104例骨质疏松性病理骨折的临床分析

本文回顾性分析了１０４例骨质疏松性病理骨折的资料。女性２５例，６０岁以上占８０％。男性７９例，７０岁以上占７７％。女性骨折类型中髋和椎体骨折占９２％，而男性则占８５％。在１４例骨Ｘ线片所证实的脊椎骨折中，ＢＭＤ达－３．０ＳＤ者１例，－１．１～－２．４ＳＤ者７例，－１．０～＋１．０ＳＤ者６例。因此ＢＭＤ－１．０ＳＤ或更严重者，有必要对骨质疏松作治疗。对骨质疏松的诊断来说，既要用双能Ｘ线骨密度仪测定ＢＭＤ，又要拍脊柱Ｘ线平片。测定尿中脱氧吡啶啉和羟脯氨酸，以及血骨钙素来决定骨转换率时，１４例老年男性骨质疏松性骨折资料显示，骨转换率正常者６例，增加者５例，降低者３例。本组骨质疏松的独立病因如下：９３％为原发性退化性，７％为继发性，包括原发性甲旁亢、肾小管酸中毒和多发性骨髓瘤。促进骨质疏松发生发展的因素有：钙和ＶｉｔＤ缺乏（４８％），肾小管酸中毒（１７％），以及心、肺、神经、消化系的慢性老年病     

维持性血液透析患者骨质疏松的患病情况及危险因素

目的分析维持性血液透析患者骨质疏松的患病情况及危险因素。方法人组的稳定血液透析患者52例，男27例（占51．9％），测定其血清全段甲状旁腺激素（iPTH）、钙、磷、钙磷乘积及骨密度等，分析骨密度的可能危险因素。结果骨量丢失者21例（占40．4％），骨质疏松者13例（占25．0％），其中女性占所有骨质疏松者的92．3％；多元线性回归分析显示非透析人群中的传统危险因素如干体重、糖尿病、碱性磷酸酶等多种因素均与骨密度相关，而iPTH尽管是调节钙磷代谢的重要因子，多元回归分析显示iPTH并不与骨密度相关。结论在维持性血液透析患者中骨质疏松是个较为严重的问题，传统因素如干体重低、糖尿病等均是骨质疏松的危险因素，碱性磷酸酶高者骨密度低，而iPTH并不是骨密度的独立危险因素。     

影响肱骨近端骨折手术疗效的因素

肱骨近端骨折是指包括肱骨外科颈以及其以上部分的骨折,国外的流行病学调查报告其发病率为全身骨折4％～5％,国内的统计为全身骨折的2．5％,同时发现其骨折与老年骨质疏松有关,并随年龄增加而发生率增高121。而儿童的肱骨近端骨折很少,只占所有干骺端骨折的3％。随着国内老龄人口的增多,骨科界对其的关注渐趋重视。[第一段]     

河南电业脑力劳动者腰椎骨密度检测分析

目的　调查河南电业基层３６ 个单位３１６ 名从事脑力劳动者腰椎的骨矿含量。方法　应用美国ＨＯＬＯＧＩＣ公司双能Ｘ 线４５００Ｗ 型骨密度仪,行腰椎前后位和侧位骨矿含量检测,重点分析了腰椎侧位感兴趣区ＢＭＤ。结果　在被检测的３１６ 名脑力劳动者中,腰椎前后位和侧位ＢＭＤ 男女组均于３０～３９ 岁达峰值,以后随年龄增长ＢＭＤ 呈下降趋势,腰椎侧位感兴趣区ＢＭＤ 显著低于腰椎侧位ＢＭＤ,经统计学处理Ｐ＜ ０．００１;轻度骨质疏松３４ 例（占１０．７５％ ）;中度骨质疏松６４ 例（占２０．２５％ ）;重度骨质疏松２５ 例（占７．９１％ ）;总计骨质疏松发生率为３９．９１％ 。结论　腰椎侧位感兴趣区骨矿含量检测能早期反映ＢＭＤ 的变化;分析脑力劳动者骨质疏松原因之一是户外活动和体力劳动相对减少。     

