仙灵骨葆胶囊对骨质疏松性髋部骨折的研究近况

骨质疏松症是老年人的常见病和多发病,其最大的危害是导致骨折的发生。随着老龄化社会的到来,骨质疏松性髋部骨折的发病率也显著增高。仙灵骨葆作胶囊具有滋补肝肾,活血通络,强筋壮骨的功效。具有类雌激素样作用,能提高全身的骨量,同时对骨质疏松性髋部骨折具有良好的防治效果,能减少骨折发生,促进骨折愈合,缓解疼痛。本文就仙灵骨葆治疗骨质疏松性髋部骨折进行综述。     

补阳还五汤对老年Colles骨折手法复位小夹板外固定后患者早期骨痂X线评分及血清碱性磷酸酶水平的影响

目的:探讨补阳还五汤对老年Colles骨折手法复位小夹板外固定后患者早期骨痂X线评分及血清碱性磷酸酶水平的影响。方法:自2016年10月至2018年10月,将采用手法复位小夹板外固定治疗的60例老年Colles骨折患者分为试验组和对照组,每组30例。对照组男15例,女15例;年龄56～75(67.81±5.41)岁;骨密度(0.82±0.24)g/cm~2;术后3 d予抬肩、屈伸肘关节、五指伸直和握拳锻炼,每日3次,每次30 min,持续1个月。试验组男13例,女17例;年龄57～77(66.02±5.16)岁;骨密度(0.76±0.23)g/cm~2;在对照组康复锻炼基础上口服补阳还五汤400 ml,每日2次,7 d为1个疗程,共服4个疗程。比较两组患者复位14、28 d时RUSS评分,测定两组患者复位即刻、复位14及28 d血清碱性磷酸酶(ALP)浓度及血清钙离子浓度以观察骨折愈合情况。结果:两组患者复位固定顺利,无再次骨折及并发症发生。两组患者复位后获得随访,时间30～35(31.60±1.03) d。试验组复位14、28 d时RUSS评分分别为4.58±0.31、7.07±0.36,对照组分别为3.98±0.30、6.15±0.35,试验组RUSS评分较对照组明显提高(P0.01)。试验组复位即刻、复位14及28 d血清碱性磷酸酶浓度分别为(90.62±12.19) mmol/L、(105.40±11.63) mmol/L、(160.86±35.77) mmol/L,对照组分别为(91.27±13.52) mmol/L、(94.60±11.10) mmol/L、(144.17±26.27) mmol/L;两组复位即刻碱性磷酸酶浓度比较差异无统计学意义(P0.05);复位14、28 d试验组血清碱性磷酸酶浓度较对照组升高(P0.05)。两组复位即刻、复位14及28 d血清钙浓度比较差异无统计学意义(P0.05)。结论:补阳还五汤治疗老年Colles骨折能促进患者早期骨痂形成,有效增加机体血清碱性磷酸酶浓度,促进骨折愈合。     

仙灵骨葆对卵巢切除大鼠股骨骨折愈合影响的实验研究

目的 研究仙灵骨葆对卵巢切除大鼠股骨骨折愈合的作用.方法 健康12周龄雌性SD大鼠40只,体重(258±14)g,随机分为4组,每组10只.A组仅作切口暴露腹腔;B组仅切除卵巢;C、D组切除卵巢同时制备右侧股骨中段横型骨折,髓内针固定,术后分别采用生理盐水及250 mg/(kg·d)仙灵骨葆灌胃.于术后即刻、1、2、3、4及5周测量A、B组大鼠体重.术后5周取各组右侧股骨标本,双能X线骨密度仪测量股骨全长骨密度(total femur bone mineral density,tBMD)、远1/3段骨密度(distal femur bone mineral density,dBMD)和中1/3段骨密度(middle femur bone mineral density,mBMD),并行C、D组CR摄片、HE染色和免疫组织化学染色.结果 B组大鼠体重从第3周开始显著高于A组(P＜0.05),绝经后骨质疏松模型制备成功.CR摄片示D组骨痂量相对较多,骨折线模糊;C组骨痂量较少,骨折线清晰.B组tBMD和dBMD明显低于A组,D组mBMD明显高于C组,差异均有统计学意义(P＜0.05);D组tBMD和dBMD较C组有增高趋势,但差异无统计学意义(P＞0.05).组织学观察D组与C组比较,骨折端大部分骨性愈合,骨髓腔可见较多毛细血管植入.免疫组织化学染色示C、D组BMP-2的积分吸光度(IA)值分别为2.2366±0.1818和3.7273±0.8742,VEGF的IA值分别为2.8355±0.5370和3.8396±0.2230,差异均有统计学意义(P＜0.05).结论 仙灵骨葆可促进卵巢切除大鼠股骨骨折愈合,加快编织骨向板层骨的转化,这可能与上调BMP-2和VEGF表达相关.     

