绝经后骨质疏松症的预防和药物联合序贯治疗

背景:绝经期后的妇女由于雌激素水平下降导致骨吸收迅速增加,造成骨吸收和形成之间的不平衡,增加了骨质疏松和相关部位骨折的风险。然而,目前的临床防治并不足以抑制长期的骨丢失和不断增加的骨折风险。近年来,针对绝经后骨质疏松症及时有效的预防和抗骨质疏松药物序贯联合治疗已成为必然趋势。目的:就绝经后骨质疏松症的预防和抗骨质疏松药物治疗的相关文献进行总结,介绍绝经后骨质疏松症的临床预防措施和常见的抗骨质疏松药物联合序贯治疗进展。方法:作者于2020年1月应用计算机检索2009年1月至2019年12月中国期刊全文数据库CNKI、万方和PubMed数据库的相关文章,中文检索词"绝经后骨质疏松症,预防,药物,治疗";英文检索词"Postmenopausal osteoporosis,prevention,drug therapy,medication",根据纳入标准及排除标准摘选41篇文章进行分析讨论。结果与结论:①绝经后妇女要及时进行骨密度测试,通过改变饮食结构和生活方式进行预防,以降低骨折风险;②与单一药物相比,联合序贯疗法可以更有效地治疗绝经后骨质疏松症,对绝经后骨质疏松症的治疗具有深远的意义。     

绝经后骨质疏松症相关基因的研究进展

绝经后骨质疏松症是困扰绝经后妇女的常见病,基因因素在其发病过程中占有很大比例,近几年已成为研究热点,本就其几种相关基因的研究进展做一概述,以期进一步对其发病机制进行探索。     

绝经后骨质疏松症患者细胞因子、骨密度及雌激素水平的关系

绝经后骨质疏松症是指绝经后妇女由于体内卵巢功能低下,雌激素水平低落,骨偶联过程失调,破骨细胞的骨吸收大于成骨细胞的骨形成作用所导致的骨量减少,骨脆性增加,进而易于发生骨折的代谢性骨疾病。雌激素水平降低是绝经后骨质疏松发病的首要原因,本文旨在观察绝经后骨质疏松症（PMOP）的雌激素水平与细胞因子的关系。     

绝经后骨质疏松症相关基因的研究进展

绝经后骨质疏松症是困扰绝经后妇女的常见病 ,基因因素在其发病过程中占有很大比例 ,近几年已成为研究热点。本文就其几种相关基因的研究进展做一概述 ,以期进一步对其发病机制进行探索     

绝经后的妇女骨丢失与性激素和骨钙素测定的临床研究

为了解绝经妇女血清Ca、P、AKP(碱性磷酸酶)、性激素和骨钙素的水平，探讨绝经妇女的骨合成和骨丢失的发病机理，本文对177例绝经妇女，按不同绝经年限分为5组，用放免法测定血清总雌二醇(E2)、睾酮(T)、骨钙素(BGP)；用免放法测定血清促黄体生成素(LH)、促卵泡激素(FSH)、泌乳素(PRL)；用生化分析法测定Ca、P、AKP。结果显示：绝经妇女E2、T降低，E2最为明显，LH、FSH升高，PRL略降低。结论：绝经妇女雌激素缺乏和卵巢功能衰退是骨丢失的重要原因。     

骨质疏松症治疗中的运动疗法

背景：骨质疏松症是以骨量减少、骨组织显微结构退化为特征,以致骨的脆性增高而骨折危险性增加的一种全身骨病,通常治疗的首要手段为药物治疗。而单纯药物治疗无法提高肌肉力量,改善平衡功能,进而预防跌倒的发生,因此已不能满足骨质疏松症的综合管理。运动作为一种重要的非药物治疗手段,在骨质疏松症的预防中公认应作为首选,在骨质疏松症的治疗中的重要性逐渐被认识。 目的：结合最新的一些研究文献,探讨运动在骨质疏松症治疗中的作用。 方法：以“骨质疏松症,骨密度,骨强度,治疗,运动,应力,太极,肌肉,骨组织构建”为中文检索词,以“osteoporosis,bone mineral density, bone strength, treatment,exercise,stress,tai chi,muscle,bone architecture”为英文检索词,检索中国知网(CNKI)期刊全文数据库和Medline 2001年1月至2013年2月有关不同运动类型对人骨强度的影响特别是对骨质疏松症患者的治疗作用的临床报道及机制研究。排除重复性研究和不典型报道。 结果与结论：治疗性运动包括有氧运动、抗阻运动、冲击性运动、振动运动等类型,可以安全的提高骨强度,提高肌肉力量,改善平衡功能,预防跌倒和骨折。对于脊柱畸形者适当选用矫形器可提高安全性、促进运动治疗。与药物治疗一样,运动治疗也遵循个体化原则,在良好的依从性和安全性条件下进行运动方案的选择,各种运动的效果均较小,包含高应变速率的运动似乎更有效,但均需要长期坚持运动以维持疗效。     

