骨质疏松症的社区三级预防

骨质疏松症是一种以低骨量、骨结构破坏而导致骨脆性增加和骨折为表现特征的全身性疾病。65岁以上妇女中，绝大多数骨折由骨质疏松所致。骨质疏松症是绝经后妇女的常见疾病，严重影响了绝经后妇女的生活质量。随着人口老龄化，骨质疏松现已成为危害公共健康的最严重问题之一。     

对绝经妇女钙代谢与骨质疏松症的探讨

骨质疏松是老年人中常见的一种骨科疾病,多发生于女性绝经后,女性发病比男性高数倍.妇女绝经后至老年,约有25.0%患骨质疏松症,多发于绝经后两年后或更长的时间,一旦出现骨质疏松症,将增加骨折的危险,这是绝经后威胁妇女健康的重要变化.     

氟化物在治疗骨质疏松中的作用

随着社会老年人口数量的快速啬，骨折的发病率也明显提高，而骨质疏松是老年人和绝经后妇女发生骨折的主要原因，骨质疏松症的防治已成为公共卫生急待解决的首要问题，氟化物能增加骨密度，降低老年人和绝经后妇女的骨折发病率，因此氟化物对骨质疏松症的治疗起到了积极作用。     

肌力、脂肪含量与绝经后骨质疏松症患者骨密度T值的相关性分析

目的探讨肌力、脂肪含量与绝经后骨质疏松症患者骨密度T值的相关性,为临床防治绝经后骨质疏松症提供依据。方法选择2015年6月-2017年6月江苏省中医院骨伤科收治的骨质疏松症患者84例设为观察组,根据骨密度T值测定结果分为骨量减少组32例、骨质疏松组41例及严重骨质疏松组11例;另选择同期入院健康体检者40例设为对照组。采用Inbody720型电子背力计分别测定各组腰背部伸肌力(取平均值),利用美国Hologic公司生产的全身型双能X线骨密度仪测定各组全身脂肪及腰椎L1～4骨密度值,采用SPSS Pearson相关性分析软件对肌力、脂肪含量对绝经后骨质疏松症患者骨密度T值的相关性进行分析。结果观察组绝经后骨质疏松症患者肌力、骨密度水平低于对照组,腹部脂肪含量高于对照组,差异均有统计学意义(P0. 05)。骨量减少组肌力、骨密度水平高于骨质疏松组和严重骨质疏松组,脂肪含量低于骨质疏松组和严重骨质疏松组,差异均有统计学意义(P0. 05);骨质疏松组肌力、骨密度水平高于严重骨质疏松组,脂肪含量低于严重骨质疏松组,差异均有统计学意义(P0. 05)。绝经后骨质疏松症骨密度水平与肌力呈正相关性(P0. 05),与脂肪含量呈负相关性(P0. 05)。结论绝经后骨质疏松症患者肌力、脂肪含量较少,并且与骨密度之间存在紧密的联系。     

绝经后骨质疏松症的诊断与防治

原发性骨质疏松症分绝经后骨质疏松症（ＰＭＯＰ、Ⅰ型）和老年性骨质疏松症（ＳＯＰ、Ⅱ型）两个基本类型。ＰＭＯＰ的发病与绝经有关,其特点是骨的转换增高,骨质流失加快,松质骨变化更显著,易发椎骨及长骨端部的骨折事件。妇女绝经后骨质疏松（ＯＰ）患病率明显增加,约１／３的绝经后妇女受骨质疏松之累,还有相当多的低骨量者,均处于较高的骨折风险之中。美国白人绝经后妇女分别有３０％和５４％患ＯＰ和骨质缺乏（Ｏｓｔｅｏｐｅｎｉａ）。我国妇女绝经后ＯＰ的患病率多在４０％以上。因而骨质疏松症的防治已成为公众关注的热点和…     

原发性骨质疏松

骨质疏松是一种以骨量减少、骨组织的微结构破坏、骨骼的脆性增加和易发生骨折为特征的全身性代谢性骨病.可分为原发性和继发性两大类.原发性骨质疏松又分为两型:Ⅰ型为绝经后骨质疏松症,多发生在妇女绝经后5～10年内;Ⅱ型为老年性骨质疏松症,多见于60岁以上的中、老年人.     