仙灵骨葆胶囊对骨质疏松性骨折大鼠骨生长因子及骨折愈合的影响

目的 探讨仙灵骨葆胶囊对骨质疏松性骨折大鼠骨生长因子BMP-2、IGF-1表达及骨折愈合的影响。方法 48只雌性SD大鼠随机分为：假手术组、模型组、雌二醇组、仙灵骨葆组，12只/组，采用“双侧卵巢切除术+右侧股骨干骨折髓内固定术”构建骨质疏松性骨折大鼠模型，评估骨折愈合情况，检测股骨骨痂BMD、股骨骨生物力学指标和血清骨代谢相关指标，检测骨痂BMP-2、IGF-1蛋白表达。结果 模型组较假手术组骨折愈合评分、股骨痂BMD、股骨骨生物力学指标（最大载荷、最大应力、最大位移）、骨痂BMP-2和IGF-I阳性表达均显著降低（P<0.05），雌二醇组、仙灵骨葆组较模型组骨折愈合评分、股骨痂BMD、股骨骨生物力学指标、骨痂BMP-2和IGF-I阳性表达均显著升高（P<0.05），均以仙灵骨葆组最高。模型组较假手术组血清骨代谢指标（BGP、PICP、TRACP-5b）均显著升高（P<0.05），雌二醇组、仙灵骨葆组较模型组血清骨代谢指标均显著降低（P<0.05），以仙灵骨葆组最低。结论 仙灵骨葆胶囊可能通过介导提高骨质疏松性骨折大鼠骨生长因子BMP-2和IGF-1表达，改善骨代谢，加速骨痂形成，增加骨密度，提高骨生物力学，促进骨折愈合。     

仙灵骨葆对卵巢切除小鼠骨质疏松症的影响

目的 利用卵巢切除骨质疏松症小鼠模型,研究仙灵骨葆抗骨质疏松症的疗效.方法 30只129SV品系雌性小鼠随机分为三组:卵巢假切+安慰剂组(SHAM+NS,0.2 ml·d-1);卵巢切除+安慰剂组(OVX+NS,0.2 ml·d-1),卵巢切除+仙灵骨葆组(OVX+XLGB,500 mg·kg-1·d-1),持续治疗12周后取材,应用Micro-CT检测骨密度(BMD)和骨小梁结构、组织病理切片观察骨形态、三点弯曲试验和压缩试验检测骨生物力学指标.结果 Micro-CT 检测股骨BMD,OVX+NS组BMD(498.6±13.0 mg/cm2)较SHAM+NS组(636.5±12.4 mg/cm2)下降22%(P＜0.01),OVX+XLGB组BMD (561.0±18.6 mg/cm2) 与OVX+NS组相比提高了13%(P＜0.05).Micro-CT检测小鼠腰椎(L2-5)骨小梁结构显示:OVX+NS组骨小梁BV/TV、Tb.Th 分别低于SHAM+NS组22%、35%,Tb.Sp高于SHAM+NS组11%,差异有统计学意义(P＜0.05).给予仙灵骨葆治疗后,腰椎BV/TV及Tb.Th分别高于OVX+NS组15%、16%,Tb.Sp低于OVX+NS组9%,具有显著性差异(P＜0.05).三点弯曲和压缩试验检测OVX+NS组股骨和腰椎的最大载荷和最大应力,股骨最大载荷和最大应力较SHAM+NS组显著降低42%、49%,腰椎最大载荷和最大应力显著降低42%、43%(P＜0.05).仙灵骨葆治疗后,股骨和腰椎的最大载荷分别提高了75%和47%,最大应力分别提高了47%和47%,差异有统计学意义(P＜0.05).结论 仙灵骨葆能够显著提高卵巢切除引起的骨密度,改善骨微结构破坏,提高骨生物力学参数,表明仙灵骨葆具有良好的抗骨质疏松症疗效.     

