Clinical practice guideline of traditional medicine for primary osteoporosis

BACKGROUND Primary osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue,leading to enhanced bone fragility and a consequent increase in fracture risk. Primary osteoporosis is particularly common in senile persons and in postmenopausal women.It ranks the fifth of diseases in the modern society.There are about two billion patients with osteoporosis all over the     

Clinical update of pulsed electromagnetic fields on osteoporosis

Objective To understand the effects of low-frequency pulsed electromagnetic fields （PEMFs） on chronic bony pain, bone mineral density （BMD）, bone strength and biochemical markers of bone metabolism in the patients of osteoporosis.
Data sources Using the key words “pulsed electromagnetic fields” and “osteoporosis”, we searched the PubMed for related studies published in English from January 1996 to December 2007. We also searched the China National Knowledge Infrastructure （CNKI） for studies published in Chinese from January 1996 to December 2007.
Study selection Inclusion criteria： （1） all articles which referred to the effects of low-frequency pulsed magnetic fields on osteoporosis either in primary osteoporosis or secondary osteoporosis; （2） either observational studies or randomized controlled studies. Exclusion criteria： （1） articles on experimental studies about osteoporosis; （2） repetitive studies; （3） case reports; （4） meta analysis.
Results Totally 111 related articles were collected, 101 of them were published in Chinese, 10 were in English. Thirty-four were included and the remaining 84 were excluded.
Conclusions Low-frequency PEMFs relieves the pain of primary osteoporosis quickly and efficiently, enhances bone formation and increases BMD of secondary osteoporosis. But the effects of PEMFs on bone mineral density of primary osteoporosis and bone resorption were controversial.     

Efficacy and Safety of Risedronate Sodium in Treatment of Postmenopausal Osteoporosis

With the aging of the population,the inci-dence of pri mary osteoporosis is getting higher andhigher,among which post menopausal osteoporosis(PMOP)is the most commontype.As an effectivemedicine to inhibit bone absorption,bisphospho-nates has become the main medicationtotreat oste-oporosis.In this clinical trial,we investigated theefficacy of residronate sodium,the third-generationbisphosphonates made in China,in the treat mentof PMOP by exploring its effect on bone mineraldensity(BMD)and b…     

Interventional value of total flavonoids from Rhizoma Drynariae on Cathepsin K, a potential target of osteoporosis

Osteoporosis,the sixth most common disease in the world,is bringing increasingly serious harm to people’s health.Cathepsin K,which plays an important role in bone resorption,is a potential target in the treatment of osteoporosis.Total flavonoids,the active ingredients in Rhizoma Drynariae,have shown obvious therapeutic effect on osteoporosis.In previous studies,it was presumed that the mechanism for the therapeutic effect was through inhibiting the expression of Cathepsin K.However,there are still no detailed reports on some key issues such as the specific inhibitory results of total flavonoids on Cathepsin K and the pathway of inhibition and so on.Based on previous studies on total flavonoids from Rhizoma Drynariae,the pathway for the effect of total flavonoids inhibiting Cathepsin K and their interventional value on Cathepsin K were analyzed in this paper, so as to explore the interventional feasibility and value of total flavonoids in Rhizoma Drynariae on Cathepsin K.     

Zoledronic acid： 4 mg or 5 mg？

Zoledronic acid is an aminobisphosphonate that is a potent inhibitor of bone resorption. Now there are two kinds of zoledronic acid（4 mg and 5 mg） on the shelf of the pharmacy with different FDA-approved indications（antihypercalcaemia and anti-osteoporosis）, which makes clinicians and pharmacists confused. Our hypothesis is that 4 mg zoledronic acid could be effective in osteoporosis patients. Theoretically, the mechanism of the anti-osteoporosis effect and anti-hypercalcaemia effect is to inhibit the osteoclasts, thus reducing the serum Ca2＋ concentration and improving the bone mineral density. And the anti-osteoporosis effect of zoledronic acid is dose-dependent. What’s more, some clinical trials showed that 4 mg zoledronic acid was effective in treating osteoporosis. Moreover, several clinical trials have demonstrated that zoledronic acid（4 mg） may be effective in countering bone loss resulted from aromatase inhibitor therapy or endocrine therapy. Thus maybe 4-mg dose is enough for both diseases and the 5-mg dose seems unnecessary. We just need to optimize the dosing frequency according to different conditions.     