绝经后骨质疏松症的临床评价与防治进展

绝经后骨质疏松症是一种严重危害老年妇女生活质量的隐袭性疾病,常发生于绝经后5～10年.60岁以后女性骨质疏松发病率为30%～50%,因骨质疏松引起的骨折已成为老年人缩短寿命、致残、致畸的主要原因[1].随着我国老龄化人口的增加,其发生率还有继续增长的趋势.目前,由于专业知识所限或对其认识不足,绝经后骨质疏松症常被忽略,发现时病情已很难逆转.笔者旨在引导基层医务人员正确认识绝经后骨质疏松症的临床特点,早期诊断并尽早干预.     

绝经妇女骨质疏松性骨折患病率及其危险因素分析

目的调查山西白求恩医院绝经妇女骨质疏松性骨折患病情况并分析其危险因素。方法根据年龄将2017-06/2019-06于山西白求恩医院体检或门诊绝经妇女分为38～49岁,50～59岁,60～69岁,70～岁,采用PASS 11.0软件估算总样本量为1 004例,假设中途退出率为5%,最终纳入样本量为1 054例,采用随机数字表法对各年龄组进行单纯随机抽样。根据骨质疏松性骨折诊疗指南自制一般资料调查问卷收集患者一般资料。利用SPSS 20.0软件对数据进行统计分析,不同年龄段骨质疏松症绝经妇女骨折发生率和一般资料中计数资料采用卡方检验,两组患者一般资料中计量资料采用独立样本t检验,骨质疏松性骨折危险因素采用逐步Logistic回归分析。结果 2017-06/2019-06该院体检或门诊骨质疏松绝经妇女骨折总发生率为3.98%,与38～59岁骨质疏松症绝经妇女比较,60岁以后骨折发生率明显增加(P0.05);年龄(OR=1.374,95%CI:1.154～1.636)、BMI(OR=1.213,95%CI:0.342～1.597)、饮酒史(OR=3.845,95%CI:1.658～8.919)、绝经年龄(OR=5.896,95%CI:2.247～15.468)、绝经时长(OR=2.010,95%CI:1.408～2.869)为骨质疏松症绝经妇女发生骨质疏松性骨折危险因素。结论山西白求恩医院绝经妇女骨质疏松性骨折患病率较高,高龄、高BMI、饮酒史、绝经年龄早、绝经时间长为其高危因素,可将高危因素作为筛选指标给予相应干预措施促进绝经女性骨骼健康,同时应加强60岁以上绝经妇女钙剂的补充以降低骨折发生率。     

绝经后女性骨质疏松的治疗研究进展

骨质疏松是多种原因引起的一组骨病,骨组织有正常的钙化,钙盐与基质呈正常比例,以单位体积内骨组织量减少为特点的代谢性骨病变.骨质疏松与机体生理机能退化、代谢等过程关系密切,其发生对生活的质量影响在绝经期妇女中表现得尤为明显.绝经后骨质疏松症是以雌激素缺乏为主,合并多种原因引起,以骨强度受损,导致骨折危险性升高为特征的骨骼疾病.本文就女性绝经后骨质疏松的治疗研究进行讲述.     

绝经后骨质疏松症的控制及社区防护

骨质疏松症是绝经后妇女的常见疾病.通过对骨生理学研究和骨质疏松症的主要危险因素探讨,提出妇女从儿童时起就应积极锻炼身体,定期进行户外活动,平衡饮食,每日摄入钙800～1500mg,避免吸烟和大量饮酒,并适当配合激素治疗,从而增加骨质密度,降低骨折发生率.对骨质疏松防护具有社会价值和经济价值.     

A Vicious Cycle of Osteosarcopenia in Inflammatory Bowel Diseases—Aetiology,Clinical Implications and Therapeutic Perspectives

Sarcopenia is a disorder characterized by a loss of muscle mass which leads to the reduction of muscle strength and a decrease in the quality and quantity of muscle. It was previously thought that sarcopenia was specific to ageing. However, sarcopenia may affect patients suffering from chronic diseases throughout their entire lives. A decreased mass of muscle and bone is common among patients with inflammatory bowel disease (IBD). Since sarcopenia and osteoporosis are closely linked, they should be diagnosed as mutual consequences of IBD. Additionally, multidirectional treatment of sarcopenia and osteoporosis including nutrition, physical activity, and pharmacotherapy should include both disorders, referred to as osteosarcopenia.     

