二次骨折风险评价：老年女性髋部骨折后6-12个月骨密度及骨代谢变化

背景：国内外文献中关于骨折后骨代谢指标及骨密度变化量的前瞻性研究在20世纪60年代就开始有文献报道,但主要集中于胫腓骨和踝关节骨折患者,且样本量较低。 目的：观察老年女性髋部骨折愈合后(伤后6-12个月)骨密度及骨代谢指标的变化情况,并分析其相关性。 方法：选择2011年5月至2013年7月北京航天总医院骨科收治的老年女性髋部骨折患者48例,制定随访标准进行L1-4、患侧、健侧髋部骨密度测量及骨代谢指标骨碱性磷酸酶、骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b水平测定,并行骨折愈合后患侧全髋部骨密度与血清骨代谢指标的多元线性回归分析。 结果与结论：患者骨折愈合后,患髋及腰椎骨密度显著低于基线值,健髋部位骨密度与基线值差异无显著性意义。患者在伤后6个月,即骨折完全愈合时,骨代谢指标骨碱性磷酸酶、骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b水平均显著高于基线值(P < 0.05)。患者在伤后12个月,即骨折完全愈合6个月,骨钙素水平显著高于基线值,其余骨代谢指标与基线值差异无显著性意义。骨折达到临床及影像学愈合后,血清骨钙素水平的改变量与患髋骨密度改变量的偏回归系数最大。提示骨折达到临床愈合后,骨钙素血清水平对于评估骨密度回升速度具有较高价值。骨折愈合后监测相应的骨代谢指标可以提高判断骨密度变化的准确性,以降低罹患二次骨折的风险。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

绝经后2型糖尿病并发骨质疏松患者骨转换标志物的变化及探讨

目的探究绝经后2型糖尿病并发骨质疏松患者骨转换标志物的变化及检测意义。方法选取我院在2016年2月~2017年2月收治的100例绝经后女性患者进行研究,经诊断确诊后的50例绝经后骨质疏松患者作为对照组,50例绝经后2型糖尿病并发骨质疏松患者作为研究组,观察对比研究组患者骨转换标志物的相关因素分析、两组患者生化指标以及两组患者骨密度。结果研究组患者空腹血糖(FBG)、糖化血红蛋白(HbA1c)、碱性磷酸酶(ALP)以及抗酒石酸酸性磷酸酶(TRAP-5b)、甲状旁腺素(PTH)、血肌酐(Scr)、显著高于对照组患者(P0.05),血清25羟维生素D(250HD)明显低于对照组患者(P0.05);研究组患者与对照组患者骨密度之间无明显差异(P0.05);N端中段骨钙素(N-MID)与糖尿病病程呈负相关以及抗酒石酸酸性磷酸酶(TRAP-5b)、I型胶原羧基端交联肽(CTX)与骨密度呈负相关。结论经检测发现2型糖尿病主要通过影响破骨细胞的活性进而影响骨代谢,绝经后2型糖尿病并发骨质疏松患者骨转换标志物可能是抗酒石酸酸性磷酸酶,对指标的检测有助于疾病的早期诊断。     

绝经后妇女骨代谢过程中血清基质金属蛋白酶3和骨桥蛋白的变化

背景：骨桥蛋白和基质金属蛋白酶3具有高度的亲和力,此二者的表达可能与骨代谢有关。 目的：观察绝经后妇女血清基质金属蛋白酶3和骨桥蛋白水平,并观察其与骨保护蛋白、骨保护蛋白配体及骨代谢指标的关系。 方法：将120名绝经后妇女分为骨密度正常组、低骨量组和骨质疏松组3 组,对其血清基质金属蛋白酶3、骨桥蛋白、骨保护蛋白、骨保护蛋白配体及骨碱性磷酸酶、骨钙素、Ⅰ型胶原交联C端肽和尿Ⅰ型胶原交联N端肽进行测定,计算骨桥蛋白/基质金属蛋白酶3比值。 结果与结论：骨质疏松组中血清骨桥蛋白和基质金属蛋白酶3的水平高于正常组(P < 0.05)。绝经后妇女血清基质金属蛋白酶3、骨桥蛋白和骨桥蛋白/基质金属蛋白酶3比值与血清骨保护蛋白配体、骨碱性磷酸酶和骨钙素水平呈明显负相关 (P < 0.05),与骨保护蛋白、尿尿Ⅰ型胶原交联N端肽/肌酐比值呈明显正相关性(P < 0.05)。骨质疏松组中血清基质金属蛋白酶3、骨桥蛋白和骨桥蛋白/基质金属蛋白酶3比值与血清骨保护蛋白配体、骨碱性磷酸酶和骨钙素水平呈明显负相关 (P < 0.05),与骨保护蛋白、尿尿Ⅰ型胶原交联N端肽/肌酐水平比值存在明显正相关性(P < 0.05)。提示绝经后妇女血清骨桥蛋白水平和骨桥蛋白/基质金属蛋白酶3比值升高与绝经后骨质疏松症伴随骨代谢转换过程增快有关。     

