质疏松症已成为世界范围内流行的疾病,运动早已被认为是防治骨质疏松的有效措施之一。运动能防止各种原因引起的骨质丢失,其机理有:运动对骨骼产生机械应力,刺激骨细胞,造成DNA合成增加,最终导致胶原蛋白的含量增加,从而增加骨质水平;适量运动可促进某些激素的释放,特别是睾酮、雌二醇,可促进骨的蛋白质的合成,有利于钙的保留和沉淀,促进骨骼的生长、发育;运动增加骨骼对钙的需求量,并可以促进钙的吸收和利用。另外.本文从运动处方这个角度阐明:大负重、爆发性的运动方式在维持和提高骨矿密度上优于有氧运动;运动项目的选择要有目的性,针对要防治的部位,选择应力刺激集中于该部位的运动项目;运动量要因人而异。防治骨质疏松症应多种方法联合使用,才能达到良好的效果。     

跟骨定量超声评估强直性脊柱炎患者的骨质疏松

目的：研究强直性脊柱炎(ankylosing spondylitis，AS)患者骨矿物质密度(bone mineral density，BMD)的变化，并探讨强直性脊柱炎患者发生骨质疏松的机理。方法：采用定量超声骨密度仪测定210例AS患者跟骨的骨密度，其中男165例，女45例，并与性别、年龄匹配的健康人作对照，分析AS的骨质疏松发生率。结果：AS患者早期即有较高的骨质疏松发病率，AS组骨密度(患者骨密度观测定和年轻人骨密度峰值的比较，t-Score)均显著低于对照组(男：-2．32&;#177;1．19和1．26&;#177;0．89，女：-1．0l&;#177;1．18和1．45&;#177;0．36：t=29．8，13．7，P&;lt;0．05)；AS组骨质疏松发生率(男47．9%，女2％)与对照组(男7．3％，女4％)比较差异有显著性意义(χ^2=8．77，0．35，P&;lt;0．05)。HLA-B27(+)与HLA-B27(-)患者骨密度(-2．26&;#177;1．15和-2．56&;#177;0．70)比较无显著性差异(t=1．47，P&;gt;0．05)：结论：骨质疏松是AS患者的常见并发症，疾病早期即有骨质疏松发生，超声骨密度可敏感检测AS继发骨质疏松，提示对AS患者早期既应注意骨质疏松的防治。     

应用骨超声衰减评估绝经后骨质疏松药物疗效的研究

目的 :研究跟骨超声衰减 (BUA)测量对药物治疗骨质疏松疗效评价的作用。方法 :40例绝经 3年以上患骨质疏松的老年女性服用阿伦膦酸钠 6个月。服药前后分别用超声测量跟骨的BUA ,双能X线测量第 2～ 4腰椎和髋部的骨密度 (BMD) ,行配对t检验并作相关回归分析 .结果 :用药前左跟骨BUA平均值为 ( 5 3 7± 5 2 )dB/MHz ,服药后为 ( 5 5 7± 2 8)dB/MHz (P =0 0 2 ) ,显示BUA检测能反映疗效变化 ,并与左股骨颈的BMD变化有相关 (r =0 387,n =40 ,P <0 0 5 ) ,但与腰椎和髋部总的BMD变化无相关。结论 :服药后BUA值比服药前有明显增加 ,提示BUA可初步估计治疗效果。     

骨质疏松诊断及骨矿含量测定方法

1 骨质疏松的诊断 骨质疏松（osteoporosis）的诊断一直为学者们所关注，鉴于目前生化检查尚不能作为诊断指标，故骨矿含量（bone mineral content，BMC）测定或骨密度（bone mineral density，BMD）测定已成为目前诊断骨质疏松的重要手段。1994年世界卫生组织批准并颁布了Kanis等提出的白人妇女骨质疏松的诊断标准即：骨矿密度（BMD）或骨矿含量（BMC）在青年成人平均值的1个标准差（standard deviation，简称s）以上者为正常；     

定量超声测定法筛查健康人群骨质疏松的患病率

目的：回顾分析健康人群使用定量超声测定法（QUS）的骨密度测定结果,为骨质疏松的诊断与筛查提供依据。方法：对上海地区的4173例健康人进行跟骨的Qus骨密度测定,对骨密度测定结果分性别、年龄进行统计学分析,分别计算人群中绝经前妇女、绝经后妇女和男性的骨质疏松患病率。结果：男性、绝经前、绝经后妇女的骨量减少、骨质疏松患病率分别为58．04％、3．32％;58．37％、1．20N;70．15％、7．38％。结论：定量超声测定法可作为人群普查或筛查骨质疏松的一种方法,有助于提高其早期诊断率,并有助于及早进行初级预防。     

