唤醒式健康教育对绝经后女性骨量异常人群骨密度的影响研究

目的探讨唤醒式健康教育对绝经后女性骨量异常人群腰椎及髋部骨密度的影响。方法选取2016-03~2016-09在该院健康体检中心行健康体检的61例绝经后骨量异常者,按随机数字表法随机分为观察组(31例)和对照组(30例),观察组进行唤醒式健康教育,对照组进行一般健康教育,干预1年后,比较两组腰椎(L1~L4)及髋部(股骨颈、大转子和Wards三角区)的骨密度。结果干预1年后,观察组腰椎骨密度增加7. 28%,髋部骨密度增加9. 24%;对照组腰椎骨密度下降1. 09%,髋部骨密度下降0. 28%;干预后两组腰椎及髋部骨密度比较,差异有统计学意义(P 0. 05)。结论对绝经后女性骨量异常人群实施唤醒式健康教育,能有效提高该人群腰椎及髋部骨密度,达到切实增强骨质,延缓或减少骨质疏松症的发生和发展的目的,值得临床推广应用。     

雷洛昔芬与大豆异黄酮对绝经后妇女骨代谢影响的比较

目的 比较雷洛昔芬与大豆异黄酮对绝经后妇女骨代谢指标及骨密度的影响.方法 75例健康绝经后妇女随机均分为3组.雷洛昔芬组每日口服雷洛昔芬60 mg,大豆异黄酮组每日口服大豆异黄酮90 mg,安慰剂组口服安慰剂.并于服药前及服药12个月后各进行1次骨密度、骨代谢生化指标的测定.结果 用药后雷洛昔芬组桡骨骨密度升高,血清钙、碱性磷酸酶、骨钙素(BGP)、尿钙/尿肌酐比值水平下降(P＜0.05);大豆异黄酮组仅碱性磷酸酶、BGP水平下降(P＜0.05).雷洛昔芬组和大豆异黄酮组各指标均无显著性差异(P＞0.05).结论 雷洛昔芬较大豆异黄酮对防治绝经后妇女骨质疏松疗效可能更明显一些.     

雷洛昔芬对中国健康绝经后妇女骨密度、骨代谢和血脂的影响

目的　观察雷洛昔芬 (RLX)对绝经后妇女腰椎及髋部骨密度、骨代谢生化指标及血脂的影响。方法　选取绝经后妇女 68名随机分为RLX组与对照组 ,双盲给药 1 2个月 ,观察其骨密度、血清C端交联肽 (CTX)和骨钙素、血脂的变化。结果　与用药前相比 ,RLX组腰椎及全髋、股骨颈骨密度均有显著增高 (P <0 0 5) ,与对照组组间比较有显著统计学差异。RLX组CTX和骨钙素水平均较治疗前显著降低 ,与对照组比较存在显著差异 (P <0 0 5)。RLX组总胆固醇 (T CH)与低密度脂蛋白胆固醇 (LDL C)较用药前分别降低 7 77%和 32 1 9% ,而对照组则分别降低 0 58%和1 7 82 % ,组间比较存在显著差异 (P <0 0 5)。两组间高密度脂蛋白胆固醇 (HDL C)和甘油三酯 (TG)没有显著差异。结论　盐酸RLX可提高绝经后妇女骨密度 ,降低骨转换率及T CH、LDL C。     

