早期类风湿关节炎骨质疏松发生情况研究

目的探讨早期类风湿关节炎(RA)患者骨质疏松(OP)发生情况及相关临床危险因素。方法收集94例住院早期RA患者(男29例,女65例)和81例正常对照组(男28例,女53例),采用DEXA法测定股骨颈、Ward区、大转子、总股骨区和腰椎2~4部位骨密度(BMD),采用酶联免疫吸附法检测骨代谢指标(CTX、PINP)和炎症因子(IL-17、IL-6、TNF-α)。采用Logistic回归分析研究相关的风险因素。结果早期RA患者的股骨颈、GT区、L2、L4部位BMD明显低于正常对照组,早期RA的骨质疏松发生率为14.89%(14/94),明显高于对照组6.17%(5/81)。早期RA患者的CTX、TNF-α、IL-6、IL-17水平较正常对照组高。Logistic回归分析显示早期RA患者年龄(OR=1.08,P0.001,95%CI:1.04~1.12)、DAS28评分(OR=1.56,P=0.0102,95%CI:1.11~2.19)是发生骨质疏松的危险因素。结论早期RA患者骨质疏松发生率高,临床应重视。年龄、DAS28评分是早期RA患者发生骨质疏松的危险因素,改善RA病情有助于骨质疏松的预防及治疗。     

密骨方对去势大鼠骨质疏松后骨折愈合的影响

目的 观察密骨方对骨质疏松性骨折(OPF)的影响.方法 将90只雌性Wistar大鼠随机分为对照组(Sham),模型组(OVX)与密骨方治疗组(MGF),模型组及治疗组行卵巢摘除术,同时MGF组和OVX组大鼠均致其右侧股骨上1/3处骨折.MGF组按100 mg/(kg·d)的剂量灌胃给药,Sham组和OVX组给予同体积的生理盐水,每日1次,疗程分别为2周、4周、6周,用苏木素-伊红(HE)染色检测骨折端的形态学变化;用放射免疫法测定不同时段血清雌二醇(E2)、骨钙素(BGP)的表达;用生化法测定碱性磷酸酶(ALP)的表达.结果 MGF组血清E2在时间上有显著升高趋势(P＜0.05);MFG组血清BGP值在3个时间段有降低趋势,且差异有统计学意义(P＜0.05);MFG组血清ALP值总体比较有显著降低趋势(P＜0.05).结论 MGF有抑制破骨细胞的活性及促进骨折愈合的作用.     

肾移植后骨质疏松

本文就近年来肾移植后骨质丢失的原因、机制、临床表现及预防和治疗进展作一综述.     

经皮椎体后凸成形术治疗老年骨质疏松性胸腰椎骨折患者早期疗效及影响因素分析

目的 分析经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗老年骨质疏松性胸腰椎骨折患者的临床疗效,并探讨其影响因素.方法 选取2016年1月～2019年12月本院行PKP手术治疗的133例老年骨质疏松性胸腰椎骨折患者进行回顾性分析.收集患者一般资料及围术期指标,以术后2d的VAS评分改...     

抗骨质疏松治疗对髋关节置换术后疼痛影响的临床研究

目的 探讨骨质疏松与置换术后疼痛是否互相影响及机制,为临床髋关节置换术后疼痛制定更有效、合理的治疗方案提供启示和理论支持.方法 30例髋关节置换术后疼痛伴有骨质疏松患者进行Singh指数测定,分为骨质疏松治疗组(治疗组)和消炎镇痛组(对照组),参照美国Harris髋关节功能评分标准评分进行对比分析.结果 治疗组治疗后的Harris评分明显高于对照组(P<0.01).结论 骨质疏松是髋关节置换术后产生疼痛的重要原因,髋关节置换术后疼痛进行系统地抗骨质疏松治疗应当引起临床的更加重视.     