2型糖尿病男性骨代谢生化指标与骨密度的变化

背景:2型糖尿病患者发生骨质疏松症的概率较高,但其发生发展机制尚不明确。目的:了解男性2型糖尿病患者骨代谢特点及骨密度的变化。方法:纳入2008-09/2010-01北京大学人民医院老年科住院及门诊男性2型糖尿病患者97例,均符合WHO 1999年糖尿病诊断标准,并排除血肌酐升高及糖尿病肾病患者;同时纳入同期的非糖尿病男性76例。空腹采血测定血骨保护素、抗酒石酸酸性磷酸酶、骨钙素、骨碱性磷酸酶、Ⅰ型胶原C末端水平。同时收集相关临床资料及生化指标,应用Hologic双能X射线骨密度仪测定骨密度。结果与结论:男性糖尿病患者各部位骨密度与非糖尿病者差异无显著性意义(P0.05)。男性糖尿病患者骨保护素及Ⅰ型胶原C末端较非糖尿病者显著升高(P0.05),而骨钙素、骨碱性磷酸酶、抗酒石酸酸性磷酸酶水平与非糖尿病者差异无显著性意义(P0.05)。提示骨保护素及I型胶原C末端在男性2型糖尿病患者骨质疏松症的发生中有一定的作用。     

依降钙素干预膝骨关节炎模型大鼠软骨下骨的变化

文题释义： 依降钙素：为人工合成的鳗鱼降钙素多肽衍生物,其主要作用是抑制破骨细胞活性,减少骨的吸收,防止骨钙丢失,同时可降低正常动物和高钙血症动物血清钙,对实验性骨质疏松有改善骨强度、骨皮质厚度、骨钙质含量、骨密度等作用。 p38丝裂原活化蛋白激酶(p38 MAPK)：p38 MAPK是MAPK亚族中的一员,它以转录因子为作用目标,通过对转录因子的磷酸化来调节许多转录因子的活性,进而介导炎症反应和细胞凋亡,参与体内细胞的应激反应。研究认为p38 MAPK是调节膝关节骨关节炎发病机制中炎症产生的关键上游信号,影响骨关节炎的发生与发展,是近年来研究的热点。 背景：骨关节炎存在软骨下骨吸收和骨形成失去平衡,课题组前期研究发现膝骨关节炎大鼠关节软骨改变前软骨下骨就已经发生改变。 目的：通过观察膝骨关节炎大鼠膝关节软骨下骨的变化,探讨依降钙素对软骨下骨p38 MAPK表达及软骨下骨吸收的影响。 方法：雌性3月龄SD大鼠随机分为3组：假手术组(n=6)不切除卵巢,切除同卵巢等体积大小的脂肪组织,切开双侧膝关节,但不损伤交叉韧带;模型组(n=6)切除双侧卵巢后,再切断双侧膝关节前交叉韧带,建立卵巢切除+前交叉韧带切断模型,不进行药物干预;依降钙素组(n=6)建立卵巢切除+前交叉韧带切断模型后,依降钙素5 IU/kg,每周2次肌肉注射。12周后分析软骨下骨的骨密度、软骨下骨p38蛋白表达水平以及血清Ⅰ型胶原交联C-末端肽、Ⅱ型胶原交联C-末端肽、白细胞介素1、白细胞介素6、骨特异性碱性磷酸酶、抗酒石酸酸性磷酸酶5b水平。实验方案经南华大学动物实验伦理委员会批准。 结果与结论：①依降钙素组软骨下骨的骨体积分数、骨小梁数量显著高于模型组(P < 0.05),骨小梁分离度显著低于模型组(P < 0.05);②模型组的骨体积分数、骨小梁数量、骨小梁厚度显著低于假手术组(P < 0.01或< 0.05)、骨小梁分离度显著高于假手术组(P < 0.01);③依降钙素组血清Ⅰ型胶原交联C-末端肽、白细胞介素1、白细胞介素6、抗酒石酸酸性磷酸酶5b显著低于模型组(P < 0.05),模型组Ⅰ型胶原交联C-末端肽、Ⅱ型胶原交联C-末端肽、白细胞介素1、白细胞介素6、抗酒石酸酸性磷酸酶5b明显高于假手术组(P < 0.05);④软骨下骨p38蛋白表达水平依降钙素组显著低于模型组(P < 0.01)、模型组显著高于假手术组(P < 0.01);⑤结果说明,依降钙素可能通过下调p38 MAPK表达,抑制骨关节炎促炎因子分泌及软骨下骨吸收。 ORCID: 0000-0002-2108-9820(伍琦) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