锥形螺纹钉治疗老年骨质疏松性股骨颈骨折79例报告

报告１组应用３枚锥形螺纹钉治疗老年股骨颈骨折７９例，按Ｓｉｎｇｈ〔１〕标准全部病例均有不同程度的骨质疏松。其中有并存症者占７０．９％，２种以上并存症者占１９％。术后平均获得２６个月的随访，结果优５６例（７３．２％），尚好１７例（２１．５％），差６例（７．６％）。作者认为此钉治疗老年股骨颈骨折具有损伤小，手术时间短，固定简单可靠，符合生物力学要求，下床早并发症少等优点，大大提高了老年人骨折后的生存质量。     

中国人口状况及原发性骨质疏松症诊断标准和发生率

中国是世界人口大国，约占世界人口的1／5。2000年我国第五次人口普查结果显示2000年全国总人口为129533万人，其中65岁以上人口达8811万人，占总人口6．96％。了解我国人口的数量与结构对于骨矿研究和骨质疏松的防治具有重要意义。参考世界卫生组织1994年提出的高加索女性骨质疏松诊断标准和日本骨代谢学会制定的日本人群的骨质疏松诊断标准，根据我国近5年来大量DEXA测量的结果，得出如下中国人群原发性骨质疏松症建议诊断标准：以双能X线骨密度仪检测的股骨颈、正位腰椎L2－4的平均骨密度值和上世纪80年代末4万人群用SPA测前臂中远端1／3的结果为依据，凡其骨密度值与当地同性别的峰值骨密度相比，减少1％－12％为基本正常，减少13％－24％为骨量减少，减少＞25％为骨质疏松，其中＞37％为严重骨质疏松。又结合2000年我国第五次人口普查的结果，预测原发性骨质疏松约为8800万人，约占总人口的6．97％。60岁以上的女性将患有 绝经后骨质疏松和老年性骨质疏松，75岁以上的男性将患老年性骨质疏松。     

基因重组人生长激素（r—hGH）对骨质疏松性骨折愈合影响的实验 …

目的 观察基因重组人生长激素（ｒ－ｈＧＨ）对骨质疏松性骨折愈合的作用及影响,以期为骨质疏松性骨折提供一种有效的治疗方法。方法 选择８月龄、雌性、ＳＤ大鼠３６只,随机分为治疗组与对照组,每组各１８只。手术方法建立骨质疏松性骨折实验模型后,治疗组动物每只每天皮下注射基因重组人生长激素（ｒ－ｈＧＨ）２．７ｍｇ／ｋｇ,连续１０天;对照组同法给予等量生理盐水。分别于用药后２、４、８周检测血浆ＩＧＦ－１浓度,     

外科危重患者的预后评估

为准确评估外科危重患者的预后，作者对外科３８６例危重患者进行了前瞻性研究，疾病的危重程度评价采用ＡＰＡＣＨＥⅡ评分系统。结果显示：ＡＰＡＣＨＥⅡ评分均值为１５．６±５．８（０～３８）；死亡患者（１０７例，占２７．７％）的ＡＰＡＣＨＥⅡ评分明显高于存活患者（２７９例，占７２．３％）的评分，差异有显著意义（１８．７±４．３ｖｓ。９．７±３．９，Ｐ＜０．０１）。随着ＡＰＡＣＨＥⅡ评分增高，死亡率从１．９％逐渐升高至１００％，两者之间垦显著相关（ｒ＝０．７５，Ｐ＜０．００１）。受试者工作特征曲线显示，随着危险度和ＡＰＡＣＨＥⅡ评分的增加，特异度从８９．２％增至９９．３％，而敏感度却从５９．８％下降至１８．７％。作者认为人ＰＡＣＨＥⅡ评分系统是评估外科危重患者预后的良好指标，值得临床上推广应用。     

贲门周围血管离断术治疗门脉高压症并发上消化道大出血的疗效分析

本文报道贲门周围血管离断术治疗门脉高压症并发上道大出血３２例。肝功能按Ｃｈｉｌｄ分级，Ａ级７例，Ｂ级１４例，Ｃ级１１例。急症手术２４例（７５％），择期手术８例（２５％）。治疗效果比较满意。急症手术者获得止血２２例（９１．７％）。手术死亡占１２．５％，均为急症手术者。２７例术后获得随访２－１１年，全身状况改善者８２．２％，无肝性脑病发生。作者对影响疗效的有关因素作了探讨。     

