阿仑膦酸钠治疗绝经后骨质疏松性骨痛的研究

目的 观察用阿仑膦酸钠治疗６０例绝经后妇女的骨质疏松有痛的疗效。方法 对照阿仑膦酸钠使用６个月前后疼痛,骨密度的变化。结果 经治疗６个月后效果良好,骨痛缓解有效率达９３．３％,骨密度增加显,－／ｘ±ｓ由用药前的０．４６７ｇ／ｃｍ＾２±０．０３６增加到用药后的０．５２８ｇ／ｃｍ＾２±０．０３７,Ｐ〈０．０１。结论 阿仑膦酸钠通过抑制骨吸收的作用使失衡的骨代谢得以恢复,为治疗绝经后骨质疏松提供了一个     

阿仑膦酸钠治疗绝经后骨质疏松症的临床观察

目的 评价阿仑膦酸钠治疗骨质疏松症的近期临床疗效和安全性。方法 绝经后骨质疏松患３４例（诊断条件：按ＷＨＯ标准诊断骨质疏松,自然绝经后,临床上排除其他继发疾病,肝肾功能、血钙、血磷、血ＡＬＰ正常）,连续服用阿仑膦酸钠（１０ｍｇ／ｄ,早餐前顿报）和碳酸钙（凯思立Ｄ５００ｍｇ／ｄ或钙尔奇Ｄ６００ｍｇ／ｄ晚餐前顿服）,６个月后复测患骨密度,包括腰椎（Ｌ２－４）正、侧位（ＡＰＬ２－４,ＬａｔＬ２－４）     

阿仑膦酸钠治疗伴骨质疏松症的髋部骨折

目的　观察阿仑膦酸钠 (固邦 )治疗髋部骨折的骨质疏松症患者的临床疗效及安全性。方法　对 77例髋部骨折的骨质疏松症患者进行为期 1年随机双盲对照研究。用骨密度测量仪测定骨密度。结果　固邦治疗 1年时 ,腰椎、股骨颈、Wards三角、大转子骨密度分别平均增加 7 0 %±13 0 %、7 3%± 11 1%、4 6 %± 5 9%、4 5 %± 3 2 % ,安慰剂组增加 - 2 0 %± 4 5 %、0 9%± 6 9%、-3 6 %± 4 9% ,- 1 14 %± 6 0 %、两组差异有显著意义 (P <0 0 5 )。治疗前后用药组及对照组血Ca、血P、血ALP、血BGP及尿Pyd/Cr差异均无显著性意义。副作用轻微 ,为一过性 ,主要为消化道反应。结论　阿仑膦酸钠治疗骨质疏松症骨折显著有效并且安全     

阿仑膦酸钠对骨小梁力学特性的作用

目的　评价阿仑膦酸钠对骨小梁力学特性的作用。方法　选取成年雌性Hound犬 16只 ,随机分成两组 ,实验组 8只 ,口服阿仑膦酸钠 ,剂量为 0 5mg·kg-1·d-1,另选 8只作为对照组。 12周后处死 16只犬并收集其L1和L2 标本 ,进行压缩试验计算腰椎力学参数。结果　实验组在服用阿仑膦酸钠后其杨氏模量在样本头尾 (CC)、前后 (AP)和左右 (LR)方向上分别增加了 18 5 %、2 7 8%和3 3 1%。与对照组相比 ,实验组极限应力、骨折能量和头尾方向上的杨氏模量显著增加。结论　口服阿仑膦酸钠 ,剂量为 0 5mg·kg-1·d-1时 ,进行短期治疗能增强犬科骨小梁的力学特性。故阿仑膦酸钠短期内有增强健康骨小梁力学特性的作用     