洋葱干预后对去势大鼠骨质疏松的影响

目的观察洋葱粉对去势大鼠骨密度(bone mineral density,BMD)及血钙、血磷、雌二醇含量变化的影响。方法 3月同龄雌性SD大鼠55只,随机分为对照组(CON)10只,45只进行造模(双侧卵巢切除术)。造模一周后造模组被随机分为模型组(OVX)、低剂量洋葱粉组(LO)、中剂量洋葱粉组(MO)、高剂量洋葱粉组(HO)。分别于12周及24周测量骨密度值,24周后测量血清中钙、磷、雌二醇含量的变化。结果造模12周后,与OVX组比较,MO组、LO组大鼠骨密度值明显增加(P0.05),HO组大鼠骨密度值略增加,差异无统计学意义(P0.05);造模24周后,与OVX组比较,MO组、HO组、LO组大鼠骨密度值均明显增加(P0.05)。MO组、HO组、CON组、OVX组大鼠血清血钙、血磷水平与LO组比较差异具有统计学意义(P0.05);其它各组两两比较血钙、血磷水平差异无统计学意义(P0.05)。大鼠血清E2水平由大到小为MO组HO组CON组LO组OVX组,除LO组大鼠血清E2水平与OVX组和CON组比较差异无统计学意义(P0.05)外,其它各组两两比较大鼠血清E2水平差异具有统计学意义(P0.05)。结论洋葱具有提高大鼠雌二醇水平含量,促进雌激素水平分泌,增加BMD作用,达到防治骨质疏松症的目的。     

经皮椎体成形术治疗骨质疏松性椎体压缩骨折早期疗效观察

目的：评价经皮椎体成形术治疗骨质疏松性椎体压缩骨折病人的临床效果。方法：自2001年10月起共对15例骨质疏松性椎体压缩骨折的病人采用椎体成形术治疗，对临床疗效进行评价。结果：所有治疗的15例病例在术后6－36h内均有腰疹部疼痛的缓解，其中13例疼痛明显减轻或基本消失，其余2例有中等程度减轻，未有并发症产生。随访平均6个月（2－8个月），未有新的骨折形成。结论：椎体成形术对骨质疏松性椎体骨折有良好的镇痛效果。     

针刺对骨质疏松性骨折愈合的影响

目的　用针刺加药物与单纯用药物的方法治疗骨质疏松性骨折进行临床观察 ,以证实针刺对治疗骨质疏松促进骨折愈合有疗效。方法　从 50例髋部骨折和腰椎骨折的病历中分组。针刺取穴采用补肾、健脾及温经通络的方法 ,进行临床治疗观察 ,从对饮食量、二便、肿胀压痛及骨痂生长情况 ,骨密度的测量证实疗效。结果　 50例病人顺利完成观察项目。饮食、二便、针刺药物组较单纯药物组恢复快 (P <0 0 5)。肿胀消退及疼痛减轻也明显加快 (P <0 0 5) ,骨痂生长具有明显差异 ,骨密度有所提高。结论　采用针刺治疗骨质疏松性骨折 ,可以促进骨折的愈合 ,较单纯用药物治疗骨折更有效。并可使骨折后的临床症状有明显改善     

骨质疏松性骨折椎体成形术后再骨折的治疗

骨质疏松性椎体骨折是由于骨强度下降并遭受轻微创伤或其他原因而导致的骨折.以前骨科治疗这种骨折以止痛、卧床、佩带支具等保守治疗为主,但长期卧床对老年人容易产生深静脉栓塞、肺部及泌尿系感染等并发症.椎体成形术（PVP）能短期内加强椎体的强度、止痛,便于早期下床活动,提高了生活质量,是比较好的治疗方法,但远期可能增加邻近节段椎体骨折的风险.我科从2002年6月至2005年3月,用椎体成形术治疗骨质疏松性骨折256例共306个椎体,收到了良好的治疗效果,但术后2个月～1.5年相邻椎体再次骨折21例,占8.2%,再骨折患者行椎体成形术后也取得良好治疗效果,总结报告如下.     

