尿毒症腹膜透析患者骨质疏松及危险因素

目的 通过分析患者的临床随访数据,探讨已规律行腹膜透析的尿毒症患者骨质疏松的患病率及相关危险因素。方法 本研究纳入了260例规律行腹膜透析6月以上的尿毒症患者,记录患者一般资料和生化指标,测定骨密度判断是否为骨质疏松,并对可能影响骨质疏松的危险因素进行单因素分析和Logistic多因素回归分析。结果 骨质疏松者128例（49.2%）,骨质疏松的发生与性别(OR=5.086,P=0.001)、年龄(OR=2.783,P=0.017) 、透析龄(OR=2.145,P=0.021)、糖尿病(OR=1.684,P=0.029)显著相关,与体重指数、抗酒石酸酸性磷酸酶-5b、全段甲状旁腺素、血钙、磷、钙磷乘积、碱性磷酸酶、尿素清除指数、白蛋白、血脂等无显著相关性( P＞0.05)。结论 腹膜透析患者骨质疏松的患病率较一般人群高,性别、年龄、透析龄、糖尿病是其危险因素。     

Analysis of relationships between sex hormone dynamics and bone metabolism and changes in bone mass in surgically induced menopause

A 3-year follow-up study was performed of bone metabolism and bene changes induced by surgical menopause as a consequence of hysterectomy and oophorectomy (OVX) in 52 nonmenopausal women. We investigated 22 bone parameters and determined seven bone indices as indieators of bone mineral content by dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), and microdensitometry (MD). The significant correlations between levels of sex hormones and/or bone parameters and bone indices demonstrated that marked sex-steroid deficiency after surgical menopause induced bone uncoupling during high bone turnover and subsequent rapid bone loss in the early period after OVX. Principal component analysis using correlation coefficients suggested a seven-loading-factor matrix composed of bone parameters and a two loading-factor matrix composed of bone indices. Two groups of parameters—estradiol and estriol, and androstenedione together, and luteinizing hormone and follicle-stimulating hormone together—indicated that the rate of bone loss was greater in the trabecular bone than in the cortical bone. Three other groups of parameters—urine calcium, urine hydroxyproline, and serum bone Gla-protein together; serum alkaline phosphatase, serum calcium, and 1,25-dihydroxy-cliolecalciferol [1,25(OH)₂D] together; and plasma tartrateresistant acid phosphatase—indicated that bone uncoupling, with a prevalence of resorption over formation of bone, was greater in trabecular bone than in cortical bone and also that the magnitude and rate of bone loss in the axial vertebrae surpassed those in the appendicular metacarpals after OVX. Two other groups of parameters, namely, trabecular bone mineral density (D_d) and bone mineral content (D_c), both measured by DXA, and bone mineral density (L₂, L₃), measured by QCT, together; and the cortical thickness index (MCI), cortical bone mineral density (GS/D), and the ratio of GSmin/max, measured by MD, indicated that the relative rates of bone reduction at the 3-year follow-up were greater in the axial vertebrae than in the appendicular metacarpals. Thus, bone change in the trabecular bone was associated with rapid loss during the early phase after OVX, whereas that in the cortical bone was slow during the late phase.     

原发性骨质疏松发病的相关因素

阐明原发性骨质疏松发病与性别、年龄、饮食、体重、绝经年限和体内雌激素水平的关系。结果证明骨质疏松发生率女性比男性明显增高，并随年龄增长而增高；饮食中加食牛奶者比不食用牛奶者较低；超重和肥胖者比瘦者为低；绝经后骨质疏松随着年龄的增长而增高，并与雌二醇水平呈负相关。     

骨质疏松症患者的牙周组织检查

骨质疏松症和牙周炎均为中老年人的多发病，并都有骨的吸收破坏，骨量减少。为了阐明两者的关系，本研究对２９例中重度骨质疏松症患者和２５例骨密度正常者的牙周状况进行了检查与对比。结果表明：骨质疏松症患者和骨密度正常者的牙周炎患病率无明显差别，表明骨质疏松症与牙周炎之间无明显的相关关系。根据本研究结果提示：骨质疏松症在牙周炎的发生上并不起主要作用，局部（菌斑诱导的非特异性炎症）因素比全身因素在牙周炎的发病机理中更为重要。     

