绝经后女性骨关节炎行全髋置换术人群中骨质疏松和维生素D缺乏情况

不少流行病学研究骨质疏松性骨折认为骨关节炎患者中骨折发生率低 ,有些研究认为骨关节炎患者存在骨质密度增高现象。新近的研究认为骨关节炎和骨质疏松症存在反关系。笔者研究了6 7例女性骨关节炎需作全髋置换的患者。通过患者问卷调查 ,骨密度测量及实验室检查等研究 ,意外地发现 17例(2 5 % )骨关节炎患者达到世界卫生组织的骨质疏松诊断标准。依此将患者分为骨质疏松组和非骨质疏松组 ,两组在年龄、绝经后年限和体重方面差异有显著性 ,两组血钙、2 5 OHVitD、甲状旁腺素水平差异无显著性。很显然 ,本研究结果否定了骨关节炎患者不存…     

瘀血痹片联合抗骨质疏松症药物对膝骨关节炎的临床疗效及膝关节功能评分的影响研究

目的研究瘀血痹片联合抗骨质疏松症药物运用于膝骨关节炎中的疗效及对患者膝关节功能评分的影响。方法选择上海市普陀区中心医院2019年3月-2020年2月纳入的90例膝骨关节炎患者作为研究对象,依照随机双盲法分成研究组和对照组,每组45例。研究组给予瘀血痹片+抗骨质疏松症药物,对照组给予抗骨质疏松症药物,用药后对所有实验对象进行总有效率评价。在用药前后测定两组的白介素-8(IL-8)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平,并执行视觉模拟(VAS)、膝关节功能(Lysholm)、生活质量(QOL)评分调查,比较两组用药结果。结果研究组的总有效率为91.11%,明显高于对照组的80.00%(P0.05),但研究组的不良反应发生率(6.67%)与对照组(8.89%)比较差异,无统计学意义(P0.05)。用药前两组指标比较差异,无统计学意义(P 0.05),用药后研究组的IL-8、CRP、TNF-α水平均低于对照组(P 0.05)。用药前两组评分比较无差异统计学意义(P0.05),用药后研究组的VAS、Lysholm评分均优于对照组(P0.05)。用药前两组QOL评分比较差异无统计学意义(P0.05),用药后研究组的食欲、精神、睡眠、日常生活评分均高出对照组(P0.05)。结论瘀血痹片联合抗骨质疏松症药物运用于膝骨关节炎中的疗效较为突出,并且未增加不良反应的发生率,同时能快速改善患者关节功能,减轻疼痛,促进炎症消退,提高生活质量。     

骨质疏松症与骨关节炎的相关性研究新进展

近10多年来,骨质疏松症与骨关节炎的相关性研究取得长足进展。骨质疏松症与骨关节炎在流行病学、发病机制、遗传基因及其他因素方面都有其相关性。本文旨在回顾国内外骨质疏松症与骨关节炎相关方面重要的代表性研究成果,并结合文献进行临床观察,总结现有的骨质疏松症与骨关节炎相关性的研究成果,并思考目前研究中存在的价值和问题,努力找出二者相关性研究中需要关注的问题。     

老年骨质疏松症患者全髋置换术股骨假体固定方法的现状

随着世界人口日趋老龄化,骨质疏松症的发病率逐年增加。美国多中心统计其国内75岁以上老年人骨质疏松症发病人数已达2000～2500万,而每年行全髋置换术(THA)患者约12万例,约8.9%为骨质疏松症患者。临床上,用THR治疗股骨头无菌性坏死、骨关节炎、先天性髋关节脱位、股骨颈骨折、骨肿瘤等髋关节疾病已逐渐成为主流。在固定方法的选择上,非骨水泥(cement less)作为髋臼假体的固定方法已被广泛接受[1]。但股骨假体的固定方法一直是学者们争论的话题,其焦点在于骨水泥(cement)固定与非骨水泥固定两者的疗效比较上。笔者就老年骨质疏松症患者TH…     