骨代谢指标在骨质疏松患者椎体变形中的意义

背景：骨质疏松常导致胸腰段椎体变形,鉴于骨代谢指标可灵敏的反映个体骨转换过程,结合骨密度可减少漏诊,预测骨折风险,提前干预可降低重度椎体畸形的发生率。 目的：分析骨代谢指标在骨质疏松患者椎体变形中的意义。 方法：将157例老年人骨质疏松患者按是否存在椎体变形分为椎体变形组和椎体形态正常组,椎体变形组中根据骨密度的不同分为骨密度正常和骨密度减低亚组,进行骨密度和总Ⅰ型胶原氨基端前肽、β胶原特殊序列、N端骨钙素骨代谢指标进行检测,比较了2组间及椎体变形组内骨密度正常和骨密度减低亚组间各骨代谢指标的差异。 结果与结论：椎体变形组总Ⅰ型胶原氨基端前肽、β胶原特殊序列、N端骨钙素水平较椎体形态正常组增高(P < 0.05);骨密度正常亚组总Ⅰ型胶原氨基端前肽与β胶原特殊序列水平较骨密度减低亚组增高(P < 0.05),N端骨钙素在2亚组间差异无显著性意义(P > 0.05)。结果表明骨质疏松患者中椎体变形者总Ⅰ型胶原氨基端前肽、β胶原特殊序列、N端骨钙素的骨代谢水平高于无椎体变形者,在存在椎体变形的患者中,骨密度正常者总Ⅰ型胶原氨基端前肽、β胶原特殊序列的骨代谢水平高于骨密度降低者,骨代谢水平增高结合骨密度及椎体变形可用于骨质疏松的诊断和椎体脆性骨折的预测。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

艾塞那肽对新诊断2型糖尿病患者骨代谢的影响

 目的:观察24周胰高糖素样肽1受体激动剂艾塞那肽治疗对新诊断2型糖尿病患者骨密度及骨转化标志物的影响。方法:20名新诊断2型糖尿病患者,予以艾塞那肽治疗24周。治疗前后检测体重、空腹血糖（FPG）、餐后2 h血糖（PBG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、骨密度、体脂分布和空腹血清中的骨转化标志物水平,包括骨形成标志物骨钙素（OC）、骨吸收标志物Ⅰ型胶原交联羧基末端肽（CTX）和抗酒石酸酸性磷酸酶5b（TRAcP5b）。结果:新诊断2型糖尿病患者经过24周艾塞那肽治疗后,FPG、PBG和HbA1c降低（P<0.01）,HOMA胰岛素抵抗指数改善(P<0.05),体重及体脂含量下降（P<0.05）;虽然患者OC水平下降,骨吸收标志物（CTX和TRAcP5b）水平上升,骨密度增加,但均未达统计学意义。结论: 24周艾塞那肽治疗改善新诊断2型糖尿病患者的血糖和胰岛素抵抗,使体重及体脂含量下降,但尚未对患者骨密度及骨转化标志物产生影响。     