Correlation between osteoporosis and degeneration of intervertebral discs in aging rats

This study examined the correlation between osteoporosis and the degeneration of in-tervertebral discs. Sprague-Dawley rats were maintained up to 22 or 28 months. The femoral bone, tibial bone and lumbar vertebra were histologically studied and the expression of collagen type Ⅱ and Ⅹ in intervertebral discs was immunohistochemiscally determined. Several indices for the de-generation of intervertebral discs and osteoporosis and the correlation among them were then ana-lyzed. Close correlations were found among the indices for the degeneration of intervertebral discs, including the relative area of the vascular bud, the ratio of the uncalcified and the calcified layers, the expression of collagen type Ⅱ and Ⅹ. The correlation with collagen type Ⅹ was negative. There existed positive correlations among the indices for osteoporosis, including the thickness ratio of cor-tical bone, the relative area of bone trabecula, the density of femoral and vertebral body bones, and the maximum stress and strain on bone. Analysis on the relationship of osteoporosis and the disease on disc showed that the indices of osteoporosis were negatively correlated with the indices of the de-generation of intervertebral discs but the expression of collagen type Ⅹ was positively correlated, with the density of vertebral body bones having the strongest dependence on collagen type Ⅹ. The maximum stress and strain bore no correlation with the degeneration of intervertebral discs. These results suggest that osteoporosis was negatively correlated with the degeneration of intervertebral discs.     

Theories and Practice in Prevention and Treatment Principles in Relation to Chinese Herbal Medicine and Bone Loss

Osteoporosis is a world wide problem that is increasing in significance as the global population both increases and ages. While osteoporosis has been extensively studied in recent years, the utilization of Traditional Chinese Herbal Medicine for the prevention and treatment of this condition have seldom been examined in the Western world. This paper reviews the theories and the literature that relate to prevention and treatment of bone loss at the time of menopause according to the principles of Traditional Chinese Herbal Medicine. Practical developments in these areas are also illustrated in this paper based on the authors‘ research findings in recent studies.     

Management of steroid-induced osteoporosis

Purpose To review the pathogenesis, clinical presentation, diagnostic assessment and treatment regimens of steroid-induced bone loss. Data sources An English-language literature search (MEDLINE 1966-1999) and bibliographic reviews of textbooks and review articles. Study selection Cross-sectional and prospective studies with BMD measurements or fracture rate. Results The greatest rate of bone loss occur during the first 6 to 12 months of steroid therapy, affecting trabecular more than cortical bone. High steroid dosage for a prolonged period, prevalent fracture, hypogonadism, older age, low calcium intake and family history of osteoporosis are risk factors for steroid-induced bone loss. Based on bone density results, patients with osteoporosis or osteopenia with a T-score below -1.5 should receive antiresorptive treatment during steroid therapy. Among the various antiresorptive agents, bisphosphonates have the strongest evidence of preventing steroid-induced bone loss. Conclusion The most important step in the management of steroid-induced osteoporosis is the proper assessment of the individual patient’s risk of bone loss, and the selection of appropriate anti-resorptive agent for each patient.     

Asymptomatic Paget’s disease of bone presenting with complete atrioventricular block

Paget＇s disease of bone is a deforming bone disease （osteitis deformans） characterized by increased bone remodeling, bone hypertrophy, and abnormal bone structure, leading to bone expansion, deformities, easy fractures, and occasionally, neoplastic transformation. It is the second most common bone disorder after osteoporosis. The disease is relatively rare in Asia but is common in Europe and North America, affecting approximately 2% of the population over 50 years,     

Positive Effects of Qing'e Pill(青娥丸)on Trabecular Microarchitecture and its Mechanical Properties in Osteopenic Ovariectomised Mice