唑来磷酸盐对I型骨质疏松患者骨代谢的影响

目的:探讨唑来磷酸盐对I型骨质疏松患者骨骼代谢的影响.方法:选取我院骨科门诊I型骨质疏松患者21名接受唑来磷酸盐治疗,治疗组11名给以唑来磷酸盐治疗,对照组10名以生理盐水分别在0个月、6个月、12个月检查患者骨矿密度(BMD )、血清学骨特异性碱性磷酸酶(BALP)、I型前胶原氨基末端前肽(PIMP )、抗酒石酸酸性磷酸酶(TRACP) 5b、Ⅰ型胶原C端肽(CTX);视觉模拟疼痛评分(VAS).分析血清学指标的变化规律和相关关系,分析骨骼代谢水平和监测骨折风险.结果:与对照组比较,在治疗开始前两组指标无显著性差异;6个月时骨治疗组吸收指标TRAP5b与CTX显著下降而骨形成指标BALP与PINP下降但幅度较小;治疗12个月时,治疗组的骨代谢指标与骨形成指标均下降,伴VAS疼痛评分下降骨矿密度升高.随访期间治疗组患者未发生骨折,对照组发生1例Colles,骨折.结论:唑来磷酸盐治疗降低I型骨质疏松患者骨转换而达到抗骨质疏松、提高骨矿密度的作用;治疗期间骨吸收指标先于骨形成指标下降切幅度较大.     

骨定量超声的临床应用

骨定量超声(quantitative ultrasound,QUS)测量技术最早于1984年由Langton等[1]报道用于评估骨组织情况,其证实QUS能识别与绝经相关的骨量变化,并可评估因骨脆性增加而导致的骨折风险。如今,该技术已广泛应用于临床研究,特别是用于绝经期妇女的骨质疏松评估,其不仅能反映     

热固耦合式超声骨强度仪的可重复性及相关性研究

目的:评估一款国产热固耦合式超声骨强度仪的可重复性和有效性。方法:选择11名志愿者,用该仪器测得右跟骨的两个超声参数,分别是超声速度(SOS)和宽带超声衰减(BUA),计算每个参数的变异系数均方根百分比(CVRMS%),评估该仪器的短期可重复性;选择18名志愿者,用类似的方法评估该仪器的中期可重复性;选择29名志愿者,用双能X线吸收法(DEXA)测量腰椎骨密度(BMD),并与用该仪器测得的跟骨SOS,BUA值进行相关性分析,评估该仪器的有效性。结果:①超声参数SOS,BUA的短期CVRMS%分别为0.30,4.24;中期CVRMS%分别为0.41,4.20。②SOS与腰椎BMD的相关系数r=0.486(P<0.01),BUA与腰椎BMD的相关系数r=0.629(P<0.01)。结论:与国际主流定量超声(QUS)检测仪器相比,热固耦合式超声骨强度仪具有较高的可重复性和准确性,可用于临床骨质状况评估。     

慢性阻塞性肺疾病患者的骨超声和骨矿含量的改变

目的　通过观察慢性阻塞性肺疾病 (COPD)患者的跟骨超声振幅衰减 (BUA)、超声声速 (SOS)、髋部骨矿含量(BMC)及骨密度 (BMD)变化 ,进一步了解COPD与骨质疏松的关系。方法　测定COPD老年男性患者及对照组各 3 0例的跟骨BUA、SOS和股骨颈、Ward’s三角、股骨粗隆的BMD、BMC以及动脉血气。结果　老年COPD组的股骨颈、Ward’s三角、股骨粗隆的BMD、BMC以及跟骨的BUA、SOS均较对照组的测定值低 ,差异有显著性。COPD组动脉血气分析氧分压较对照组低 (P <0 .0 1)。结论　COPD患者因缺氧引起各脏器受损 ,加速骨量丢失而易患骨质疏松症     

胫骨定量超声法检测骨质量的临床应用及评价

目的：通过马鞍山市区正常人群胫骨超声声速（SOS）的测定,达到对骨质疏松症作出早期诊断和预测骨折危险性,方法：用骨定量超声（QUS）仪检测1368例健康者右胫骨超声速度。各性能、年组之间进行比较,全部数据由计算机处理分析。结果：正常人SOS峰值（PV）炎性在40－49年龄组,女性在30－39年龄组。男性60岁以上各年龄组SOS下降,70岁以上明显下降（P＜0．01。女性40岁以上SOS即下降（P＜0．05）。50岁以上明显下降（P＜0．01）。40岁以前女性高于男性,50岁以后女性明显低于男性（P＜0．01）。结论：QUS对早期诊断骨质疏松和预测骨折危险性具有准确、快捷、无创伤等优点,从而为今后医疗保健提供依据。老年人胫骨SOS明显下降,老年女性下降更为明显,停经因素是导致骨质疏松的重要因素之一,与青年组比较,SOS减少2．0SD为骨质疏松症的诊断标准较适合本地区情况。     

