Treatment of severe osteoporosis for internal medicine

Some physicians of internal medicine recognize what is called severe osteoporosis is the bed-ridden condition because of severe pain and spinal deformity due to compression fractures. And also hip fracture makes a bed-ridden. In the end stage of osteoporosis, as effects of drugs to increase bone mineral density are limited, prevention of bed-ridden is needed a team-treatment not only by physician or orthopedic doctor but also by rehabilitation doctor and psychologist.     

Perspectives on osteoporosis in pediatric inflammatory bowel disease

Osteoporosis is now recognized as a problem in children with chronic illness. Decreased bone mineral density and increased risk of fracture have been reported in children with inflammatory bowel disease (IBD). Recent studies have led to a better understanding of the pathogenesis of bone loss. There are many risk factors for osteopenia and osteoporosis in children with IBD. Dual-energy x-ray absorptiometry remains the diagnostic procedure of choice for assessment of bone mineral density, but other modalities are being explored. Guidelines for diagnosis and treatment of osteoporosis in children have not been established. This article reviews the current understanding of osteopenia and osteoporosis in children with IBD.     

Perspectives of traditional Chinese medicine in pancreas protection for acute pancreatitis

Acute pancreatitis(AP)is one of the most common diseases.AP is associated with significant morbidity and mortality,but it lacks specific and effective therapies.Traditional Chinese medicine(TCM)is one of the most popular complementary and alternative medicine modalities worldwide for the treatment of AP.The current evidence from basic research and clinical studies has shown that TCM has good therapeutic effects on AP.This review summarizes the widely used formulas,single herbs and monomers that are used to treat AP and the potential underlying mechanisms of TCM.Because of the abundance,low cost,and safety of TCM as well as its ability to target various aspects of the pathogenesis,TCM provides potential clinical benefits and a new avenue with tremendous potential for the future treatment of AP.     

骨质疏松与中医体质的相关性

目的探讨骨质疏松与中医体质之间的关系,从而为骨质疏松的筛查提供依据。方法收集江苏省中医院门诊及住院的骨质疏松患者80例,使用中医体质量表进行测评,研究哪些中医体质类型对骨质疏松具有易患性或易感性。结果 (1)在骨质疏松患者中医体质调查中,阳虚体质的人最多,其次为阴虚质、气虚质、血瘀质。(2)在倾向体质出现的频次中,有气虚倾向的人最多,其次为血瘀倾向、气郁倾向、痰湿倾向。(3)在骨折患者中医体质调查中,骨折人群中阳虚体质的人最多,其次为阴虚质、气虚质。(4)在骨折患者倾向体质出现的频次中,有气虚倾向的人最多,其次为血瘀倾向、气郁倾向。结论骨质疏松患者中阳虚体质最多,其次是气虚质、阴虚质、血瘀质,即骨质疏松与阳虚质相关度最高,其次是气虚质、阴虚质、血瘀质。在脏腑辨证体系中,与阳虚、气虚、阴虚病机均有密切关联的为肾脏系统,故认为骨质疏松患者体质特点为"肾虚血瘀"。     

Perspectives about complementary and alternative medicine in rheumatology

Complementary and alternative medical (CAM) treatments are considered nonmainstream therapies. The popularity and widespread usage of CAM reflects the inadequacies of the current understanding and management of rheumatic and musculoskeletal (and other) diseases despite significant progress. Better science in the future will relegate certain CAM therapies to the margins of medicine or to history and perhaps see the adoption of others into mainstream medicine. Despite the recent increased interest in CAM, particularly for rheumatic diseases, few clinically important contributions have emerged thus far.     

The epidemiology of osteoporosis and fractures in geriatric medicine

Several conclusions can be drawn from this article, the most important of which are as follows: 1. Low bone mass is widely prevalent among older men and women and is associated with important fracture consequences. 2. The prevalence of osteoporosis and fracture is projected to increase over the next several decades. 3. Although Caucasian women are at greatest risk, substantial numbers of men and women of non-Caucasian heritage are also affected. 4. The population burden of disease consequences, including mortality, morbidity, and social and personal cost, is anticipated to increase as well. 5. In the group at greatest risk (Caucasian women), osteoporosis and fracture have well-established risk factors, many of which are modifiable. 6. Relevance of these risk factors for groups other than Caucasian women appears likely but requires further investigation. 7. Personal and societal costs associated with osteoporosis are enormous; as such, identification of persons at risk and prevention and treatment of this disease should be public health priorities.     

中药内服治疗原发性骨质疏松的系统评价

目的探讨内服中药治疗原发性骨质疏松的疗效。方法计算机检索Cochrane Library、MEDLINE、EMbase、CBM、CNKI、VIP等数据库,人工检索相关临床随机对照研究文献,依据统一的纳入排除标准,对纳入研究的文献质量进行评估。采用Rev Man5.3进行Meta分析,对患者用药后总体疗效、腰椎、股骨颈、股骨大粗隆、ward三角、跟骨骨密度以及肝肾功能、血液流变学指标进行评价。结果纳入9篇文献,共计1 372例原发性骨质疏松患者。内服中药治疗组较对照组总体有效率高(P<0.01);内服中药能够显著提高患者腰椎和股骨颈骨密度(P<0.01),但股骨粗隆、ward三角以及跟骨密度无统计学差异(P>0.05)。此外,中药能够增加患者血清中骨钙素、1,25(OH)2D3含量,同时改善血液流变学相关指标。结论内服中药对原发性骨质疏松具有一定疗效。     