二膦酸盐对2型糖尿病绝经后妇女骨密度及骨生化指标的影响

目的观察二膦酸盐对2型糖尿病绝经后女性患者骨密度以及生化指标的影响。方法2型糖尿病绝经后女性骨密度减低患者55例,随机分为两组,二膦酸盐组和糖尿病对照组,分别给予二膦酸盐10mg/d、维生素B110mg/d;基础用药:钙尔奇D600mg/d,治疗1年。检测治疗前后空腹血糖(FBS)、空腹胰岛素(Ins)、糖基化血红蛋白(HbA1c)。治疗前后采用双能X线骨密度测量仪(DEXA)测量腰椎、髋部骨密度;检测血清骨钙素、尿吡啶酚/尿肌酐(尿PYD/Cr);观察新骨折发生和不良反应。结果二膦酸盐治疗组腰椎骨密度增加1.45%,髋部骨密度增加1.93%;而对照组腰椎、髋部的骨密度分别下降0.7%、2.3%;二膦酸盐治疗组血清骨钙素、尿PYD/Cr分别下降17%、24%。二膦酸盐的不良反应主要为上腹部不适。结论二膦酸盐能提高2型糖尿病绝经后女性患者骨密度;结合补充适量钙剂,是预防和治疗2型糖尿病病人绝经后骨质疏松症的重要手段。     

绝经前妇科手术对绝经后妇女骨量的影响

目的探讨绝经前不同术式切除子宫、卵巢与绝经后妇女骨量的关系。方法对2002年4月至2006年3月绝经20年内的妇女绝经前行一侧卵巢切除术18例、单纯子宫切除术者63例,子宫加单侧卵巢切除术者44例,子宫加双侧卵巢切除术者87例,以及同期自然绝经101例妇女进行骨密度测定,并对各组的骨密度和骨质疏松症的发生率进行比较。骨质疏松症的诊断标准为骨密度值低于或等于正常年轻妇女平均骨密度峰值减去2.5个标准差。结果自然绝经组与一侧卵巢切除术组平均年龄分别59.8±6.8,56.5±5.5岁;平均绝经年龄分别为49.8±3.2、49.5±3.9,两组在腰椎、股骨颈、大转子、华氏三角区骨密度差异无统计学意义,且两组骨质疏松症发生率分别为61.4%、50%,两组差异无统计学意义（P〉0.05）。单纯子宫切除术组、子宫加单侧卵巢切除术组、子宫加双侧卵巢切除术组腰椎骨密度分别为0.91±0.17、0.88±0.18、0.80±0.14（g/cm^2）,股骨颈骨密度分别为0.75±0.11、0.77±0.14、0.70±0.12（g/cm^2）,大转子骨密度分别为0.60±0.10、0.62±0.12、0.56±0.10（g/cm^2）,华氏三角区骨密度分别为0.56±0.13、0.59±0.16、0.50±0.12（g/cm^2）。子宫加双侧卵巢切除术组骨密度在腰椎、股骨颈、大转子、华氏三角区明显低于单纯子宫切除术组和子宫加单侧卵巢切除术组;后两组组间差异无统计学意义。单纯子宫切除术组、子宫加单侧卵巢切除、子宫加双侧卵巢切除术组骨质疏松症发生率分别为34.9%、38.6%、62.1%。子宫加双侧卵巢切除术组明显高于单纯子宫切除术组、子宫切除术加单侧卵巢切除术组（P〈0.01）,后两组间差异无统计学意义。结论1.绝经前行单侧卵巢切除后不影响绝经后妇女骨量、骨质疏松症的发生率;2.绝经前子宫切除术者尽可能保留单侧或双侧卵巢,以避免远期骨量降低,骨质疏松症发生率增加。     