Ultrasonic parameters of bone in young normals: effect of age and sex

This study was carried out in order to investigate the early effects of ageing on both broadband ultrasound attenuation and speed of sound through the os calcis. A total of 217 normal subjects, subdivided into 113 fertile women (age range 18–51 years, mean±1 SD=29.4±8.4 years) and 104 age-matched men (age range 20–49 years, mean29.3±7.1 years), were investigated. Mean broadband ultrasound attenuation values in men (127.3±12.8dBMHz⁻¹) were significantly higher than those found in women (118.3±17.2, P <0.001), whereas no significant differences were found as far as mean speed of sound values was concerned. Both broadband ultrasound attenuation ( r =−0.196, P <0.046) and speed of sound ( r =−0.226, P <0.02) values were inversely related to age in men; only a decrease of speed of sound values with age was noted in women ( r =−0.400, P <0.001). Finally, there was a very high significant correlation between broadband ultrasound attenuation and speed of sound values in men ( r =0.458, P <0.001), but this was lacking in women. Admitting that the measurement of broadband ultrasound attenuation is influenced not only by bone density but also by trabecular quantity, spacing and orientation, our results seem to indicate that, even during adulthood, and well before the deleterious effects of oestrogen lack become apparent, structural properties of skeletal tissue in female subjects are disadvantageous with respect to those found in male subjects. Furthermore, while there is a progressive and balanced involvement of both the elastic (as reflected by speed of sound) and the structural properties of skeletal tissue in men, an uncoupling between the two is typical of women.     

How does quantitative ultrasound compare to dual X‐ray absorptiometry at various skeletal sites in relation to the WHO diagnosis categories?

The World Health Organisation (WHO) has proposed a set of guidelines for the diagnosis of osteoporosis in adult women based on a measurement of bone mineral density (BMD) expressed as the number of SD below young adult mean (t‐score). In this study, we investigated the number of subjects classified as either osteopenic or osteoporotic according to these guidelines using dual X‐ray absorptiometry (DXA), at the hip, at the spine and at the lower forearm and quantitative ultrasound (QUS), at the heel. A total of 247 men, 209 postmenopausal women and 195 premenopausal women were included in the study. Furthermore, the study provides the first normative data showing the influence of sex, age and menopause on broadband ultrasound attenuation (BUA) and speed of sound (SOS), as measured by the DTU‐one imaging ultrasound scanner. The difference between the number of patients classified into either diagnosis group by the investigated parameters is large ranging from 25·9% of the women being diagnosed as osteopenic by BUA at the heel to 43·0% by BMD at the femoral neck. For men, the same range is from 20·5% by BUA to 44·1% by BMD at the femoral neck. For the classification into the osteoporotic group, the range is from 2·5% by intertrochanteric BMD to 24·4% by BMD at Ward’s triangle for women and from 0% by SOS to 29·0% by BMD at Ward’s triangle for men. Using total hip BMD as the reference parameter to categorize the subjects as normal, osteopenic or osteoporotic, the agreement of the other parameters with this classification is assessed in terms of sensitivity and specificity. We conclude that there are significant differences in the classification of osteoporosis/osteopenia depending on the site measured and the technique used for the bone mass assessment. Furthermore, we suggest that development of technique and site specific cut‐off values may increase the accuracy of the classification of osteoporosis/osteopenia in both men and women.     

