铁调素治疗围绝经期和绝经后骨质疏松症

目前采用激素替代疗法治疗绝经后骨质疏松症仅部分有效.近年的研究发现,绝经后骨质疏松症的发生除与雌激素缺乏有关外,还可能与铁过载有关.铁调素是一种肽类激素,主要调节体内铁的平衡.铁调素可以有效抑制肠道对铁的吸收,降低铁水平,因而具有预防和治疗围绝经期和绝经后女性骨质疏松症的潜在价值.     

骨质疏松症的激素替代治疗

绝经后骨质疏松症多发生于绝经后5～10年之间,可随着年龄的增长合并增龄性的骨骼变化,于70岁后即形成退行性骨质疏松症(又称增龄性或老年性骨质疏松症).不论绝经后骨质疏松症或增龄性骨质疏松症,其后果均是在轻微外伤或体位变动时即发生骨折,由此引起疼痛、活动受限、合并症以及死亡率增加等问题,对绝经后妇女的健康、寿命及生活质量造成很大的影响.     

骨代谢指标测定在骨质疏松诊治中的应用价值

目的 比较妇女绝经前后骨代谢指标的变化，研究各指标在骨质疏松症治疗后的变化率，对各指标在骨质疏松症诊治中的应用作出初步评价。方法 48例绝经前妇女、48例绝经后妇女测定10项骨代谢指标．45例绝经后骨质疏松症患者．治疗前、治疗6个月后分别测定10项骨代谢指标，观察其变化率。12名绝经后妇女，每两个月测定10项骨代谢指标。共观察一年。结果 绝经后妇女骨代谢指标明显升高，绝经后骨质疏松症患者经抗吸收治疗后．大部分骨代谢指标明显降低，血清骨形成指标比尿骨吸收指标长期个体内的变异要小。结论 绝经后骨质疏松症患者骨转换加快，部分血清骨代谢指标优于尿骨代谢指标，尤以血清骨形成指标N—mid骨钙素和血清骨吸收指标CTX为优。     

原发性骨质疏松症

骨质疏松症是一种骨质低下,骨微结构破坏,导致骨脆性增加,易发生骨折为特征的全身性骨病.骨质疏松症分为原发性和继发性两大类.原发性骨质疏松症又分为绝经后骨质疏松症(Ⅰ型),老年性骨质疏松症(Ⅱ型)和特发性骨质疏松(包括青少年型)三类.     

绝经后2型糖尿病患者骨密度与颈动脉内膜中膜厚度的关系

目的 探讨绝经后2型糖尿病患者骨密度与颈动脉内膜中膜厚度的关系.方法 选择符合纳入标准的93例绝经后2型糖尿病患者和55例健康对照者,测定其正位腰椎L_(1～4)及左股骨颈骨密度,并根据骨密度将2型糖尿病患者分为并发骨质疏松症组和无骨质疏松症组,同时测定颈动脉内膜中膜厚度,并收集三组患者的年龄、绝经年限、体质指数等资料.结果 骨质疏松症组与无骨质疏松症组比较年龄、绝经年限、病程及体质指数差异有统计学意义(P<0.01);与无骨质疏松症组和对照组比较,骨质疏松症组正位腰椎L_(1～4)、左股骨颈骨密度下降(P<0.01),颈动脉内膜中膜厚度增厚(P<0.01),斑块发生率增高(P<0.05).相关分析显示,2型糖尿病患者正位腰椎L_(1～4)和左股骨颈骨密度与患者年龄、病程、绝经年限及颈动脉内膜中膜厚度呈负相关,与体质指数呈正相关.结论 绝经后2型糖尿病患者骨密度与颈动脉体质指数存在一定的联系,低骨密度绝经后2型糖尿病患者更易发生动脉粥样硬化.     