阿仑膦酸钠治疗男性骨质疏松症临床研究

目的 探讨阿仑膦酸钠对男性骨质疏松症患者骨密度、血生化及骨标志物的影响.方法 选择2012年1月～2013年1月在我科门诊及住院50岁以上男性骨质疏松患者共169例,每人每天服用元素钙600 mg,活性维生素D0.25 μg作为基础补充剂,每周服用阿仑膦酸钠70 mg,共治疗12个月.观察骨密度、骨标志物等指标,骨密度测定采用双能X线吸收法,骨标志物测定采用酶联免疫吸附法.结果 研究结果显示,治疗1年后,L2、L3、L2～4、Neck、Ward's三角骨密度分别为0.791±0.150 g/cm2、0.817±0.149 g/cm2、0.827±0.154 g/cm2、0.875±0.153 g/cm2、0.703±0.138 g/cm2、0.522±0.133 g/cm2,均较治疗前0.772±0.144 g/cm2、0.800±0.156 g/cm2、0.861-±0.168 g/cm2、0.685±0.109 g/cm2、0.490 ±0.121 g/cm2有明显提高,差异具有统计学意义(P＜0.05),其他部位骨密度无明显差异(P＞0.05);治疗后血清CTX、BGP、BAP为0.20±0.11 ng/ml、7.73±4.11 ng/ml、14.57±7.20 ng/ml,较治疗前0.32±0.23 ng/ml、11.39±5.6 ng/ml、16.17±8.81 ng/ml显著降低,差异具有统计学意义(P＜0.05).结论 阿仑膦酸钠能有效降低破骨细胞活性,抑制骨破坏,显著提高骨量,对老年男性骨质疏松疗效显著.     

阿仑膦酸钠对骨质疏松性大鼠钛合金假体骨整合影响的实验研究

[目的]观察阿仑磷酸钠对骨质疏松大鼠假体骨整合的影响。[方法]SD雌性大鼠39只,双侧胫骨结节处垂直骨面置入定制钛合金假体,随机分为正常组、对照组、治疗组(每组13只),正常组不做任何处理;对照组和治疗组8周后行双侧切除卵巢建立骨质疏松模型。骨质疏松模型建成后,对照组术后每周空腹生理盐水灌胃;治疗组术后每周空腹阿仑膦酸钠灌胃,剂量1 mg/(kg/周),持续8周。灌胃结束后处死取材,进行组织学观察及组织形态计量学测定。[结果]组织学观察发现,正常组假体周围纤维界膜薄且稀少,新生骨与假体界面为直接接触,大部位新生骨与假体界面完全整合。对照组假体周围由新生骨、类骨质和纤维界膜构成。纤维界膜较厚,与新生骨或类骨质间界限清晰。治疗组假体周围纤维界膜薄且稀少,新生骨与假体界面多为直接接触,有些部位新生骨与假体界面完全整合。组织形态计量学测定发现,治疗组假体周围界膜的厚度和面积均明显大于对照组,差异有统计学意义(P<0.05)。[结论]阿仑膦酸钠经胃肠给药对骨质疏松大鼠假体骨整合有一定的促进作用。     

阿仑膦酸钠联合骨肽治疗骨质疏松症患者的临床效果

目的分析骨质疏松症患者使用阿仑膦酸钠联合骨肽注射液治疗的临床效果和影响。方法将我院2013年5月-2015年8月收治的500例骨质疏松症患者作为分析对象,按照随机分组方式分成对照组和试验组各250例,对照组患者采取阿仑膦酸钠治疗骨质疏松症,而试验组患者在对照组基础之上联合骨肽注射液治疗骨质疏松症,对比两组患者的临床治疗总有效率、治疗前后股骨密度的改善情况和临床不良反应率。结果对照组患者的临床治疗总有效率(72.0%)明显低于试验组(96.80%),差异具有统计学意义(P0.05);试验组患者在治疗后骨密度情况明显优于对照组;试验组患者的临床不良反应率(6.80%)明显优于对照组(40.0%),组间差异具有统计学意义(P0.05)。结论骨质疏松症患者使用阿仑膦酸钠联合骨肽注射液治疗的临床效果良好,可以有效提高患者的骨密度。     

伊班膦酸钠和阿仑膦酸钠对绝经后骨质疏松的干预研究

目的评价伊班膦酸钠和阿仑膦酸钠对绝经后骨质疏松骨量变化的作用。方法 64例年龄47～80岁,的绝经后骨质疏松妇女随机分为两组,Ⅰ组予以口服伊班膦酸钠150 mg,每月一次;Ⅱ组服用阿仑膦酸钠70 mg,每周一次,两组患者均每天服用钙剂0.6 g及维生素D 200 IU,治疗时间1年,治疗前后测量腰椎及髋部骨密度,评价伊班膦酸钠及阿仑磷酸钠对绝经后骨质疏松骨量变化的作用。结果Ⅰ组治疗半年和1年后,患者腰椎骨量较治疗前分别增加了6.25%和9.64%,(P<0.05),Ⅱ组治疗半年和1年后,患者腰椎骨量较治疗前分别增加了6.82%和11.4%,(P<0.05),两组患者治疗1年后髋部骨量较治疗前也有所增加,以腰椎骨量增加最为明显。结论两种双磷酸盐治疗绝经后骨质疏松均能显著改善患者骨量,临床疗效相近,但伊班膦酸钠临床耐受性较好。     