2型糖尿病性骨质疏松危险因素及定量CT的早期诊断

目的探讨2型糖尿病性骨质疏松的危险因素及定量CT在疾病早期诊断中的应用价值。 方法选取2016年2月至2017年2月期间在苏北人民医院治疗的2型糖尿病患者220例,研究对象同时接受双能X线吸收定量法（DXA）和定量CT两种方法分别检测腰椎骨密度和体积骨密度,根据DXA测量的椎体骨密度结果分为骨质疏松组和非骨质疏松组。比较2组性别、年龄、病程、BMI、空腹血糖（FPG）、餐后2 h血糖（2hPG）、空腹C肽（FCP）及餐后2 h C肽（2hCP）、糖化血红蛋白（HbA1c）、总胆固醇、三酰甘油、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、碱性磷酸酶、血磷、血钙、甲状旁腺激素（PTH）、Ⅰ型胶原羧基末端肽（CTx）、血清骨钙素（N-MID）、Ⅰ型胶原氨基末端肽（TP1NP）、维生素D、肌酐等指标的差异并行相关和回归分析。 结果2型糖尿病患者女性骨质疏松患病率较男性高（46.4% vs 29.3%;χ²=8.319,P=0.012）;骨质疏松组年龄、病程、HbA1c、PTH、CTx较非骨质疏松组高（P<0.05）,骨质疏松组BMI、N-MID、TP1NP、维生素D较非骨质疏松组低（P<0.05）;CTx与2hPG呈负相关（r=-0.165,P<0.05）;TP1NP与FPG（r=-0.224）、2hPG（r=-0.191）呈负相关（P<0.05）;N-MID与FPG（r=-0.280）、2hPG（r=-0.183）、三酰甘油（r=-0.293）、HbA1c（r=-0.238）呈负相关（P<0.05）;维生素D与病程（r=-0.224）呈负相关,与BMI（r=0.167）呈正相关（P<0.05）。2型糖尿病患者腰椎骨密度与年龄（r=-0.371）、HbA1c（r=-0.173）、病程（r=-0.230）呈负相关（P<0.05）,与BMI呈正相关（r=0.231,P<0.05）。2型糖尿病患者腰椎骨密度与年龄、病程、BMI、HbA1c、PTH、CTx有线性回归关系;定量CT与DXA检测方法相比,敏感度为100%,特异度为80.3%,定量CT诊出率较DXA高（P<0.05）。 结论（1）糖代谢和骨代谢有相关关系,血糖控制不佳,骨形成减少;（2）女性、高龄、病程长、血糖控制不佳是骨质疏松症的主要危险因素,BMI在一定范围适度增加为骨质疏松症的保护因素;（3）年龄、HbA1c、病程、PTH、CTx、BMI对腰椎骨密度的影响依次增大;（4）定量CT对2型糖尿病性骨质疏松的诊断具有更高的应用价值。     

Quantitative Ultrasound of the Calcaneus in Hemodialysis Patients

The aim of this study was to investigate the bone status of hemodialysis patients and identify factors that have influence on bone quality. Four hundred eighty-nine subjects (213 males and 276 females) on maintenance hemodialysis and 696 healthy subjects (309 men, 387 women) were enrolled in this study. Speed of sound (SOS), broadband ultrasound attenuation (BUA) and quantitative ultrasound index (QUI) were assessed by quantitative ultrasound (QUS) at the right calcaneus in both groups. Serum levels of intact parathyroid (iPTH), total alkaline phosphatase (ALP), calcium and phosphate were measured to determine their influence on bone status in hemodialysis patients. All QUS parameters were significantly lower in hemodialysis patients than in controls (p < 0.0001). Stepwise multiple linear regression analysis in male patients indicated that age, weight, calcium-phosphate product and ALP were significant predictors of QUS parameters (adjusted R² = 0.15 in SOS; adjusted R² = 0.17 in BUA and QUI). In female patients, same findings including number of parity were observed in SOS only (adjusted R² = 0.25 in SOS). In postmenopausal patients, the duration of menopause was significant negatively correlated with all QUS parameters (p < 0.01). In conclusion, patients on maintenance hemodialysis had additional risk of bone loss. Advanced age, low body weight, high calcium-phosphate product and high ALP level were important risk factors for deterioration of bone quality. (E-mail: tcchu@mx.nthu.edu.tw)     

The role of quantitative ultrasound in the assessment of bone: a review

Quantitative ultrasound (QUS) bone measurement is a promising, relatively new technique for the diagnosis of osteoporosis. Unlike to the more established method of bone densitometry [measurement of bone mineral density (BMD) e.g. using dual X-ray absorptiometry (DEXA)], QUS does not use ionizing radiation. It is cheaper, takes up less space and is easier to use than densitometry techniques. The two QUS parameters currently measured are broadband ultrasound attenuation (BUA) and speed of sound (SOS). The reported age-related changes for healthy women range from ?0·27% to ?1·62% per year for BUA and from ?0·06% to ?0·19% per year for SOS. Precision ranges from 1·0 to 3·8% (CV) for BUA and from 0·19 to 0·30% (CV) for SOS. The new method of imaging ultrasound has improved the precision of QUS measurements. QUS is significantly correlated with BMD. Studies with the latest equipment have shown r-values between 0·6 and 0·9 in site-specific measurements, and QUS is thus believed to reflect mainly BMD. However, other studies indicate that QUS measures something other than the actual mineral content of bone, namely bone quality, e.g. in vitro studies have shown that QUS reflects trabecular orientation independently of BMD. In both cross-sectional and prospective studies, QUS seems to be as good a predictor of osteoporotic fractures as BMD. In two large prospective studies, QUS also predicted fracture risk independently of BMD. QUS has just begun to be used systematically for monitoring the response to anti-osteoporotic treatments in prospective trials. In the studies performed, QUS has been found to be useful in the follow-up of patients. QUS is thus a promising new technique for bone assessment.     