CiteSpace知识图谱可视化分析中医药防治绝经后骨质疏松症

文题释义： CiteSpace知识图谱：CiteSpace基于Java语言,将应用数学、统计学、文献计量学、信息科学等各学科的理论和方法相结合,对领域内研究文献的引文、作者、关键词进行时间空间多元共现分析,把数据分析映射在二维、三维图形中,从宏观、微观等多层面展现学术网络结构和动态变化,形成领域的知识图谱。 绝经后骨质疏松症：主要发生于绝经后女性的骨质疏松症,是由于雌激素缺乏导致骨量减少及骨组织结构变化。该病隐匿发生,临床主要有骨痛、驼背或身高变矮、局部压痛叩击痛等表现,发生骨折或合并症后严重影响老年人的身体健康和生活质量,甚至缩短寿命。背景：中医药防治绝经后骨质疏松症有着悠久的历史,相关领域内研究逐步发展壮大,但目前针对该领域内研究文献的发表情况、核心作者、研究力量等要素分析及系统综述较少。 目的：针对中医药防治绝经后骨质疏松症的相关文献研究进行CiteSpace知识图谱绘制及可视化分析,了解该领域研究过程、研究热点、发展趋势,为其后续发展提供依据与可行性建议。方法：计算机检索中国知识基础设施工程(CNKI)数据库1993至2019年关于中医药防治绝经后骨质疏松症的相关文献,统计分析纳入文献年度发文量、科研基金资助情况、高频被引文献等,并将纳入文献以RefWorks格式导出使用CiteSpace V软件生成发文机构、作者、关键词等信息的知识图谱,进行可视化分析。结果与结论：①共纳入453篇文献,该领域研究自1993年开展并逐渐获得重视,研究文献以期刊论文为主要形式;②各类科研基金中以国家自然科学基金的资助项目最多;③核心作者有12人,主要研究者有郑洪新、梁文娜、葛建荣等,并形成相应的主要研究团队;④主要研究机构有广州中医药大学附属骨伤科医院、辽宁中医药大学等中医药院校及其附属医院;⑤研究形成了9个具有代表性的关键词聚类,并随时间推移呈现研究方向的转变趋势;⑥由以上分析可见,中医药防治绝经后骨质疏松症的相关研究历经20余年,形成多个研究力量、研究主题,其发展仍处于上升期;如能从国家发展战略高度整合优势资源,促进不同地区、机构合作,进一步发掘中医药特色,有望促进中医药走向世界,兴旺发展。 ORCID: 0000-0003-0247-9863(李绍烁) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

尼尔雌醇用于绝经后妇女取IUD中的体会

自1997年1月起，对85例绝经后妇女在取器一周前给予尼尔雌醇口服，取得满意效果，现报道如下：     

绝经后骨质疏松症新药——罗莫索单克隆抗体综述

骨质疏松是一种代谢性骨质病变,好发于绝经后妇女,常表现为骨骼疼痛等,可增加老年女性的骨折风险。本文基于临床常用的骨质疏松治疗药物,结合国内外研究进展,围绕新型治疗药物——罗莫索单克隆抗体的作用机制、临床应用以及药效对比等进行综述,为绝经后患有骨质疏松的妇女提供治疗选择。     

绝经后妇女卵巢肿物的超声诊断价值及临床分析

目的：探讨绝经后妇女卵巢肿物的超声诊断价值及临床分析。方法本次共选择100例绝经后妇女有卵巢肿物的患者作研究对象,均为我院2012年2月~2014年2月收治,采用超声诊断,评估诊断价值及临床特征。结果本次选取的绝经后100例卵巢肿物女性中,恶性肿瘤30例,良性70例,肿物直径经检测示为2~30cm。分析组织学类型：生殖细胞肿瘤20例,占20%;性索间质肿瘤10例,占10%;上皮性肿瘤60例,占60%;其它10例,占10%。本次选取对象80例为单侧病变,16例为恶性病变,占20%;20例为双侧病变,14例为恶性病变,占70%,故意相较单侧病例者,双侧病变有更高恶性病变几率(<0.05)。单侧病变80例中,最大径线<5cm组恶性病变率为7.5%,5~10cm组为15%,>10cm组为47.5%。最大径线组与其它径线比较,有统计学差异(<0.05)。采用彩超诊断显示,良性肿瘤无血流信号探及40例,占40%;恶性肿瘤均有血流信号探及。结论绝经后妇女卵巢肿物采用超声诊断,有较高敏感性及特异性,具无创、快速、方便优点,可为疾病诊断及治疗方案的制定提供有力的参考条件。     