Exercise and Nutrition Impact on Osteoporosis and Sarcopenia—The Incidence of Osteosarcopenia: A Narrative Review

Osteoporosis and sarcopenia are diseases which affect the myoskeletal system and often occur in older adults. They are characterized by low bone density and loss of muscle mass and strength, factors which reduce the quality of life and mobility. Recently, apart from pharmaceutical interventions, many studies have focused on non-pharmaceutical approaches for the prevention of osteoporosis and sarcopenia with exercise and nutrition to being the most important and well studied of those. The purpose of the current narrative review is to describe the role of exercise and nutrition on prevention of osteoporosis and sarcopenia in older adults and to define the incidence of osteosarcopenia. Most of the publications which were included in this review show that resistance and endurance exercises prevent the development of osteoporosis and sarcopenia. Furthermore, protein and vitamin D intake, as well as a healthy diet, present a protective role against the development of the above bone diseases. However, current scientific data are not sufficient for reaching solid conclusions. Although the roles of exercise and nutrition on osteoporosis and sarcopenia seem to have been largely evaluated in literature over the recent years, most of the studies which have been conducted present high heterogeneity and small sample sizes. Therefore, they cannot reach final conclusions. In addition, osteosarcopenia seems to be caused by the effects of osteoporosis and sarcopenia on elderly. Larger meta-analyses and randomized controlled trials are needed designed based on strict inclusion criteria, in order to describe the exact role of exercise and nutrition on osteoporosis and sarcopenia.     

Sarcopenia in elderly men and women: the Rancho Bernardo study

BACKGROUND: Sarcopenia risk factors are poorly understood. METHODS: This study examines sarcopenia prevalence and risk factors in community-dwelling men (694) and women (1006) aged 55-98 years (mean=73) who attended a 1988-1992 Rancho Bernardo Study clinic visit. Height, weight, muscle strength, fat-free mass (FFM), fat mass by bioelectric impedance analysis, and grip strength were measured; alcohol and medication use, smoking, and physical activity were ascertained. RESULTS: Mean FFM was 43.5 kg for women and 61.7 kg for men. Sarcopenia, defined as FFM of > or =2.0 standard deviations below the gender-specific mean of a young reference population, was present in 6.0% overall. Prevalence increased dramatically from 4% of men and 3% of women aged 70-75 to 16% of men and 13% of women aged 85 and older. Both men and women with sarcopenia had a significantly lower fat mass and body mass index than those without sarcopenia. Men with sarcopenia were twice as likely to have fallen in the past year compared with those without sarcopenia. Grip strength, but not quadriceps strength, was lower in men and women with sarcopenia. Physically active women were about half as likely to have sarcopenia, but no association was found in men. Few men and women were current smokers, but they were more likely to have sarcopenia. Comorbidities (heart disease, diabetes, pulmonary disease, arthritis, cancer) and medications (thyroid hormones, corticosteroids, and hormone replacement therapy) were not associated with sarcopenia. CONCLUSIONS: Sarcopenia increases with age. This study also identified lack of physical activity and current smoking as reversible risk factors for sarcopenia.     

Importance of Considering Malnutrition and Sarcopenia in Order to Improve the QOL of Elderly Hemodialysis Patients in Japan in the Era of 100-Year Life

In the current aging society of Japan, malnutrition and resultant sarcopenia have been widely identified as important symptomatic indicators of ill health and can cause impairments of longevity and quality of life in older individuals. Elderly individuals are recommended to have sufficient calorie and protein intake so as to enjoy a satisfactory quality of life, including maintaining activities of daily living in order to avoid emaciation and sarcopenia. The prevalence of emaciation and sarcopenia in elderly hemodialysis (HD) patients in Japan is higher than in non-HD elderly subjects due to the presence of malnutrition and sarcopenia associated with chronic kidney disease (CKD). Furthermore, comorbidities, such as diabetes and osteoporosis, induce malnutrition and sarcopenia in HD patients. This review presents findings regarding the mechanisms of the development of these early symptomatic conditions and their significance for impaired QOL and increased mortality in elderly HD patients.     