Objective: To investigate the impact of Qing'e Pill(青娥丸,QEP) on the cancellous bone microstructure and its effect on the level of β-catenin in a mouse model of postmenopausal osteoporosis.Methods: Ninety-six 8-week-old speci?c pathogen free C57 BL/6 mice were randomly divided into 4 groups(24/group): sham,ovariectomised osteoporosis model,oestradiol-treated,and QEP-treated groups.Three months after surgery,the third lumbar vertebra and left femur of the animals were dissected and scanned using micro-computed tomography(micro-CT) to acquire three-dimensional(3 D) parameters of their cancellous bone microstructure.The impact of ovariectomy,the effect of oestradiol and QEP intervention on cancellous bone microstructure,and the expression of β-catenin were evaluated.Results: The oestradioland the QEP-treated groups exhibited a signi?cant increase in the bone volume fraction,trabecular number,trabecular thickness,bone surface to bone volume ratio(BS/BV),and β-catenin expression compared with those of the model group(P0.05).In contrast,the structure model index,trabecular separation,and BS/BV were signi?cantly decreased compared with those of the ovariectomised osteoporosis model group(P0.05).No differences were observed in the above parameters between animals of the QEP-and oestradiol-treated groups.Conclusions: The increased β-catenin expression may be the mechanism underlying QEP's improvement of the cancellous bone microstructure in ovariectomised mice.Our ?ndings provide a scienti?c rationale for using QEP as a dietary supplement to prevent bone loss in postmenopausal women.     

Relationship between glucocorticoid-induced osteoporosis and vitamin D receptor genotypes.

By means of polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay, the association between vitamin D receptor (VDR) genotypes and bone mineral density (BMD) in the patients receiving long-term glucocorticoid therapy was studied. The clinical data and blood of 71 patients with rheumatosis who received long-term glucocorticoid therapy were collected. BMD was measured by dual-energy X-ray absorptimometry. VDR gene fragment (about 185 bp) was amplified by PCR from the extracted genomic DNA, then digested with restriction endonuclease Bsm I. The genotypes were evaluated based on the fragment length following endonuclease digestion and the association between genotypes and BMD or Z-score values was analyzed. Among the 71 cases, the detected genotypes were Bb and bb with the distribution frequency being 11.3% and 88.7% respectively. The distribution frequency of the alleles was in agreement with the Hardy-Weinberg equilibrium. There was no significant difference between the two genotypes in age, gender, body mass index (BMI), disease duration, disease types, time of glucocorticoid administration and cumulative dosage (P > 0.05). Osteoporosis rate of the patients with Bb or bb genotype was 37.5% and 33.3% respectively, with the difference being not significant (chi 2 = 0.05, P = 0.8). The BMD and Z-score values at lumbar spine and femur in two genotypes were not similar, but the difference had no significant (P > 0.05). The distribution frequency of bb type of VDR genotypes in Han populations of China was more prevalent, followed by Bb and bb types in turn. In the patients receiving long-term glucocorticoid therapy, there was no significant difference in BMD between Bb and bb genotypes. The data suggest that the VDR genotypes may not be means of identifying patients at greater risk of glucocorticoid-induced osteoporosis, which await to be further confirmed by a large sample size.     

维生素D受体和降钙素受体基因多态性与新疆地区汉族女性人群骨密度的相关性

目的 研究维生素D受体(VDR)和降钙素受体(CTR)基因多态性与新疆地区汉族女性人群骨密度(BMD)的关系,探讨原发性骨质疏松症发病的遗传易感因素.方法 采用聚合酶链反应 (PCR-RFLP)限制性片段长度多态性技术,对336例新疆地区汉族女性人群的VDR和CTR基因进行多态性分析,双能X线吸收法测定受试者L2~4、Ward′s三角、大粗隆、股骨干4个部位的BMD值,比较不同基因型各部位BMD值的差异.结果 (1)336例受试者VDR、CTR受体基因型频率分布均符合Hardy-Weinberg定律,90例骨质疏松组与246例非骨质疏松组VDR与CTR基因型分布频率差异无统计学意义(P>0.05).(2)年龄与不同部位BMD值之间呈负相关(P<0.05),体质指数与BMD值之间呈正相关(P<0.05),在将年龄和体质指数进行校正后发现非骨质疏松组中CTR CT基因型在Ward′s三角的BMD值高于CC基因型(P<0.05);VDR Bb基因型在L2~4、Ward′s三角部位BMD均低于bb型(P<0.05), Bb基因型的BMD值在大粗隆、股骨干部位较bb型有降低趋势(P>0.05);VDR-CTR复合基因CCBb型的BMD值最低.结论 年龄与BMD值变化密切相关;体质指数是新疆汉族女性非骨质疏松的保护性因素,适当增加体重对防治骨质疏松有积极的意义;VDR Bb基因型与BMD降低密切相关;VDR-CTR复合基因CCBb型可作为预测新疆地区女性发生骨质疏松危险性的遗传学标志.     