降低“铁过载”:一个防治绝经后骨质疏松的新方案

绝经后骨质疏松症的发生机制、防治方法已有许多研究,但近年关于体内铁过载与绝经后骨质疏松症相关的研究越来越多。许多学者认为,绝经后骨质疏松症常伴有铁过载,降低铁过载能改善部分骨质疏松症指标。在降低铁过载的方法中,铁调素具有良好的运用前景。本文针对这些研究进行梳理整合,较详细地介绍降低铁过载可能成为防治绝经后骨质疏松新方案的研究背景和有关研究成果,旨在为研究骨质疏松症的同行提供新的理念和新的思维。     

迪诺单抗与绝经后妇女骨质疏松症

迪诺单抗是目前欧美国家对有高骨折风险、经其他药物治疗失败或耐受的绝经后骨质疏松症女性推荐用药。本文对近年关于迪诺单抗对绝经后骨质疏松症患者骨密度、骨折发生率、依从性、不良事件发生率等研究进展做一综述。     

尼尔雌醇加孕激素治疗绝经后骨质疏松症的研究

目的　观察小剂量雌孕激素复方制剂 (每片含尼尔雌醇 0 .5mg ,左炔诺酮 0 .15mg ,每周口服 1片 )防治绝经后骨质疏松症的一年临床疗效。方法　随机对照 (自身对照及组间对照 )分组 ,双盲比较观察绝经后骨质疏松患者 119例用药与 72例用安慰剂 1年对绝经后骨质疏松症的疗效。结果　小剂量雌、孕激素制剂可阻止骨质疏松的发展 (P <0 .0 5 ) ,同时用药者的肝、肾功能 ,乳腺红外线扫描 ,子宫内膜厚度和子宫大小B超 ,阴道脱落细胞学形态等均与对照组差异无显著性 ,亦无阴道流血发生。结论　小剂量雌孕激素替代疗法具有疗效确切、副作用少、服用方便等优点 ,可作为绝经后骨质疏松症的常规治疗方法     

骨密度测量可预示骨质疏松症骨折的危险性

骨密度测量可预示骨质疏松症骨折的危险性孟迅吾原发性骨质疏松症（包括绝经后和老年性骨质疏松症）是老年人的一种常见病，随着人们寿命的延长，社会的老龄化，本病的发生率日趋上升，如美国骨质疏松病人已有２５００万，１／３至１／２的绝经后妇女患有此病，每年有１３...     

绝经后H型高血压合并骨质疏松症患者高敏C反应蛋白、白细胞介素6和同型半胱氨酸水平与骨代谢标志物的关系

目的 观察绝经后女性H型高血压合并骨质疏松症患者血清高敏C反应蛋白(hsCRP)、白细胞介素-6(IL-6)和同型半胱氨酸(Hcy)水平与骨代谢标志物的相关性.方法 选择2019年6月至2020年11月接受治疗的绝经后女性H型高血压合并骨质疏松症患者150例作为合并组,另选同期就诊的绝经后H型高血压女性150例作为单纯...     

The concept of severe osteoporosis

In diagnostic criteria of primary osteoporosis in Japan, there is no expression of severe osteoporosis. In the primary osteoporosis, the criteria of WHO is difficult to use in our daily medical care. In 1992, we opened "The osteoporosis dock" in the department of osteopaedics of National Nishisaitama Chuo Hospital. From experience of our osteoporosis dock, we tried to answer the question with "what is the concept of severe osteoporosis?".     

Determining causation--a case study: adrenocorticosteroids and osteoporosis. Should the fear of inducing clinically important osteoporosis influence the decision to prescribe adrenocorticosteroids?

It is generally accepted that exogenous adrenocorticosteroids cause clinically important osteoporosis. We have reviewed the evidence regarding causation in two stages: an examination of the strength of the methods used, and an application of five "diagnostic tests" for causation. The methods that have been used to investigate the association are weak: there have been no randomized clinical trials or prospective cohort studies. The measures of bone density used to quantify osteoporosis do not bear a close relation to clinically important outcomes. Nine analytic surveys and two before-after studies have examined the relation between steroids and osteoporosis. Although some have shown a strong relation, this finding has not been consistent. Evidence regarding temporality , dose-response gradient, and underlying mechanisms are conflicting. The available evidence does not substantiate a causal role of exogenous adrenocorticosteroids in producing clinically important osteoporosis, and does not support withholding steroid therapy on the basis of fears of osteoporosis induced pain and disability.     