骨代谢标志物在老年骨质疏松症诊疗中的意义

背景:骨质疏松症并非一个简单的骨定量的问题。骨质疏松症的评估是年龄、性别、骨代谢、骨形成和骨生物力学动态结果。抗酒石酸酸性磷酸酶5b和骨碱性磷酸酶分别反映的是骨吸收和骨形成的两个重要指标。目的:分析骨代谢标志物在老年骨质疏松症诊疗中的临床意义以及其与骨密度的相关性。方法:选取老年骨质疏松症患者100例,年龄分布:65-70岁30例、71-75岁40例、76-80岁30例;排除合并糖尿病、肿瘤及其他影响骨质状况疾病。所有患者入院后检测骨生化4项,包括:抗酒石酸酸性磷酸酶5b、骨碱性磷酸酶、骨钙素N端中分子片段以及25-羟维生素D。据检测结果患者分成抗酒石酸酸性磷酸酶5b升高组和骨碱性磷酸酶升高组,分别行抗骨质疏松症治疗3个月。分析患者骨密度和骨生化4项检查结果与性别、年龄的相关性;进行两组治疗前后骨生化4项差异性比较及组间差异性比较。结果与结论:腰椎和髋关节骨密度随年龄增加而降低(P0.05);男性组的腰椎和股骨颈Word三角区骨密度测量值较女性组高。抗酒石酸酸性磷酸酶5b、骨碱性磷酸酶、骨钙素N端中分子片段随年龄增加在人体内含量升高(P0.05),而25-羟维生素D随年龄增加在人体内含量降低(P0.05);女性骨质疏松症患者抗酒石酸酸性磷酸酶5b、骨碱性磷酸酶、骨钙素N端中分子片段在人体内含量较男性患者高,而25-羟维生素D在人体内含量较男性患者低。两组患者使用抗骨质疏松症药物治疗后骨生化4项指标均较治疗前有改善。结果提示,骨代谢标志物检测能明确患者体内是以成骨细胞功能为主和还是以破骨细胞功能为主,以便指导临床针对性使用抗骨质疏松症药物,为临床治疗骨质疏松症和监测疗效提供科学依据。     

抗骨质疏松药物应用的依据：骨生化代谢标志物及骨组织病理学

背景：目前国际上公认双能X射线吸收测定法为诊断骨质疏松症的金标准,但常由于测量部位异位骨化、骨质增生等因素使得测量结果存在误差。目的：探讨骨代谢标志物在老年骨质疏松骨折诊疗中的临床意义以及它与骨密度和骨组织形态病理学改变的相关性。方法：选取50例需行手术治疗的老年骨质疏松骨折患者,行骨生化4项检测,其中抗酒石酸酸性磷酸酶5b(TRACP 5b)检测值明显增高患者25例(标记为抗酒石酸酸性磷酸酶5b升高组),骨碱性磷酸酶(BAP)检测值明显升高患者25例(标记为骨碱性磷酸酶升高组)。术中抽取两组各8例患者骨折断端部分骨组织,苏木精-伊红染色普通光镜检查和扫描电镜检查病理学改变。术后,抗酒石酸酸性磷酸酶5b升高组患者使用鲑鱼降钙素抗骨质疏松治疗,骨碱性磷酸酶升高组患者使用骨肽注射液抗骨质疏松治疗,6个月后再次检测骨密度和骨生化4项。结果与结论：两组患者术前骨密度和骨生化4项检查结果相比较差异无显著性意义(P > 0.05)。抗酒石酸酸性磷酸酶5b升高组患者骨折断端骨组织病理检查示成骨细胞减少、破骨细胞增多;骨碱性磷酸酶升高组患者骨折断端骨组织病理检查示成骨细胞减少;两组骨小梁/骨面积比值均降低,且抗酒石酸酸性磷酸酶5b升高组较骨碱性磷酸酶升高组降低程度差异有显著性意义(P < 0.05)。扫描电镜检查示两组破骨细胞都较正常组活跃,抗酒石酸酸性磷酸酶5b升高组骨小梁较骨碱性磷酸酶升高组稀松明显,吸收空泡增大。两组于术后使用抗骨质疏松药物治疗,两组治疗前与治疗后骨密度和骨生化4项检测结果差异有显著性意义(P < 0.05)。结果显示：①骨代谢标志物检测能明确患者骨组织是以成骨细胞功能和数量减低还是以破骨细胞功能和数量增加为主,以便指导临床针对性使用抗骨质疏松药物。②骨折断端骨组织形态病理学检查能更好地反映患者骨组织内成骨细胞、破骨细胞和骨小梁等状况。骨质疏松患者针对性使用抗骨质疏松药物治疗能提高疗效、降低相关并发症。     