阿仑膦酸钠与唑来膦酸治疗绝经后骨质疏松症疗效比较

目的回顾性分析口服阿仑膦酸钠以及静脉注射唑来膦酸治疗绝经后骨质疏松症的临床疗效。方法从2014年12月-2016年1月就诊的绝经后骨质疏松妇女中筛选出接受阿仑膦酸钠治疗至少1年和接受唑来膦酸治疗至少1年的妇女各80例作为研究对象,分别为口服阿仑膦酸钠组(70 mg/周)以及静脉注射唑来膦酸组(5 mg/年),所有患者均口服碳酸钙600 mg/d和维生素D 125 IU/d。采集所有患者基线及治疗12个月后腰椎L1-4、股骨颈和全髋部位的骨密度(bone mineral density,BMD),血清I型胶原羧基端肽交联(carboxy-telopeptide of type Ⅰ collagen,β-CTX)等资料,进行组间及药物治疗前后对照。结果阿仑膦酸钠组患者平均年龄(66.48±8.39)岁,唑来膦酸组患者平均年龄(65.11±7.69)岁。治疗12个月后,阿仑膦酸钠组腰椎BMD上升(5.46±4.42)%、股骨颈BMD上升(2.81±3.83)%,全髋BMD上升(2.72±2.76)%(均P0.001)。唑来膦酸组腰椎BMD上升(6.66±6.37)%、股骨颈BMD上升(1.97±3.13)%,全髋BMD上升(2.20±3.63)%(均P0.001)。分别比较两药物组腰椎、股骨颈、全髋BMD以及β-CTX变化率差异均无统计学意义(P值分别为0.216、0.132、0.312、0.066)。结论阿仑膦酸钠70 mg/周和唑来膦酸5 mg/年治疗1年均能够显著提高绝经后骨质疏松妇女的腰椎以及髋部BMD,两者疗效比较,差异无统计学意义(P0.05)。     

骨质疏松椎体骨折成形术后新骨折发生的分析研究

目的 探讨骨质疏松椎体骨折经皮椎体成形术后新骨折发生的影响因素.方法 29名胸腰椎脆性骨折经皮单椎体成形术的绝经后妇女被分成两组,14名伴术后椎体新骨折发生者为新骨折组,另15名术后未有新骨折发生者为对照组.分析内容包括:年龄,体质指数,骨折史,代谢性疾病及其治疗史,抗骨质疏松治疗,腰背支具使用,腰椎和髋部骨密度,甲状旁腺激素和血钙磷水平,椎体成形术后时间等.结果新骨折组与对照组比较,下列项目有统计学差异,体质指数显著降低(P=0.027),腰椎骨密度显著下降(P=0.015),髋部骨密度显著下降(P=0.037),甲状旁腺激素水平明显升高(P=0.017).骨折史,代谢性疾病及其治疗史,抗骨质疏松治疗,腰背支具使用亦影响新骨折的发生.另外,新骨折组14例中有12例(86%)的新骨折发生在椎体成形术后的6个月内,14例中有10例(71%)为邻近椎体成形术椎体骨折.结论 骨质疏松椎体骨折经皮椎体成形术后新骨折发生有三分之二发生在成形术的邻近椎体,新骨折发生受到体质指数,骨折史,代谢性疾病及其治疗史,抗骨质疏松治疗,腰背支具使用,腰椎和髋部骨密度等因素影响.     

体脂比率与OPG基因启动子G209-A和T245-G多态性联合作用与骨质疏松症发生的关系

目的探讨护骨素(OPG)基因启动子区G209-A和T245-G多态性及其脂肪保护作用、联合作用对绝经后正常妇女和绝经后骨质疏松症妇女骨密度(BMD)的影响。方法随机抽取25个样本经SSCP-PCR法寻找异常迁移条带,再采用测序方法确定扩增区域中的单核苷酸点突变位点,最后采用PCR-限制性片段长度法(RFLP)对所有样本进行分析;双能X线吸收法测定BMD。结果73例绝经后骨质疏松症妇女和61例绝经后正常妇女OPG启动子扩增区中找到两个单核苷酸点突变多态性位点,G209-A和T245-G。分析显示这两个多态性位点基因型频率在两组实验对象中的分布均符合Hardy-Weinberg定律。G209-A和T245-G多态性位点单一基因型和复合基因型的分布在两组实验对象之间没有显著性差异(P>0.05)。对各单一基因型及其复合基因型的BMD分析显示:绝经后骨质疏松症妇女的腰椎和髋部BMD明显低于绝经后正常妇女,同时,绝经后骨质疏松症妇女的全身体脂比率也明显低于正常妇女。结论G209-A和T245-G多态性对绝经后骨质疏松症和绝经后正常妇女的骨量影响没有协同作用;单一的和复合的G209-A、T245-G多态性各基因型不能作为预测中国汉族妇女是否发生骨质疏松症的遗传标志,但可能是骨质疏松症发生的易感基因,并且合理的含脂饮食有利于骨保护。     

