绝经前后健康妇女骨钙素和骨矿的水平与骨代谢的关系

目的 :通过检测骨代谢的免疫、生化指标和骨矿 ( BMD)的水平 ,判断健康妇女绝经前后骨代谢的状况 ,为更年期妇女预防骨质疏松提供理论依据。方法 :采用化学法、放射免疫法、骨矿分析测定仪 ,分别测定绝经前后健康妇女血清钙( Ca)、磷 ( P)、碱性磷酸酶 ( AL P)、雌二醇 ( E2 )、骨钙素 ( BGP)、尿钙、磷 ( P)含量及 BMD的水平。结果 :各组之间血清E2 、BGP、P、尿钙相差非常显著 ( P<0 .0 1) ,血清 Ca、BMD相差显著 ( P<0 .0 5 ) ,AL P、尿磷相差不显著 ( P>0 .0 5 )。结论 :妇女进入围绝经期后 ,血 Ca、E2 的浓度降低 ,伴随 BGP、尿钙显著升高 ,未来发生骨质疏松的危险性增高     

激素替代治疗对绝经后妇女骨代谢指标的影响

目的探讨激素替代治疗对绝经后妇女碱性磷酸酶(ALP)、骨钙素(BGP)及尿钙/肌酐(Ca/Cr)的影响。方法选择2018年6月-2019年6月该院收治的绝经后妇女75例为研究对象,随机数字表分为观察组和对照组。对照组37例患者行安慰剂治疗,观察组38例患者进行激素替代治疗。用药6个月后对两组患者的治疗效果进行评估,比较两组患者的骨代谢水平和骨密度。结果观察组患者中由于绝经时间不同,观察组患者的雌酮(E1)、雌二醇(E2)水平均高于对照组患者(P0.05),而睾酮(T)水平与对照组患者比较差异无统计学意义(P0.05);患者在接受药物治疗前,两组患者的骨代谢指标中ALP、BGP及Ca/Cr差异无统计学意义(P0.05),同时两组患者骨矿含量(BMC)水平与E1、E2呈正相关(P0.05);在连续药物治疗6个月后,观察组患者的骨代谢相关指数和BMC与药物治疗前相比均明显降低(P0.05),而对照组患者的骨代谢指数与药物治疗前无明显差异(P0.05),但BMC与药物治疗前相比小幅减少(P0.05);两组患者在治疗前骨密度生活水平无明显差异(P0.05),治疗后观察组患者的腰2、腰3的骨密度有所上升,对照组患者腰2、腰3、腰4以及股骨颈的骨密度均有所下降(P0.05)。结论激素替代治疗对绝经后妇女骨代谢及ALP、BGP及Ca/Cr的影响,能有效减少绝经妇女骨质疏松的发病率,值得推广应用。     

绝经后骨质疏松症不同激素治疗方案对骨代谢的影响分析

目的 :研究不同激素治疗方案对绝经后骨质疏松患者骨代谢的影响分析.方法 :研究对象选取我院2014.06到2016.01期间收治的绝经后骨质疏松患者129例,采用随机数字法将其分为予甲、乙、丙三组,每组各43例,甲组给予戊酸雌二醇治疗,乙组则给予醋酸甲羟孕酮(M PA)治疗,丙组给予复方雌孕片治疗,用药6个月后均接受随访,比较三组治疗前后骨密度(BMD)水平、尿钙/尿肌酐(Ca/Cr)水平、骨钙素(BGP)水平.结果 :三组BM治疗前后比较,差异不显著(P均>0.05);甲组治疗前后Ca/Cr水平变化虽有下降,但差异不明显(P>0.05),乙、丙两组治疗前后Ca/Cr水平变化差异显著(P<0.01);三组骨钙素(BGP)治疗前后比较,甲组具有明显差异(P<0.01),乙、丙两组差异不显著(P>0.05).结论 :MPA可以促进绝经后骨质疏松妇女的骨转换和骨形成,从而防止骨的流失,戊酸雌二醇与复方雌孕能有效地抑制骨吸收.     