PIXI bone density screening for osteoporosis in postmenopausal women

OBJECTIVES: The aim of this study was to evaluate a pragmatic screening programme for osteoporosis based on the identification of known risk factors. A secondary aim was to assess the validity of peripheral instantaneous X-ray imager (PIXI) scanning against dual energy X-ray absorptiometry (DEXA) in women identified as having osteopenia. METHODS: A cross-sectional two stage screening programme. The study was carried out in 14 practices in Surrey. Women aged 60-80 years of age were screened with a questionnaire. Those identified with one or more risk factors were offered a PIXI scan of the ankle in their own surgery. Those with an intermediate score on PIXI scan were offered a DEXA scan of hip, spine and forearm. RESULTS: Four thousand six hundred and forty-six women completed questionnaires, 2688 had a PIXI scan and 553 were found to be at high risk of osteoporosis. Multivariate analysis identified the three most important risk factors associated with increased risk of osteoporotic fracture as age, a previous fracture and the presence of a stooped posture. Hormone replacement therapy (HRT) was shown to be protective. Twenty three percent of women with an intermediate score on PIXI scan were found to have osteoporosis on DEXA scan of hip and spine. CONCLUSIONS: PIXI scanning proved acceptable, practicable but only had moderate comparability with DEXA. The findings suggest that patients over the age of 60 years with a history of a fracture or evidence of spinal collapse are likely to have osteoporosis and should be offered screening. HRT past the menopause would seem to confer benefit and the recent reduction in its use may lead to increasing numbers of women suffering osteoporotic fractures.     

Elevated arterial stiffness in postmenopausal women with osteoporosis

OBJECTIVES: Osteoporosis and increased pulse wave velocity (PWV) are cardiovascular risk factors. We investigated the relationship between PWV and bone mass in the lumbar spine in postmenopausal women. METHODS: We studied the PWV in 95 women; 38 postmenopausal women with normal spinal bone mineral density (BMD), 32 osteopenic postmenopausal women, and 25 osteoporotic postmenopausal women. The brachial-ankle PWV (baPWV) was measured using an automated device. The BMD of the lumbar spine (L2-L4) was measured using dual-energy X-ray absorptiometry. RESULTS: After adjusting for age and years since menopause, women with osteoporosis had a significantly higher baPWV than those with normal BMD (1500 +/- 220 cm/s versus 1340 +/- 215 cm/s; P < 0.05), but no significant differences in baPWV were seen between the osteoporotic and osteopenic groups or between the osteopenic and normal BMD groups. In univariate regression analysis, the baPWV was significantly negatively correlated with BMD (r = -0.450, P < 0.01), and significantly positively correlated with age (r = 0.601, P < 0.01), years since menopause (r = 0.577, P < 0.01), systolic blood pressure (r = 0.295, P < 0.01), and diastolic blood pressure (r = 0.264, P < 0.05), but was not with other variables. In multivariate regression analysis, the baPWV was significantly correlated with BMD (P < 0.05), but not with other variables. CONCLUSIONS: Postmenopausal women with osteoporosis may have elevated arterial stiffness, suggesting that osteoporotic postmenopausal women may have a higher risk of cardiovascular disease.     