载脂蛋白E对绝经后妇女骨质疏松影响的研究进展

载脂蛋白E(Apolipoprotein E,Apo E)在脂代谢中起核心作用,载脂蛋白E不仅作为重要角色参与脂代谢,也同时会影响骨代谢。现阶段多种研究表明,骨质疏松与脂代谢异常是受各种原因影响的代谢性疾病,二者关系紧密,绝经后妇女由于雌激素水平变化,常导致骨代谢与脂代谢紊乱,同时雌激素水平也被证实对Apo E有较大影响。国内外学者多将绝经后妇女骨质疏松与脂代谢异常的着重点放于Apo E,集中研究Apo E对骨代谢与脂代谢的调节作用。骨代谢与脂代谢的异常在我国中老年妇女人群中出现率极高,且往往伴随发生。骨质疏松对中老年妇女的日常生活,甚至生命安全皆有重要影响。本文通过整理载脂蛋白E对骨代谢以及绝经后妇女骨质疏松影响的现阶段研究,进一步对其相关性制作综述。     

骨质疏松骨折史和合并症对健康相关生活质量的影响

目的观察骨质疏松骨折史和合并症对健康相关生活质量(HRQOL)的影响。方法基于2013年至2018年获得的5年数据。使用双能X射线吸收法测量骨密度,在2078名调查参与者中诊断出骨质疏松症。根据骨质疏松症诊断标准T评分≥-1.0被认为骨密度正常,T评分-1～-2.5为骨量减少,而T评分-2.5为骨质疏松症。EuroQol五维问卷(EQ-5D)指数评分用于评估生活质量。结果在2078例被诊断患有骨质疏松症的患者中,发现骨折发生率为11.02%。手腕骨折最常见,为4.52%,男性和女性患病率差异有统计学意义(P0.001)。骨质疏松症患者的EQ-5D指数评分为0.84±0.01。除癌症外,与没有相关疾病的患者相比,患有骨关节炎、类风湿关节炎、高血压、糖尿病、慢性阻塞性肺病和心血管事件的患者的EQ-5D指数评分显著降低。结论发现低HRQOL评分与先前的脊柱骨折和骨质疏松症患者的合并症有关,且经历多次骨折的骨质疏松症患者HRQOL严重下降。     

Microalbuminuria in adults after prenatal exposure to the Dutch famine

Maternal undernutrition during gestation is associated with an increase in cardiovascular risk factors in the offspring in adult life. The effect of famine exposure during different stages of gestation on adult microalbuminuria (MA) was studied. MA was measured in 724 people, aged 48 to 53, who were born as term singletons in a university hospital in Amsterdam, the Netherlands, around the time of the Dutch famine 1944 to 1945. Twelve percent of people who were exposed to famine in mid gestation had MA (defined as albumin/creatinine ratio >/=2.5) compared with 7% of those who were not prenatally exposed to famine (odds ratio 2.1; 95% confidence interval 1.0 to 4.3). Correcting for BP, diabetes, and other influences that affect MA did not attenuate this association (adjusted odds ratio 3.2; 95% confidence interval 1.4 to 7.7). The effect of famine was independent of size at birth. Midgestation is a period of rapid increase in nephron number, which is critical in determining nephron endowment at birth. Fetal undernutrition may lead to lower nephron endowment with consequent MA in adult life.     

Long-term effects of early stress due to earthquake exposure on depression symptoms in adulthood: a cross-sectional study

ObjectiveThis study aimed to investigate the long-term effects of early stress by Tangshan earthquake on symptoms of depression in adulthood.MethodA total of 1534 volunteers born and raised in Tangshan were investigated; finally, 1328 subjects were enrolled in the study. They were divided into three groups according to their birth dates: infant exposure, prenatal exposure, and non-exposure. The questionnaires and psychological evaluation of all subjects were completed using a one-on-one psychological test.ResultsThe rate of depressive symptoms in the prenatal exposure group was the highest, and the lowest in the non-exposure group, with statistical differences among the three groups (P = 0.002). Moreover, the incidences of depressed mood, suicide ideation and work and loss of interest in the prenatal exposure group were significantly higher than those in the infant exposure group and the non-exposure group (P = 0.008, P = 0.001, P = 0.038, respectively). Multiple logistic regression analysis showed that male could be a protective factor for symptoms of depression in adulthood, and earthquake exposure was an important predictor of the incidence of depression symptoms.ConclusionsFetal or infancy exposure to earthquake might correlate to depression symptoms in adulthood.     

