2型糖尿病骨量改变与钙代谢调节激素的关系

为了探讨2型糖尿病患者骨密度与钙代谢调节激素的关系，我们使用双能X线吸收仪测定100例2型糖尿病患者骨密度，同时测定部分钙调节激素甲状旁腺素（TPH）和降钙素（CT）以及血钙（Ca）、血磷（P）等生化指标，就其结果报告并分析如下。     

维生素D3在治疗老年性骨质疏松症中的疗效观察

本文观察了２１６例老年人血清中甲状旁腺素（ＰＴＨ），降钙素（ＣＴ），骨钙素（ＢＧＰ），血清碱性磷酸酶（ＡＫＰ），骨碱性磷酸酶（ＢＡＫＰ），血钙（Ｃａ），血磷（Ｐ）的水平，并且对其中患有老年骨质疏松症的７９例患者进行了维生素Ｄ３６０万单位，每月一次肌肉注射连续三月。在此基础上加用钙剂每日１～２克的治疗，发现经治疗后患老年骨质疏松症患者的骨痛症状得到不同程度的改善和好转。血中甲状旁腺素，降钙素，血碱性磷酸酶的水平向有利于老年人的骨代谢方面转化。提示老年骨质疏松症患者采用具有调节骨代谢作用的维生素Ｄ３治疗，可以减轻或消除老年骨质疏松症患者的骨痛症状和改善与骨代谢有关的激素和酶的水平。在初治患者，采用每月６０万单位连续用药三月的剂量治疗，未见副作用出现     

骨密度测定及生化检查在原发性Ⅰ型骨质疏松诊断中的意义及临床应用（附100

通过对１００例原发性Ⅰ型骨质疏松患者的诊断，阐述了普通Ｘ线及定量ＣＴ检查在没有双光子吸收仪及双能Ｘ线骨密度测定仪的情况下，同样能比较正确地作出骨质疏松的诊断。性激素、甲状旁腺素、降羟素、血尿钙及尿钙／肌酐比值、尿羟脯氨酸／肌肝比值等生化检查，可以对骨质疏松的病因，病情的轻重及与其它疾病鉴别提供有力的佐证，并且对预防，治疗骨质疏松症提供依据。     

骨密度测定及生化检查在原发性Ⅰ型骨质疏松诊断中的意义及临床应用（附100例报告）

通过对１００例原发性Ⅰ型骨质疏松患者的诊断，阐述了普通Ｘ线及定量ＣＴ检查在没有双光子吸收仪及双能Ｘ线骨密度测定仪的情况下，同样能比较正确地作出骨质疏松的诊断。性激素、甲状旁腺素、降羟素、血尿钙及尿钙／肌酐比值、尿羟脯氨酸／肌酐比值等生化检查，可以对骨质疏松的病因、病情的轻重及与其它疾病鉴别提供有力的佐证，并且对预防、治疗骨质疏松症提供依据。     

老年骨质疏松与骨质增生症并存病人骨代谢生化指标及骨密度研究

本文对３５例老年骨质疏松症合并骨质增生病人及４０例不伴增生病人血甲状旁腺激素（ＰＴＨ）、降钙素（ＣＴ）、骨钙素（ＢＧＰ）、碱性磷酸酶（ＡＫＰ）、Ｃａ、Ｐ、Ｍｎ、Ｚｎ、Ｍｇ、Ａｌ等及骨密度（ＢＭＤ）进行检测。结果显示增生组ＰＴＨ、ＣＴ及ＢＧＰ均显著高于非增生组，增生组血Ｃａ、Ｍｎ水平均高于非增生组。经直线相关分析，增生组ＰＴＨ与ＣＴ之间ＰＴＨ、ＣＴ与ＢＧＰ之间具显著正相关。本文认为老年骨质疏松症合并骨质增生病人存在继发性甲状旁腺机能亢进和ＣＴ代偿性上升，其ＢＧＰ升高示骨转换和成骨细胞活性增高。     