有氧运动联合左旋甲状腺素与维生素D3改善亚临床甲减大鼠骨质疏松的作用

文题释义：亚临床甲减：是指轻度甲状腺功能衰竭的表现，其临床表现为促甲状腺激素(TSH)升高而游离的甲状腺激素T3、T4基本正常，是一种内分泌代谢性疾病，是甲状腺功能障碍的早期阶段。亚临床甲减是一种系统性疾病，可以引起机体各器官功能状态变化，包括引起骨密度降低、骨质疏松等。抗酒石酸酸性磷酸酶(tartrate resistant acid phosphatase，TRACP)：为最近发现的骨吸收和破骨细胞活性的良好标志物，测定血清中抗酒石酸酸性磷酸酶尤其是抗酒石酸酸性磷酸酶5 b的浓度，有助于了解生理条件和各种病理条件下的骨代谢状况。抗酒石酸酸性磷酸酶缺乏和过度表达的大鼠模型分别表现为骨硬化和骨质疏松。背景：左旋甲状腺素可以显著改善亚临床甲减的症状，也有研究指出左旋甲状腺素可部分改善实验大鼠的骨代谢异常，但其对于亚临床甲减性骨质疏松的治疗作用却鲜有研究。 目的：在亚临床甲减大鼠模型上观察有氧运动联合左旋甲状腺素与维生素D3对骨质疏松症状的改善作用。方法：将Wistar大鼠分为空白对照组、假手术组、模型组进行造模，并检测大鼠甲功指标，此为造模阶段；造模成功后将模型组分为无处理组、运动组、左旋甲状腺素组、维生素D3组、运动+左旋甲状腺素组、运动+维生素D3组、左旋甲状腺素+维生素D3组、运动+左旋甲状腺素+维生素D3组，另设置一组正常对照组，其中正常对照组不作任何处理，其余各组分别接受相应的单一因素或者联合因素处理，共52 d，此为处理阶段。随后，检测大鼠血清中骨吸收标志物(β-Ⅰ型胶原羧基端肽和血清抗酒石酸酸性磷酸酶5b)、骨形成标志物(骨型碱性磷酸酶、Ⅰ型前胶原氨基端前肽和血清骨钙素)等骨代谢指标，并对大鼠头骨、脊柱、上肢和下肢进行骨密度扫描，测量各组大鼠血清中钙和磷及右股骨组织中Cathepsin K的蛋白水平，对各组大鼠股骨头行苏木精-伊红染色。 结果与结论：①在造模阶段，相对于空白对照组与假手术组，模型组大鼠血清中促甲状腺素水平显著增加(P < 0.05)，而血清FT3、FT4无明显变化，说明亚临床甲减大鼠造模成功。②进行干预后，与其他无甲状腺素处理的各组大鼠相比，4个补充左旋甲状腺素组大鼠的血清促甲状腺素水平明显降低(P < 0.05)，而T3、T4无明显变化，但其骨代谢指标和骨密度则显著升高(P < 0.05)，且以运动+左旋甲状腺素+维生素D3组改善最为显著(P < 0.05)。左旋甲状腺素+维生素D3组及运动+左旋甲状腺素+维生素D3组大鼠中的血清钙和磷水平显著高于其他无维生素D3处理组(P < 0.05)；4个补充左旋甲状腺素组大鼠的股骨组织中Cathepsin K蛋白表达水平低于其他各组(P < 0.05)，且其骨小梁组织形态比其他各组大鼠得到明显改善。③提示：亚临床甲减可诱发骨质疏松，而补充左旋甲状腺素是至关重要的一环；补充维生素D3通过增加血清钙和磷的水平起到改善骨质疏松的作用；有氧运动能显著增加左旋甲状腺素及维生素D3对亚临床甲减性骨质疏松的改善作用；亚临床甲减性骨质疏松的治疗中，应重视甲状腺素、维生素D3及有氧运动的综合性治疗手段。 ORCID: 0000-0002-9466-9885(武青梅) 中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程     