Osteosarcopenia,an Asymmetrical Overlap of Two Connected Syndromes: Data from the OsteoSys Study

Osteoporosis and sarcopenia are two chronic conditions, which widely affect older people and share common risk factors. We investigated the prevalence of low bone mineral density (BMD) and sarcopenia, including the overlap of both conditions (osteosarcopenia) in 572 older hospitalized patients (mean age 75.1 ± 10.8 years, 78% women) with known or suspected osteoporosis in this prospective observational multicenter study. Sarcopenia was assessed according to the revised definition of the European Working Group on Sarcopenia in Older People (EWGSOP2). Low BMD was defined according to the World Health Organization (WHO) recommendations as a T-score < −1.0. Osteosarcopenia was diagnosed when both low BMD and sarcopenia were present. Low BMD was prevalent in 76% and the prevalence of sarcopenia was 9%, with 90% of the sarcopenic patients showing the overlap of osteosarcopenia (8% of the entire population). Conversely, only few patients with low BMD demonstrated sarcopenia (11%). Osteosarcopenic patients were older and frailer and had lower BMI, fat, and muscle mass, handgrip strength, and T-score compared to nonosteosarcopenic patients. We conclude that osteosarcopenia is extremely common in sarcopenic subjects. Considering the increased risk of falls in patients with sarcopenia, they should always be evaluated for osteoporosis.     

A path model of sarcopenia on bone mass loss in elderly subjects

Objective

Aging is associated with decreases in muscle mass, strength, power (sarcopenia) and bone mineral density (BMD). The aims of this study were to investigate in elderly the role of sarcopenia on BMD loss by a path model, including adiposity, inflammation, and malnutrition associations.

Methods

Body composition and BMD were measured by dual X-ray absorptiometry in 159 elderly subjects (52 male/107 female; mean age 80.3 yrs). Muscle strength was determined with dynamometer. Serum albumin and PCR were also assessed. Structural equations examined the effect of sarcopenia (measured by Relative Skeletal Muscle Mass, Total Muscle Mass, Handgrip, Muscle Quality Score) on osteoporosis (measured by Vertebral and Femoral T-scores) in a latent variable model including adiposity (measured by Total Fat Mass, BMI, Ginoid/Android Fat), inflammation (PCR), and malnutrition (serum albumin).

Results

The sarcopenia assumed a role of moderator in the adiposity-osteoporosis relationship. Specifically, increasing the sarcopenia, the relationship adiposity-osteoporosis (β: ?0.58) decrease in intensity. Adiposity also influences sarcopenia (β: ?0.18). Malnutrition affects the inflammatory and the adiposity states (β: +0.61, and β: ?0.30, respectively), while not influencing the sarcopenia. Thus, adiposity has a role as a mediator of the effect of malnutrition on both sarcopenia and osteoporosis. Malnutrition decreases adiposity; decreasing adiposity, in turn, increase the sarcopenia and osteoporosis.

Conclusions

This study suggests such as in a group of elderly sarcopenia affects the link between adiposity and BMD, but not have a pure independent effect on osteoporosis.     

COPD合并肌少症病人营养与运动干预的护理研究进展

肌少症是机体在增龄过程中出现的进行性、广泛性骨骼肌肌量、肌力及功能下降进而引起残疾、生活质量下降或死亡等不良结局的综合征。骨骼肌是人体最重要的运动器官和能量代谢组织,COPD病人由于疾病的消耗、营养与运动不足,以及高龄等原因,肌少症患病风险较高。本文就COPD合并肌少症的发病机制、营养与运动的护理干预等方面进行综述,期望为COPD合并肌少症的病人提供合理有效的营养与运动干预方案,促进病人机体康复、减少COPD急性发作次数,提高病人生活质量提供参考。     