绝经妇女骨关节炎与骨质疏松症的关系

在世界的大部分地区,与男性相比,女性有着较高的预期寿命。据统计,60%的绝经妇女面临着两大威胁健康的问题:骨关节炎(osteoarthritis,OA)与骨质疏松症(osteoporo-sis,OP)。两者是导致50岁以上中老年人尤其是妇女运动功能障碍、慢性致残的主要疾病。考虑到这两种疾病的患病率以及发病特点,两者可能有很多共同的情况。本文参考很多已有的研究,试图从两者的发病机理与预防治疗两方面去明确OP与OA的一些关系。1发病机理骨质疏松症(OP)是以骨强度受损易使骨折危险增加的一种骨骼疾病。骨强度主要反映骨密度和骨质量的完整性。骨关节炎(OA)是…     

中老年女性骨关节炎患者骨密度的特点

目的　通过测量骨关节炎患者腰椎和髋部骨密度 ,探讨骨关节炎患者骨密度的特点及骨关节炎与骨质疏松症的关系。方法　本组研究对象均为中老年女性膝关节骨关节炎患者 ,其中 5 9例测量了腰椎和髋部骨密度 ,12例仅测量了腰椎骨密度。所有患者均按Kellgren分级标准对膝关节进行了评分。结果　绝经后妇女膝关节X线评分随Kellgren分级级数的增高患者腰椎骨密度均值逐渐增高 ,4级骨关节炎患者腰椎骨密度均值明显高于 2级患者 (P <0 0 5 ) ,而髋部骨密度均值随Kellgren分级级数的增高差异无显著性。如以低于同性别同部位峰值骨量的 2 0SD为骨质疏松诊断标准 ,腰椎和髋部符合骨质疏松症诊断的分别为 4 3 7%和 77%。在控制年龄和骨关节炎的影响后 ,股骨颈骨密度与体重指数的偏相关系数为 0 4 0 7(P <0 0 1)。结论　中老年女性骨关节炎患者中同时患有骨质疏松症的比例较高 ,同髋部骨密度测量相比 ,腰椎骨密度测量受骨关节炎影响较大。     

唑来膦酸对合并骨关节炎的绝经后骨质疏松症患者的影响

目的 探讨唑来膦酸对合并骨关节炎的绝经后骨质疏松症（Postmenopuasal osteoporosis,PMOP)患者的影响。方法 选取我院2010年2月至2014年5月收治的98例合并骨关节炎的绝经后骨质疏松症患者为研究对象,采用随机数字表法分为观察组和对照组各49例,对照组予以钙剂(碳酸钙D3片600 mg qd)、活性维生素D(阿法骨化醇软胶囊0. 25μg qd)基础补充治疗,同时予以玻璃酸钠25 mg qw关节腔内注射治疗;观察组在上述药物治疗基础上联合唑来膦酸5 mg 一年一次静脉滴注治疗。研究比较两组治疗前后膝关节功能lysholm评分、疼痛VAS评分、生活质量评分（SF-36)以及腰椎及股骨的骨密度变化。结果 Lysholm与VAS评分:治疗6、12个月后,观察组膝关节功能lysholm评分显著高于对照组,VAS评分显著低于对照组(P <0. 05);骨密度：治疗6、12个月后,观察组L1-L4、Ward’ s三角、股骨颈、股骨Troch等部位骨密度显著高于对照组（P < 0.05);生活质量:观察组PF、RP、BP、GH、VT、SF、RE、MH、Total评分均显著高于对照组（P <0.05)。结论唑来膦酸有助于缓解合并骨关节炎的绝经后骨质疏松症患者疼痛程度,增加骨密度,改善膝关节功能,提高生活质量。     