国产重组人甲状旁腺素(1-34)对绝经后骨质疏松症的治疗作用研究

目的评价国产重组人甲状旁腺素(1-34)治疗绝经后骨质疏松症的临床疗效和安全性。方法入选绝经后骨质疏松症患者37例,年龄64.2±8.1岁,采用自身前后对照试验设计,每日皮下注射重组人甲状旁腺素(1-34)20μg,同时口服钙尔奇D600 0.6g/d,试验时间6个月,观察患者治疗前后骨密度变化、骨折发生情况,以及血尿常规、肝肾功、电解质、心电图改变等。结果试验期间有1例脱落;经过6个月治疗后,患者L1骨密度增加23.2%(P<0.05),L2骨密度增加18.0%(P<0.05),L3骨密度增加12.5%(P<0.05),L4骨密度增加19.9%(P<0.05),腰椎平均骨密度增加17.8%(P<0.05),股骨颈骨密度增加2.2%(P>0.05),大粗隆骨密度降低6.0%(P>0.05),Wards区骨密度降低1.3%(P>0.05);试验期间新发骨折2例,1例右肱骨骨折,另1例腰椎压缩骨折,无其他严重不良事件发生。结论重组人甲状旁腺素(1-34)治疗绝经后骨质疏松症有效,对腰椎骨密度改善显著,不良反应较轻。     

绝经后骨质疏松患者的全段甲状旁腺素变化及其意义

为了解甲状旁腺功能在绝经后骨质疏松发病中的作用，本文采用免疫放射法测定３１例绝经后骨质疏松患者和２７例健康绝经后妇女的全段甲状旁腺素（１－８４肽，ＩＰＴＨ），同时了解这一变化与骨密度（用双能Ｘ线吸收仪测定）及骨吸收生化指标尿吡啶啉的相关性。结果发现绝经后骨质疏松患者较对照组ＩＰＴＨ明显增高，且ＩＰＴＨ值与尿吡啶啉的变化正相关，与骨密度值负相关。提示甲状旁腺功能增高所致的骨吸收增加是绝经后骨质疏松的发病机理之一。     

鲑鱼降钙素结合脉冲电磁场治疗脊髓损伤致骨质疏松症的临床效果

目的观察鲑鱼降钙素联合低频脉冲电磁场治疗脊髓损伤所致骨质疏松症的临床效果。方法 2012年9月至2015年9月本科收治的脊髓损伤致骨质疏松症患者90例,按随机数字表法将其分为降钙素组(n=30)、电磁场组(n=30)及联合治疗组(n=30)。降钙素组给予鲑鱼降钙素治疗,电磁场组给予低频脉冲电磁场进行治疗,联合治疗组给予低频脉冲电磁场联合鲑鱼降钙素治疗,共3个月。测定治疗不同时间段患者疼痛视觉模拟评分(VAS),腰椎及股骨颈骨密度(BMD)及甲状旁腺素(PTH)、骨钙素(BGP)、1,25-双羟维生素D3[1,25-(OH)2D3]等生化指标的变化情况。结果治疗1、2、3个月及6个月后联合治疗组患者VAS评分显著低于降钙素组及电磁场组。治疗后,联合治疗组腰椎及股骨颈骨密度均显著高于降钙素组及电磁场组(P0.05);联合治疗组PTH、BGP均显著低于降钙素组及电磁场组(P0.05),1,25-(OH)2D3显著高于降钙素组及电磁场组(P0.05)。结论低频脉冲电磁场联合鲑鱼降钙素可有效减轻脊髓损伤所致骨质疏松症患者的骨性疼痛程度,提升患者骨密度。     

老年慢性肾功能不全患者的骨密度及骨代谢变化

目的 探讨老年慢性肾功能不全患者的骨密度及骨代谢,以及影响因素.方法 用DEXA骨密度仪测定120例70岁以上的老年患者(60例慢性肾功能不全者、60例肾功能正常者)的腰椎及股骨端骨密度,并检测生化及骨代谢指标.结果 慢性肾功能不全组的腰椎及股骨端各部位骨密度明显下降,骨代谢指标中血磷、甲状旁腺素、降钙素、I型胶原吡啶交联终肽显著升高(P<0.01),血钙明显下降,碱性磷酸酶、25羟维生素D,和骨钙素变化不大.血肌酐水平与甲状旁腺素、降钙素、I型胶原吡啶交联终肽呈正相关,其中与I型胶原吡啶交联终肽水平相关程度最高.结论 慢性肾功能不全者主要表现在骨吸收增加,骨密度下降,骨吸收活跃程度与血肌酐水平密切相关.     