唑来膦酸静脉注射联合核心稳定性训练治疗绝经后骨质疏松症的治疗效果

目的观察唑来膦酸静脉注射联合核心稳定性训练治疗绝经后骨质疏松症患者骨转换、骨密度、脊柱稳定功能的变化。方法采用随机对照研究,观察期1年。230例绝经后骨质疏松症患者采用数字表法随机分为治疗组,给予基础治疗+唑来膦酸治疗+核心稳定性训练;对照组,给予基础治疗+唑来膦酸治疗。观察用药前和用药1年后Ⅰ型前胶原N端肽(procollagen type 1 N-terminal peptide,P1NP)、Ⅰ型胶原羧基末端肽片段(βcross-linked C-telopeptide of type 1 collagen,β-CTX)、骨钙素(osteocalcin,N-MID)等骨转换指标及腰椎、髋部骨密度、视觉模拟评分(visual analogue scale,VAS)、站起测试(sit to standing performance,STS)、计时起走测试(timed"upgo",TUG)的变化,并观察治疗不良反应和随访依从性。结果治疗1年,2组各有113例和110例患者得到随访。两组VAS、STS、TUG、P1NP、N-MID、β-CTX治疗1年均较治疗前下降,治疗组分别为84.5%、19.7%、32.6%、46.3%、38.3%和37.4%,对照组分别为82.7%、9.7%、18.7%、39.5%、40.4%和41.7%,差异均有统计学意义(P0.05);VAS、STS、TUG治疗组变化优于对照组(P0.05)。治疗1年,治疗组腰椎、髋部、股骨颈骨密度均较治疗前有不同程度提高,分别为3.0%、1.4%和4.4%,差异均有统计学意义(P0.05);对照组腰椎、髋部、股骨颈骨密度亦均较治疗前有不同程度提高,分别为2.8%、4.6%和2.8%,差异均有统计学意义(P0.05);血钙、血磷治疗1年较治疗前无显著变化(P0.05)。结论唑来膦酸静脉注射联合核心稳定性训练对绝经后骨质疏松症的治疗效果明显,能够有效抑制骨吸收,降低骨转换率,提高骨密度并且能够加强腰部稳定性功能,增加活动能力。     

老年女性糖尿病患者与参考人群骨密度和骨质疏松患病率的比较

目的 探讨老年女性2型糖尿病患者是否容易并发骨密度减少和骨质疏松.方法 测量60～85岁老年女性2型糖尿病患者659例及老年女性健康体检者(对照组)666例的腰椎和髋部骨密度.结果 糖尿病组的腰椎骨密度显著高于对照组,分别为(0.757±0.122)g/cm2和(0.722±0.124)g/cm2(P＜0.001);骨质疏松患病率显著低于对照组,分别为33.1%和41.7%(P＜0.01);糖尿病组与对照组之间髋部各骨骼区域骨密度的差异均无统计学意义,但糖尿病组大转子的骨质疏松患病率显著高于对照组,分别为30.0%和24.3%(P＜0.05).以年龄为控制因子,糖尿病组和对照组的骨密度与绝经年龄无关,与绝经年限呈显著性偏相关[γ=-(0.116～0.265),P＜0.01],糖尿病组的病程与大转子和髋部总体的骨密度呈偏相关(γ=-0.134和-0.112,均为P＜0.01).结论 老年女性2型糖尿病患者的腰椎和髋部并非容易并发骨密度减少和骨质疏松.     