Differences in the bone mineral density in patients with Kanemi Yusho treated before and after the age of 18 years

This study examined patients with Kanemi Yusho. The patients' height, weight, and bone mineral density were measured. The density of the distal end of the radius was measured using dual energy X-ray absorptiometry and the calcaneum was measured with ultrasound. We also measured urine levels of cross-linked N-telopeptides of type I collagen, serum tartrate-resistant acid phosphatase 5b, serum bone-specific alkaline phosphatase, serum Ca, serum P and blood PCB level. The patient group that took PCBs when they were 0 to 18 years old (such patients were 42 to 60 years old at the time of the study) showed no correlation between the bone density of the radius and calcaneum in spite of treatment received when they were over 18 years of age (> 60 years of age at the time of the study). The bone mineral density in Kanemi Yusho was not different from the control group. The levels of only serum bone-specific alkaline phosphatase were correlated with the bone mineral density of the radius and calcaneum in patients treated when they were over 18 years of age (currently over 60 years old). PCBs might have had an effect on bone density and bone metabolism.     

Relationship of osteocalcin and matrix Gla protein gene polymorphisms to serum osteocalcin levels and bone mineral density in postmenopausal Korean women

OBJECTIVE: To investigate the relationship of osteocalcin and matrix Gla protein (MGP) gene polymorphisms to serum osteocalcin levels, and bone mineral density (BMD) in postmenopausal Korean women. DESIGN: The osteocalcin gene Hind III and MGP gene cytosine-adenine polymorphisms were analyzed in 267 postmenopausal Korean women. Serum osteocalcin, bone alkaline phosphatase, C-telopeptide of type I collagen, and BMD at the lumbar spine and femoral neck were measured. RESULTS: No significant differences in BMD of the lumbar spine and femoral neck were observed across MGP genotypes, whereas a significant lower BMD at the lumbar spine (but not at the femoral neck) was observed in women with the (h) allele (lower case 'h' signifies the presence of the Hind III site) in a dose-response manner. Serum osteocalcin levels among bone turnover markers studied were significantly higher in women without the 210-bp MGP (cytosine-adenine) allele, or with the osteocalcin hh genotype. CONCLUSIONS: The osteocalcin gene Hind III polymorphism is a genetic factor that is associated with BMD of the lumbar spine in Korean women, and Gla gene polymorphisms are associated with higher osteocalcin levels.     

Ⅰ型胶原N末端肽和定量CT骨密度早期测定实验性骨不连

BACKGROUND: Currently, X-ray examination is mainly used for diagnosis of nonunion. However, this method that relies only on the clinician’s experience and degree of callus mineralization has less accuracy because it is vulnerable to projection, processing conditions and subjective factors. OBJECTIVE: To establish an animal model of nonunion and to detect the variation of biochemical markers and bone mineral density.   METHODS: Twenty New Zealand white rabbits were randomly divided into two groups, and bone defect and fracture models were made in the midshaft of the forearm radius, respectively. X-ray examination of the forearm, quantitative CT measurement of bone mineral density and serological test were carried out before and at 2, 3, 4, 5, 6, 7, 8, 10, 12 weeks after surgery. RESULTS AND CONCLUSION: Postoperative X-ray films showed that the in the bone defect group, a little callus formed in three rabbits at 2 weeks, the callus formed stably at 5 weeks, but there was still no healing at 8 weeks; in the fracture group, the fracture line was blurred at 2 weeks and a large number of calluses formed at 6-8 weeks. Compared with the fracture group, the value of bone mineral density in the bone defect group began to decrease significantly at 5 weeks after surgery. Results from the serological test showed that in the bone defect group, the activity of bone-specific alkaline phosphatase increased after surgery, reached peak at 4 weeks, began to decrease at 5 weeks and became stable at 6 weeks; the activity of tartrate-resistant acid phosphatase 5b increased after surgery, peaked at 4 weeks, then decreased and stabilized basically; the expression of N-terminal telopeptide of type I collagen decreased significantly at 5 weeks after surgery and became stable at 6 weeks. These findings indicate that the systematic monitoring of changes in bone mineral density and biochemical indicators such as bone-specific alkaline phosphatase, tartrate-resistant acid phosphatase 5b and type I collagen N-terminal telopeptides may help to reflect the early progress of rabbit nonunion.       

