糖皮质激素诱导骨质疏松的细胞及分子学机制

长期大剂量使用糖皮搏击激素会诱导骨质疏松,其机制为糖皮质激素抑制成骨细胞的增殖及分化,促进成骨细胞的凋亡,并降低其功能,使骨形成延迟并减少。它可抑制破骨细胞的产生,但是否影响破骨细胞的活性则尚不清楚;此外,它也可促进破骨细胞凋亡。     

类风湿关节炎的骨质疏松研究进展

类风湿关节炎（RA）是最常见的一种关节炎，是最主要的致残性疾病之一。在中国RA的患病率约为0．3％，有近400万患者。在RA患者，骨关节的破坏是其致残的主要原因。骨关节受损主要表现为骨侵蚀以及关节周围和全身的骨质疏松．随着病程的发展导致椎体或非椎体骨折的危险增加。放射线上关节周围的骨质疏松和侵蚀损害（囊性变）是RA诊断的重要标准之一。     

细胞凋亡与骨质疏松

本文研究表明,破骨细胞、成骨细胞均可通过凋亡而死亡,且与骨质疏松的发病机制及其治疗有密切关系,本文就此问题进行综述。     

糖皮质激素诱导骨质疏松的细胞及分子学机制

长期大剂量使用糖皮质激素会诱发骨质疏松 ,其机制为糖皮质激素抑制成骨细胞的增殖及分化 ,促进成骨细胞的凋亡 ,并降低其功能 ,使骨形成延迟并减少。它可抑制破骨细胞的产生 ,但是否影响破骨细胞的活性则尚不清楚 ;此外 ,它也可促进破骨细胞凋亡。     

骨保护素与骨质疏松

肿瘤坏死因子家族新成员骨保护素(OPG)通过与细胞核因子κB受体活化因子(RANK)配体(RANKL)结合,抑制RANKL/RANK对破骨细胞信号转导的活化,发挥抗骨质疏松作用。OPG基因多态性与骨质疏松也存在相关性。OPG受多种激素、细胞因子和转录因子的调控,骨OPG/RANKL比率的改变在各型骨质疏松的发病中起重要作用。目前OPG已成为新的骨转换指标,但其在血清中的浓度变化和临床意义尚存在争论。由于在动物实验中利用OPG基因和蛋白治疗骨质疏松已取得一定进展,故OPG有望成为新一代的抗骨质疏松药物。     

白介素Ⅱ与老年性骨质疏松

本文综述了白介素Ⅱ对骨形成和骨吸收的作用，及与老年性骨质疏松的关系。     

老年女性骨质疏松与激素治疗

一、女性激素在骨代谢中的作用 绝经后骨质疏松属于原发性骨质疏松.性激素对骨代谢有重要作用，青少年时期，性激素参与骨骼的生长发育,维持成年骨骼的骨矿平衡。性激素水平低下时骨转换速度加快，形成快速骨丢失。绝经后骨质疏松的主要发病原因就是性激素缺乏。卵巢分泌的性激素有雌激素、雄激素及孕激素，基础研究及临床实践证实上述3种性激素均能影响骨代谢，其中雌激素最为显著.Albright于1941年首先提出绝经后雌激素水平低下引起骨质疏松,激素补充治疗可以抑制骨量丢失。大量的基础及临床研究结果表明,绝经最初3年内骨量丢失速度最快.骨量的变化可行骨密度测定。现在使用最多的手段是双能量X线骨密度仪,骨密度的测定被认为是判断有无骨质疏松或鉴定药物疗效的金标准；此外，骨代谢生化指标的变化可以体现骨吸收与骨形成间的动态平衡。骨吸收指标代表破骨细胞活动的产物,以往常采用空腹尿钙与肌酐比值，近年来多采用血或尿中N端或C端交联多肽、血清抗酒石酸酸性磷酸酶；骨形成指标代表成骨细胞的产物，现多采用血骨钙素、血总碱性磷酸酶和骨特异性碱性磷酸酶。     

破骨细胞凋亡与骨质疏松

破骨细胞凋亡与骨质疏松邱明才正常人的骨组织处在不断的转换中，旧骨不断地破坏，新骨不断地形成，周而复始，使骨骼维持在正常状态。衰老是原发性骨质疏松的主要病因，而绝经则是女性衰老的一种特有表现。卵巢功能减退，雌激素急剧减少是导致绝经后骨质疏松的主要原因。...     