Alendronate produces greater effects than raloxifene on bone density and bone turnover in postmenopausal women with low bone density: results of EFFECT (Efficacy of FOSAMAX versus EVISTA Comparison Trial) International

OBJECTIVES: Alendronate and raloxifene are antiresorptive agents with different mechanisms of action, each used to treat osteoporosis in postmenopausal women. This study was undertaken to compare the efficacy and tolerability of alendronate to raloxifene in postmenopausal women with low-bone density. DESIGN: Randomized, double-masked, double-dummy multicentre international study. SETTING: Clinical trial centres in Europe, South America and Asia-Pacific. SUBJECTS: A total of 487 postmenopausal women with low bone density, based on bone mineral density (BMD) of the lumbar spine or hip (T-score < or =-2.0). Interventions. Patients received either alendronate 70 mg once weekly and daily placebo identical to raloxifene or raloxifene 60 mg daily and weekly placebo identical to alendronate for 12 months. MAIN OUTCOME MEASURES: Evaluations included BMD of the lumbar spine and hip and markers of bone turnover at 6 and 12 months and adverse event reporting. RESULTS: Alendronate demonstrated substantially greater increases in BMD than raloxifene at both lumbar spine and hip sites at 12 months. Lumbar spine BMD increased 4.8% with alendronate vs. 2.2% with raloxifene (P < 0.001). The increase in total hip BMD was 2.3% with alendronate vs. 0.8% with raloxifene (P < 0.001). Reductions in bone turnover were significantly larger with alendronate than raloxifene. Overall tolerability was similar, however, the proportion of patients reporting vasomotor events was significantly higher with raloxifene (9.5%) than with alendronate (3.7%, P = 0.010). The proportion of patients reporting gastrointestinal events was similar between groups. CONCLUSION: In postmenopausal women with low bone density, improvements in BMD and markers of bone turnover were substantially greater during treatment with alendronate compared to raloxifene.     

阿仑膦酸钠对绝经后骨质疏松疗效及与雌激素13受体基因AluⅠ多态性的关系

目的通过分析绝经后骨质疏松患者阿仑膦酸钠治疗前后骨密度变化及与雌激素B受体（ESR2）基因Alu Ⅰ多态位点的关系,明确是否存在与疗效有关的基因型。方法为前瞻性研究,入选80例绝经后骨质疏松患者,平均年龄（64．2±7．7）岁,口服阿仑膦酸钠70mg每周一次及钙尔奇D600mg每天一次治疗一年。治疗前后分别使用双能X线吸收仪检测腰椎2-4及左股骨近端各部位骨密度,利用PCR-RFLP检测ESR2基因Alu Ⅰ多态性。结果67例患者完成阿仑膦酸钠一年治疗,患者腰椎2-4和髋部的骨密度均有显著上升。其中腰椎24上升（5．48±4．68）％、股骨颈上升（1．77±4．72）％、大转子区上升（3．81±5．10）％、转子间上升（2．60±3．14）％、总髋部上升（2．50±3．14）％（P值均〈0．01）;在本研究人群中未发现ESR2基因Alu Ⅰ位点的AA基因型,Aa基因型和aa基因型频率分别为10．4％和89．6％。治疗前后腰椎和左髋各部位骨密度变化百分比在aa和Aa基因型之间差异均无统计学意义。结论阿仑膦酸钠提高绝经后骨质疏松患者的骨密度疗效显著,腰椎骨密度的升高超过髋部,但骨密度的变化与ESR2基因Alu Ⅰ多态性不相关,不存在与疗效有关的基因型。可进一步扩大样本量并对该基因多个多态位点进行研究。     

阿伦膦酸钠对老年女性2型糖尿病骨质疏松患者骨代谢标志物的影响

目的观察老年女性2型糖尿病（T2DM）骨质疏松患者应用阿伦膦酸钠（ALN）联合钙尔奇D治疗后骨密度（BMD）和骨代谢指标的变化。方法采用双能X线骨密度仪（DEXA）对34例老年女性糖尿病骨质疏松患者给予ALN联合钙尔奇D治疗6个月,对比治疗前后腰椎和髋部BMD及骨代谢标志物的变化。结果 ALN联合钙尔奇D治疗6个月后腰椎和髋部T值和BMD均增加,尤其L1、L3、L4及L总部位增加显著;血清抗酒石酸酸性磷酸酶5b、尿羟脯氨酸/肌酐比值和骨碱性磷酸酶水平较治疗前降低,血清降钙素水平较治疗前升高（P均〈0.05）。结论 ALN联合钙尔奇D治疗老年女性T2DM患者骨质疏松疗效明显,短时间内可显著改善骨代谢指标和提高腰椎BMD。     

