五禽戏防治原发性骨质疏松症的研究探讨

原发性骨质疏松症是目前危害中老年健康的一大顽疾,如何攻克这一顽疾成为近年来研究的热点。实践证明,科学合理的运动可有效地增加骨量,延缓骨量丢失,从而起到防治骨质疏松的目的。五禽戏作为一种运动疗法,对原发性骨质疏松症的防治起到重要的作用。本文着重从五禽戏的来源、机理、功效、对骨代谢的影响及防治原发性骨质疏松症的研究进展等方面作一探讨。     

从肝论治原发性骨质疏松症的研究进展

骨质疏松症是一种以骨量低下,骨微结构损坏,导致骨脆性增加,易发生骨折为特征的全身性骨病。随着老龄化的加剧,老年人健康问题尤其是骨密度下降引起的骨质疏松越来越引起重视,但是目前原发性骨质疏松症的基础研究和临床诊治主要集中在"肾主骨,生髓"方面,肾虚是其主要病机,而肝对本病的研究和治疗相对较少。原发性骨质疏松症是一个复杂的、多因素导致的疾病,中医整体观要求我们不能一味地治疗某一症状或某一脏腑,要结合传统医学和现代医学分析其病因病机,辨证施治。从中医学肝对骨质疏松的认识到肝与骨质疏松的基础研究再到滋补肝肾的临床疗效,都说明肝对骨质疏松的重要性。补肾兼顾治肝,及早调肝养肝有益于防治骨质疏松症。     

新疆中老年人骨质疏松发病率调查研究

原发性骨质疏松症是危害中老年人健康的一种无声无息的流行病，发病率较高。为了解我区发病情况，本文采用了单光子骨矿检测仪测定了新疆昌吉地区６１３名中老年人的骨矿含量。测量结果表明，中老年人骨量随年龄的增加而逐年下降，骨量与年龄呈明显负相关，男女两性同年龄组ＢＭＤ呈显著差异Ｐ＜０．０５；骨质疏松症的发生，女性从４０岁开始，男性从５０岁开始，女性发生时间较男性早１０年，骨质疏松发生率女性为男性的２．７８倍；在绝经后妇女，绝经年限与骨质疏松发生率呈直线正相关ｒ＝０．９４２５Ｐ＜０．０５，且在绝经后前１０年骨质疏松发生率为３５．９７％，提示在绝经后早期骨量呈加速丢失阶段。以上结果为我们制定防治原发性骨质疏松症的措施提供了依据。     

五禽戏和运动疗法对原发性骨质疏松症的影响

运动疗法是常用的防治骨质疏松的方法之一,但持续过度的运动,又不利于骨生物力学特性改善。因此,探索合适的运动疗法一直是防治骨质疏松研究领域的热点。为了更深刻的认识和探讨这一问题,笔者从生物力学和运动医学角度就五禽戏在预防和治疗原发性骨质疏松症方面相关研究进行综述。     

中国脆性骨折术后规范化抗骨质疏松治疗指南(2021)

骨质疏松症是一种全身性的骨骼系统疾病,其特征是骨量减少和骨组织显微结构退化,导致骨骼脆性增加,骨折风险增高。根据其发病原因可分为原发性骨质疏松和继发性骨质疏松两大类。本指南仅针对原发性骨质疏松症引起的脆性骨折所制定。脆性骨折亦称为骨质疏松性骨折,是骨质疏松症的最严重后果.     

防治骨质疏松症的药物研究进展

骨质疏松症主要表现在骨BMD减少,骨质量(骨微结构,骨的转换,骨矿化,骨微损伤累积)降低,诱导骨强度下降,微骨折增加.在临床上,系统性骨质疏松症的典型表现是骨质疏松性疼痛和骨折,而最常见的骨质疏松性骨折部位是:髋部,腰椎和腕部.骨质疏松症可预防,如果早期诊断,可得到治疗.目前有两大类药物可治疗和预防骨质疏松症.① 抗骨代谢类药物; ②促骨合成药.近年来,大量的基础、临床研究表明vitamin D及其类似物不仅通过抑制骨吸收,而且有促进骨合成作用来防治骨质疏松症,笔者就骨质疏松症的药物研究进展作一综述,为更好的预防和治疗骨质疏松症具有很好的指导意义.     