瘦素和白介素-6在绝经后妇女骨代谢中的作用

目的探讨绝经后妇女骨质疏松的发病机理及瘦素在骨质疏松中的作用。方法志愿者健康女性各年龄组分别为:25~34岁37例,35~44岁31例,45~54岁30例,绝经期5年以上55~65岁40例,各组间BM I差异无显著性。并以绝经期5年以上55~65岁40例与25~34岁育龄女性37例对照,所有研究对象均做腰椎2~4前后位BMD值测定。均空腹抽血,血清Leptin、IL-6、E2、T、FSH、LH、BGP的测定均为放射免疫法。TRAP、ALP为生化法。结果非肥胖女性随着年龄的增大,Leptin呈上升趋势、BGP升高(P<0.01),瘦素相关的成骨增强;绝经后女性FSH上升,E2下降(P<0.001);IL-6、TRAP升高、BMD下降,(P<0.01);绝经后妇女E2下降,骨吸收增强。结论随着女性年龄的增加,瘦素升高,骨钙素升高,骨形成增加,瘦素是女性骨重建中促进骨形成的重要因素之一;绝经后妇女由于受雌激素和瘦素的共同影响,骨形成增强,骨吸收也增强,绝经后妇女的骨质疏松属于高转换型;绝经后妇女雌激素下降,瘦素虽促进骨形成,但雌激素在仍起关键作用,破骨仍占优势,骨吸收大于骨形成,导致绝经后妇女骨质疏松的发生。     

植物异黄酮对更年期妇女骨密度和骨代谢血清生化指标的影响

目的:研究植物异黄酮(葛根异黄酮和大豆异黄酮)对更年期妇女骨密度和骨代谢生化指标的影响。方法:将96例身体健康的更年期女性随机分为5组,安慰剂组、钙儿奇-D组、葛根异黄酮组、大豆异黄酮组和钙儿奇-D+大豆异黄酮组。服药3个月后,比较各处理组用药前后血清钙(Ca)、血清碱性磷酸酶(ALP)、骨钙素(BGP)和骨密度(BMD)等指标的变化情况。结果:服药后血清Ca有升高的趋势,其中钙儿奇-D和葛根异黄酮组的血清Ca比服药前显著升高(P<0.05);服药后血清ALP葛根异黄酮和大豆异黄酮组有上升趋势;服药后血清BGP(除了安慰剂组)各组有增加的趋势,其中钙儿奇-D组的血清BGP明显增加。结论:植物异黄酮可以使更年期妇女血清Ca升高,使血清ALP和BGP处于较活跃的水平。     

围绝经期女性血清雌二醇及卵泡刺激素变化规律及其与腰椎、髋部和股骨颈骨密度的关系

目的探索围绝经期女性血清雌二醇(E2)、卵泡刺激素(FSH)变化规律与其腰椎、髋部、股骨颈骨密度(BMD)的关系。方法选取2014年1月-2015年1月在该院进行体检的围绝经期妇女440例为研究对象,分为绝经前组(220例)和绝经后组(220例)。测定两组血清E2、FSH水平及其腰椎、髋部、股骨颈BMD值,并进行组间比较。结果绝经后组妇女血清E2与绝经前组比较明显减少,而血清FSH与绝经前组比较明显增加,差异均有统计学意义(P0.05)。绝经后组妇女腰椎、髋部、股骨颈BMD值与绝经前组比较均有明显减少,组间差异均有统计学意义(P0.05)。绝经前低骨量组和绝经后低骨量组血清E2水平均较正常骨量组明显减少,而血清FSH水平均较正常骨量组明显增加,差异均有统计学意义(P0.05)。血清E2水平与腰椎BMD、髋部BMD、股骨颈BMD均呈正相关关系(P0.05);血清FSH水平与腰椎BMD、髋部BMD、股骨颈BMD均呈负相关关系(P0.05)。结论绝经后女性BMD明显减少,雌激素水平变化可能影响骨代谢,应引起临床的高度关注。     

绝经后女性骨标志物与骨质疏松症的相关性研究

目的:探讨绝经后女性骨代谢标志物与骨质疏松之间的关系.方法:双能X线骨密度仪测定患者股骨的骨密度(BMD),计算其BMD与正常年轻人的骨峰值比值(以t值表示),并按照骨密度值将120例患者分为63例非骨质疏松组和57例骨质疏松组.选用瑞士罗氏诊断公司COBAS6000全自动电化学发光免疫分析仪,测定骨代谢标志物总骨I型前胶原N端肽(PINP)、血清骨钙素(N-MID)和β胶原特殊序列(β-crosslaps)的水平.结果:PINP、N-MID和β-crosslaps水平骨质疏松组均高于非骨质疏松组;两组患者的BMD、PINP、N-MID和β-crosslaps水平之间均具有统计学差异(P＜0.05).结论:绝经后女性的骨代谢标志物与骨质疏松的发生关系密切,血清中P1NP、N-MID、B-Crosslaps可作为诊断绝经后妇女骨质疏松症的理想生化指标.     