特立帕肽和降钙素治疗中国绝经后骨质疏松症患者的效果比较

目的比较特立帕肽[重组人甲状旁腺激素（1—34）;rhPTH（1—34）]与降钙素鼻喷剂对中国绝经后妇女骨质疏松症的治疗效果。方法特立帕肽组患者（N=217）采用特立帕肽20μg／d皮下注射,降钙素组患者（N=110）用鲑鱼降钙素鼻喷剂200IU／d滴鼻,疗程均为24周。2组患者均每天补充≥500mg的钙和200～400Iu的维生素D。主要终点是基线至终点腰椎BMD的变化率。结果特立帕肽组患者腰椎BMD从基线到终点的变化率与降钙素组相比差异有统计学意义（P〈0．0001）。与降钙素组相比,特立帕肽组患者从基线到终点血清骨钙素水平明显升高（P〈0．0001）。2组患者全髋和转子BMD变化率的差异均无统计学意义。2组患者出现不良事件（AE）者均较少,特立帕肽组AE较降钙素组多。结论特立帕肽增加腰椎BMD的效果优于降钙素,2种疗法均安全且耐受性好。     

成都地区291名绝经后女性骨密度与维生素D水平

目的了解成都地区部分绝经后妇女维生素D水平,观察血清25(OH)D3与骨密度、年龄、绝经年龄、体重指数的关系。方法用整群随机抽样方法抽取成都地区291名绝经后女性,平均年龄(63.9±9.7)岁,按每10岁为1个年龄组分组。记录身高、体重、绝经年龄等基本信息,使用双能X线吸收骨密度仪(DXA)测量腰椎2-4椎体(L2-4)、左髋关节股骨颈和全髋骨密度(BMD),用酶联免疫法测定血清25(OH)D3水平。分析绝经后女性骨量及血清25(OH)D3分布情况。结果超过半数的受试者(52.2%)患骨质疏松症,发病率随年龄增加而增高,80岁老年女性发病率达76.47%。血清25(OH)D3水平平均为18.37 ng/mL,维生素D缺乏发生率为68.38%。血清25(OH)D3水平与骨密度、年龄、绝经年龄无关,与BMI呈负相关(P=0.000)。结论成都地区部分绝经后妇女普遍存在维生素D缺乏,绝经后妇女应及时补充维生素D。     

Alendronate increases bone mass and reduces bone markers in postmenopausal African-American women