时变低频脉冲电磁场治疗腰腿痛

脉冲电磁场(pemfs)是一种高能非电离辐射,人体对一定频率的磁场高度敏感,用于治疗骨质疏松症国内外均有报道,而同时用于骨质疏松症(OP)和膝关节骨关节炎(OA)引起的腰、腿、关节痛的治疗尚未见报道。由中国科技大学和安徽振兴科技股份公司共同研制的BRT-01型骨骼关节康复治疗仪试用于临床治疗取得较满意效果,现报道如下：     

防治骨质疏松症的药物研究进展

骨质疏松症主要表现在骨BMD减少,骨质量(骨微结构,骨的转换,骨矿化,骨微损伤累积)降低,诱导骨强度下降,微骨折增加.在临床上,系统性骨质疏松症的典型表现是骨质疏松性疼痛和骨折,而最常见的骨质疏松性骨折部位是:髋部,腰椎和腕部.骨质疏松症可预防,如果早期诊断,可得到治疗.目前有两大类药物可治疗和预防骨质疏松症.① 抗骨代谢类药物; ②促骨合成药.近年来,大量的基础、临床研究表明vitamin D及其类似物不仅通过抑制骨吸收,而且有促进骨合成作用来防治骨质疏松症,笔者就骨质疏松症的药物研究进展作一综述,为更好的预防和治疗骨质疏松症具有很好的指导意义.     

基于生物信息学探讨骨质疏松症与膝骨关节炎的关系

目的利用生物信息学探索骨质疏松症与膝骨关节炎的关系。方法通过GEO数据库查找骨质疏松症和膝骨关节炎血清基因芯片表达谱;采用GEO2R筛选出差异miRNA并在miRDB、Targetscan进行靶基因预测;DAVID6.8数据库对差异基因进行功能GO分析及KEGG信号通路分析;应用STRING、Cytoscape软件建立蛋白相互作用网络。结果本研究共获得骨质疏松症与膝骨关节有交集的4个差异miRNA,蛋白相互作用网络共含278个节点与545条连线。筛选出10个核心基因:VEGFA、ESR1、CCND1、PRKACA、GSK3β、H2AFX、SHH、EGR1、DNMT3A、DNMT3B。结论交集miRNA和核心基因的发现有助于了解骨质疏松症与膝骨关节炎的相关性,了解两病的相关发病机理,为药物的开发提供靶点。     

Osteoporosis and Osteoarthritis, Rheumatoid Arthritis and Spondylarthropathies

Osteoporosis (OP) commonly occurs in the setting of inflammatory arthritis, whereas there is an inverse relationship with osteoarthritis (OA). We review the recent updates in epidemiology and pathophysiology of OP relating to several arthridities. In ankylosing spondylitis, lateral lumbar spine dual x-ray absorptiometry is better at detecting osteoporosis compared with the AP view and patients receiving treatment with anti- tumor necrosis factor medications had lower levels of bone turnover markers. With regard to rheumatoid arthritis, anticitrullinated peptide positivity without clinical arthritis as well as higher levels of interleukin-6 is associated with decreased bone mineral density and polymorphisms in the vitamin D receptor in RA patients may predispose to OP. With regard to OA, results from the Global Longitudinal Study of Osteoporosis in Women study and several radiological studies suggest that differences in the distribution of bone mass at the femoral neck may account for the inverse relationship of OA and OP, and several studies suggest that OA and OP have opposing cytokine and bone metabolism marker profiles.     

绝经后妇女骨质疏松与骨关节炎的相关性研究

目的 探讨绝经后妇女骨质疏松与骨性关节炎相关性因素。方法 200名绝经后骨质疏松患者和200名绝经后骨关节炎患者分别进行年龄、体重指数计算，骨密度测定及腰椎和膝关节X线拍片，比较骨质疏松、骨关节炎和骨质疏松并发骨关节炎时各项指标的变化。结果 绝经后妇女随年龄增高骨质疏松与骨质增生伴发率上升。体重指数与骨密度和骨关节炎均呈正相关，骨质疏松且体重指数高者合并骨性关节炎可能性明显增加，而骨性关节炎若体重指数较低时骨质疏松发生的可能性增加。结论 绝经后妇女骨质疏松与骨性关节炎的发生与增龄密切相关，但它们彼此间没有必然的相关性。     