骨形态计量学与骨质疏松

骨形态计量学与骨质疏松邱明才天津医科大学总医院内分泌科邱明才研究员衰老可使人骨量丢失，衰老的过程伴随着骨体积的减少，当达到一定程度时就出现了骨质疏松。骨质疏松所致的合并症，如病理性骨折，后果严重，常是老年人死亡的重要原因。正常人的骨组织处在不断的转换...     

破骨细胞及其功能的局部调控

综述了参与破骨细胞开发和影响其功能状态的局部因子，以及破骨细胞骨吸收过程中的一些分子机制的研究进展。影响破骨细胞功能的局部因子有两类：其中，集刺激因子、白介素１、白介素６、淋巴毒素、肿瘤坏死因子－α转化生长因子－α为刺激骨吸收的细胞因子，而干扰素、转化因子－β和白介素－４则有抑制骨吸收的效应。质子泵，粘附蛋白和Ｃ－Ｓｒｃ酪氨酸激酶在破骨细胞发生和功能中作用的阐明为加深对人谢骨病发生机制的认识和开发     

老年人骨质疏松症的防治

年龄是骨质疏松症患病的重要危险因素,老年人骨质疏松患病率和骨质疏松性骨折发生率高.死亡率增加、功能下降、长期照料需要增加、生活质量下降和医疗资源消耗增加与老年人骨质疏松性骨折密切相关.为此,我们简要介绍老年人骨质疏松和骨质疏松性骨折的流行趋势和防治要点.     

老年男性骨质疏松与骨折的防治

随着人们寿命的延长，老年男性骨质疏松症(osteoporosis．OP)的发生率也在提高。虽然其发生率不如女性高，但它引起髋部骨折的并发症、伤残率与死亡率均比女性严重，应提醒人们的重视与关注。现将老年男性骨质疏松症的一些问题，提出供同道们参考。     

The evidence for antiresorptive osteoporosis treatment in the elderly and old

PurposeThe mean age at diagnosis of osteoporosis is in the late 1960s, and fracture risk and need for fracture prevention rises sharply with increasing age. However, what is the evidence that supports the use of antiresorptive osteoporosis treatments in elderly people?MethodsThis study was a meta-analysis and meta-regression of the published literature on the clinical efficacy of antiresorptive therapy in the reduction of fracture risk in elderly (age > 70 years) and old (age > 80 years). A systematic literature search was performed. Studies included were randomised placebo controlled trials of post-menopausal women or men where the primary endpoint was vertebral, non-vertebral or hip fracture risk reduction. No papers on fractures in males were published, so BMD as primary endpoint was accepted.ResultsThirteen studies in women were included. We found increasing vertebral fracture risk reduction with increasing age, increasing BMI, and longer duration of treatment. A high baseline BMD was associated with a lesser effect. For non-vertebral fracture risk reduction, we found no effect of follow-up, age or BMD. For hip fracture risk reduction, we found no effect of treatment with increasing age or BMD, and no certain effect of duration of treatment. For men, three BMD studies were included, in these, we found a non-significant trend toward fracture reduction.ConclusionsFor women, pooled analyses showed increasing effect of antiresorptive drugs with increasing age, increasing BMI, and longer duration of treatment on vertebral fractures. The data on non-vertebral or hip fractures showed no effect on follow-up, age, or BMD. The data in men are scant at all sites and inconclusive.     