老年慢性肾功能不全患者的骨密度及骨代谢变化

目的 探讨老年慢性肾功能不全患者的骨密度及骨代谢,以及影响因素.方法 用DEXA骨密度仪测定120例70岁以上的老年患者(60例慢性肾功能不全者、60例肾功能正常者)的腰椎及股骨端骨密度,并检测生化及骨代谢指标.结果 慢性肾功能不全组的腰椎及股骨端各部位骨密度明显下降,骨代谢指标中血磷、甲状旁腺素、降钙素、I型胶原吡啶交联终肽显著升高(P<0.01),血钙明显下降,碱性磷酸酶、25羟维生素D,和骨钙素变化不大.血肌酐水平与甲状旁腺素、降钙素、I型胶原吡啶交联终肽呈正相关,其中与I型胶原吡啶交联终肽水平相关程度最高.结论 慢性肾功能不全者主要表现在骨吸收增加,骨密度下降,骨吸收活跃程度与血肌酐水平密切相关.     

The role of trace minerals in the pathogenesis of postmenopausal osteoporosis and a new effect of calcitonin

The physiologic role of calcitonin in mineral and bone homeostasis is not very well understood. Very few longitudinal studies have reported the effects of calcitonin therapy on trace minerals in postmenopausal osteoporosis despite the documented involvement of trace minerals in normal skeletal metabolism. Several trace minerals, particularly magnesium (Mg) and zinc (Zn), essential for organic bone matrix synthesis have been known for at least three decades. The present study was designed to determine whether the mineral profile was different between 70 osteoporotic and 30 nonosteoporotic postmenopausal women and to evaluate the efficacy of calcitonin therapy for 6 months on these trace minerals in postmenopausal osteoporotic women. In our study, the serum values of Mg, copper (Cu), and Zn (P < 0.05) were significantly lower in the patient group than those in the control group. After 3 months of treatment, serum Cu, Zn, and Mg levels did not differ between the patients and controls, and this situation has continued after the end of 6 months of therapy. Serum Cu, Zn, and Mg levels increased consistently during the 6-month treatment period. The higher levels of serum Mg in the 3rd and 6th months of therapy were found to be statistically significant compared to those before treatment (P < 0.05). Serum Cu and Zn levels were found to be significantly higher at all measurements during the treatment period as well as at the end of therapy (P < 0.05). These results suggest that (1) calcitonin therapy regulates Mg, Cu, and Zn levels in postmenopausal osteoporosis; (2) when serum calcium and phosphorus were normal in postmenopausal osteoporosis, serum Mg, Cu, and Zn were more useful for evaluation; and (3) further studies are essential to evaluate the role of dietary composition on the manifestations of osteoporosis. Received: March 28, 2001 / Accepted: July 2, 2001     