Identification of the risk factors for osteoporosis among postmenopausal women

ObjectivesThe aim of this study was to determine the effect of different durations of menopause at the time of bone mineral density (BMD) measurement and of different age at menopause intervals on the prevalence of osteopenia and osteoporosis among untreated postmenopausal women. We also assessed related factors leading to low BMD.MethodsA total of 2769 postmenopausal women who had not taken any anti-osteoporosis treatment and/or hormone replacement therapy were divided into three groups according to duration of menopause at the time of BMD measurement. The women were also evaluated in four different age groups according to their age at menopause onset. Multinomial logistic regression analysis was used to determine related factors leading to low BMD. Investigated parameters include demographic characteristics, plasma glucose, lipids, and lipoproteins.ResultsAccording to World Health Organization (WHO) criteria, among 2769 patients, 449 (16.2%) were identified as having osteoporosis, 1085 (39.2%) as having osteopenia, and 1235 (44.6%) as having normal BMD. Osteoporosis was determined in 10.6% and 16.2% of women with menopause duration of 0–3 years and 4–7 years, respectively, whereas this rate was 31.9% in women with menopause duration of over 7 years (p = 0.001). The percentages for osteopenia remained constant among the three different menopause durations (0–3 years: 37.2%, 4-7 years: 42.1%, and >7 years: 40.9%). Thirty percent of women with age at onset of <40 years were osteoporotic. However, the percentages of women with osteoporosis among the other age groups were similar (40–46 years: 18.3%, 47–52 years: 14.1%, and >52 years: 15.4%). The percentages for osteopenia remained relatively constant among the four age groups (36.7, 40, 39.1 and 39%). According to the multinomial logistic regression analysis, duration of menopause at the time of BMD test and parity were positively correlated with both osteoporosis and osteopenia, while glucose level was negatively correlated with both osteoporosis and osteopenia. Age at menopause was negatively correlated only for osteoporosis. Low-density lipoprotein cholesterol (LDL-c) level may be accepted as a clinically significant factor for osteopenia (OR: 1.01; CI_95%: 1.00–1.02). No differences were determined in the prevalence of osteopenia and osteoporosis in women with menopause duration of >7 years when evaluated according to the four menopause age groups as described before (p = 0.74). Contribution to the regression model was 0.8% by age at menopause, 5.6% by menopause duration at time of BMD measurement, 5.8% by both factors.ConclusionAccording to our results, osteoporosis is related more to the duration of menopause at the time of BMD measurement rather than the age at menopause among untreated postmenopausal women. High parity was determined as another risk factor for low BMD.     

Knowledge about osteoporosis in postmenopausal women undergoing antiresorptive treatment

A good understanding and knowledge of osteoporosis is a prerequisite for the success of preventive measures as well as treatment adherence.     

Markers of autoimmune liver diseases in postmenopausal women with osteoporosis

INTRODUCTION:

Osteoporosis is a common complication of chronic liver diseases. However, there is limited information about autoimmune liver diseases as a factor of secondary osteoporosis. Therefore, we aimed to investigate the autoantibodies of autoimmune liver diseases in patients with osteoporosis.

METHODS:

One hundred fifty female patients with postmenopausal osteoporosis were included. Bone mineral density was measured by dual energy X‐ray absorptiometry. We analysized autoantibodies including antinuclear antibodies, liver membrane antibodies, anti‐liver/kidney microsomal autoantibodies1, liver‐specific protein, anti‐smooth muscle antibodies, and anti‐mitochondrial antibodies by indirect immunofluorescence. Serum was assayed for the levels of aminotransferases.

RESULTS:

The mean age of the patients was 63,13±8,6 years. The mean values of L1‐L4 T‐scores and femur total T‐scores were ‐3,08±0,58 and ‐1,53±0,81, respectively. Among the 150 patients with osteoporosis, 14 (9.3%) were antinuclear antibodies, four (2.7%) were liver membrane antibodies, three (2.0%) were anti‐liver/kidney microsomal autoantibodies1, and two (1.3%) were liver‐specific protein positive. None of the patients had anti‐mitochondrial antibodies or smooth muscle antibodies positivity. The mean values of levels of aminotransferases were within normal range.

CONCLUSIONS:

The presence of liver membrane antibodies, liver‐specific protein, and anti‐liver/kidney microsomal autoantibodies1 has permitted us to see that there may be some suspicious clues of autoimmune liver diseases in patients with osteoporosis as a secondary risk factor. On the other hand, there is a need for comprehensive studies with a larger sample size and studies designed to compare the results with a normal population to understand the clinical importance of our findings.     

Associations between ABO blood groups and osteoporosis in postmenopausal women

To investigate whether any significant differences exist in the prevalence of osteoporosis in relation to ABO blood groups, 227 postmenopausal women were evaluated for bone mineral density (BMD), body composition, and anthropometric variables. There were no significant differences in age, anthropometric parameters, or body composition between women with O blood type and those with non-O blood types. However, lumbar spine and proximal femur BMDs in subjects with blood type O averaged 0.87+/-0.13 g/cm2 and 0.76+/-0.12 g/cm2, respectively, which were significantly above the values in those with non-O blood types (0.72+/-0.11 g/cm2 and 0.61+/-0.09 g/cm2, p<0.05, respectively). Among the ABO blood groups, the women with blood type AB showed the lowest BMDs (0.71+/-0.10 g/cm2 and 0.59+/-0.09 g/cm2) in the lumbar spine and proximal femur. The prevalences of osteoporosis in the proximal femur and lumbar spine averaged 2.3- and 1.7-fold higher in women with blood type AB than in those with blood type O. Thus, ABO blood group status seems to have a significant relationship to the prevalence of osteoporosis in postmenopausal women.