脉冲电磁场磁疗与骨硬化蛋白单克隆抗体联合干预绝经后新西兰大白兔骨代谢和骨微结构的变化

文题释义：低频脉冲电磁场(pulsed electromagnetic fields,PEMFs)疗法：是目前常用的骨质疏松症物理治疗方法。脉冲电磁场治疗骨质疏松症的原理是采用低频脉冲电磁场改变人体生物电、改善生物场,促使成骨细胞增生,增强成骨能力,提高骨密度治疗骨质疏松。 骨硬化蛋白的单克隆抗体(sclerostin antibody,Scl-Ab)：对骨代谢的影响集中体现在对骨硬化蛋白的拮抗作用上。骨硬化蛋白单克隆抗体在刺激成骨活动的同时,不会刺激破骨活动,对骨合成代谢有显著刺激作用,其已经成为治疗骨质疏松的潜在方法。 背景：脉冲电磁场与骨硬化蛋白单克隆抗体皆能对绝经后新西兰大白兔骨代谢产生良好影响,但关于两者联合干预的效果至今少有报道。 目的：探讨脉冲电磁场联合骨硬化蛋白单克隆抗体对绝经后新西兰大白兔骨代谢的影响,探索其对骨质疏松症的治疗价值。 方法：采用卵巢切除法建立新西兰大白兔绝经后骨质疏松动物模型。将实验动物随机分为4组：卵巢切除组、脉冲电磁场组、骨硬化蛋白单克隆抗体组和脉冲电磁场+骨硬化蛋白单克隆抗体组,每组10只。术后第1天起,脉冲电磁场组给予脉冲电磁场磁疗每天1次;骨硬化蛋白单克隆抗体组给予骨硬化蛋白单克隆抗体皮下注射每周2次;脉冲电磁场+骨硬化蛋白单克隆抗体组接受脉冲电磁场磁疗每天1次、每周5次,骨硬化蛋白单克隆抗体皮下注射每周2次;卵巢切除组皮下注射相同剂量的生理盐水每周2次,干预共8周。8周后行骨代谢指标检查、骨密度测定、MicroCT骨微结构参数检测。动物研究中的所有程序经复旦大学实验动物科学部批准(20171263A193)。 结果与结论：①卵巢切除6个月新西兰大白兔骨密度显著下降,提示骨质疏松模型建立成功;②与卵巢切除组相比,3个治疗组L₃椎体的骨密度均显著增加(P < 0.05);③3个治疗组血清骨特异性碱性磷酸酶水平均显著高于卵巢切除组,血清抗酒石酸酸性磷酸酶5b水平均显著低于卵巢切除组;脉冲电磁场+骨硬化蛋白单克隆抗体组血清抗酒石酸酸性磷酸酶5b的水平明显低于脉冲电磁场组、骨硬化蛋白单克隆抗体组;④脉冲电磁场+骨硬化蛋白单克隆抗体组骨微结构参数(骨体积分数､骨小梁厚度､骨小梁数量､骨小梁分离度)均优于脉冲电磁场组、骨硬化蛋白单克隆抗体组(均P < 0.05);⑤骨硬化蛋白单克隆抗体和脉冲电磁场联合治疗可以增强去势新西兰大白兔骨密度,改善骨代谢和骨微结构。 ORCID: 0000-0001-7052-4262(钱光) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Comparison of effects of alendronate and raloxifene on lumbar bone mineral density, bone turnover, and lipid metabolism in elderly women with osteoporosis