74例老年骨质疏松患者应用鲑鱼降钙素联合阿仑膦酸钠治疗的疗效观察

目的　评估联合应用鲑鱼降钙素与阿仑膦酸钠治疗缓解老年性骨质疏松症患者骨关节疼痛及血清骨钙素(BGP)、降钙素(CT)及骨密度(BMD)水平的变化。方法 联合应用鲑鱼降钙素和阿仑膦酸钠治疗本院收治的74例老年性骨质疏松症患者,给予鲑鱼降钙素50IU肌肉注射,隔日1次,连续使用15次后改为口服阿仑膦酸钠1粒/周,共经6个月治疗,采用数字模拟评分法(VAS)比较治疗前、后全身骨关节疼痛程度,治疗前、后骨钙素、降钙素及第2～第4腰椎(L2-4 )、股骨颈、Ward区骨密度水平的变化,并进行统计学分析。结果 鲑鱼降钙素联合阿仑膦酸钠治疗老年性骨质疏松症患者6个月后,对缓解骨关节疼痛症状疗效良好,治疗前与治疗后比较差异显著(P<0.01);治疗前后骨密度、血清骨钙素和降钙素水平均有显著差异（P<0.05）。结论 鲑鱼降钙素联合阿仑膦酸钠治疗老年性骨质疏松症使血清降钙素的水平明显升高,骨钙素水平明显降低,能显著减轻患者骨关节疼痛,改善症状,并增加骨密度,对老年性骨质疏松症有明显的疗效。     

降钙素治疗骨质疏松症骨质量病变的研究

目的研究降钙素在骨质疏松症治疗中对骨密度bonemineraldensityBMD、骨强度及骨质疏松脆性骨折发生率的作用。方法为期1年的单中心、前瞻性、随机研究135例原发性骨质疏松症女性患者随机分成降钙素 钙剂组和钙剂组,进行开放、对比研究。降钙素 钙剂组66例鲑鱼降钙素50IU,肌内注射,第1周每天1次,第2周隔日1次,以后每周2次;同时口服元素钙600mg每天1次。钙剂组69例元素钙600mg每天1次。治疗前后分别进行血清钙、磷、碱性磷酸酶、骨钙素、尿羟脯氨酸、双能X线BMD和超声骨强度测量以及脊椎胸腰段正、侧位X线片比较。结果治疗1年后,降钙素 钙剂组53例获随访,与治疗前比较,腰椎BMD上升约1%P<0.05,髋部BMD无明显变化,桡骨和胫骨骨强度均明显改善;钙剂组59例获随访,腰椎、髋部BMD和桡骨、胫骨骨强度均较治疗前下降P<0.05。两组治疗前后各项生化检测指标无明显变化,骨质疏松脆性骨折的发生率钙剂组明显高于降钙素 钙剂组。结论降钙素治疗骨质疏松症有良好作用,不仅能有效地缓解骨痛,还能确实提高骨质量,降低骨质疏松脆性骨折的发生率。     

Acute Effects of Calcitonin Nasal Spray on Serum C-telopeptide of Type 1 Collagen (CTx) Levels in Elderly Osteopenic Women with Increased Bone Turnover

Salmon calcitonin is a potent inhibitor of osteoclastic activity. The effect of calcitonin in elderly women with high bone turnover at higher risk of developing osteoporosis has not been studied. To investigate acute effects of calcitonin treatment on bone resorption markers in elderly women, we conducted a randomized trial in women >65 years of age with high bone turnover assessed as urinary N-telopeptide of type-I collagen (NTx) levels 1 SD higher than mean premenopausal levels, which was irrespective of bone density. A total of 98 elderly women were randomly assigned to receive either 200 IU calcitonin nasal spray (n = 75) with calcium (500 mg) and vitamin D (200 IU) or calcium and vitamin D (n = 23) alone for 6 months. Blood and urine samples were collected at 0, 2, 4, and 6 months and analyzed for urinary NTx and serum C-telopeptide of type-1 collagen (CTx). At baseline, mean age was 72.1 ± 4.7 (mean ± SD) in the calcitonin group and 72.2 ± 6 years in the control group. The spine and total hip BMD, serum PTH levels and urinary calcium/creatinine ratios were similar in both groups. Mean BMD was in the osteopenic range in both groups. Calcitonin treatment resulted in significant decreases in serum CTx levels, 2, 4 and 6 months after treatment as compared to baseline, and after 4 and 6 months as compared to controls. A maximum decrease from baseline of 33% was seen at 6 months. The urinary resorption marker, urine NTx, showed a significant decrease in the calcitonin group when compared to baseline only at the 6-month time point. Analysis of least significance change (LSC) showed that 70% of calcitonin patients were categorized as responders using serum CTx after 6 months of treatment. We conclude that 200 IU calcitonin effectively decreases bone resorption within 60 days of therapy, thus preventing further bone loss in elderly women who are at a high risk of developing osteoporosis.     