阿仑膦酸钠对骨关节炎关节软骨保护作用的研究进展

目的综述阿仑膦酸钠(alendronate,ALN)对骨关节炎(osteoarthritis,OA)关节软骨保护作用的研究进展。方法广泛查阅近年国内外相关文献,并进行综合分析。结果 ALN能改善OA关节软骨代谢微环境,抑制软骨下骨骨重塑,对关节软骨有潜在保护作用。结论 ALN有望成为一种OA疾病改善药物,但OA治疗尚缺乏统一的基础与临床评价标准,制定统一标准并获取临床数据对ALN的开发和应用有指导性意义。     

阿仑膦酸钠治疗绝经后骨质疏松症

目的　探讨阿仑膦酸钠治疗绝经后骨质疏松症的临床疗效 ,评价其安全性。方法　 5 5例绝经后骨质疏松症患者作为期 1年的随机双盲、安慰剂平行对照研究 ;113例绝经后骨质疏松症患者作为期半年的开放前瞻性研究。用药半年比较治疗前后骨密度和药物的副作用。用双能量X线骨密度测量仪测定骨密度。结果　用药组治疗 1年时 ,腰椎骨密度、股骨颈骨密度分别平均增加 4 7%±3 0 %、1 4 %± 3 7% ,安慰剂组增加 0 1%± 4 1%、- 1 3%± 5 8% ,差异有显著性 (P <0 0 5 )。用药组骨转换指标Ca/Cr、Hop/Cr在 3个月时降低到最低点 ;ALP在 6个月时降低到最低点 (P <0 0 1)。在开放组中 ,腰椎骨密度、股骨颈骨密度平均分别增加 4 5 %± 4 3% (P <0 0 1)、1 5 %±5 2 % (P <0 0 1) ,用药前后差异有显著性。主要副作用为消化道反应 (13 3% )、其次为皮疹和头昏 ,均为轻度、一过性 ,继续用药后自然缓解。结论　阿仑膦酸钠治疗绝经后骨质疏松症有效并且安全。     

Changes in osteoprotegerin and markers of bone metabolism during glucocorticoid treatment in patients with chronic glomerulonephritis

It is well known that long-term glucocorticoid treatment causes osteoporosis, but the precise mechanism remains unclear. Recently, osteoprotegerin (OPG) has been identified as a cytokine that inhibits osteoclast differentiation. We have previously demonstrated that serum OPG is suppressed by glucocorticoids. Therefore, the present study was carried out to clarify the interrelationships between OPG and other markers of bone metabolism during glucocorticoid treatment. Thirteen patients (7 men, 6 women; 44.1 ± 5.9 years old) with chronic glomerulonephritis who were to be treated with glucocorticoids for the first time were chosen for this study. Markers of bone metabolism, including serum OPG, osteocalcin (OC), bone-specific alkaline phosphatase activity (bAP), parathyroid hormone (PTH), tartrate-resistant acid phosphatase (TRAP), and bone mineral density (BMD), were measured before and during the treatment period. Glucocorticoids significantly reduced BMD of the lumbar spine in the 6 month treatment period (p < 0.01). Serum OPG was decreased significantly by glucocorticoids within 2 weeks (p < 0.001), and serum TRAP, a marker of bone resorption, was markedly increased (p < 0.001). On the other hand, there were no remarkable changes in serum PTH. Serum OC and bAP, markers of bone formation, were transiently reduced during the treatment period (p < 0.01). Furthermore, only serum OPG was positively and independently correlated with percentage BMD of age-matched reference (%AMR). These findings imply that glucocorticoid-induced bone loss develops rapidly via enhanced bone resorption and suppressed bone formation. Moreover, the increased bone resorption caused by glucocorticoids may be, at least in part, mediated by inhibition of OPG, not increment of PTH.     