大鼠骨密度测定方法及其在骨质疏松模型建立中的应用

精确定量测定骨密度是分析骨代谢改变的重要内容。本文应用（１２５）ＩＳＰＡ大鼠骨密度仪和双能Ｘ线骨密度仪，对由维甲酸和卵巢切除两种方法诱发的大鼠骨质疏松模型进行股骨和全身骨密度测定，结果为前者模型的骨密度较对照分别降低６．７％和４．８％，后者模型的骨密度较对照分别降低７．６％和８．３％，降低均有显著意义。由此表明，大鼠骨密度测定在骨质疏松模型建立中是十分有用的指标之一。     

Awareness and health beliefs of women towards osteoporosis

A population-based survey was conducted to determine the awareness, knowledge of risk factors, and attitudes toward osteoporosis in middle-aged and elderly women in Singapore. Chinese women aged 45 years and above (n=1,376) living in Teban Gardens (community on the western side of Singapore) were randomly sampled. Household interviews were conducted and questions on socioeconomic status, knowledge of osteoporosis, identification of risk factors for osteoporosis, and health beliefs were assessed. There were 946 (68.8%) women who were postmenopausal and 430 (31.2%) who were not. Fifty-eight percent of the sample had heard of osteoporosis. Women who were younger, better educated, who exercised regularly, or who were single were more likely to have heard of osteoporosis. The main sources of information about osteoporosis were the mass media and friends. The identification of risk factors ranged from fair to good: 85.7% of women identified low calcium intake, 43.7% identified lack of exercise, and 30.5% identified family history of osteoporosis as risk factors for osteoporosis. Most women (79.1%) were concerned about developing osteoporosis but only 15.2% thought that osteoporosis was more serious than cancer. Community-based health education programs on osteoporosis that target a wide audience including the less well educated, could be implemented. Increasing the awareness of osteoporosis and its risk factors may be essential in efforts to decrease the incidence of this disease.     

上海市闵行区中老年群体中不同骨密度人群的尿钙水平调查分析

目的探索上海市闵行区中老年人群钙营养状况及其与骨质疏松的相关性。方法对长期居住在上海闵行区的50岁以上的1460例体检人群进行问卷调查和体格检查,DXA测定腰椎、总髋、股骨颈和Ward三角区的骨密度,化学发光法测定空腹血钙、尿钙。根据WHO标准诊断骨量正常、减少和疏松,尿钙低于1.7 mmol/L为缺钙,骨质疏松尿钙高于5.3 mmol/L为高尿钙流失,其余为正常尿钙水平。结果 1460人中,骨质疏松人数为337人,占总人数的23.08%,骨量正常人数为420人,占总人数的28.77%。其中男性骨质疏松率为4.12%,女性骨质疏松率为37.88%。尿钙水平偏低人数为365人,占总人数的25.0%,高尿钙水平人数为176人,占总人数的12.1%。其中男性尿钙水平偏低率为30.32%,女性尿钙偏低率为22.78%。尿钙水平值以60岁以下骨量减少组3.67 mmol/L最高。三年尿钙水平变化值以女性骨质疏松组差异最显著(P0.05)。结论缺钙率女性略低于男性群体,但骨质疏松率女性远远高于男性。老年群体中缺钙为普遍现象,缺钙外加高钙流失是导致老年性骨质疏松的主要因素。骨质疏松干预过程中,除补钙外,采取有效防治钙流失的措施是防治骨质疏松的关键。     

老年人服用复方钙剂与肾结石患病率的关系

目的调查老年人服用维生素D和钙复方制剂(以下简称复方钙剂)与肾结石患病率的关系。方法对772例60~91(83±4)岁老年人服用复方钙剂的情况进行调查,并进行双肾B超检查,然后分析服用复方钙剂与肾结石患病率的关系。结果老年人肾结石患病率为4.27%,其中男性(5.30%)明显高于女性(2.28%)(P0.05)。服用复方钙剂与肾结石的患病率无关(P0.05)。结论老年人服用复方钙剂可能不会增加肾结石的患病率。     