An outreach program improved osteoporosis management after a fracture

This longitudinal retrospective cohort study evaluated implementation of an intervention to improve management of osteoporosis after a fracture in a nonprofit group-model health maintenance organization (HMO) in the U.S. Pacific Northwest with 480,000 members and electronic medical record data. Participants were female HMO members aged 67 and older who sustained a qualifying clinical fracture(s) and who had not received a bone mineral density (BMD) measurement or osteoporosis treatment in the 12 months before the fracture (N=3,588). Phase 1 included outreach to clinicians and patients; Phase 2 added clinician and staff incentives. Primary outcome was "osteoporosis management"--receipt of a BMD measurement or osteoporosis medication in the 6 months after an index fracture. Before the intervention, 13.4% (95% confidence interval (CI)=12.0-14.8%) of patients had received osteoporosis management, and the time trend was not significant. Post-intervention, the probability of osteoporosis management increased on average 3.1% (95% CI=2.6-3.5%) every 2 months throughout both study phases without a significant added improvement in Phase 2. Improvement varied according to clinic and was less likely for patients with dementia. Overall, the probability of osteoporosis management increased from the baseline level of 13.4% to 44.0% (95% CI=40.0-48.0%) by the end of the study period (20 months post-intervention). The study found that an outreach program to primary care providers and patients improved the management of osteoporosis after a fracture. If widely implemented, this intervention could substantially improve the secondary prevention of osteoporosis. More-individualized interventions may be necessary for high-risk subgroups.     

Opportunistic Screening for Osteoporosis Using Computed Tomography: State of the Art and Argument for Paradigm Shift

Purpose of Review

Osteoporosis is disproportionately common in rheumatology patients. For the past three decades, the diagnosis of osteoporosis has benefited from well-established practice guidelines that emphasized the use of dual x-ray absorptiometry (DXA). Despite these guidelines and the wide availability of DXA, approximately two thirds of eligible patients do not undergo testing. One strategy to improve osteoporosis testing is to employ computed tomography (CT) examinations obtained as part of routine patient care to “opportunistically” screen for osteoporosis, without additional cost or radiation exposure to patients. This review examines the role of opportunistic CT in the evaluation of osteoporosis.

Recent Findings

Recent evidence suggests that opportunistic measurement of bone attenuation (radiodensity) using CT has sensitivity comparable to DXA. More importantly, such an approach has been shown to predict osteoporotic fractures.

Summary

The paradigm shift of using CTs obtained for other reasons to opportunistically screen for osteoporosis promises to substantially improve patient care.

     

How much do the Arab females know about osteoporosis? The scope and the sources of knowledge

Three hundred fifty-eight educated women, 172 with secondary school education (49%) and 186 (51%) with higher education, were consented for the study. Eighty-five percent were Arab females with an average age of 28.8 years. They expressed their knowledge on osteoporosis on one-one interview. A score of two or more correct items would qualify the respondents to indicate the source(s) of their knowledge. Highly educated women had significantly less 0-1 score (37/186, 20%) than the other subgroup (74/172, 44%, p = 0.001). They, on average, expressed 2.5 items of knowledge vs. 1.69 by the other subgroup (p = 0.002). A total of 245 females, then, became eligible to indicate the source of knowledge. Osteoporosis as a "disease of menopause women" (84%) followed by "disease of easily fractured bones" (64.5%) were the highest in the list in their perception collectively and individually. Items relevant to lifestyle habits, complications, and disease associations were identically not acknowledged. They, however, significantly differed in their response to two items: "a disease of low bone density" and the "role of immobilization and low exercise." Highly educated women appeared more respondent than the other group (p = 0.008 and p = 0.05, respectively). Both were dependent on the "visual media," "relatives," and the "medics" as main sources of information. "Reading books" and "listening to radio programs" on osteoporosis were never considered. The highly educated Arab females have excelled over others with secondary education in terms of frequency and averaging the items of knowledge on osteoporosis. They, however, were not different in the way they perceived osteoporosis as well as in indicating their sources of knowledge. The results reemphasize the lack of an international standard in the understanding of osteoporosis among different populations of females.     