绝经后妇女骨质疏松症与骨关节炎的相关性研究

目的探讨绝经后妇女骨质疏松症与骨关节炎的相关性。方法对128例绝经后妇女进行年龄、身高、体重、骨密度（BMD）、血钙（Ca）水平及胰岛素样生长因子（IGF）含量进行测定,观察骨质疏松症患者与骨关节炎患者的各项指标的变化。结果L1-4平均BMD：OP组与OA组、正常组比较,差异均有统计学意义（P〈0．05）;而OA组与正常组比较,差异无统计学意义（P〉0．05）;血Ca水平：OP组与OA组、正常组比较,差异均有统计学意义（P〈0．05）;而OA组与正常组比较,差异无统计学意义（P〉0．05）;IGF含量：OP组、OA组与正常组之间两两比较,差异均有统计学意义（P〈0．05）。结论骨质疏松与骨关节炎患者均有升高的趋势,骨质疏松能够加速骨关节的病变,而骨关节炎也能够加速骨质疏松的进程,二者呈现出相辅相成的正相关关系。     

Osteoarthritic versus osteoporotic bone and intra‐skeletal variations in normal bone: Evaluation with µCT and bone histomorphometry

Several studies have shown that in contrast to osteoporosis (OP), osteoarthritis (OA) is characterized by high bone mineral density (BMD). Bone strength not only depends on mineral content as determined by dual X‐ray absorptiometry (DXA), but also on bone microarchitecture. We studied intertrochanteric bone from normal controls and OA and OP patients by bone histomorphometry (BHM) and microcomputed tomography (µCT) as well as DXA in order to first, test the differences between OA and OP comparing both groups to healthy controls, second, to assess variations between three different skeletal sites in controls and third, to determine the level of agreement between µCT, BHM, and DXA. Analysis was performed on 115 samples from OA and OP patients, and controls. We found significant differences between OA and OP samples in structural parameters and in the osteoid fraction (p < 0.05). The majority of the intra‐skeletal differences were shown between lumbar spine and femoral head samples (p < 0.05). Significant agreements were found between µCT and BHM and DXA (r = 0.32–0.45, p < 0.05). Our findings suggest differences in intertrochanteric bone between OA and OP, the age‐related intra‐skeletal variations and a correlation between microscopic and macroscopic bone evaluation methods. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1059–1066, 2013     

The relationship between osteoarthritis and osteoporosis

The relationship between osteoarthritis (OA) and osteoporosis (OP), the two most common skeletal disorders related to aging, is controversial. Previous studies suggest that OA is inversely related to OP when studied cross-sectionally and systematically. However, there are differences in the results depending on the parameter used to define OA. The purpose of this review is to analyze and summarize the literature, and derive possible answers to three key questions along with a brief introduction on underlying mechanisms: (1) Is OA correlated to a high bone mineral density (BMD)? (2) Does OA influence the progression of OP or osteoporotic fractures? (3) Does high BMD affect the incidence and progression of OA? A review of the literature suggests that OA is inversely related to OP in general when studied cross-sectionally and systematically. However, when analyzed in individual bones, the BMD of the appendicular skeleton in OA-affected joints may decrease, particularly in the upper extremities. On whether OA influences bone loss or osteoporotic fractures, differences are observed according to the affected joints. The risk for osteoporotic fracture does not seem to decrease despite a high BMD in patients with OA, probably due to postural instability and muscle strength. Low BMD at the lumbar spine is associated with a lower incidence of knee OA although it does not arrest the progression of knee OA.     