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目的 探讨辅助检查在诊断亚急性甲状腺炎中的作用。方法 回顾分析372例亚急性甲状腺炎病人所做的各项辅助检查结果。结果 血沉，B超，彩色多普勒，甲状腺核素扫描，甲状腺吸^131I率测定，细针穿刺细胞学，TMA，TGA等项检查诊断本病的阳性率分别为93.75%,81.63%,95.62%,89.66%,69.70%,89.41%,13.46%和9.62%。T3，T4，TSH检查结果随着病程的进展变化较大。结论 血沉检查对诊断本病缺乏特异性；彩色多普勒，细针穿刺细胞学检查诊断率高，特异性强，是首选的检查手段；甲状腺核素扫描可以准确地反映甲状腺功能状态；检测血清中T3，T4，TSH水平可以协助诊断本病，判断疾病所处时期。     

Effects of teriparatide on serum calcium in postmenopausal women with osteoporosis previously treated with raloxifene or alendronate

SUMMARY: The effect of teriparatide (20 microg/day) on serum calcium was examined in postmenopausal women previously treated with alendronate or raloxifene. Women previously treated with alendronate or raloxifene who added teriparatide or switched to teriparatide did not have clinically meaningful increases in mean predose serum calcium. INTRODUCTION: The effects of a 6-month treatment with teriparatide (20 microg/day; rhPTH(1-34), TPTD) on serum calcium (Ca) was examined in a prospective study of postmenopausal women previously treated with alendronate (70 mg/week or 10 mg/day [ALN] or raloxifene 60 mg/d [RLX]) for > or =18 months. METHODS: Women continued their usual ALN or RLX during a 2-month antiresorptive phase. Women previously treated with ALN were randomized to add TPTD (n = 52) or switch to TPTD (n = 50) and women previously treated with RLX were randomized to add TPTD (n = 47) or switch to TPTD (n = 49). All were to take at least 500 mg/day of elemental Ca and 400-800 IU/day of vitamin D. RESULTS: Predose mean serum Ca did not significantly change in groups adding TPTD to either RLX or ALN treatment. In patients who switched from RLX or ALN to TPTD, mean serum Ca increased by 0.05 mmol/L and 0.04 mmol/L respectively. Only 1 patient had the predefined calcium endpoint of serum calcium > 2.76 mmol/L (11 mg/dL) at more than one visit. CONCLUSIONS: Women previously treated with ALN or RLX who added TPTD or switched to TPTD did not have clinically meaningful increases in mean predose serum Ca.     

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目的 探讨亚急性甲状腺炎药物治疗效果及甲状腺功能与形态变化特点。方法：对２９例病人应用超声显像法观察甲状腺的形态变化，用放免法测定甲状腺素（Ｔ３、Ｔ４）甲状腺微粒体抗体（ＴＭＡ）、甲状腺球蛋白抗体（ＴＧＡ）及促甲状腺素的变化，结果 １６例Ｔ３、Ｔ４增主贩病人，治疗后Ｔ３、Ｔ４明显下降。８例ＴＧＡ、ＴＭＡ增高的病人，治疗后ＴＧＡ、ＴＭＡ恢复正常。１８便腺体增大者，经治疗后体积恢复正常。有１例炎症消退     

Variations along the 24-hour cycle of circulating osteoprotegerin and soluble RANKL: a rhythmometric analysis