仙灵骨葆胶囊治疗社区老年原发性骨质疏松症的研究

为了现察仙灵骨葆胶囊治疗社区老年原发性骨质疏松症的临床效果,研究仙灵骨葆胶囊在治疗社区老年原发性骨质疏松症的作用争价值,本人自2009年8月以来选择社区门诊老年原发性骨质疏松症患者96例,随机分为治疗组和对照组两组,各48例,对照组口服钙尔奇D,每次600mg,每日2次,治疗组在对照组治疗的基础上口服仙灵骨葆胶囊,每次1.5克.每日2次,两组疗程半年.结果:治疗组总有效率达到95.9%,对照组总有效率52.1%,两组比较具有显著性差异P<0.01.结果表明:仙灵骨葆胶囊治疗原发性骨质疏松症的疗效确切,能有效改善和缓解原发性骨质疏松症造成的疼痛症状,且能消除小腿抽筋现象,同时能够有效提高原发性骨质疏松症患者的骨密度,并且安全可靠,无明显的不良反应,具有抑制骨吸收、降低骨转换、提高骨量的作用,对治疗社区老年原发性骨质疏松症具有重要的价值,可以推广应用.     

补肾通络汤联合仙灵骨葆胶囊治疗老年骨质疏松性桡骨远端骨折临床研究

目的探讨补肾通络汤联合仙灵骨葆胶囊治疗骨质疏松性桡骨远端骨折的临床疗效。方法:选取我院2021年1月—2022年12月收治的骨质疏松性桡骨远端骨折患者124例,按随机数字表法分为观察组与对照组各62例,对照组患者给予西医常规治疗,观察组在对照组基础上给予补肾通络汤联合仙灵骨葆胶囊治疗,比较两组治疗前后临床疗效,中医证候评分,以及骨折愈合时间、肿胀消退时间和疼痛缓解时间,血清骨代谢指标(血清骨钙素、I型前胶原氨基端前肽、Ⅰ型胶原C端肽β降解产物),骨密度水平,腕关节功能及并发症情况。结果:治疗后观察组总有效率(94.92%)显著高于对照组(84.75%),差异有统计学意义(P ＜0.05);治疗后两组中医证候评分、血清Ⅰ型胶原C端肽β降解产物水平均较治疗前降低,且观察组低于对照组(P ＜0.05);治疗后观察组骨折愈合时间、肿胀消退时间及疼痛缓解时间均短于对照组(P ＜0.05);治疗后两组血清骨钙素、I型前胶原氨基端前肽及骨密度水平、掌倾角、尺偏角角度均较治疗前升高,且观察组高于对照组(P ＜0.05);治疗后观察组并发症发生率(6.78%)显著低于对照组(20.34%),差异有统计学意义(P ＜0.05)。结论:补肾通络汤联合仙灵骨葆胶囊治疗老年骨质疏松性桡骨远端骨折临床疗效显著。     

小儿外周血骨碱性磷酸酶含量与钙营养关系的分析

目的 通过对我院儿保门诊就诊的40～55天的小儿骨碱性磷酸酶的测定结果 进行分析,了解此年龄段小儿钙营养状况及其相关影响因素.方法 对本院门诊就诊的650例小儿进行骨碱性磷酸酶测定,并对其测定结果 进行分析比较.结果 1～3月份出生的小儿骨碱性磷酸酶升高几率最高,7～9月份相对最低.母孕中晚期及生后未补充维生素D、钙小儿较补充者发生骨碱性磷酸酶升高的几率高.结论 1～3月份出生的小儿、母孕中晚期及生后未补充维生素D、钙小儿易发生缺钙而导致佝偻病.     