运动防治老年人骨质疏松的研究进展

骨质疏松症（osteoporosis,OP)现已成为世界十大慢性疾病之一,50岁以上的人群中,30%的女性和10%的男性都患有OP。国际上将OP从病因学上简单地分为原发性、继发性、特发性骨质疏松症三大类;原发性骨质疏松是随着年龄增长必然发生的一种生理退行性病变,发病人群主要为老年人,可分为绝经后骨质疏松症和老年性骨质疏松症。绝经后骨质疏松症是指妇女绝经后雌激素迅速减少,骨吸收大于形成,骨量丢失加快;老年性骨质疏松症是指随着年龄增加,人体单位体积骨量低于正常,骨小梁间隙增大、骨基质减少、骨强度降低。OP会使老年人骨结构遭到破坏,骨折风险增加,肌肉力量下降,造成身体不同部位的疼痛和麻木,降低生活质量。目前针对OP的治疗方法主要有药物治疗、营养治疗和运动治疗。其中运动作为OP的一种康复干预手段,因其能改善骨生物力学及有效减少骨量继续流失的特性,准确适度的运动处方已作为一种相对经济、高效、安全的治疗方法,在OP的临床治疗用中备受医务工作人员和患者的关注。在此我们将不同运动疗法对老年人及绝经 后老年妇女骨质疏松症的影响做一综述,希望对今后老年人群OP的预防及治疗有所帮助。     

骨活素胶囊对原发性骨质疏松症腰椎骨密度的影响

原发性骨质疏松症是中老年人的常见病、多发病，临床发病率高，严重危害广大中老年人的身体健康。骨质疏松症在全球常见病中居第6位，据全球不完全统计约有两亿人患骨质疏松症。美国2000年第5次人口普查已有1000万骨质疏松患者和1800万人可能发展为骨质疏松的低骨量患者。骨质疏松症的严重后果是骨折或致残。治疗骨质疏松的关键是提高全身骨密度，我们研制的骨活素胶囊用于原发性骨质疏松症的治疗，观察腰椎骨密度情况报告如下。     

骨质疏松症应用单氟磷酸盐对骨量和骨代谢的影响

骨质疏松症应用单氟磷酸盐对骨量和骨代谢的影响朱汉民在骨量低下（Ｏｓｔｅｏｐｅｎｉａ）和骨质疏松（Ｏｓ－ｔｅｏｐｏｒｏｓｉｓ）患者，增加骨量是提高骨质量的主要措施，在众多的防治骨质疏松药物中氟制剂是目前唯一能应用于临床的促成骨的药物，自７０年代应用以来...     

运动疗法防治骨质疏松症机制的研究进展

骨质疏松症是一类全身性、代谢性骨病，表现为持续骨量减少、骨组织微结构退变，骨的强度降低，继发骨脆性增加，引起疼痛和驼背等症状，并能极易出现病理性骨折的疾病。合理适当的运动有助于改善骨质流失而防治骨质疏松症。为更加清晰地认知运动疗法防治骨质疏松的理论基础，以帮助指导临床制定更为合理的运动治疗处方，更好发挥其防治骨质疏松症的优势，本文详细介绍了中西运动疗法在防治骨质疏松症的作用机制。例如西医注重运动机械应力对骨骼的效应作用、运动对钙的调节效应作用、运动诱导细胞调节因子、激素的变化对骨代谢的作用、运动对骨代谢信号通路的调节作用以及其他新陈代谢作用；中医则认为其病因病机主要是与肾、脾、肝三脏的关系，传统中医导引运动疗法防治骨质疏松的作用机制正是通过功法由外到内的调理三脏。中医运动疗法-导引功法与西医运动疗法比较更适合在我国的推广，临床应用中更具有独特的优势，以发挥其“简、便、廉、效”的目的。     

Exercise therapy for osteoporosis

Our experimental and clinical studies lead to the following conclusions:

运动对生长期骨骼影响的基础与临床研究进展

随着人口老龄化进程加快,骨质疏松的发病率越来越高。相比青少年,老年群体骨密度(bone mineral density,BMD)下降,骨矿含量(bone mineral content,BMC)改变,导致脆性骨折的发生率上升,严重影响了老年人的生活质量和健康状况。目前普遍认为,青少年时期是峰值骨量(peak bone mass,PBM)积累的关键时期,尽可能地提高PBM是延缓或预防老年时期骨质疏松发生的有效措施。此外,大量动物实验和临床试验均表明,不同运动类型对骨有不同的影响,相比于有氧运动,抗阻运动和冲击性运动促进生长期骨量积累的效果更为明显。具体作用机制可能与运动通过ERK、BMP以及Wnt/β-catenin等信号通路对成骨细胞分化的调控密切相关。因此,笔者通过综述不同运动类型对生长期骨骼影响的基础与临床研究,为指导青少年运动锻炼促进骨健康提供科学的理论依据。     

慢性阻塞性肺病对骨强度作用的研究进展

慢性阻塞性肺病(COPD)及骨质疏松均好发于老年人,且两者之间存在共病关系,可通过多种机制互相影响,降低患者生存质量.骨强度包括骨密度及骨质量,骨密度是目前诊断骨质疏松的金标准,占骨强度的70％,但骨质量也在COPD患者导致骨质疏松和骨折过程中承担着重要角色.COPD对骨强度的影响是多方面综合作用,如体质指数、运动耐量...     

Osteoporosis

Osteoporosis is a disorder of decreased bone mass, microarchitectural deterioration, and fragility fractures. Osteoporosis is widespread and can affect people of all ethnic backgrounds and many older women and men. An essential element in preventing osteoporosis is the achievement of normal peak bone mass. Adequate nutrition, appropriate calcium and vitamin D intake, regular menstrual cycles and a well balanced exercise program of exercise are essential elements in achieving peak bone mass. At menopause women undergo accelerated bone loss. Thereafter, women and men gradually lose bone mass. A loss of one standard deviation give rise to an enhanced twofold risk of spine fractures or a 2.5 risk of hip fracture. Bone mass is determined by dual energy x-ray absorptiometry, quantitative computed tomography scan, and a peripheral ultrasound. Dual energy x-ray absorptiometry has outstanding precision (within 1% to 2%), and has the ability to show the efficacy of drug intervention. Peripheral measurements may identify osteoporosis but only have a 70% correlation with hip and spine bone mass. Dual energy x-ray absorptiometry determines bone mass in a patient but the bone collagen breakdown products (N-telopeptide crosslinks) establish the current rate of bone loss. Major risk factors leading to fragility fracture include low body weight, history of fracture, family history of osteoporosis, and smoking. All individuals should ingest adequate calcium and vitamin D, exercise, and prevent falls. Women with low bone mass, high urinary bone collagen breakdown products, and/or major risk factors should consider hormone replacement therapy or a selective estrogen receptor modulator (Evista), calcitonin and bisphosphonates (alendronate). These agents successfully increase bone mass and limit fracture risk. Men at risk for fragility fractures respond similarly as women to alendronate and calcitonin. Although vertebral compression fractures can occur spontaneously, hip fractures are attributable to low bone mass coupled with a fall. Hence, fall prevention programs in addition to medical treatment are critical in the prevention of fragility fractures.     

中国维吾尔族女性特发性骨质疏松患者临床分析及生活方式相关因素的调查

目的 通过分析中国维吾尔族女性特发性骨质疏松患者临床特点与生活方式的相关性,为药物治疗及生活方式的干预,预防和减少特发性骨质疏松的发生提供依据。方法 回顾性分析中国维吾尔族女性特发性骨质疏松患者36例临床特点,采用统一问卷对生活方式进行调查。结果 女性特发性骨质疏松患者发病基本在孕期及哺乳期,常见临床表现有腰背部酸痛及臀部疼痛。骨密度可有骨量减少,骨质疏松。实验室检查血钙水平低或正常低值,血碱性磷酸酶及甲状旁腺激素水平增高。治疗后血碱性磷酸酶及甲状旁腺激素水平下降明显。发病原因孕期或哺乳期饮食及生活方式相关。结论 妊娠期和哺乳期妇女应保证合理营养,适当户外活动和日光照射,可预防女性特发性骨质疏松的发生。     

Bone loss and muscle atrophy in spinal cord injury: epidemiology, fracture prediction, and rehabilitation strategies