Different responsiveness to mechanical stress of bone cells from osteoporotic versus osteoarthritic donors

Introduction Osteoporosis (OP) and osteoarthritis (OA) are both common diseases in the elderly, but remarkably seldom coexist. The bone defects that are related to both diseases develop with increasing age, which suggests that they are related to some form of imperfect bone remodeling. Current opinion holds that the bone remodeling process is supervised by bone cells that respond to mechanical stimuli. An imperfect response of bone cells to mechanical stimuli might thus relate to imperfect bone remodeling, which could eventually lead to a lack bone mass and strength, such as in OP patients. Materials To investigate whether the cellular response to mechanical stress differs between OP and OA patients, we compared the response of bone cells from both groups to fluid shear stress of increasing magnitude. Bone cells from 9 female OP donors (age 60-90 year) and 9 female age-matched OA donors were subjected to pulsating fluid flow (PFF) of low (0.4±0.1 Pa at 3 Hz), medium (0.6±0.3 Pa at 5 Hz), or high shear stress (1.2±0.4 at 9Hz), or were kept under static culture conditions. Results We found subtle differences in the shear-stress response of the two groups, measured as nitric oxide (NO) and prostaglandin E₂ (PGE₂) production. The NO-response to shear stress was higher in the OP than the OA cells, while the PGE₂-response was higher in the OA cells. Conclusions Assuming that NO and PGE₂ play a role in cell-cell communication during remodeling, these results suggest that slight differences in mechanotransduction might relate to the opposite bone defects in osteoporosis and osteoarthritis.     

Osteoporosis and osteoarthritis--is there really an inverse relation?

OBJECTIVE: Increasing bone mineral density (BMD) has been found in several studies in patients with osteoarthritis (OA). Therefore, the simultaneous occurrence of osteoporosis (OP) and OA is denied by many clinicians. Because of our clinical impression, however, we suggest that we have to consider a common occurrence. In the present study we have examined the relationship between osteoathritis of the knee or the hip and osteoporosis. METHOD: The BMD of the lumbar spine and the proximal femur of 117 OA patients (82 postmenopausal female patients aged 50-83 and 35 male patients aged 36-86 years) who subsequently required hip or knee replacements, but were otherwise healthy, was measured by dual-energy X-ray absorptiometry (DXA; Hologic QDR-2000). The results are given as required by the WHO and the new German guidelines of the DVO. The BMD was measured and categorised in a sex-related manner and the occurrence of disuse osteoporosis on the affected limb was examined. Furthermore, a comparison was made in the level of BMD between the OA of the involved hip or knee. RESULTS: There was a high occurrence of low BMD among the patients. 23.2 % of the women were affected by OP. This reflects the normal distribution of OP in the female population. 20 % of the male patients had occult OP. This is astonishingly high. Osteopenia was measured for 37.1 % of the male patients and 42.7 % of the female patients. Age proved to be a significant factor in the degree of BMD. Neither a disuse osteoporosis, nor a significance in the OA-affected joint to the degree of BMD, could be proven. CONCLUSION: We cannot support the hypotheses that OA prevents OP. Moreover, the occurrence of OP in our study reflected the incidence of OP in the average female and was astonishingly high in the male population; this does not support the hypothesis that the two conditions are mutually exclusive. Also a lower risk of fractures among OA patients cannot be concluded. There is current open discussion whether a known BMD should influence the decision for a cemented or an uncemented prosthesis.     

Triglyceride metabolism in bone tissue is associated with osteoblast and osteoclast differentiation: a gene expression study