甘肃省20-80岁和绝经后女性骨质疏松症患病影响因素分析

目的 了解甘肃省20-80岁汉族女性以及绝经女性骨质疏松症患病率,探讨女性骨质疏松症的影响因素。 方法 2016年7-8月采用分层整群随机抽样方法在甘肃省兰州市、张掖市、高台县、肃南裕固族自治县选取20-80岁汉族女性进行问卷调查,应用法国Medilink公司生产的Pegasus超声骨密度仪检测跟骨骨强度,采用?2检验和非条件logistic回归对骨质疏松症的可能影响因素进行分析。 结果 甘肃省20-80岁汉族女性骨质疏松症总患病率为15.10%,40-80岁绝经后女性骨质疏松症患病率为25.88%。体重指数越大(OR=0.392,95%CI: 0.229-0.672)、从事的职业劳动强度重(OR=0.461,95%CI: 0.295-0.721)和体育锻炼频次多(OR=0.565,95%CI: 0.407-0.786)有利于降低骨质疏松症发生,有既往骨折史的女性发生骨质疏松症风险高(OR=1.544, 95%CI: 1.080-2.205)。绝经是骨质疏松症的危险因素(P未绝经组=8.33% vs P绝经组=22.76%,P?0.0001;OR=2.633,95%CI: 1.655-4.190),其中绝经年限越长骨质疏松症的发生风险越高(OR=2.910,95%CI: 1.426-5.939),女性绝经年龄越晚发生骨质疏松症的风险越低(OR=0.354,95%CI: 0.172-0.628)。 结论 针对体重指数低、有既往骨折史、运动少、绝经年龄早和绝经年限长的女性应该格外关注。在膳食上注意补充钙和维生素D,生活上经常锻炼运动。了解骨质疏松症的患病情况及研究其影响因素对成年妇女的健康促进具有重要意义。     

Osteoporosis treatment in postmenopausal women after peripheral fractures: impact of information to general practitioners

A low-impact fracture in a postmenopausal woman should prompt investigations for osteoporosis followed, if needed, by appropriate treatment. OBJECTIVES: To evaluate the impact of information alerting general practitioners to the need for osteoporosis treatment in postmenopausal women with a recent history of peripheral fracture. METHODS: We conducted a prospective 7-month follow-up study of 78 postmenopausal women, with a mean age of 81.5 years, admitted to the emergency department for peripheral fractures. Three months after the fracture, we sent a letter to the general practitioner of each patient emphasizing the probable contribution of osteoporosis to the fracture and the need for osteoporosis treatment. Six months after the fracture, we interviewed the patients by telephone, and one month later we mailed a questionnaire to those physicians who had not followed the treatment recommendation. RESULTS: At emergency room admission, 9 patients were receiving treatment for osteoporosis (hormone replacement therapy in one patient and calcium and vitamin D supplementation in eight patients). Admission to a ward was required in 66 (85%) patients. No treatment for osteoporosis was given at discharge. Six months after discharge, seven patients reported recent initiation of calcium and vitamin D supplementation, and none reported other osteoporosis treatments. The response rate to the physician questionnaire mailed 7 months after discharge was 54% (n=28); responses showed treatment of 11 additional patients, by calcium and vitamin D supplementation in six cases and by bisphosphonates with or without calcium and vitamin D supplementation in five cases. Treatment initiation rates were similar in patients younger and older than 80 years. CONCLUSIONS: Despite information of general practitioners about the need for osteoporosis treatment, such treatment was initiated in only 30.5% of patients. General practitioners may be reluctant to initiate osteoporosis treatment in patients who are very old or have multiple comorbidities.     

Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis

The risk of hip fracture is commonly expressed as a relative risk. The aim of this study was to examine the utility of relative risks of hip fracture in men and women using World Health Organization (WHO) diagnostic criteria for low bone mass and osteoporosis. Reference data for bone mineral density (BMD) at the femoral neck, from the third National Health and Nutrition Examination Survey (NHANES III), were applied to the population of Sweden. Relative risks (RRs) were calculated from the known relationship between BMD at the femoral neck and hip fracture risk. The apparent prevalence of low bone mass and osteoporosis depended on the segment of the young population chosen for reference ranges. Using a reference derived from women aged 20-29 years, the prevalence of osteoporosis was 21.2% in women between the ages of 50 and 84 years and 6.3% in men. The RRs associated with osteoporosis depended markedly on the risk comparison. For example, in men or women aged 50 years, the RR of hip fracture in those with osteoporosis compared to those without osteoporosis was 7.4 and 6.1, respectively. The RR of those at the threshold value for osteoporosis compared to those with an average value for BMD at that age was 6.6 and 4.6 in men and women, respectively. RRs were lower comparing those at the threshold value compared to the risk of the general population at that age (4.2 and 2.9, respectively). When RR was expressed in relation to the population risk rather than to the risk at the average value for BMD, RR decreased at all ages by 37%. Such adjustments are required for risk assessment in individuals and for the combined use of different risk factors. Because the average T score at each age decreased with age, the RR of hip fracture at any age decreased with advancing age in the presence of osteoporosis. The decrease in relative risk with age is, however, associated with an increase in absolute risk. Thus, for clinical use, the expression of absolute risks may be preferred to relative risks.     