长效避孕皮下埋植剂对生育妇女骨质的影响

为探讨长期缓释单孕激素对妇女骨代谢的影响,测定使用国产Ⅰ、Ⅱ型长效避孕皮下埋植剂和Norplant 3年以上妇女的骨密度及骨代谢指标。采用回顾、设对照组的研究方法,测定123例妇女骨密度(BMD)及其骨代谢指标血钙(Ca)、磷(P)、碱性磷酸酶(ALP)、骨钙素(BGP)、血清雌激素(E_2),尿钙(Ca)、尿肌肝(Cr)和尿羟脯氨酸(HYP)等。结果表明国产Ⅰ、Ⅱ型和Norplant组妇女骨峰值形成期(30～40岁)使用皮埋剂的三组妇女平均E_2水平有不同程度降低,但均在正常低限水平内,与对照组间无差别。除对照组外三组妇女平均E_2水平与BMD之间不呈线性关系;Norplant组妇女BMD和Ca/Cr、HTP/Cr的变化说明骨吸收过程增强。使用国产Ⅰ、Ⅱ型皮埋剂和Norplant妇女3年后平均E_2水平在正常低水平上波动,未造成BMD的变化及其它骨代谢指标的明显变化;三组皮埋剂妇女骨峰值形成期(30～40岁),骨密度处于正常水平范围。长效LNG缓释皮埋剂对育龄妇女在骨代谢方面是安全的。     

骨密度检测对老年女性骨折风险的预测价值

目的探讨骨密度(BMD)检测对老年女性骨折风险的预测价值。方法采用整群抽样的方法对上海市虹桥街道所辖户籍≥60岁的女性居民进行抽样,采用骨密度检测仪测定BMD值,抽取调查对象的空腹静脉血3.0 m L,测定其钙(Ca)、磷(P)、碱性磷酸酶(ALP)含量等钙磷代谢指标,采用电化学发光法检测其中骨代谢指标的含量,包括骨钙素(BGP)、Ⅰ型胶原吡啶交联终肽(β-CTx)、抗酒石酸酸性磷酸酶(TRAP)、脱氧吡啶啉(DPD)。对不同BMD值调查对象的钙磷代谢和骨代谢指标进行分析。结果共对1 890名上海市虹桥街道所辖户籍≥60岁的老年女性居民进行调查,平均年龄为(68.1±6.9)岁。BMD值正常组408人,BMD T值为(-0.73±0.19);骨质减少组964例,T值为(-1.73±0.32);骨质疏松组518例,T值为(-2.94±0.42);3组人群的BMD值差异有统计学意义(P0.05)。骨质疏松组、骨质减少组女性血清中Ca、P、ALP的水平均低于正常组,且骨质疏松组女性血清中Ca、P、ALP的水平低于骨质减少组,差异均有统计学意义(均P0.05)。骨质疏松组、骨质减少组老年女性血清中BGP的含量低于正常组,β-CTx、TRAP、DPD的含量高于正常组,且骨质疏松组血清中BGP的含量低于骨质减少组,β-CTx、TRAP、DPD的含量高于骨质减少组,差异均有统计学意义(均P0.05)。结论老年女性BMD值检测可客观反映其钙磷代谢、骨代谢异常程度,是预测远期骨折风险的可靠指标。     

辛伐他汀治疗女性糖尿病伴高脂血症及骨质疏松症的临床观察

目的:观察辛伐他汀治疗女性糖尿病伴高脂血症及骨质疏松患者的临床疗效。方法:将温州医学院附属第一医院2007年6月～2009年12月收治的糖尿病伴高脂血症及骨质疏松的患者60例随机分为治疗组和对照组,两组均在常规治疗糖尿病的基础上,对照组采用口服非诺贝特0.2,治疗组采用口服辛伐他汀20mg治疗,每晚顿服。均以12个月为一个疗程,比较两组患者的骨钙素(BGP)、L2～4及股骨颈的骨密度(BMD),血清钙(Ca)、磷(P)及碱性磷酸酶(ALP)。结果:两组患者治疗前后血清Ca、P水平无显著变化(P>0.05)。治疗组的BGP、L2～4及股骨颈的BMD、ALP的改善程度显著高于对照组(P<0.05)。结论:辛伐他汀能促进骨细胞增殖,抗骨吸收,促进成骨细胞产生骨钙素,长期治疗能够改善骨密度,促进BGP升高,并且通过促进血管形成、抑制炎症作用而缓解病情。     

Nutrition and bone

It is commonly believed that diet composition is important throughout life for optimizing bone health and reducing osteoporotic fracture risk. This contribution offers a critical overview of the main dietary components which are reported to be important. There is evidence to suggest that peak bone mass and later fracture risk are influenced by nutritional exposures in utero, in infancy and during childhood and adolescence. There are also particular concerns that individuals with a low calcium intake or vitamin D status may be at an increased risk, particularly at vulnerable periods during growth, and at times of high requirement (e.g. during pregnancy and lactation). Several other nutrients may play a key role in bone health, including vitamin K, phosphorus, potassium, magnesium, protein and sodium. In addition to specific nutrients, food groups (e.g. fruit and vegetables, pulses) may also have a positive effect on bone health.     