血清睾酮与老年男性原发性骨质疏松症的关系

目的 探讨血清睾酮与老年男性原发性骨质疏松的关系，为防治老年男性原发性骨质疏松症提供理论依据。方法 双能X线骨密度仪测定腰椎(L1-4)骨密度；全自动生化分析法测定尿钙、肌酐；AKP用比色法，Ca、Mg用MTB法，P用磷酸亚铁胺法；放射免疫法测定血清E2、T、BGP、CT、PTH-m。获得的参数骨质疏松组与正常对照组比较。结果 男性原发性骨质疏松组骨代谢生化指标与同年龄同性别的对照组比较，血清Ca、P、Mg、Cu以及PTH-m、E2、AKP、BGP两组差异无显著性；血清降钙素显著降低；尿钙与肌酐比值非常明显地增多；男性主导性激素睾酮骨质疏松组非常明显地低于对照组。结论 老年男性原发性骨质疏松的发病因素虽然是多方面的，但血清睾酮水平的降低是老年男性骨质疏松症发病的一个非常重要的原因。     

Effect of salmon calcitonin on experimental osteoporosis induced by ovariectomy and low-calcium diet in the rat

To investigate the action and effect of calcitonin on osteoporosis, this study was performed in osteoporotic rats that had been ovariectomized and maintained on a low-calcium diet. Significant bone loss was noted in ovariectomized rats compared with those that underwent sham surgeries, and histological findings proved bone turnover to be increased. In comparison with this osteoporotic rat group, those given calcitonin showed less bone loss; the reduction in bone loss was obvious in the vertebral body, and rats given a high dose of calcitonin over a long duration showed even less bone loss, but this was hardly seen in the proximal tibial metaphysis. Histological findings proved that calcitonin inhibited the bone resorption that was stimulated by the ovariectomy. Values for osteoblast surfaces were relatively higher while those of reversal surfaces were lower. The results confirm that salmon calcitonin has an inhibitory action on bone resorption as well as being effective in maintaining and stimulating bone formation in vivo. These effects of calcitonin prevented progress of the osteoporosis that had been induced by ovariectomy, and the effects appeared differently in each region. Received: March 26, 1997 / Accepted: Dec. 10, 1999     

The effect of long-and short-term corticosteroids on plasma calcitonin and parathyroid hormone levels

The role of calcitonin and parathyroid hormone (PTH) in corticosteroid-induced osteoporosis is controversial. We therefore measured plasma calcitonin and PTH levels in 34 adults receiving chronic pharmacological corticosteroids for obstructive airways disease, and in controls matched for age, sex, menopause, and disease. In addition, the acute effect of a 7-day course of 15 mg prednisolone daily on fasting and calcium-stimulated calcitonin was studied in 10 normal male volunteers. There was no difference in calcitonin and PTH levels in the corticosteroid-treated patients when compared with controls. The corrected serum calcium was significantly higher in the steroid-treated patients (patients mean 2.40 (SEM 0.01) mmol/liter; controls mean 2.33 (SEM 0.01) mmol/liter; P<0.001). The short course of corticosteroids in volunteers did not alter basal or stimulated calcitonin, PTH, or calcium levels. These results suggest that neither calcitonin deficiency nor PTH excess is a feature of corticosteroid-induced osteoporosis.     