Effects of neridronate treatment in elderly women with osteoporosis

Osteoporosis is a common disorder, especially among elderly post-menopausal women. Elderly women are often affected by co-morbidities, impaired gastrointestinal function and reduced mobility; therefore, the treatment strategy for their osteoporosis can be difficult. In this randomized pilot study, we have investigated the effects of a 12-month treatment with neridronate on bone mineral density (BMD), bone turnover markers and quality of life (QoL). The study included 40 women (age, 65-80 yr; post-menopausal period, >15yr) from a single osteoporosis centre. Twenty women received a monthly im injection of 25 mg of neridronate associated with a daily dose of 500 mg of calcium and 400 U of vitamin D. Twenty women received calcium plus vitamin D supplements alone. Changes in BMD at the lumbar spine and femoral neck were measured by dual energy X-ray absorptiometry. Serum type I collagen C-telopeptide (sCTX), urinary free-deoxypyridinoline (ufDPD), bone alkaline phosphatase (ALP) and serum osteocalcin levels were determined. For the QoL assessment, the Italian version of the SF-36 test was administrated. Spine and hip BMD rose by 6.6 +/- 3 and 4.2 +/- 2.3%, respectively (p < 0.05), after 12 months of neridronate treatment. Markers of skeletal turnover significantly fell already after 3 months of neridronate treatment and decreased progressively thereafter within 12 months. The mean decrease at 12 months ranged from 38 +/- 11% for sCTX to 25.2 +/- 15% for ufDPD (p < 0.001, all). The mean improvement in QoL in the treated group was 45.7% for bodily pain, 37.5% for general health perception, 23.1% for vitality, 18% for emotional role functioning and 12% for physical role functioning. The changes observed in BMD, turnover markers and QoL in the untreated group were ns. The intermittent neridronate administration was easily manageable and well tolerated. In conclusion, neridronate currently represents a valid option for the treatment of osteoporosis, since it helps just as much as oral BPs in the improvement of BMD and in particular conditions it can be even more effective.     

Sustained-release sodium fluoride in the treatment of the elderly with established osteoporosis

BACKGROUND: We ascertained the safety and efficacy of fluoride in augmenting spinal bone mass and reducing spinal fractures in older women with established osteoporosis. We compared a combination of sustained-release sodium fluoride, calcium citrate, and cholecalciferol (SR-NaF group) with calcium and cholecalciferol alone (control group). METHODS: Eighty-five ambulatory women aged 65 years or older with 1 or more nontraumatic vertebral compression fractures were enrolled in a 42-month randomized, double-blind, placebo-controlled trial. Primary outcome measures were vertebral fracture rate, bone mass, and safety. RESULTS: The vertebral fracture rate determined by means of computer assistance in the SR-NaF group was significantly lower than that in the control group (relative risk [RR], 0.32; 95% confidence interval [CI], 0.14-0.73; P =.007). Results of visual adjudicated inspection also confirmed a significant reduction in fracture rate (RR, 0.40; 95% CI, 0.17-0.95; P =.04). Bone mineral density in L2 through L4 increased significantly from baseline in the SR-NaF group by 5.4% (95% CI, 2.7%-8.2%; P<.001), and by 3.2% in the control group (95% CI, 0.8%-5.6%; P =.01). The between-group differences in bone mineral density were not significant. The femoral neck and total hip bone mineral density remained stable in the SR-NaF group and was not significantly different from that of the control group. There were no significant differences in adverse effects between groups. CONCLUSION: The SR-NaF group significantly decreased the risk for vertebral fractures and increased spinal bone mass without reducing bone mass at the femoral neck and total hip.     

The management of osteoporosis in the elderly

In the elderly, the clinical features of osteoporosis are characterized by the variety among patients. For the purpose of the fracture prevention, it is important that the managements are suitable for the personal pathophysiological status, and coordinated by both the treatment of osteoporosis and the reduction of fall risks. In addition, the management plan should be immediately modified when the difficulties are observed.     

老年人呼吸衰竭诊治特点

呼吸衰竭是呼吸系统或其他疾病、创伤、药物中毒等导致通气和(或)换气功能障碍，引起缺氧或合并二氧化碳潴留，进而引起机体系列生理功能紊乱和代谢异常的临床综合症。老年人呼衰病因与发病机理与非老年人基本一致，但由于老年人有增龄性各脏器功能的减退，人体各系统的器官会发生相应的老化．呼吸系统也不例外，