仙灵骨葆胶囊治疗骨质疏松症的疗效及其对骨代谢及骨转换指标的影响分析

目的 分析仙灵骨葆胶囊治疗骨质疏松症的疗效及其对骨代谢及骨转换指标的影响。方法 将160例原发性骨质疏松症(POP)患者分为观察组80例和对照组80例。对照组患者行钙尔奇D联合唑来膦酸盐治疗,观察组患者行仙灵骨葆胶囊治疗。于2组患者治疗前、治疗3疗程后及6个疗程后,测量患者的腰椎正位(L2-4)和右股骨颈的骨密度（BMD),并检测患者的骨代谢指标包括血钙(Ca)、磷(P)、碱性磷酸酶(ALP)及骨转换指标包括骨钙素（OC)和I型胶原交联C-末端肽（CTX-1)。 同时,分析BMD与OC、CTX-1的相关性。结果 治疗后,2组患者的BMD较治疗前均增加(P均<0.05),但治疗6个疗程后,观察组患者BMD的增加幅度大于对照组(P <0. 05)。治疗后,2组患者的OC均较治疗前上升（P均<0. 05)、CTX-1均较治疗前下降(P均<0. 05);但治疗6个疗程后,观察组患者OC、CTX-1的改善幅度均大于对照组（P均< 0. 05)。BMD与OC呈正相关性(r = 0.352,P =0.21),与CTX-1呈负相关性(r = -0.453,P =0.017)。结论 仙灵骨葆胶囊治疗骨质疏松症的疗效 显著,能有效增加患者的骨密度,改善骨代谢及骨转换状态,控制骨量减少;且OC、CTX-1与患者BMD密切相关,可作为评价 POP疗效的有效指标。     

仙灵骨葆对兔膝骨性关节炎治疗作用的研究

[目的]研究仙灵骨葆(xianlinggubao, XLGB)对兔骨性关节炎关节软骨及软骨下骨的保护作用.[方法]30只3个月龄雄性日本大耳白兔,随机分为对照组(Sham)、盐水组(ACLT+NS)和仙灵骨葆组(ACLT+XLGB),每组各10只.盐水组和仙灵骨葆组行右膝关节前交叉韧带切断术(anterior cruciate ligament transaction, ACLT)造成膝骨性关节炎模型.术后仙灵骨葆组125 mg/(kg*d)灌胃;盐水组则给予等剂量生理盐水.6周后处死动物,取股骨测量骨密度,之后脱钙制片,行HE染色、Mankin评分及BMP-2、MMP-13免疫组化染色;取右膝胫骨近端包埋,制成硬组织切片,用于骨组织形态计量学测量.[结果](1)Mankin评分:仙灵骨葆组显著低于盐水组.(2)股骨远端骨密度及胫骨近端软骨下骨骨量:仙灵骨葆组均显著高于盐水组.(3)免疫组化:仙灵骨葆组MMP-13的表达显著低于盐水组,BMP-2的表达显著高于盐水组.[结论]仙灵骨葆125 mg/(kg*d)灌胃能够部分阻止骨关节炎兔关节软骨的退变,其作用机制可能与下调MMP-13的表达,上调BMP-2的表达,同时增加软骨下骨骨量,改善其微观结构有关.     

Serum calcium,phosphate and alkaline phosphatase and morphometric bone examinations in 30 patients with renal insufficiency

In 30 patients with chronic renal insufficiency (16 non-dialysed and 14 on dialysis) serum calcium, phosphate and alkaline phosphatase were determined and, in a crest biopsy specimen, morphometric determinations of bone qualities were calculated. A positive correlation was established between serum alkaline phosphatase, the osteoblast surface and the active resorption surface in both dialysed and non-dialysed patients. A positive correlation was also established between the osteoblast surface and the active resorption. In the non-dialysed patients a negative correlation was established between serum calcium and the osteoid surface.     

骨折合并Ⅱ型糖尿病患者骨转换生化指标及骨折愈合的变化

[目的]观察Ⅱ型糖尿病骨折患者骨转换生化指标-碱性磷酸酶及骨折愈合的变化.[方法]将在我科住院行手术治疗的骨折患者分为非糖尿病骨折组72例及Ⅱ型糖尿病骨折组79例,观察术前、术后两组患者血浆碱性磷酸酶(AKP)及骨折愈合情况.[结果]非糖尿病骨折组与Ⅱ型糖尿病骨折组比较,血AKP检测指标及骨折愈合情况差异具有显著性意义(P＜0.01,P＜0.05).Ⅱ型糖尿病可影响骨折后血AKP浓度的变化及骨折愈合速度.[结论]Ⅱ型糖尿病可影响骨质代谢,并易造成骨折延缓愈合.     