Circulating monomer-like calcitonin in osteoporotic patients

Physiological concentrations of monomeric calcitonin can inhibit osteoclastic bone resorption in vitro. We therefore investigated the circulating molecular forms, including monomer-like calcitonin, and their concentrations in 9 men and 9 women with established osteoporosis. Calcitonin was immunoextracted from serum by the use of rabbit calcitonin antibodies coupled to Sepharose 4B. The lyophilized extracts were incubated with 6 M urea overnight and gel chromatographed in a fast protein liquid chromatography (FPLC) system; calcitonin was measured by radioimmunoassay in the fractions. FPLC disclosed immunoreactive calcitonin of three different molecular sizes in the patients. The two largest forms were approximately 30 and 10 kDa and one eluted at the same position as monomeric calcitonin (3.4 kDa). After extraction and FPLC we found slightly higher calcitonin concentrations in osteoporotic women than previously reported levels in age-matched healthy women. Male patients had higher levels than female patients. None of the osteoporotic patients lacked monomer-like calcitonin. There was no significant correlation between the extracted total or monomer-like calcitonin and bone mineral density of the femoral neck. It is concluded that the circulating calcitonin in both male and female patients comprises three different molecular forms and that there is no deficiency of the monomer-like form. The calcitonin levels in the female patients were slightly higher than in a previous control group.     

Effect of calcitonin and vitamin D in osteoporosis

Summary Vitamin D has complex effects in bone: it stimulates matrix formation and bone maturation but also enhances osteoclastic activity and may influence differentiation of bone cell precursors. Calcitonin inhibits the function of osteoclasts, reducing bone resorption, thus, the combination of vitamin D and calcitonin could result in a positive bone balance. We tested the hypothesis that chronic treatment with high doses of vitamin D (150,000 U/week), moderate doses of salmon calcitonin (120 MRC U/week), and adequate Ca supplementation (1 g/day) could be beneficial in osteoporosis. Thirteen women with postmenopausal osteoporosis received this treatment for 2–6 years (mean 3.5 years). No side effects, hypercalcemia, or hypercalciuria occurred. There was marked reduction in bone pain. The fracture rate in 11 patients with vertebral compression fracture was 240/1,000 patient years, threefold lower than the reported 834 fractures for untreated patients of similar age. Single photon bone densitometry of the radius did not change. Iliac crest bone biopsies obtained at the initiation and conclusion of the study showed a 43% increment in trabecular bone volume (P=0.0003), without changes of the normal osteoid thickness, surface, and volume. Because single photon densitometry reflects mostly cortical bone, the data suggest that the combination of vitamin D and calcitonin increases trabecular bone mass and prevents the fall of cortical bone mass in osteoporosis. Previous reports suggest that calcitonin alone or with small doses of vitamin D increased bone mass for about 2 years. The present study suggests a prolonged beneficial effect of the combination of high doses of vitamin D with rather moderate (<150 MRC U/week) doses of calcitonin in postmenopausal osteoporosis. Presented in part at the 61st Annual Meeting of the Central Society for Clinical Research, November 10, 1988, Chicago, IL, USA.     

Osteoporosis after kidney transplantation: preliminary report from a single center

OBJECTIVE: One of the major adverse effects of kidney transplantation is osteoporosis, which is mainly related to steroid use. Only limited data are available on calcitonin therapy for posttransplantation osteoporosis. METHOD: From March 2007 to August 2007, 67 kidney recipients agreed to enter this study. Dual energy X-ray absorptiometry (DEXA) was performed to evaluate bone mineral density (BMD) in the lumbar (L) spine and left femoral neck. We prescribed calcitonin nasal spray to osteoporosis patients (DEXA T < -2.5 SD) who agreed with the treatment. A second and a third DEXA were performed at 3-month subsequent intervals later to evaluate the therapeutic effects. RESULTS: The incidence of osteoporosis in our kidney recipients was 46.26% (31/67 patients). Osteopenia accounted for 38.81% (26/67 patients) and only 14.93% (10/67 patients) were normal. Calcitonin inhalation seemed to improve the BMD with 61% showing improvement on the second DEXA study in our preliminary data. CONCLUSION: Our preliminary data suggested that calcitonin may help to restore bone mass in kidney recipients with osteoporosis. Steroid elimination may prevent the onset of osteoporosis and might even enhance calcitonin efficacy. In the future we need a longer study period to confirm the results and compare it with the outcomes of bisphosphonates therapy.