Previous studies indicated that aminobisphosphonate alendronate sodium, a potent inhibitor of bone resorption, increases bone mineral density (BMD) at the hip and spine, reduces markers of bone turnover, and reduces the risk of fractures in Caucasian postmenopausal women. The purpose of the present study was to investigate whether alendronate increases BMD and reduces markers of bone turnover in African-American postmenopausal women. In a multicenter, randomized, double-blind, placebo-controlled study, 65 African-American women, aged 45 to 88 yr, were randomly assigned to either placebo (n = 33) or alendronate 10 mg daily (n = 32) for 2 yr. Mean BMD T scores of the lumbar spine at baseline were -3.18 in the placebo-treated group and -3.09 in the alendronate-treated group. All women took 500 mg elemental calcium daily in the form of calcium carbonate and 500 IU vitamin D. Alendronate significantly increased BMD and reduced markers of bone formation and resorption, compared with placebo. At 2 yr, mean changes +/- SE in BMD were 6.5% +/- 0.7% for the lumbar spine (P < 0.001), 4.5% +/- 1.0% for the femoral neck (P < 0.001), 6.4% +/- 0.6% for the femoral trochanter (P < 0.001), 4.1% +/- 0.7% for the total hip (P < 0.001), 0.7% +/- 0.5% for the one third forearm (NS), and 2.0% +/- 0.4% for the total body (P < 0.001) in women treated with alendronate, compared with 0.9% +/- 0.6% (NS), 0.5% +/- 1.1% (NS), -0.2 +/- 0.8 (NS), -1.1 +/- 0.7% (NS), -0.8% +/- 0.6% (NS), and -1.2% +/- 0.6% (P < 0.05) for the lumbar spine, femoral neck, trochanter, total hip, one third forearm, and total body, respectively, in women treated with placebo. At 2 yr, mean serum bone-specific alkaline phosphatase had declined by 46.3% with alendronate (P < 0.001) and 13.6% with placebo (P < 0.01), and mean urinary N-telopeptide of type I collagen/creatinine ratio had declined by 70.5% with alendronate (P < 0.001) and 6.7% with placebo (NS). The incidence of adverse experiences was not different between the two groups. We conclude that in postmenopausal African-American women with osteoporosis, alendronate, 10 mg daily for 2 yr, increases BMD at the lumbar spine, hip, and total body and reduces markers of bone remodeling and is well tolerated.     

外周血护骨素和核因子κB受体活化因子配体水平在女性类风湿关节炎中的变化及其与骨质疏松的关系

目的探讨女性类风湿关节炎（RA）患者外周血核因子-κB受体活化因子配体（RANKL）和护骨素（OPG）水平的变化及其与女性RA骨质疏松的相关性。方法采用ELISA法测定55例女性RA患者和53例正常女性外周血中RANKL和OPG水平,采用双能X线骨密度吸收仪测定骨密度。结果（1）和正常女性相比,女性RA患者RANKL水平明显升高,OPG水平明显降低（P〈0．001）。（2）女性RA组中骨质疏松发生率38．2％（21／55）明显高于正常女性组[11．3％（6／53）];这种改变不但体现在已绝经的女性RA患者和已绝经的正常女性,同样体现在未绝经的女性RA患者和未绝经的正常女性（Neck部位骨密度除外）。（3）女性RA患者OPG水平与骨密度呈正直线相关;RANKL与之相反（P〈0．05）。（4）Logistic分析显示：OPG／RANKL比值为女性RA患者中骨质疏松发生的保护因素（OR=0．027,P=0．014,95％CI：0．001～0．478）。结论女性RA患者外周血OPG水平、RANKL水平的变化与骨代谢状态的变化密切相关;外周血OPG／RANKL比为女性RA患者中骨质疏松发生的保护因素。     

Comparison of alendronate and intranasal calcitonin for treatment of osteoporosis in postmenopausal women

This study compared the effects of oral alendronate and intranasal calcitonin for treatment of osteoporosis in postmenopausal women. Women at least 5 yr postmenopause (n = 299) were randomized to either 10 mg alendronate, matching alendronate placebo, or open-label intranasal calcitonin 200 IU daily for 12 months. Hip and spine bone mineral density (BMD) and markers of bone turnover were measured, and safety and tolerability were assessed. Alendronate produced greater increases in BMD than calcitonin at 12 months at the lumbar spine (5.16% vs. 1.18%; P < 0.001), trochanter (4.73% vs. 0.47%; P < 0.001), and femoral neck (2.78% vs. 0.58%; P < 0.001). Changes in BMD with calcitonin were greater than with placebo at the femoral neck, but were not different from placebo at either the trochanter or lumbar spine. Greater decreases in bone turnover were seen with alendronate than with calcitonin (serum bone-specific alkaline phosphatase, 43% vs. 9%, P < 0.001; urinary N-telopeptide, 62% vs. 11%, P < 0.001). Similar percentages of patients in each group reported an adverse experience during the study. We conclude that, in postmenopausal women with osteoporosis, 12 months of therapy with alendronate produced significantly greater increases in BMD of the hip and spine and greater decreases in bone turnover than intranasal calcitonin.     