Effects of 1,25-dihydroxycholecalciferol on fracture healing calcium,phosphate, and zinc in callus and serum

Summary The incorporation of calcium, phosphate, and zinc into the callus of closed tibial fractures was studied in adult rats fed a standard diet. Low doses (60ng/kg per day) of 1,25(OH)₂D₃ 5 days a week greatly increased early callus mineralization. This was not related to an increased serum calcium-phosphate molar product but rather to a decreased ratio. The incorporation of zinc into callus seemed to be correlated to the mineralization process but not to the 1,25(OH)₂D₃ administration as such. The question of a direct, indirect, or a complex role of 1,25(OH)₂D₃ in bone formation and mineralization is discussed.

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Zusammenfassung Der Einbau von Kalzium, Phosphat und Zink in den Kallus bei geschlossenen Tibiafrakturen wurde an erwachsenen Ratten untersucht, die mit einer standardisierten Diät ernährt wurden. Niedrige Dosen (60 ng/kg pro Tag) von 1,25(OH)₂D₃ an 5 Tagen pro Woche haben die frühzeitige Mineralisation des Kallus bemerkenswert erhöht. Dies stand nicht in Zusammenhang mit einem erhöhten molaren Kalzium-Phosphat-Produkt, sondern eher mit einem herabgesetzten Verhältnis. Der Einbau von Zink schien mit der Mineralisation in Zusammenhang zu stehen, jedoch nicht mit der Verabreichung von 1,25(OH)₂D₃ als solcher. Die Frage einer direkten, indirekten oder komplexen Bedeutung von 1,25(OH)₂D₃ bei der Knochenbildung und der Mineralisation wird diskutiert.

     

Clinical evaluation of fracture healing by serum osteocalcin and alkaline phosphatase.

The serum osteocalcin (BGP) concentration and alkaline phosphatase (AP) activity were measured prospectively during the healing phases of crural fractures in 15 patients. They were divided into two groups, the time of union of the fracture being under (group 1) or over 16 weeks (group 2). The mean values of BGP and AP were somewhat higher from the outset in the group 1 than in the group 2, but the difference was not significant. A significant increase in BGP and AP (P less than 0.05) was evident in both groups at 6 weeks. In cases with undisturbed healing of fractures (group 1) the values of serum BGP and AP then declined towards the values at the time of accident. Contrary to this, in group 2 both the values of the serum BGP and AP were still at a significantly higher level than those at the day of the fracture. However, no significant difference in the serum BGP or AP was seen between the two groups at 6 or 12 weeks. The results support some earlier ones: the changes in serum BGP and AP may provide a prognostic indicator for consolidation of a fracture.     

Colles fracture, spine fracture, and subsequent risk of hip fracture in men and women. A meta-analysis

BACKGROUND: In postmenopausal women, a history of any fracture is an important risk factor for a future hip fracture. Whether similar findings apply to aging men remains to be established. We conducted a systematic review and meta-analysis of the literature to compare men and women with respect to the relative risk of hip fracture after a wrist or spine fracture. METHODS: Studies published in full from January 1982 through September 2002 in English, French, or German were identified from the PubMed database and from reference lists of retrieved articles. We included cohort studies that reported fractures associated with minimal trauma of the wrist or spine as a risk factor for a subsequent hip fracture among (white) women and men who were fifty years old or older. Data were extracted by two independent reviewers and were checked for accuracy in a second review. Differences in assessments were resolved by consensus of the two reviewers. RESULTS: Nine cohort studies were included in this meta-analysis: five studies were conducted in the United States and four, in Europe. After homogeneity of association was demonstrated across all studies, a fixed-effects meta-analysis was used to calculate pooled relative risks with 95% confidence intervals. Among postmenopausal women, the relative risks for a future fracture of the hip after a fracture of the wrist or spine were 1.53 (95% confidence interval, 1.34 to 1.74; p < 0.001) and 2.20 (95% confidence interval, 1.92 to 2.51; p < 0.001), respectively. In older men, these relative risks were 3.26 (95% confidence interval, 2.08 to 5.11; p < 0.001) and 3.54 (95% confidence interval, 2.01 to 6.23; p < 0.001), respectively. Fractures of the distal part of the radius increased the relative risk of hip fracture significantly more in men than in women (p = 0.002). The impact of a spine fracture, conversely, did not differ between genders (p = 0.11). Sensitivity analyses with use of random-effects methodology confirmed these findings to be robust. CONCLUSIONS: This meta-analysis suggests that a previous spine fracture has an equally important impact on the risk of a subsequent hip fracture in both genders. The prospective association between a Colles fracture and a subsequent hip fracture, however, is significantly stronger among men than among postmenopausal women. Men with a Colles fracture are at high risk for a future hip fracture and should be evaluated as candidates for preventive measures.     