骨感染性炎症与骨肿瘤的影像学比较

目的探讨分析四肢长骨感染性炎症和骨肿瘤的影像学改变,以实现四肢长骨感染性炎症和骨肿瘤的鉴别诊断,为临床资料提供参考依据。方法调查2006年1月-2013年2月住院156例患者,分为四肢长骨感染82例和骨肿瘤组74例患者;骨质异常的X线、CT和MRI征象以回顾性分析进行界定、观察、记录和统计学比较,采用SPSS 13.0统计软件进行分析。结果骨感染组死骨形成、髓腔内脓肿发生率均为100.00%,骨肿瘤组死骨形成、髓腔内脓肿发生率均为0,两组比较差异有统计学意义(P<0.05)。结论使用X线平片、CT、MRI、DSA等多种影像学检查手段,充分了解、运用各征象的意义,可以对四肢长骨感染性炎症和骨肿瘤进行正确的鉴别诊断,避免误诊。     

Obesity during childhood and adolescence augments bone mass and bone dimensions

BACKGROUND: Studies of the effect of childhood obesity on bone accrual during growth have yielded conflicting results, largely related to the failure to adequately characterize the confounding effects of growth, maturation, and body composition. OBJECTIVE: The objective of this study was to determine the effect of childhood obesity on skeletal mass and dimensions relative to height, body composition, and maturation in males and females. DESIGN: In 132 nonobese (body mass index < 85th percentile) and 103 obese (body mass index > or = 95th percentile) subjects aged 4-20 y, whole-body and vertebral bone mineral content (BMC) was determined by using dual-energy X-ray absorptiometry, and bone area, areal bone mineral density (BMD), and fat and lean masses were measured. Vertebral volumetric BMD was estimated as BMC/area(1.5). RESULTS: Obesity was associated with greater height-for-age, advanced maturation for age, and greater lean mass for height (all P < 0.001). Sex-specific multivariate regressions with adjustment for maturation showed that obesity was associated with greater vertebral areal BMD for height, greater volumetric BMD, and greater vertebral BMC for bone area (all P < 0.05). After adjustment for maturation and lean mass, obesity was associated with significantly greater whole-body bone area and BMC for age and for height (all P < 0.001). CONCLUSIONS: In contrast with the results of prior studies, obesity during childhood and adolescence was associated with increased vertebral bone density and increased whole-body bone dimensions and mass. These differences persisted after adjustment for obesity-related increases in height, maturation, and lean mass. Future studies are needed to determine the effect of these differences on fracture risk.     

Hypervitaminosis A and bone

Animal, human, and in vitro data all indicate that excess vitamin A stimulates bone resorption and inhibits bone formation. This combination would be expected to produce bone loss and to contribute to osteoporosis development and may occur with relatively low vitamin A intake. It is possible that unappreciated hypervitaminosis A contributes to osteoporosis pathogenesis.     

Diabetes and bone metabolism

In the past decade several novel findings point to the critical role of the skeleton in several homeostatic processes, including energy balance. The connection begins in the bone marrow with lineage allocation of mesenchymal stem cells to adipocytes or osteoblasts. Osteoblasts and adipocytes produce factors affecting insulin homeostasis. The hormonally active adipose tissue can regulate bone metabolism. In this review authors discuss targets taking critical part in the bone-fat network: leptin, osteocalcin, PPAR γ2 and the Wnt/beta catenin pathway. Leptin regulates energy metabolism through controlling appetite. Mutation of the leptin gene resulting leptin resistance leads to high leptin levels, enormous appetite and pathologic obesity. Leptin also can influence the bone mass. The main effects of the thiazolidinedions - PPARγ agonists - are mediated through receptors located in adipocytes. However, beside their positive effects, they also suppress osteoblastogenesis and increase the risk for pathologic fractures. Osteocalcin, a known marker of bone formation, produced by osteoblasts decreases fat mass, promotes adiponectin production and insulin sensitivity, increases the number of pancreatic β-cells and increases insulin secretion. Thus, the skeletal system can regulate glucose metabolism and this substantially changed our view on this issue. Novel molecules can now be tested as targets in order to enhance bone formation and possibly prevent fractures.     

Geometry and bone density

Bone development is a key process in the growing child. It is, therefore, of paramount importance to survey this process, which is characterized by increasing length and size of the bone together with its progressive mineralization. The bone status can be evaluated by different techniques, each of them having its pros and cons. Furthermore, it should be underlined that the results of bone assessment depend not only from the employed technique but also from the auxological characteristics of the subjects. It is, therefore, the aim of this review to examine the characteristics of the various methods of bone evaluation, such as dual energy X-ray absorptiometry (DEXA), peripheral quantitative computed tomography (pQCT), ultrasound and metacarpal index and to explain how changes in bone structure and geometry may influence the results.