Risk for osteoporosis in black women

Models of involutional bone loss and strategies for the prevention of osteoporosis have been developed for white women. Black women have higher bone densities than white women, but as the black population ages there will be an increasingly higher population of black women with osteoporosis. Strategies should be developed to reduce the risk of black women for fragility fractures.Dual energy X-ray absorptiometry measurements of the total body, femur, spine, and radius were performed on 503 healthy black and white women aged 20–80 years. Indices of bone turnover, the calcitrophic hormones, and radioisotope calcium absorption efficiency were also measured to compare the mechanisms of bone loss.The black women had higher BMD values at every site tested than the white women throughout the adult life cycle. Black women have a higher peak bone mass and a slightly slower rate of adult bone loss from the femur and spine, which are skeletal sites comprised predominantly of trabecular bone. Indices of bone turnover are lower in black women as are serum calcidiol levels and urinary calcium excretion. Serum calcitriol and parathyroid hormone levels are higher in black women and calcium absorption efficiency is the same in black and white women, but dietary calcium intake is lower in black women.Black and white women have a similar pattern of bone loss, with substantial bone loss from the femur and spine prior to menopause and an accelerated bone loss from the total skeleton and radius after menopause. The higher values for bone density in black women as compared with white women are caused by a higher peak bone mass and a slower rate of loss from skeletal sites comprised predominantly of trabecular bone. Low-risk strategies to enhance peak bone mass and to lower bone loss, such as calcium and vitamin D augmentation of the diet, should be examined for black women. The risk vs. benefits of hormonal replacement therapy should be determined, especially in older women.     

降钙素对骨质疏松症治疗的临床观察

目的 研究降钙素在骨质疏松症（OP）治疗中对骨密度（BMD）的作用。方法 198例根据自愿选择分为钙剂组92例，降钙素＋钙剂组102例，其中各组按疗程分为3个月和6个月两个亚组；钙剂组：每日口服元素钙600mg，维生素D125U。降钙素＋钙剂组：每日口服元素钙600mg，维生素D125U；鲑降钙素50IU（商品名密钙息，北京诺华制药有限公司），肌肉注射，每d1次，连续14d，接着隔日1次，连续14次，以后为每周2次直至完成疗程。治疗前及疗程结束后，采用双能X线骨密度仪测定前后位k。腰椎及非优势侧（左）股骨颈骨密度。结果 降钙素＋钙剂组缓解疼痛快而有效。降钙素＋钙剂组腰椎和股骨颈骨密度在3个月和6个月治疗后均有显著提高，6个月组骨密度提高大3个月组（P〈0．01），腰椎疗效优于股骨颈。结论 降钙素治疗骨质疏松症有明显疗效，选择适当的长疗程患者受益更大。     

骨密度测量技术诊断骨质疏松的评价

骨矿密度(BMD)是诊断骨量减少(低骨量,骨质疏松),评价骨丢失率和疗效的重要客观指标。被世界卫生组织(WHO)用来定义骨质疏松(OP)的诊断标准。目前非创伤性骨密度测量方法主要有以下几种:X线光密度法(RA),单光子吸收法(SPA),双光子吸收法(DPA),双能x线吸收测定(DEXA),定量CT(QCT)。不同的测量方法的优、缺点和临床意义不同,在此简要综述几种BMD测量方法和特点。     

DXA、QCT和SPA方法测量47例绝经后妇女骨质疏松症的比较

以骨密度测量应用最广的３种方法（ＤＸＡ─双能ｘ线吸收法，ＱＣＴ─定量ＣＴ法和ＳＰＡ─单光子吸收法）测量绝经后妇女的骨矿密度，比较其测量值、诊断结果和相关关系。首先用ＳＰＡ法测量绝经后妇女１８１例，诊断骨质疏松（ＯＰ）４７例。三种方法测量骨矿密度的均值分别低于峰值骨量的Ｍ─２ｓ的９％、２１．４％和２１％，且ＤＸＡ和ＱＣＴ两种方法测量的均值都在骨折阈值范围内。ＤＸＡ和ＱＣＴ诊断４７例ＯＰ之间无显著性差异，当排除椎骨骨质增生后的ｘ２＝０．２３７，且ＤＸＡ和ＱＣＴ测量值之间为正相关，ｒ＝０．７９９，而ＤＸＡ、ＱＣＴ和ＳＰＡ之间的相关系数，ｒ＝０．１８５和０．２８５，ＤＸＡ诊断ＯＰ的敏感性为８６．６％，特异性为７０％。     

Prevalence of osteoporosis in patients requiring spine surgery: incidence and significance of osteoporosis in spine disease