Relationship of body composition with prevalence of osteoporosis in central south Chinese postmenopausal women

Objectives To elucidate the relationship between body composition and bone mineral density (BMD) and the prevalence of osteoporosis in central south Chinese postmenopausal women. Methods A cross‐sectional study was conducted on 954 healthy central southern Chinese postmenopausal women, aged 50–82. Total body, lumbar spine and left femur BMD and total body soft tissue composition were measured by dual X‐ray absorptiometry. Results Among the study population, 578 (60·5%) subjects were without osteoporosis and 376 (39·4%) subjects were osteoporotic. The osteoporotic women were older, shorter and thinner, had an earlier age at menopause, a lower BMD and bone mineral content (BMC) of the total body and at different sites, and had lower body mass and body mass components than the women without osteoporosis. Both fat mass and lean mass were positively correlated with age at menopause, height, weight, body mass index (BMI) and BMD at all sites. Fat mass and lean mass were also inversely correlated with age and years since menopause (P < 0·05). After controlling for age, age at menopause and height, both fat mass and lean mass were positively correlated with BMD at the lumbar_1–4 spine, the femoral neck and the total hip. Fat mass was the most significant determinant of BMD at the lumbar_1–4 spine with a higher R² change and a partial R² compared with that of lean mass, while lean mass had more impact on the total hip values. Either a fat mass below 18·4 kg or a lean mass below 33·9 kg was correlated with a higher prevalence of osteoporosis at the lumbar spine or total hip. Conclusions In central south Chinese postmenopausal women, both fat mass and lean mass are correlated with BMD at the lumbar spine and hip. Fat mass was the most significant determinant of BMD at the lumbar spine, while lean mass had more impact on the total hip value. Both lower values of fat mass and lean mass are related to a higher prevalence of osteoporosis at either the lumbar spine or the total hip. Thus, it is important to maintain a reasonable body weight to balance bone health and other metabolic disorders.     

Effect of L-000845704, an alphaVbeta3 integrin antagonist, on markers of bone turnover and bone mineral density in postmenopausal osteoporotic women

The alphaVbeta3 integrin (vitronectin receptor) plays a pivotal role in bone resorption. We hypothesized that L-000845704, an alphaVbeta3 integrin antagonist, would potently inhibit bone resorption, thereby increasing bone mass as assessed by bone mineral density (BMD) in women with postmenopausal osteoporosis. In a multicenter, randomized, double-blind, placebo-controlled, 12-month study, 227 women (average 63 yr) with low lumbar spine or femoral neck BMD were randomly assigned to receive 100 or 400 mg L-000845704 once daily (qd), 200 mg L-000845704 twice daily (bid), or placebo. L-000845704 increased lumbar spine BMD (2.1, 3.1, and 3.5% for the 100-mg-qd, 400-mg-qd, and 200-mg-bid treatment groups, respectively, vs. -0.1% for placebo; P < 0.01 all treatments vs. placebo). Only 200 mg L-000845704 bid significantly increased BMD at the hip (1.7 vs. 0.3% for placebo; P < 0.03) and femoral neck (2.4 vs. 0.7% for placebo; P < 0.05). No L-000845704 group increased total body BMD. All doses of L-000845704 resulted in a similar approximately 42% decrease from baseline of N-telopeptide cross-links (P < 0.001 vs. placebo). L-000845704 was generally well tolerated; adverse events resulting in discontinuation from the study were relatively infrequent. In conclusion, the antiresorptive effect of the alphaVbeta3 integrin antagonist L-000845704 translated into significant increases in lumbar spine BMD. Furthermore, 200 mg L-000845704 bid provided efficacy at the hip sites. These data suggest that the alphaVbeta3 integrin antagonist L-000845704 could be developed as an effective therapeutic agent for osteoporosis.