Summary The variability of serum osteoprotegerin (OPG) and soluble RANKL (sRANKL) along the 24-h cycle was assessed in 20 healthy women. No rhythmic variations of serum OPG, sRANKL or sRANKL/OPG ratio were detected as a group phenomenon. Timing of sampling is unlikely to influence the results of measurements of circulating OPG and sRANKL. Introduction Physiological bone turnover shows diurnal variations. The aim of the study was to assess variability of OPG and sRANKL serum levels along the 24-h cycle. Methods Blood was collected from 20 healthy women (median age 31 years, range 25–65 years) at 4-h intervals between 08:00 and 24:00 and at 2-h intervals between 24:00 and 08:00. Serum albumin, cortisol, osteocalcin (OC), C-terminal telopeptide of type I collagen (CTX), OPG and total sRANKL were measured. Temporal variations were assessed by the COSINOR model. Results Circadian rhythms of cortisol and albumin documented a normal synchronization within the circadian structure. Serum OC and CTX showed rhythmic variations, peaking at night-time. Rhythmic variations of serum OPG, sRANKL and sRANKL/OPG ratio were not detected as a group phenomenon. On an individual basis, rhythmic changes were detected in ten patients for OPG and eight patients for sRANKL, with very small amplitudes and heterogeneous acrophases. Conclusions The absence of consistent rhythmic variations of circulating OPG and sRANKL levels may reflect the absence of rhythmic variations of their expression in the bone microenvironment. Were this the case, the nocturnal rise of bone resorption should be accounted for by different, not RANKL/OPG-mediated factors. Since circulating OPG and sRANKL may derive from sources other than bone, rhythmicity could be masked by non-rhythmic or non-synchronized rhythmic expression in these sources. Timing of sampling is unlikely to influence the results of measurements of circulating OPG and sRANKL. Andrea Dovio and Daniele Generali contributed equally to the study.     

云克治疗糖皮质激素性骨质疏松模型大鼠的实验研究

目的 探讨云克对地塞米松诱导的骨质疏松症大鼠的治疗作用.方法 12周龄的雌性Wistar大鼠30只,随机分为3组,对照组、模型组和治疗组,每组10只.模型组和治疗组给予5mg/kg地塞米松肌注,1次/周,连续注射12周,对照组肌注等剂量的生理盐水.DEXA骨密度仪检测大鼠股骨骨密度,各组均取2只处死,HE染色观察股骨结构的病理改变鉴定骨质疏松大鼠模型是否构建成功.骨质疏松模型构建成功后,治疗组大鼠尾静脉注射云克(0.05 μg/kg),对照组和模型组注射等剂量的生理盐水,1次/周,连续注射15周,治疗前后尾静脉采血,ELISA法检测血清骨碱性磷酸酶和酒石酸酸性磷酸酶水平的变化.检测各组大鼠治疗后的股骨骨密度,之后,处死各组大鼠,取股骨,免疫组化法检测大鼠股骨骨保护素的变化,HE染色观察骨结构的病理改变.结果 (1)模型组和治疗组大鼠经地塞米松处理12周后,股骨骨密度较对照组明显降低(P＜0.05);病理改变为骨小梁稀疏、数目明显减少甚至断裂,而对照组骨小梁结构较完整.(2)与模型组相比,治疗组大鼠血清骨特异碱性磷酸酶水平明显升高(P＜0.05),而抗酒石酸酸性磷酸酶水平有所下降,但无统计学差异(P＞0.05).(3)治疗组治疗后血清骨特异碱性磷酸酶水平明显升高(P＜0.05),而抗酒石酸酸性磷酸酶水平有所下降,但无统计学差异(P＞0.05).(4)与模型组和治疗前相比,治疗组大鼠股骨骨密度无明显改变(P＞0.05).(5)与模型组相比,治疗组大鼠股骨骨保护素表达明显增加.(6)云克治疗后,治疗组大鼠股骨有新生骨小梁的广泛形成,骨小梁结构破坏较模型组明显减轻.结论 云克对糖皮质激素性骨质疏松大鼠有治疗作用.     

Femoral strength in osteoporotic women treated with teriparatide or alendronate

To gain insight into the clinical effect of teriparatide and alendronate on the hip, we performed non-linear finite element analysis of quantitative computed tomography (QCT) scans from 48 women who had participated in a randomized, double-blind clinical trial comparing the effects of 18-month treatment of teriparatide 20 μg/d or alendronate 10 mg/d. The QCT scans, obtained at baseline, 6, and 18 months, were analyzed for volumetric bone mineral density (BMD) of trabecular bone, the peripheral bone (defined as all the cortical bone plus any endosteal trabecular bone within 3 mm of the periosteal surface), and the integral bone (both trabecular and peripheral), and for overall femoral strength in response to a simulated sideways fall. At 18 months, we found in the women treated with teriparatide that trabecular volumetric BMD increased versus baseline (+ 4.6%, p < 0.001), peripheral volumetric BMD decreased (− 1.1%, p < 0.05), integral volumetric BMD (+ 1.0%, p = 0.38) and femoral strength (+ 5.4%, p = 0.06) did not change significantly, but the ratio of strength to integral volumetric BMD ratio increased (+ 4.0%, p = 0.04). An increase in the ratio of strength to integral volumetric BMD indicates that overall femoral strength, compared to baseline, increased more than did integral density. For the women treated with alendronate, there were small (< 1.0%) but non-significant changes compared to baseline in all these parameters. The only significant between-treatment difference was in the change in trabecular volumetric BMD (p < 0.005); related, we also found that, for a given change in peripheral volumetric BMD, femoral strength increased more for teriparatide than for alendronate (p = 0.02). We conclude that, despite different compartmental volumetric BMD responses for these two treatments, we could not detect any overall difference in change in femoral strength between the two treatments, although femoral strength increased more than integral volumetric BMD after treatment with teriparatide.     