Early rheumatoid arthritis: Toward tailor-made therapy

Therapeutic possibilities for the treatment of early rheuma-toid arthritis (RA) have expanded largely. New treatment modalities appear very effective with respect to relevant outcomes, such as radiographic progression. At the same time, the costs of disease-modifying antirheumatic drugs (DMARDs) have exponentially increased so that—given the rather high prevalence of RA—cost may become a limiting factor in the treatment of patients with RA. Therefore, there is a need to define the profile of those patients that should be treated with the most effective, and, unfortu-nately, the most costly, DMARDs. The authors describe herewith the heterogeneity of RA with respect to its most important outcomes, as well as the inability to predict those outcomes appropriately at the individual patient level. This heterogeneity of RA is not acknowledged in the mod-ern landmark clinical trials that the authors base therapeu-tic decisions on, and the external validity of those trials is at stake. In this article, the authors discuss the consequences of the heterogeneity of RA in light of the perceived lack of external validity of evidence-generating landmark trials. The authors propose the following solutions to overcome this discrepancy: 1) earlier recognition of RA, and 2) appropri-ate prediction of treatment efficacy, because the most chal-lenging scientific efforts may be taken in the near future in order to arrive at a tailor-made therapy for every individual presenting with RA.     

中医药治疗骨质疏松症的研究进展

骨质疏松症(OP)是由于骨量减少及骨微结构恶化而导致的全身性骨病。中医在OP的治疗上有着丰富的临床经验,通过辨证论治,采用中药、针刺疗法、艾灸疗法等治疗方法,在临床中取得了显著的疗效。本文基于近年来中医药治疗OP的研究概况,对OP的中医病因病机、中医治疗方法等进行综述。     

Hormone replacement therapy and osteoporosis from the perspective of evidence-based medicine

Preparations of the estrogen (HRT) are considered the gold standard for the prevention and treatment of postmenopausal osteoporosis. However, supporting evidence based on the results of large, prospective, randomized controlled trials of estrogen preparations was largely lacking. In 2001 the results of two major studies were reported. The first was a meta-analysis of 22 randomized studies, and the second was an 11-year survey. Both of these studies provide very reliable evidence. The recently published interim report of the Women's Health Initiative states that the incidence of femoral fractures decreased by 34% in women who received HRT. HRT thus remain one gold standard for the prophylaxis and therapy of osteoporosis.     

Screening for osteoporosis

PURPOSE: To review evidence that screening for osteoporosis by measuring bone mass in postmenopausal women would reduce fracture incidence. DATA IDENTIFICATION: An English-language literature search using MEDLINE (1966 to 1989), bibliographic reviews of book chapters and review articles, technology assessments of bone mass measurement, and other publications. STUDY SELECTION: We summarize prospective studies of fracture risk prediction done with widely used bone mass measurement techniques, and we document noncontroversial or peripheral points with recent papers and reviews. DATA EXTRACTION: Without osteoporosis screening trials, no quantitative analysis is possible. Instead, we assess the ability of screening tests to measure bone mass and define fracture risk categories, the ability of risk categories to determine treatment, and the ability of treatment to reduce fracture incidence. RESULTS OF DATA SYNTHESIS: Bone mass measurement meets many of the criteria for a screening test, and indirect evidence suggests that a screening program might reduce osteoporosis-related fracture incidence. No trial has shown this directly; however, and questions remain about overall benefits and costs of mass screening. CONCLUSIONS: Although there are clinical indications for bone mass measurement, unselective screening for osteoporosis cannot be recommended until a specific program is formulated and justified.     

补肾法中药对去卵巢大鼠骨质疏松骨代谢指标的影响

目的探讨补肾法中药对去卵巢大鼠骨质疏松(OP)骨密度(BMD)、骨生物力学、血清碱性磷酸酶(ALP)、血清Ⅰ型前胶原羧端肽原(PICP)的影响。方法将36只SD雌性大鼠随机分为治疗组、假手术组和模型组。切除双侧卵巢造模,治疗组给予补肾法中药治疗,模型组予等量生理盐水,灌胃3个月后取材。Medical viva CT40测量获得BMD;三点弯曲实验获得最大应变和弹性模量;酶联免疫吸附(ELISA)试剂盒检测血清ALP、PICP的含量。结果与假手术组比较,模型组BMD水平明显降低(P<0.05),最大应变和弹性模量均明显下降,血清ALP水平明显升高,血清PICP水平明显降低(均P<0.05)。与模型组比较,治疗组BMD无明显差异,但均有增长的趋势,最大应变和弹性模量均明显升高,血清ALP水平明显降低,PICP水平明显升高(均P<0.05)。结论补肾法中药可能通过降低OP模型大鼠血清ALP含量,升高PICP含量,提高骨生物力学性能和BMD,达到治疗OP的作用。     

骨质疏松症的筛查

骨质疏松症是一种最常见的骨骼疾病,其患病率随年龄的增加而显著增高。在人口老龄化现象突出的当今社会,其对个人健康、家庭负担和社会资源消耗的影响达到了令人震惊的地步。由于各种原因,骨质疏松症并未得到临床医生足够的重视,其在临床上漏诊、误诊现象突出。加强骨质疏松症的筛查,早期、及时发现骨质疏松症患者具有十分重要的临床价值。临床上应该首先根据国内外骨质疏松症临床诊治的相关指南意见和患者的具体表现,确定骨质疏松症筛查对象。其次,临床医生需熟悉骨质疏松症的各种筛查方法,合理评估筛查结果,对骨质疏松症进行确诊。再次,由于骨质疏松症临床表现的多样化,导致患者可能就诊于各个临床科室,临床各科医生都应该成为骨质疏松症筛查的主体,肩负起筛查骨质疏松症的责任,全面保障患者健康。