Vitamin D receptor gene polymorphism and bone mineral density in patients with type 2 diabetes mellitus

Objective To explore the relationship between vitamin D receptor (VDR) gene polymorphisms and bone mineral density (BMD) in patients with type 2 diabetes mellitus (DM) an d to better understand the pathogenesis of osteoporosis. Methods Ninety seven patients with type 2 DM were recruited for this study. BMD was mea sured by single photon absorptiometry at the lower one third of the nondominant radius and ulna. Polymorphisms of the VDR gene were analyzed by DNA amplificati on with polymerase chain reaction (PCR) and endonuclease digestion with Bsm Ⅰ. Results The respective frequencies of VDR genotypes were BB 18. 6%, Bb 27. 8% and bb 53 . 6%. The Z scores of the three groups were -1. 57±-0. 60, -1. 45±-0. 67 and -1. 41±-0. 81, respectively. Although the BMD of the Bb genotype DM patients was higher than that of BB genotype DM patients and lower than that of bb genoty pe DM patients, there were no significant differences. Conclusion These findings suggest a small influence of VDR gene polymorphism on the BMD of patients with type 2 DM. Further study on the value of VDR genotypes in the pat hogenesis of osteoporosis in diabetes mellitus is still needed.     

广州地区绝经前妇女维生素D受体基因多态性与骨密度无关

目的 研究广州地区绝经前妇女维生素D受体基因多态性的分布及其与骨密度的关系.方法 应用聚合酶链反应-限制性片段长度多态性等技术检测193例绝经前广州地区妇女维生素D受体基因型,用双能X线骨密度仪测量腰椎、股骨颈、瓦氏三角、大转子等处骨密度.结果 193例测试对象中,维生素D受体基因型分别为bb型120例(62.2%)、Bb型64例(33.2%),BB型9例(4.6%);b等位基因频率为78.76%,B等位基因频率为21.24%.基因分布符合Hardy-Weinberg定律,其基因型与所测量部位的骨密度无关.结论 未观察到绝经前妇女维生素D受体基因型与骨密度有关,维生素D受体基因BsmI多态性还不能作为预测广州地区绝经前妇女是否易患骨质疏松危险性的遗传标志物.     

绝经后妇女维生素 D 受体基因多态性与骨密度的关系

目的：探讨广州市绝经后妇女维生素Ｄ受体（ＶＤＲ）基因多态性与骨密度关系,方法：选绝经后妇女１３８例,用分子生物学技术,限制性内切酶片段长度多态性（ＲＦＬＰ）检测ＶＤＲ基因,用双能Ｘ线骨密度仪（ＤＥＸＡ）测定其Ｌ２～４,颈、Ｗａｒｄ’Ｓ等部位的骨密度。结果：ＶＤＲ基因ＢＢ、ｂｂ、Ｂｂ分别占５．０７％、５３．６３％、４１．３０％。绝经后妇女ＶＤＲ基因型发生骨质疏松（ＯＰ）分别为：ＢＢ占８５．７％、ｂｂ     

我国哈萨克族与汉族维生素D受体基因多态性的分布

目的　为研究我国哈萨克族与汉族维生素 D受体基因多态性分布与骨质疏松的关系 .方法　采用聚合酶链反应(PCR)限制性片段长度多态性技术 ,对哈萨克族 (年龄 5 0± 2岁 )的健康妇女 93例 ,和汉族 (年龄 5 9± 3岁 )健康妇女 179例进行 VDR基因检测 .结果　在中国哈萨克族 93例中 ,bb型 44例 (4 7% ) ,Bb型 45例 (4 8% ) ,BB型 4例 (4 % ) ;在汉族179例中 ,bb型 16 2例 (90 % ) ,Bb型 17例 (10 % ) ,未见 BB型 .结论　中国哈萨克族 VDR基因多态性分布与汉族相比存在非常显著性差异 (P<0 .0 0 5 ) .     