Transient estrogen exposure of female mice during early development permanently affects osteoclastogenesis in adulthood

Estrogens modulate bone tissue turnover in both experimental animal models and postmenopausal women. Our previous studies have shown that exposure to diethylstilbestrol (DES) during the perinatal period increases peak bone mass in female mice in adulthood. We investigated whether developmental DES exposure can influence bone mass by affecting osteoclastogenesis. Female mice were injected with 100 microg/kg body weight DES from days 9-16 of gestation or, alternatively, pups received neonatal injections of 2 microg of DES from days 1-5 of life. Animals were weaned at 21 days of age and effects of estrogen on bone cells were evaluated in adulthood. A significant increase in bone mass in female mice was already observed at 2 months, with a maximal effect in older animals. Bone sections from DES-treated animals showed a significant decrease in osteoclast number and tartrate-resistant acid phosphatase (TRAP) enzymatic activity as compared with controls. To verify the importance of the estrogen surge at puberty in this event, a group of control and DES-treated mice were ovariectomized at 17 days to prevent puberty, and potential effect on osteoclastic cells was evaluated in adulthood. As expected, ovariectomy induced an increase of TRAP-positive cells. DES treatment blunted the ovariectomized-dependent increase of the total number of osteoclastic cells, suggesting a role of developmental DES exposure in the process of bone-cell imprinting. Our data indicate, for the first time, that transient changes in estrogen levels during development modulate bone turnover and osteoclastogenesis likely participating in bone-cell imprinting during early phases of bone development, and that this effect could be induced by direct alteration of bone microenvironment.     

The impact of switching once-weekly teriparatide to denosumab in osteoporosis patients

Background

It has been reported that switching from daily (d) teriparatide (TPTD) to denosumab (DMAb) is effective for severe osteoporosis patients. However, there have been no reports about switching from weekly (w) TPTD to DMAb in patients with osteoporosis. Once-weekly 56.5-μg TPTD treatment increases bone mineral density (BMD) and reduces fracture events. The objective of the current retrospective study was to elucidate the impact of switching w-TPTD to DMAb in patients with osteoporosis.

Growth in early life predicts bone strength in late adulthood: the Hertfordshire Cohort Study

Infant growth is a determinant of adult bone mass, and poor childhood growth is a risk factor for adult hip fracture. Peripheral quantitative computed tomography (pQCT) allows non-invasive assessment of bone strength. We utilised this technology to examine relationships between growth in early life and bone strength. We studied 313 men and 318 women born in Hertfordshire between 1931 and 1939 who were still resident there in adult life, for whom detailed early life records were available. Lifestyle factors were evaluated by questionnaire, anthropometric measurements made, and peripheral QCT examination of the radius and tibia performed (Stratec 4500). Birthweight and conditional weight at 1 year were strongly related to radial and tibial length in both sexes (p<0.001) and to measures of bone strength [fracture load X, fracture load Y, polar strength strain index (SSI)] at both the radius and tibia. These relationships were robust to adjustment for age, body mass index (BMI), social class, cigarette and alcohol consumption, physical activity, dietary calcium intake, HRT use, and menopausal status in women. Among men, BMI was strongly positively associated with radial (r=0.46, p=0.001) and tibial (r=0.24, p=0.006) trabecular bone mineral density (BMD). Current smoking was associated with lower cortical (radius: p=0.0002; tibia: p=0.08) and trabecular BMD (radius: p=0.08; tibia: p=0.04) in males. Similar trends of BMD with these anthropometric and lifestyle variables were seen in women but they were non-significant. Current HRT use was associated with greater female cortical (radius: p=0.0002; tibia: p=0.001) and trabecular (radius: p=0.008; tibia: p=0.04) BMD. Current HRT use was also associated with greater radial strength (polar SSI: p=0.006; fracture load X: p=0.005; fracture load Y: p=0.02) in women. Women who had sustained any fracture since the age of 45 years had lower radial total (p=0.0001), cortical (p<0.005) and trabecular (p=0.0002) BMD, poorer forearm bone strength [polar SSI (p=0.006), fracture load X and Y (p=0.02)], and lower tibial total (p<0.001), cortical (p=0.008), and trabecular (p=0.0001) BMD. We have shown that growth in early life is associated with bone size and strength in a UK population aged 65-73 years. Lifestyle factors were associated with volumetric bone density in this population.     