Calcium Supplementation: Is Protecting Against Osteoporosis Counter to Protecting against Cardiovascular Disease?

Calcium is the dominant mineral in bone and is a shortfall nutrient in the diet. For those consuming inadequate dietary calcium, calcium supplements have been a standard strategy for prevention of osteoporosis. Recently, calcium supplementation has been linked to both increased and decreased cardiovascular disease risk creating considerable uncertainty. Moreover, recent reports have shed uncertainty over the effectiveness of calcium supplements to reduce risk of fracture. The evidence for calcium supplementation effects to both reduce risk of fracture and increase coronary heart disease and mortality are reviewed. Although the importance of good calcium nutrition is well known, determining the advantage of calcium supplementation to either bone or heart health has been hampered by poor subject compliance and study design flaws. At present, the current Recommended Dietary Allowances for calcium still appear to be a good target with potential risks for chronic disease if intakes fall too short or greatly exceed these recommendations.     

上海市区居民3051例跟骨骨密度的测量

对上海市区居民３０５１人进行了跟骨骨密度测定。其中男１４４４人，女１６０７人，年龄１１～９５岁，按５岁为一年龄组将其分为１７组。结果：跟骨骨峰值出现在２０～２４岁组，女性骨峰值显著小于男性，中年开始出现跟骨骨量丢失，女性的骨丢失速度显著快于男性。女性骨累积丢失量也显著大于男性。女性的跟骨累积丢失量仅次于Ｗａｒｄ三角。跟骨骨密度除了随年龄变化外，也受身高、体重及体重指数的影响。６０岁以上老年女性骨质疏松症的患病率显著高于男性，男、女分别为１３．９％、５８．０％。结论：跟骨骨密度的测量能较好地反映人体骨矿含量的变化规律     

Calcium supplement and osteoporosis medication use in women and men with recent fractures

Patients with low-trauma fractures are at risk of future fractures and so should be evaluated and treated for osteoporosis. This study was conducted to assess and compare bone medication use and calcium and vitamin D intake at the time of and after an acute fracture. One hundred and six patients, mean age 66.7±10.3 years, were administered medical history and diet questionnaires at enrollment (in an urban hospital) and again 6 and 12 months later (by telephone). Of 86 patients who could be contacted 6 months after their fracture, 36.2% of the women and 7.4% of the men had recently discussed osteoporosis with their primary care doctor. At 6 months, 24.2% of the women and 3.6% of the men were taking bone medications (compared with 27.8% and 3.6% before the fracture; NS). At 6 months, 52.6% of the women and 10.7% of the men indicated that their doctor had recently recommended calcium or vitamin D. Among the women who had recently been advised by their primary care doctor to use calcium or vitamin D, supplement use increased from 63.3% to 90.0% (P=0.021) and dairy food intake increased from 1.5±1.1 to 2.4±1.9 servings/day (P=0.016). Only three men received this advice and two of them heeded it. Among women and men not receiving this advice, there was no significant increase in calcium supplement use or dairy food intake. At 12 months, the treatment profiles were unchanged from 6 months and 9.6% of the women and 4.3% of the men had had another fracture. In conclusion, the occurrence of a fracture did not increase likelihood of pharmacologic treatment for osteoporosis. After their fractures, the women did increase their intake of calcium supplements and dairy foods when this was recommended by their doctor. This suggests that the primary care physician is well positioned to bring about much needed change in the quality of care of fracture patients.This material is based on work supported by the US Department of Agriculture, under agreement No. 58-1950-9001. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors, and do not necessarily reflect the view of the US Department of Agriculture.