Summary The purpose of this study is to evaluate the incidence of osteoporosis in patients requiring spine surgery. Among patients older than 50 years, the rate of osteoporosis in males was 14.5% and the rate osteoporosis in females was 51.3%. We strongly recommend an evaluation and treatment for osteoporosis in the patients requiring spine surgery, especially in females over 50 years old. Introduction Because lifespan is increasing, there is an increase in the incidence of osteoporosis in elderly spine surgery patients. The osteoporosis may adversely influence the fusion rate and the surgical outcome. The purpose of this study is to evaluate the incidence of osteoporosis in patients requiring spine surgery. Methods A total of 1,321 patients underwent spine surgeries at our institute from January 1, 2005 to December 31, 2005. Among them, there were 562 patients (42.5%) younger than 50 years old, and 759 patients (57.6%) older than 50 years old. Prior to operation, we evaluated the patients for osteoporosis on both the femur head and lumbar spine by measuring the bone mineral density (BMD) by the dual-energy X-ray absorptiometry (DXA). Based on the World Health Organization (WHO) criteria for osteoporosis, we chose the T-score to determine normal (>−1), osteopenia (−1≥, >−2.5), and osteoporosis (≤−2.5). Among the 562 patients younger than 50 years, DXA was performed in 22 (3.9%) patients and there were 13 (2.3%) cases of osteopenia and 2 (0.3%) cases of osteoporosis. Results Among 759 patients older than 50 years, DXA was performed on 516 (68.0%) patients, 193 males and 323 females. Among the male patients, there were 89 (46.1%) patients with osteopenia and 28 (14.5%) with osteoporosis. Among the female patients, there were 134 (41.4%) with osteopenia and 166 (51.3%) with osteoporosis. The incidence of osteoporosis was higher in female patients and significantly increased with increasing age. Among 759 patients older than 50 years, 676 patients underwent a major spine operation with or without fusion. Among these patients, DXA was performed in 446 (66.0%) patients and there were 207 (46.4%) patients with osteopenia and 139 (31.1%) with osteoporosis. Conclusions The patients over 50 year-old who need spine operation have osteoporosis often. In conclusion, the number of spine operations in elderly patients is increasing and the incidence of osteoporosis in spine surgery patients is also increasing. We strongly recommend an evaluation for osteoporosis and post-operative treatment for osteoporosis in patients over 50 years old, especially for female patients.     

老鹳草素对地塞米松诱发大鼠骨质疏松症的影响

目的 观察老鹳草素对地塞米松诱发大鼠骨质疏松症的影响.方法 将6个月龄雌性Wistar大鼠随机分为对照组、模型组、5、10、20 mg/kg老鹳草素组和2 mg/kg阿仑膦酸钠组.大鼠肌肉注射地塞米松(1 mg/kg),老鹳草素连续灌胃90d,对股骨和腰椎进行骨密度及骨组织形态计量学检测.结果 对照组股骨和椎骨骨密度分别为(0.20±0.01)和(0.18±0.01) g/cm2,模型组分别为(0.15±0.01)和(0.10 ±0.01) g/cm2,差异有统计学意义(P＜0.05).与模型组比较,10、20 mg/kg老鹳草素能显著提高股骨和椎骨的骨密度.5 mg/kg老鹳草素可增加模型组大鼠股骨骨小梁表面积百分率、骨小梁间距和骨小梁节点数;10、20 mg/kg老鹳草素明显增加模型组大鼠股骨和椎骨骨小梁计数、骨小梁宽度和骨小梁表面积百分率,增多小梁节点数、减少骨小梁间隙距离和小梁游离末端数.结论老鹳草素具有抑制地塞米松引起大鼠骨质疏松症的作用,并呈剂量-效应关系.     