Sarcopenia in Asia: Consensus Report of the Asian Working Group for Sarcopenia

Sarcopenia, a newly recognized geriatric syndrome, is characterized by age-related decline of skeletal muscle plus low muscle strength and/or physical performance. Previous studies have confirmed the association of sarcopenia and adverse health outcomes, such as falls, disability, hospital admission, long term care placement, poorer quality of life, and mortality, which denotes the importance of sarcopenia in the health care for older people. Despite the clinical significance of sarcopenia, the operational definition of sarcopenia and standardized intervention programs are still lacking. It is generally agreed by the different working groups for sarcopenia in the world that sarcopenia should be defined through a combined approach of muscle mass and muscle quality, however, selecting appropriate diagnostic cutoff values for all the measurements in Asian populations is challenging. Asia is a rapidly aging region with a huge population, so the impact of sarcopenia to this region is estimated to be huge as well. Asian Working Group for Sarcopenia (AWGS) aimed to promote sarcopenia research in Asia, and we collected the best available evidences of sarcopenia researches from Asian countries to establish the consensus for sarcopenia diagnosis. AWGS has agreed with the previous reports that sarcopenia should be described as low muscle mass plus low muscle strength and/or low physical performance, and we also recommend outcome indicators for further researches, as well as the conditions that sarcopenia should be assessed. In addition to sarcopenia screening for community-dwelling older people, AWGS recommends sarcopenia assessment in certain clinical conditions and healthcare settings to facilitate implementing sarcopenia in clinical practice. Moreover, we also recommend cutoff values for muscle mass measurements (7.0 kg/m² for men and 5.4 kg/m² for women by using dual X-ray absorptiometry, and 7.0 kg/m² for men and 5.7 kg/m² for women by using bioimpedance analysis), handgrip strength (<26 kg for men and <18 kg for women), and usual gait speed (<0.8 m/s). However, a number of challenges remained to be solved in the future. Asia is made up of a great number of ethnicities. The majority of currently available studies have been published from eastern Asia, therefore, more studies of sarcopenia in south, southeastern, and western Asia should be promoted. On the other hand, most Asian studies have been conducted in a cross-sectional design and few longitudinal studies have not necessarily collected the commonly used outcome indicators as other reports from Western countries. Nevertheless, the AWGS consensus report is believed to promote more Asian sarcopenia research, and most important of all, to focus on sarcopenia intervention studies and the implementation of sarcopenia in clinical practice to improve health care outcomes of older people in the communities and the healthcare settings in Asia.     

Falls, sarcopenia, and growth in early life: findings from the Hertfordshire cohort study

Recent studies have shown that people whose early growth is poor have an increased risk of sarcopenia. Sarcopenia is an important risk factor for falls, but it is not known whether poor early growth is related to falls. The authors investigated this association in the Hertfordshire Cohort Study (1998-2004), where 2,148 participants from the United Kingdom provided their history of falls. Grip strength was used as a marker of sarcopenia. Birth weight, weight at 1 year, and conditional infant growth were analyzed in relation to history of falls. The prevalence of any fall in the last year was 14.3% for men and 22.5% for women. Falls in the last year were inversely related to adult grip strength, height, and walking speed in men and women as well as to lower conditional infant growth in men (odds ratio = 1.27, 95% confidence interval: 1.04, 1.56 per standard deviation decrease in conditional infant growth; p = 0.02). This association was attenuated after adjustment for grip strength. These findings support an association between poor early growth and falls in older men that appears to be mediated partly through sarcopenia. The lack of a relation with birth weight suggests that postnatal rather than prenatal influences on muscle growth and development may be important regarding the risk of falls in later life.     

Protein and exercise in the prevention of sarcopenia and aging

Aging is associated with a progressive decline in skeletal muscle mass and strength. The decline, known as sarcopenia, could lead to physical disability, poor quality of life, and death. In addition, the older population usually experiences age-related muscle changes that affect muscle mass, muscular strength, and functional abilities. The purpose of this review is to describe the role of protein and exercise in slowing the progression of sarcopenia. It will also discuss whether age-related changes can be attenuated by dietary protein and exercise in the older population. This review will also cover one of the possible mechanisms of how dietary protein and exercise are involved in sarcopenia prevention, as well as the available measurement tools. Based on the findings of this review, the adequate amount of protein required for older men and women needs to be revised and likely be higher. Moreover, studies are required to explore some inconclusive findings concerning sarcopenia in the older population. Further research is required to investigate the following: (1) the safety and effectiveness concerning the consumption of 1.4 g of protein/kg of body weight (or more) in this vulnerable population; (2) the effectiveness of amino acid supplementation in reducing progression of sarcopenia over time through longitudinal studies; (3) the preferred source and timing of protein for the older population to maintain muscular strength and attenuate sarcopenia; (4) exercise interventions, especially those of longer duration, in the attenuation of sarcopenia; (5) other types of exercise and their effects on age-related muscle changes; (6) the mechanism of how protein and exercise prevent muscle loss with aging; and (7) determine the best method to diagnose sarcopenia.