Odds ratios for hip- and lower forearm fracture using peripheral bone densitometry; a case-control study of postmenopausal women

Background: Dual‐energy X‐ray absorptiometry (DXA) measured at the lumbar spine and particularly at the hip remain the gold‐standard for diagnosing osteoporosis. However, devices for assessing the peripheral skeleton present several advantages in terms of lower price and portability. A major concern when using peripheral densitometry is the poor correlation with the central measurements. The main aim of this study is, therefore, to assess the possibility of expressing ultrasound measurements at the heel and bone mineral density (BMD) measured at the distal forearm as fracture odds ratios rather than an absolute measure of bone mass. Methods: A total of 76 women with lower forearm fracture, 47 women with hip fracture and 231 age‐matched women (controls) were included. All had broadband ultrasound attenuation (BUA) and speed of sound (SOS) measured at the heel using the DTU‐one ultrasound scanner as well as BMD measured by dual X‐ray absorptiometry on the DTX‐200 at the distal forearm. Results: BUA, SOS and BMD at the distal forearm were all significantly lower in fracture patients compared with their respective control groups. The odds ratio for lower forearm fracture was 3·1 (95% CI: 1·8; 5·2) for heel‐BUA (T‐score cut‐off: –2·3), 4·1 (2·3; 7·4) for heel‐SOS (–2·1) and 2·2 (1·3; 3·7) for lower forearm BMD (–2·7). The odds ratio for hip fracture was 3·4 (1·5–7·7) for heel‐BUA (–2·7), 3·6 (1·6; 8·1) for heel‐SOS (–2·6) and 3·2 (1·4; 7·4) for lower forearm BMD (–2·9). Conclusion: Peripheral densitometry can discriminate between hip‐ and lower forearm fracture patients and age‐matched controls. Significantly elevated odds ratios for incurring these fractures can be calculated using device‐ and site specific t‐score cut‐off values. The results from this case–control study need to be confirmed by prospective cohort studies.     

Quantitative Bone Ultrasound at the Distal Radius in Adults with Cystic Fibrosis

It is of clinical importance to identify bone disease related to cystic fibrosis (CF) early in its course to allow therapeutic interventions that optimize bone health. To test the technical (precision) and clinical (percentage of abnormal results, correlation with clinical parameters) performance of a commercial quantitative ultrasound apparatus for radial measurements, speed of sound (SOS) was measured at the distal third of the left radius with the Omnisense 7000p apparatus (Sunlight Medical, Tel-Aviv, Israel) in a group of young adult CF patients with regular follow-up at the Brussels and Ghent University Hospital. Sixty-three (37 males) CF patients at a median (range) age of 23.5 y (18.1–39.9) were included. SOS, SOS z-score and SOS t-score were respectively 4017 ± 97 m/s, −0.31 ± 0.74 and −0.60 ± 0.78 in males and 4086 ± 97 m/s, −0.19 ± 0.75 and −0.51 ± 0.95 in females. Mean SOS t-score was significantly lower compared with the manufacturer's reference data for males (p < 0.0001) and females (p = 0.01). SOS z- and t-scores correlated with weight z-score and body mass index z-score in females. No significant correlation was found between SOS and forced expiratory volume in 1 s (%). Neither diabetes mellitus nor liver disease was found to influence SOS. Radial quantitative ultrasound has a precision of 0.55%. The SOS is in the low normal range in 14% of CF patients and is influenced by weight in female patients, but not by the severity of the lung disease.     

定量CT骨密度测量诊断中国老年男性人群骨质疏松

目的 评价定量CT(QCT)骨密度测量在诊断老年男性骨质疏松症中的应用价值。方法 收集我院同时接受腰椎DXA、髋关节DXA和腰椎QCT检查、年龄>60岁的男性受检者314例。比较DXA和QCT对骨质疏松症检出率的差异。结果 DXA(腰椎正位、髋关节)对老年男性骨质疏松的检出率(35/314,11.15%)低于腰椎QCT对老年男性骨质疏松的检出率(141/314,44.90%;χ²=88.70,P<0.05)。结论 腰椎QCT BMD测量对中国老年男性人群骨质疏松症的早期诊断具有重要作用。