二甲双胍对去卵巢大鼠骨质疏松症的影响及机制研究

目的 以雌二醇为对照,观察二甲双胍(metformin, MF)对去卵巢大鼠骨密度及骨矿含量的影响,并从细胞、分子水平探究MF可能的骨保护机制。方法 将60只雌性SD大鼠随机均分4组：假手术（SHAM）组、去卵巢（OVX）组、去卵巢+二甲双胍（OVX+MF）组和去卵巢+雌二醇(OVX+E2 )组。分组灌胃给药60 d后测量大鼠右侧胫骨骨密度和骨矿含量;分离培养各组大鼠骨髓间充质干细胞（BMSCs）并诱导其向成骨细胞分化,用MTT法测定细胞活性及增殖能力;测定各组碱性磷酸酶（ALP）活性、矿化结节数目、钙含量以及I型胶原（collagen type I）、骨钙素（OC）、骨保护素 (OPG)、NFκB受体的配体 (RANKL)、白细胞介素-6（IL-6）基因表达水平。结果 与OVX组相比,OVX+MF组和OVX+E2组成骨细胞的增殖能力与ALP活性明显增强,骨密度、骨矿含量以及钙沉积量显著增加(P均<0.05),且两组collagen type I、OC、OPG mRNA的表达水平显著升高,而RANKL、IL-6mRNA表达明显受到抑制;但OVX+MF组去卵巢大鼠成骨细胞的增殖能力、ALP活性、钙沉积量、collagen type I、OC、OPG mRNA表达水平低于OVX+E2组,RANKL、IL-6mRNA表达高于OVX+E2组（P均<0.05）;与SHAM组比较,OVX+MF组的collagen type I、OC、OPG mRNA的表达水平更高（P<0.05）。结论 二甲双胍可能通过OPG/RANKL/RANK信号通路促进BMSCs向成骨细胞分化,有效逆转去卵巢大鼠骨质疏松的状态,这种潜在的骨保护作用可能会改善糖尿病引起的骨质疏松。     

The impact of substance abuse on osteoporosis screening and risk of osteoporosis in women with psychotic disorders

Summary  

Review of the 1-year prevalence of screening for osteoporosis and of osteoporosis or idiopathic fracture in Maryland Medicaid administrative records found that screening rates did not differ among women in the control population, women with psychosis, and women with major mood disorders, but were reduced compared to controls in women with substance use disorder, with or without psychosis. Prevalence of osteoporosis was increased compared to controls in women with major mood disorders or women over 55 dually diagnosed with psychosis and substance use disorder.     

The impact of osteoporosis on quality-of-life: the OFELY cohort

Although the long-term outcomes of osteoporosis (Op) such as fracture, kyphosis, and pain are well known, the physical, psychological, and social consequences, beyond fracture and pain, are less clear. The Osteoporosis-targeted Quality-of-life (OPTQoL) questionnaire aimed at assessing the physical difficulty, fears, and adaptations to one's daily life was developed as a cross-sectional instrument to characterize the burden of Op within a community. The purpose of this study was to assess the impact of Op and related factors on community women participating in the OFELY study in France. Femoral neck bone mineral density (BMD) and OPTQoL questionnaire data were collected from women randomly selected from a large insurance company. Data were obtained for 756 women (mean age 59 years, range 36-92), most of whom were white. Women were classified into five groups based on the extent of physical manifestations and family history of Op. Women who had prior fractures, height loss, and/or kyphosis or both reported greater physical difficulty, more adaptations to their lives, and greater fears than women reporting no such changes. Scores on the Physical Difficulty domain, however, did not differ significantly based on BMD alone (BMD T score 相似文献