Vitamin K2 inhibits glucocorticoid-induced bone loss partly by preventing the reduction of osteoprotegerin (OPG)

We have recently demonstrated that glucocorticoid (GC) suppresses bone formation and enhances bone resorption, with resultant bone loss. This altered bone turnover is not due to the action of parathyroid hormone (PTH), but appears to be related to the suppression of osteoprotegerin (OPG). As vitamin K2 (menatetrenone) has been used for the treatment of osteoporosis, the present study was carried out to evaluate the effect of vitamin K2 on GC-induced bone loss. Twenty patients with chronic glomerulonephritis treated with GC for the first time were chosen for this study. Ten patients received GC alone (group A) and the other 10 patients each received 15 mg of vitamin K2 per day in addition to GC (group B). Markers of bone metabolism, including serum OPG, osteocalcin (OC), bone-specific alkaline phosphatase activity (BAP), PTH, tartrate-resistant acid phosphatase (TRAP), and bone mineral density (BMD), were measured before and during the treatment. OPG was significantly decreased in group A (P < 0.001), while no significant change was seen in group B. TRAP was markedly increased in both groups, more particularly in group A (P < 0.01). PTH was decreased in group A, but was increased in group B. OC was decreased at month 1 but subsequently increased until month 12 in both groups. BAP had decreased at month 3 in group A (P < 0.05), but not in group B. BMD of the lumbar spine was significantly reduced after 6 months (P < 0.01), and 12 months (P < 0.001) of treatment in group A, whereas there was no remarkable change in group B. The present study demonstrated that the inhibition exerted by vitamin K2 of the reduction in OPG induced by GC may, at least in part, play a role in the prevention and treatment of GC-induced bone loss.     

葛根素联合阿仑膦酸钠治疗绝经后骨质疏松症的效果观察

目的探索葛根素联合阿仑膦酸钠对绝经后骨质疏松症的影响。方法 148例绝经后骨质疏松症患者随机分为治疗组(n=74)和对照组(n=74)。对照组给予阿仑膦酸钠治疗,治疗组给予葛根素联合阿仑膦酸钠治疗,为期治疗6个月。检测治疗后两组患者髋部及腰椎的骨密度改变,同时测定血清雌二醇(estradiol,E2)、骨代谢指标[骨钙素(osteocalcin,BGP)、骨源性碱性磷酸酶(bone alkaline phosphatase,BALP)、抗酒石酸酸性磷酸酶-5b(tartrate-resistant acid phosphatase-5b,TRAP-5b)]、免疫因子[白细胞介素-6(interleukin-6,IL-6)、转化生长因子-β(transforming growth factor-β,TGF-β)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)以及白细胞-10(IL-10)]水平的变化,并记录治疗期间出现的药物不良反应。结果治疗前,两组的骨密度、骨代谢指标和免疫因子比较差异无统计学意义(P0.05)。治疗6个月后,两组髋部及腰椎骨密度都有不同程度的升高,其中治疗组骨密度变化更明显,和对照组比较差异有统计学意义(P0.05);同时各组血清BALP、BGP、TRAP-5b、IL-10、IL-6和TNF-α水平均降低,TGF-β1及E2水平均升高,而治疗组改变更明显,两组比较差异有统计学意义(P0.05)。两组患者治疗均未发现明显药物不良反应。结论葛根素联合阿仑膦酸钠可以通过降低骨转换率及减少免疫因子表达来改善绝经后女性骨质疏松患者髋部及腰部的骨密度,且安全性高。