PURPOSE: To compare the effects of alendronate and raloxifene on lumbar bone mineral density (BMD), bone turnover, and lipid metabolism in elderly women with osteoporosis. SUBJECTS AND METHODS: One hundred twenty-two postmenopausal women with osteoporosis (mean age: 69.4 years) were randomly divided into 2 groups of 61 patients: the alendronate group and the raloxifene group. BMD of the lumbar spine, urinary level of cross-linked N-terminal telopeptides of type I collagen (NTX), and serum levels of alkaline phosphatase (ALP), total cholesterol (TC), high and low density lipoprotein cholesterols (LDL-C and HDL-C, respectively), and triglycerides (TG) were measured during the 12-month-treatment period. RESULTS: The trial in 50 patients in the alendronate group and 52 patients in the raloxifene group could be completed. Both alendronate and raloxifene increased lumbar BMD (+8.0% and +2.4% at 12 months, respectively), followed by reductions of urinary NTX level and serum ALP level; however, the effects of alendronate were more pronounced than those of raloxifene. Only raloxifene reduced the serum levels of TC and LDL-C (-3.9% and -7.7% at 12 months, respectively), without any significant effect on the serum HDL-C and TG levels. CONCLUSION: The present study confirmed the efficacy of alendronate greater than raloxifene in increasing lumbar BMD through its effect on marked reduction of the bone turnover more than by raloxifene, and some beneficial effects of raloxifene on lipid metabolism in elderly women with osteoporosis.     

Influences of menopause, aging, and gender on the cleavage of type II collagen in cartilage in relationship to bone turnover

OBJECTIVE: It is unclear whether there are changes in cartilage turnover after menopause, although these are well documented in bone. The aim of this study was to explore the possibility that menopause might change cartilage turnover as well as bone turnover. We also examined age and gender to estimate the independent influences of these parameters together with menopause on cartilage and bone turnover.DESIGN: Serum samples were collected from 140 healthy volunteers, 69 men (mean age +/- SD, 42.8 +/- 13.8 y) and 71 women (44.4 +/- 10.5 y) with self-reported pre- or postmenopausal status who had no swelling or pain in their spine and joints. Body mass index was also recorded. The serum concentration of a biomarker of cartilage type II collagen (C2C) degradation and concentrations of serum bone alkaline phosphatase and urine cross-linked type I collagen N-telopeptide, both accepted biomarkers of bone turnover, were measured together. Analyses of covariance were performed to test the mean differences of biomarkers by gender and by menopause status with age adjustment. RESULTS: In men there were no significant correlations between age and the biomarkers. In women C2C concentration decreased with age. Cross-linked type I collagen N-telopeptide and bone alkaline phosphatase levels were both increased after menopause, whereas C2C showed no detectable changes. C2C was not significantly related to body mass index. CONCLUSIONS: This study suggests that there are fundamental differences in the degradation of uncalcified C2C and bone type I collagen degradation and bone assembly in response to menopause and aging.     

Effect of physical activity on bone turnover in young boys

AIMS: To evaluate the effect of the physical activity on bone turnover in young male soccer players at the Tanner's stage of 1-2. MATERIAL AND METHODS: 61 young soccer players (13,4 +/- 0,3 years old) who actively participated in soccer since 3,7 +/- 0,7 years were compared to 60 age and sex- matched non active subjects. Bone mineral density (BMD) of whole body, and in specific skeleton sites, fatty body mass (FBM) and lean body mass (LBM) were determined by a dual energy X-ray absorptiometry (DXA). Total plasma alkaline phosphatase (ALP) and plasma bone alkaline phosphatase (BALP), plasma osteocalcin (OC) and plasma collagen type I cross-linked C-telopeptide (CTX) were measured. RESULTS: BMD of the whole body and at the lumbar spine (L2-L4), femoral, lower limbs and LBM were significantly higher in young soccer players than in controls. The biochemical markers of bone turnover: ALP (6,7%), BALP (8,9%), OC (3%) and CTX (3,1%) were not significantly higher in sportsmen than in controls. The calcium was significantly higher in sportsmen than in controls. CONCLUSION: These results suggest that soccer practice induced an increase of bone mass in boys. The increase in the level of bone turnover evaluated by the new biochemical markers was not significant in the sportsmen.