辽宁绝经妇女骨密度与绝经年限、体重关系研究

目的　研究绝经年限、体重对辽宁地区绝经后女性不同部位骨密度的影响。方法　测定共９６ 例绝经后妇女腰椎（Ｌ２～４）、股骨颈（Ｎｅｃｋ）、大转子（Ｔｒｏｃｈ）、Ｗａｒｄ＇ｓ 区的ＢＭＤ,同时测定了血ＡＬＰ、血尿钙、肌肝（Ｃｒ）等指标,分析其相互关系。结果　１． 绝经后妇女各部位的ＢＭＤ 不同。２．Ｌ２～４的ＢＭＤ与体重（Ｗ ）、血小板、尿Ｃａ／Ｃｒ呈正相关（Ｐ＜ ０．０１、Ｐ＜ ０．０５、Ｐ＜ ０．０１）。与绝经年限的自然对数（ＰＦＮＬ）、ＡＬＰ呈负相关（Ｐ＜ ０．０１、Ｐ＜ ０．０１）。３．Ｎｅｃｋ 区ＢＭＤ 与体重、血小板呈正相关（Ｐ＜ ０．０１、Ｐ＜ ０．０５）,与ＰＦＮＬ呈负相关（Ｐ＜ ０．０５）。４．Ｗａｒｄ＇ｓ 区ＢＭＤ 与体重、血小板、尿Ｃａ／Ｃｒ 呈正相关（Ｐ＜ ０．０１、Ｐ＜ ０．０５、Ｐ＜ ０．０５）,与ＰＦＮＬ及ＡＬＰ呈负相关（Ｐ＜ ０．０１、Ｐ＜ ０．０５）。５． 大转子区骨密度与体重、血小板、转氨酶呈正相关（Ｐ＜ ０．０１、Ｐ＜ ０．０１、Ｐ＜ ０．０５）,与ＡＬＰ呈负相关（Ｐ＜ ０．０１）。结论　体重、绝经年限、尿Ｃａ／Ｃｒ、血小板及血ＡＬＰ能影响骨密度。     

上海市北蔡镇老年人骨密度测定结果分析

目的 了解上海北蔡镇老年人群骨密度(Bone mineraldensity,BMD)变化规律及骨质疏松(Osteoporosis,OP)患病率,为本地区骨质疏松症的防治提供参考.方法 使用美国GE公司的Lunar Prodigy Advance PA+300164型双能X线骨密度仪对608例上海北蔡镇60～79岁老年人正位腰椎和左股骨近端进行骨密度测定,男性205例,女性403例.结果 随着年龄的增加髋部BMD逐渐下降,而腰部BMD不随年龄的增加而下降.男性组与女性组OP患病率差异有显著性(P<0.001);60～64、65～69、70～74、75～79岁组OP患病率差异有显著性(P<0.05).结论 上海北蔡镇老年人群OP患病率随年龄增高而增高,70～79岁女性骨质疏松的患病率最高,预防骨折的重点在老年妇女.老年人应坚持适当的体育活动,及时检查骨密度,积极治疗骨质疏松症,并注意防止跌倒导致的骨折发生.     

长春市16019例汉族人群骨密度调查及骨质疏松发病率分析

目的 调查长春市16019例汉族人群骨密度,分析本地区峰值骨量及骨密度变化的人群规律.方法 采用美国Osteometer Medi Tech公司生产的DTX-200型骨密度仪,检测受试者非受力侧前臂桡尺骨远端三分之一处骨密度(BMD).将16019例检测结果按不同性别每5岁为一年龄组,应用SPSS 13.0软件统计分析骨密度均值、T评分及骨量丢失百分率.结果 长春市男、女性人群骨密度峰值分别为0.625±0.109、0.506±0.058,其峰值年龄为30～39岁年龄段,40岁以后开始缓慢下降,50～59岁年龄段男性骨质疏松发病率为7.7%,女性为6.97%;60～69岁年龄段男性骨质疏松发病率为18.13%,女性为35.97%;70～79岁年龄段男性骨质疏松发病率为36.41%,女性为59.55%,80岁以上男性骨质疏松发病率为57.53%,女性为75.56%.结论 不同年龄及同年龄组两性之间比较骨密度测定值差异显著(P<0.01).50岁以后各年龄段女性骨质疏松发病率明显高于男性(P<0.01).本研究报告的骨密度峰值高于日本、丹麦同类型骨密度仪检测结果;与北京地区骨密度检测结果相近.与西双版纳傣族、西藏、甘肃东乡族比较,差异显著(P<0.01).     

阿伦膦酸盐对绝经后骨质疏松妇女骨密度的影响

为了解阿伦膦酸盐对骨密度的影响及其安全性和耐受性,对２０名绝经后骨质疏松的妇女中进行阿伦膦酸盐（ａｌｅｎｄｒｏｎａｔｅ）１０ｍｇ／天和安慰剂的随机、双盲、前瞻性研究,为期一年。结果显示,１年后阿伦膦酸盐组与安慰剂组相比,骨密度平均增长率：椎骨分别为４．８７％与－０．２３％;股骨颈分别为６．８９％与－１．８４％,（Ｐ＜０．０５）。副反应仅为轻微胃肠道反应。结论：阿伦膦酸盐能有效增加骨密度,且药物安全,耐受性好     