Testing the effectiveness of an osteoporosis educational program for nursing students in Thailand

Objective

Osteoporosis, a health problem that is on the rise, has received considerable attention among the health care community and the public. The majority of primary prevention programs for osteoporosis have been focused on women in mid‐life. A concern is that young women may not be aware of osteoporosis risk factors and therefore may not be engaging in preventive behaviors. The purpose of this study was to test the effectiveness of an osteoporosis educational program for young women.

Methods

A sample of 100 female undergraduate students who were enrolled in the first year of a nursing program in Thailand were randomly assigned to a control group or an experimental group. Participants in the experimental group participated in a 3‐hour osteoporosis educational program (OEP). At entry to and exit from the study, all participants completed the Osteoporosis Knowledge Test, the Osteoporosis Health Belief Scale, and the Osteoporosis Self‐Efficacy Scale.

Results

The experimental group had higher change scores for knowledge, health belief, and self‐efficacy than the control group. The OEP increased knowledge of osteoporosis in these young women.

Conclusion

These findings indicate the need for further health education concerning the importance of dietary calcium and exercise on osteoporosis prevention in young women.

     

Secondary osteoporosis.

Bone loss occurs during the normal aging process. The term "primary" osteoporosis refers to osteoporosis that results from the involutional losses associated with aging and, in women, additional losses related to natural menopause. Osteoporosis that is caused or exacerbated by other disorders or medication exposures is referred to as "secondary" osteoporosis. This article describes the major causes and provides a framework for the diagnostic investigation of patients with suspected of having secondary osteoporosis.     

Full length parathyroid hormone (1–84) in the treatment of osteoporosis in postmenopausal women

Objective:

To review the pharmacological properties and the available clinical data of full length parathyroid hormone (PTH) in post-menopausal osteoporosis.

Sources:

A MEDLINE search was completed, together with a review of information obtained from the manufacturer and from the medicine regulatory agencies.

Study and data selection:

Studies were selected according to relevance and availability. Relevant information (design, objectives, patients’ characteristics, outcomes, adverse events, dosing, etc) was analyzed.

Results:

Different studies have shown that, when administered intermittently as a subcutaneous injection in the abdomen, PTH increases bone mineral density (BMD) and prevents vertebral fractures. On completion of PTH therapy (up to 24 months), there is evidence that sequential treatment with alendronate is associated with a therapeutic benefit in terms of increase in BMD. Further trials are necessary to determine long-term safety and the role of PTH in combination with other treatments for osteoporosis and the effect of repeated cycles of PTH followed by an anti-catabolic agent. There are currently no completed comparative trials with other osteoporosis treatments.

Conclusions:

Full length PTH, given intermittently as an abdominal subcutaneous injection, appears to be a safe and efficacious treatment option for high risk osteoporosis. More data are needed to determine its specific role in osteoporosis treatment.     

Successes and failures in improving osteoporosis care after fragility fracture: Results of a multiple‐site clinical improvement project

Objective

To improve osteoporosis diagnosis and treatment of fragility fracture patient populations because osteoporosis care is provided infrequently to those patients, leaving them vulnerable to further fractures and increasing debility.

Methods

Osteoporosis experts from 11 US health systems participated in a clinical improvement project based on previously described successful osteoporosis care process redesigns. Participants were taught rapid cycle process improvement methods that are widely used in clinical improvement projects, and were supported in their efforts by the program coordinator. Measures of successful process development included establishing reliable referral from orthopedic fracture care to osteoporosis diagnosis and treatment, nurse coordination and monitoring of osteoporosis care, and use of process management software for registering patients and organizing work.

Results

Four sites were able to establish these critical referral and osteoporosis management processes. Two sites were partially successful in increasing orthopedic referrals to consultative care, but otherwise continued traditional care processes. Five were unsuccessful due to inability to implement 1 or more of these key process improvements.

Conclusion

Reliable osteoporosis care for fracture patients is possible if traditional practice processes are replaced with more effective, well‐recognized approaches to chronic disease management.