The role of bone marrow adipocytes in bone tissue is not yet understood. Adipocytes express enzymes for metabolism of free fatty acids and adipokines such as adiponectin, which have been shown to exert different effects on bone cells. Our aim was to find out whether triglyceride (TG) metabolism in bone tissue is associated with osteoblast and osteoclast differentiation by gene expression analysis of lipoprotein lipase (LPL), hormone sensitive lipase (HSL), fatty acid synthase (FASN), adiponectin, RUNX2, RANK, RANKL and OPG. Bone tissue was obtained from patients undergoing hip arthroplasty due to osteoporosis (OP) (50) or osteoarthritis (OA) (48) or from healthy autopsy controls (14). Lower bone mineral density and microstructural parameters were observed in OP compared to OA. The FASN expression did not differ between groups suggesting similar de novo lipogenesis. Lower LPL and HSL in OP suggest lower FFA release and uptake in OP bone tissue. Adiponectin expression was lower in OP than in OA and a trend was seen for controls. These results suggest OP bone has lower TG metabolism than OA and normal bone. In OP bone, lower osteoblastogenesis and higher osteoclast formation were observed and correlation analysis suggests adiponectin, LPL and HSL are associated with higher osteoblastogenesis and lower osteoclastogenesis. This study gives insights into TG metabolism in the human bone microenvironment. We conclude that OP bone tissue exhibits lower osteoblastogenesis, higher osteoclastogenesis and lower TG metabolism compared to OA or healthy controls.     

The Relationship Among Hypertension, Antihypertensive Medications, and Osteoporosis: A Narrative Review

Osteoporosis and hypertension are two frequent diseases among the aging population that share a similar etiopathology and often coexist. Moreover, treatment of hypertension affects bone mineral density and, therefore, can worsen osteoporosis. This narrative review considers the influence of the main etiologic factors that contribute to the development of hypertension and osteoporosis and examines the effect of the most often used antihypertensives on bones. A computerized literature search of relevant English publications regarding the etiology of hypertension and osteoporosis as well as the impact of antihypertensives on osteoporosis from 1996 to 2011 was completed in October 2011. The latest update in the search was performed from May to June 2012. The most relevant nongenetic factors in the etiology of osteoporosis and hypertension are low calcium intake, vitamin D and vitamin K deficiency, high consumption of sodium salt, and the effects of different forms of nitric oxide. Thiazide diuretics are the only antihypertensives that have a positive influence on bone mineral density. For other antihypertensive drugs, the data are conflicting, indicating that they may have a potentially negative or positive influence on bone mineral density and fracture risk reduction. Some studies did not find a correlation between the use of antihypertensives and bone mineral density. Due to the frequent coexistence of hypertension and osteoporosis, when selecting long-term antihypertensive therapy the potential effects of antihypertensive drugs on development, worsening, or improvement of osteoporosis should also be considered.     

Osteoporosis increases the severity of cartilage damage in an experimental model of osteoarthritis in rabbits

OBJECTIVE: To evaluate the effect of osteoporosis (OP) in cartilage damage developed in an experimental model of osteoarthritis (OA) in mature female rabbits in order to investigate the relationship between OP and OA. METHODS: OA was experimentally induced by anterior cruciate section and partial medial meniscectomy in the left knee of 12 rabbits. OP was experimentally induced prior to OA in six rabbits by bilateral ovariectomy (OVX) and systemic corticosteroid administration during 4 weeks. Knees were evaluated with high resolution magnetic resonance imaging (MRI) before knee surgery to rule out any detrimental effect of corticosteroids on cartilage. Gross and microscopic cartilage changes were assessed 16 weeks after surgery in bilateral knees. Left knees were considered osteoarthritic or osteoarthritic plus osteoporotic. Right knees were used as osteoporotic and healthy controls, respectively. Bone mineral density (BMD) was measured with dual energy X-ray absorptiometry (DXA) at the lumbar spine, global knee and subchondral knee bone, and its variations correlated with cartilage abnormalities. RESULTS: MRI before knee surgery disclosed no cartilage or bone abnormalities in any of the studied groups. OP increased the severity of cartilage abnormalities in experimental knee OA significantly (P<0.05). Cartilage damage was inversely correlated with BMD variations measured at the lumbar spine (r=-0.74; P=0.015). BMD changes in global and subchondral knee bone also showed a trend to correlate inversely with cartilage damage. CONCLUSIONS: Prior induction of OP increases the severity of cartilage damage in experimental OA. Increase in cartilage damage correlates with bone loss. These findings suggest a direct relationship between OP and OA.