中国长春地区186例绝经前汉族女性维生素D受体基因多态性

目的：探讨维生素D受体（vitamin D receptor, VDR）基因多态性在中国长春地区生活10年以上无亲缘关系的绝经前健康汉族女性中的分布。 方法：应用PCR-RFLP技术检测186例绝经前健康妇女的VDR基因Bsm I的多态性。 结果：VDR基因型分布频率为BB 0例,Bb 23例 (12.4%),bb 163例(87.6%)。与广州地区汉族及新疆地区哈萨克族比较差异有显著性（P<0.005）,与新疆地区的汉族比较差异无显著性（P>0.05）。结论：中国长春地区绝经前汉族女性的VDR基因呈现多态性,但以bb型占大多数,BB型缺如。这与国内其他地区的报道不尽相同。     

ASSOCIATION OF PARATHYROID HORMONE GENE POLYMORPHISM WITH BONE MINERAL DENSITY IN CHINESE WOMEN

Osteoporosisisametabolicbonediseasecharacter-izedbylowbonemineraldensity(BMD),thedeterioratedmicrostructure,highbonefragility,andincreasedriskoffracture.BMDisdeterminedbythepeakbonemass(PBM)reachedinyoungperiodandbonelossrateinlaterlife.FamilyandtwinresearchshowsthatPBM,BMDaresignificantlyrelatedtoinheritancefactors(1,2).MorrisonreportedtheassociationofVitaminDreceptorgene(VDR)polymorphismwithBMDfirstlyin1994(3).However,itisstillcontroversialbecauseofvariousresultsindifferentcountries…     

北京地区汉族成人甲状旁腺素基因多态性与骨矿盐密度的相关性

目的：研究北京地区健康汉族成人甲状旁腺素（PTH）基因的多态性分布以及PTH基因型与年轻及绝经后妇女骨矿盐密度（BMD）的相关性。方法：对270名研究对象基因组DNA样品作限制笥内切酶Bst B1的聚合酶链反应限制性片段长度多态性检测,以确定他们的PTH基因型,部分PTH基因型经DNA序列测定证实（以“B”表示具有BstB1酶解位点,b表示缺乏该酶解位点）,采用双能X射线骨密度仪测量腰椎及髋部的BMD,结果：北京地区汉族人群PTH基因BB,Bb,bb型的频率分别为73．7％,25．9,0．4％,等位基因B,b频率分别为86．7％,13．3％,绝经后妇女BB,Bb,bb型的频率分别为67．1％,32．2％,0．7％,等位基因B,b频率分别为83．2％及16．8％。年轻妇女与绝经后妇女BB与Bb基因型组间其腰椎2－4,股骨颈,Wards三角及大转子部位BMD差异均无显著性（P＞0．05）,相关性分析表明PTH基因型与BMD无明显相关性（P＞0．05）,结论：北京地区汉族妇女PTH基因型与腰椎2－4,股骨颈,Wards三角及大转子BMD均无明显相关性。     

广西壮、汉族绝经后妇女维生素D受体基因多态性的研究

目的　探讨维生素D受体 (vitaminDreceptor,VDR)基因多态性 ,以获得在广西壮、汉族妇女VDR受体基因频率分布数据。方法　用聚合酶链反应 -限制性片段长度多态性 (polymerasechainreaction ristrictionfragmentlengthpolymorphism ,PCR RFLP)方法检测壮、汉族绝经后妇女各 80例的VDR基因型。结果　壮、汉族绝经后妇女BB、Bb和bb基因型频率分别为 0 0 6 5比 0 0 5 4、0 739比 0 6 6和 0 1 96比 0 2 86 (P >0 0 5 ) ;壮、汉族绝经后妇女B和b等位基因频率分别为 0 4 31比 0 381和 0 5 6 9比0 6 1 9(P >0 0 5 )。结论　广西壮、汉族绝经后妇女VDR基因多态性无显著性差异。