Individuals with spinal cord injury (SCI) often experience bone loss and muscle atrophy. Muscle atrophy can result in reduced metabolic rate and increase the risk of metabolic disorders. Sublesional osteoporosis predisposes individuals with SCI to an increased risk of low-trauma fracture. Fractures in people with SCI have been reported during transfers from bed to chair, and while being turned in bed. The bone loss and muscle atrophy that occur after SCI are substantial and may be influenced by factors such as completeness of injury or time postinjury. A number of interventions, including standing, electrically stimulated cycling or resistance training, and walking exercises have been explored with the aim of reducing bone loss and/or increasing bone mass and muscle mass in individuals with SCI. Exercise with electrical stimulation appears to increase muscle mass and/or prevent atrophy, but studies investigating its effect on bone are conflicting. Several methodological limitations in exercise studies with individuals with SCI to date limit our ability to confirm the utility of exercise for improving skeletal status. The impact of standing or walking exercises on muscle and bone has not been well established. Future research should carefully consider the study design, skeletal measurement sites, and the measurement techniques used in order to facilitate sound conclusions.     

Additive effects of antiresorptive agents and exercise on lumbar spine bone mineral density in adults with low bone mass: a meta-analysis

Introduction

Exercise has been recommended to increase bone mass and prevent osteoporosis. While current treatment of osteoporosis mainly involves the use of antiresorptive agents, it is unclear whether there are any additive effects in improving bone mass when antiresorptive agents and exercise are jointly used.

Methods

A structured and comprehensive search of databases was undertaken along with hand searching of key journals and reference lists. The combined interventions of antiresorptive agents and exercise were examined for their additive effects on lumbar spine bone mineral density (BMD) among adults with low bone mass. Trial quality was assessed using the Jadad quality score. Study outcomes for analysis, absolute change (grams per square centimeter) or relative change (in percent) in BMD, at the lumbar spine were compared by calculating standardized mean difference (SMD) using fixed and random effect models.

Results

Seven randomized controlled trials (RCT) met the predetermined inclusion criteria. The increase in lumbar spine BMD of the combined-intervention group was significantly greater than that of the antiresorptive agent-alone group (fixed effect model: SMD = 0.55; 95 % confidence interval (CI) = 0.36, 0.75; overall effect Z-value = 5.51; p?<?0.00001). Subgroup analyses also showed consistent results. Methodological quality of most included studies was scored 3 by the Jadad criterion, and publication bias was slight according to funnel plots.

Conclusion

It was found that combining antiresorptive agents with exercise had additive effects on improving lumbar spine bone mass gains in adults with low bone mass. To verify the additive effects further, more RCTs with longer duration and larger sample sizes are needed.     

跆拳道对女大学生骨结构特征变化的研究

目的 了解跆拳道训练对处于青春期及青春后期女大学生骨代谢的影响,为高校女大学生健身锻炼、改善与提高骨代谢及预防骨质疏松提供一定的理论依据。方法 运用追踪调査、文献资料、数理统计及逻辑分析等研究方法对山东科技大学劲松跆拳道俱乐部女大学生训练期间的骨结构特征随运动强度等因素变化的规律及特点进行研究,研究跆拳道运动训练对处于青春期及青春后期女大学生骨代谢的影响与骨量、骨矿生化成分及骨形成生化标志物的影响,并分析骨密度、骨形态结构变化的影响因素。结果 跆拳道训练作为对机体、肌肉与骨骼高强冲击性的搏击运动形式,可以提高肌肉力量从而对骨骼产生积极的影响。结论 高抗阻、有氧耐力及振动的综合性跆拳道运动能够改善女大学生的骨代谢及提高骨密度与骨量,为运动健身指导及预防骨质疏松方面提供一定的理论帮助。     

运动力学刺激对骨质量影响的研究进展

在力学的刺激下骨骼会发生适应性变化,对骨的重塑和构建产生影响。回顾近年来有关力学刺激促使骨髓间充质干细胞(mesenchymal stem cells,MSC)向成骨细胞(osteoblasts,OB)的分化和细胞形态结构影响的研究,充分揭示力学刺激可以使骨产生适应性改变的作用。大量的研究证实力学刺激能使MSC向OB分化和OB信号通路产生适应性变化。本文主要综述力学刺激可能影响骨量和骨细胞形态适应性变化的细胞分子机制,提出运动产生的力学刺激可能使MSC向OB分化和OB产生适应性变化,为运动健骨防治骨质疏松提供理论依据。