血脂紊乱与骨质疏松关系的研究进展

骨质疏松是一种常见的老年病,血脂紊乱常与其伴随出现。越来越多的研究显示二者之间可能存在一定的关系,不同类型的血脂紊乱对骨质疏松影响不一。高甘油三酯对男女性腰椎、股骨骨密度有不同的影响;低密度脂蛋白胆固醇影响骨细胞分化,低密度脂蛋白胆固醇增高可抑制成骨细胞活性,同时使破骨细胞活性增强从而引起骨质疏松;高密度脂蛋白胆固醇与骨质疏松的关系结论尚不一致。此外,他汀类药物可以促进成骨细胞分化,抑制破骨细胞活性从而增加骨密度,降低骨折风险;双膦酸盐在治疗骨质疏松的同时对血脂紊乱也有一定的影响。因此,研究血脂紊乱与骨质疏松之间的关系对于骨质疏松的防治具有一定的临床指导意义。     

国产羟乙膦酸钠防治原发性骨质疏松症的临床观察

目的 观察国产羟乙膦酸钠治疗骨质疏松症的疗效。方法 羟乙膦酸钠组６８例,服羟乙膦酸钠二疗程其共６个月,对照组４８例;２组每日均服碳酸钙０．６ｇ,维生素Ｄ１２５单位,连续半年,结果 羟乙膦酸钠组腰椎及髋部ＢＭＤ均升高,骨痛明显改善,与此同时,血清碱性磷酸酶、骨钙素、酸性磷酸酶及尿吡啶酚／肌酐比值明显降低,对照组用药前后无明显改变。不良反应轻。结论 羟乙膦酸钠是治疗原发性骨质疏松症安全、有效、方便、经     

老年男性骨质疏松症与血清痩素水平关系的研究

目的 探讨瘦素和老年男性骨质疏松的关系.方法 选择86例老年男性原发骨质疏松患者和50例正常对照者,采用放免法检测血清瘦素(Lep)浓度,骨钙素(BGP)、I型胶原前胶原氨基端前肽(PINP),采用双能X线吸收法测定腰椎及髋部骨密度,同时计算体重指数(body mass index, BMI),并分析瘦素与其他各项指标的关系.结果 老年男性骨质疏松组血清瘦素水平(4.137±2.439 μg/L)明显低于正常对照组(5.142±2.869 μg/L),两组有显著性差异,P<0.05.血清瘦素水平与BMI显著正相关(Pearsons 相关系数r=0.470, P<0.001),亦与L_(1-2), L_4的BMD 及BGP正相关(r分别为0.356,0.315,0.307,0.241, P<0.05),但在校正BMI后,瘦素与L_2的BMD及BGP的正相关关系消失,与L_1(r=0.193,P<0.05)和L_4(r=0.212, P<0.05)BMD的正相关关系亦有所减弱.结论 老年男性骨质疏松患者血清瘦素水平下降,推测瘦素可能通过外周局部作用影响骨代谢.     

绝经后妇女年龄、绝经年龄、绝经年限与腰椎和髋部骨密度的关系分析

目的 探讨绝经后妇女年龄、绝经年龄、绝经年限与腰椎和髋部骨密度的关系.方法 调查248名健康的绝经后妇女的年龄、绝经年龄、绝经年限,测量身高、体重、正位腰椎（L2～L4）、髋部骨密度进行分析.结果 随着绝经年限的增长,腰椎和髋部骨密度逐渐降低.单因素相关分析表明年龄、绝经年限与腰椎及髋部各部位骨密度呈显著负相关（P＜0.01）,绝经年龄与腰椎及髋部各部位骨密度无显著相关性（P＞0.05）.调整身高、体重指数后,年龄、绝经年龄与腰椎及髋部骨密度呈显著负相关（P＜0.01）,绝经年龄与腰椎及髋部各部位骨密度无显著相关性（P＞0.05）.多元逐步回归分析显示绝经年限与腰椎、股骨颈及股骨大转子的骨密度呈显著负相关（P＜0.01）,年龄与腰椎、股骨颈及Ward三角区骨密度呈显著负相关（P＜0.05）.结论 年龄、绝经年限与腰椎和髋部骨密度有关.     

体积骨密度的估算方法及其对诊断骨质疏松的意义

骨密度（BMD）有面积骨密度（aBMD）和体积骨密度（vBMD）两种表达方式,它们在临床实验研究中被广泛采用。本文综述了vBMD的估算方法、aBMD和vBMD存在的性别差异和种族差异,以及aBMD和vBMD对诊断骨质疏松的影响。