血液透析对患者血清碱性磷酸酶、骨硬化蛋白与骨代谢的影响

目的血液透析对患者血清碱性磷酸酶(ALP)、骨硬化蛋白(SOST)与骨代谢等指标的影响。方法选取本院2016年1月至2019年1月期间收治的血液透析患者116例为研究对象纳入观察组,另选同期在本院进行体检的50例健康受试者为对照组。采用酶联免疫吸附试验法对两组患者入院时的ALP、SOST、骨代谢指标:血清骨钙素(OC)、β胶原蛋白(β-CTX)、I型前胶原氨基末端前肽(PINP)指标水平,并进行组间对比。对观察组患者进行维持性的血液透析治疗,并检测比较在患者透析治疗前、透析治疗1、6、12个月的各项指标水平。采用Pearson检验对观察组患者的ALP、SOST与骨代谢指标的相关性进行分析。结果与对照组比较,观察组患者血液透析治疗前ALP、SOST、OC、β-CTX、PINP等指标均低于对照组受试者各项指标水平,组间比较差异有统计学意义(P<0.05)。观察组患者中随着透析治疗时间的延长,患者的ALP、SOST、OC、β-CTX、PINP等指标水平均明显上升,各时间点间比较差异有统计学意义(P<0.05)。经Pearson检验分析,血液透析患者的ALP、SOST与骨代谢指标OC、β-CTX、PINP呈正相关性。结论血液透析患体内的ALP、SOST、骨代谢指标均呈现异常降低,经持续性血液透析治疗患者的ALP、SOST、骨代谢指标均有改善,且ALP、SOST与骨代谢指标OC、β-CTX、PINP呈正相关性。     

晚期妊娠妇女血清α-L-岩藻糖苷酶和碱性磷酸酶检测及临床意义

目的测定晚期妊娠妇女血清中α-L-岩藻糖苷酶和碱性磷酸酶的含量,以探讨其临床意义。方法实验组169例妊娠期妇女,对照组137例健康育龄妇女,分别检测血清AFU、ALP含量。结果实验组血清AFU、ALP含量较对照组高,差异有统计学意义（P〈0.01）,且随孕周数增加AFU、ALP也有所增加。结论血清AFU、ALP含量测定可以作为晚期妊娠妇女监测胎儿、胎盘的指标。     

Leukocyte and serum alkaline phosphatase after hip arthroplasty, synovectomy of the knee and fracture.

The alkaline phosphatase in leukocytes (LAP) was measured in patients who had undergone various types of total arthroplasty of the hip, in patients who had undergone synovectomy and in whom tibial fractures had been treated conservatively. The LAP-Score increased rapidly and reached a maximum within a few days and returned to original levels after 14 days both after soft tissue trauma and skeletal trauma. The size of the maximal increase appears to vary only with the severity of the trauma. LAP was not found to be correlated with the increase in alkaline phosphatase in the serum. The increase in serum alkaline phosphatase occurred much later and decreased much slower and occurred only after skeletal trauma. The increase in alkaline phosphatase in the serum appears to vary with severity of skeletal trauma. A significant difference in LAP (P less than 0.05) was found between patients operated upon with total arthroplasty with success and those with deep infection. The difference between these two groups was, however, larger (P less than 0.01) regarding ESR and CRP.     

Changes of serum levels of osteocalcin,alkaline phosphatase,IGF-I and IGF-binding protein-3 during fracture healing

The purpose of this study was to determine the changes in serum markers relating to bone formation during fracture healing. Ten consecutive patients with fractures treated with or without surgery were included. Sera were collected periodically from patients for 80-280 (average 180) days after the fracture. The concentrations of intact osteocalcin, bone-specific alkali phosphatase (ALP), insulin-like growth factor (IGF)-I and IGF-binding protein (IGFBP)-3 in the serum were measured by ELISA. All these serum markers increased or decreased after fracture and fluctuated during fracture healing, however, this pattern differed among the cases. In conclusion, serum markers such as osteocalcin, ALP, IGF-I and IGFBP-3 reflected in part the osteoblastic activity during bone formation.