B-Vitamins and Bone Health–A Review of the Current Evidence

Because of ongoing global ageing, there is a rapid worldwide increase in incidence of osteoporotic fractures and the resultant morbidity and mortality associated with these fractures are expected to create a substantial economic burden. Dietary modification is one effective approach for prevention of osteoporosis in the general population. Recently, B vitamins have been investigated for their possible roles in bone health in human studies. In this review, we provide different lines of evidence and potential mechanisms of individual B vitamin in influencing bone structure, bone quality, bone mass and fracture risk from published peer-reviewed articles. These data support a possible protective role of B vitamins, particularly, B2, B6, folate and B12, in bone health. However, results from the clinical trials have not been promising in supporting the efficacy of B vitamin supplementation in fracture reduction. Future research should continue to investigate the underlying mechanistic pathways and consider interventional studies using dietary regimens with vitamin B enriched foods to avoid potential adverse effects of high-dose vitamin B supplementation. In addition, observational and interventional studies conducted in Asia are limited and thus require more attention due to a steep rise of osteoporosis and hip fracture incidence projected in this part of the world.     

正骨十四法联合中药外敷在桡骨远端骨折中的应用效果分析

【摘要】 目的 研究探讨正骨十四法联合舒筋定痛散外敷治疗桡骨远端骨折的临床疗效。方法 选取 2019年1月至2021年1月郑州市骨科医院收治的100例桡骨远端骨折患者作为研究对象,按照随机数表法将其随机分为观察组 (50例)与对照组(50例)? 观察组患者采用正骨十四法联合舒筋定痛散外敷治疗,对照组患者单纯采用正骨十四法治疗,对比观察两组患者功能训练开始时间、肿胀消退时间、骨折愈合时间、腕关节活动度以及腕关节功能? 结果 观察组患者功能训练开始时间、肿胀消退时间、骨折愈合时间均明显短于对照组 (t =6.809、4.761、4.859,P 均 <0.001); 治疗后 3 个月,观察组患者腕关节旋前、旋后、掌屈活动度均明显大于对照组 (t =20.384、22.656、20.190,P 均 <0.001); 治疗后6个月,观察组患者腕关节功能为优者7例、良者23例、可者17 例、差者3 例,与对照组患者腕关节功能为优者4例、良者19例、可者18例、差者9例无明显差异(Z = -1.800,P =0.072)。结论 正骨十四法联合舒筋定痛散外敷治疗桡骨远端骨折,可有效促进肿胀消退,缩短骨折愈合时间,改善腕关节活动度,值得临床推广应用。     

内侧皮质不同复位等级对股骨转子间骨折髓内钉内固定术后临床疗效的影响

【摘要】 目的 探究内侧皮质不同复位等级对股骨转子间骨折 (FIF) 股骨近端髓内钉内固定术后临床疗效的影响。 方法 选取2016年6月至2019年10月正阳县人民医院收治的76 例FIF患者作为研究对象,并根据股骨近端髓内钉内固定术后即刻正位 X 线片显示的头颈骨块内侧皮质和股骨干内侧皮质的位置关系将患者分为正性支撑组(25例)、中性支撑组 (26例)和负性支撑组(25例),其中正性支撑组患者头颈骨块内侧皮质位于股骨干内侧皮质内上方,中性支撑组患者头颈骨块内侧皮质与股骨干内侧皮质影像学上完全对位,负性支撑组患者头颈骨块内侧皮质位于股骨干内侧皮质外上方。 对比观察 3 组患者术中出血量、手术时间、术后即刻尖顶距(TAD)、骨折愈合时间、股骨颈长度及颈干角变化情况以及临床疗效与并发症发生情况。结果 3 组患者术中出血量、手术时间及术后即刻 TAD 无明显差异 (F =0.021、0.015、0.255,P =0.980、0.985、0.880)。 正性支撑组患者骨折愈合时间明显短于负性支撑组 (q =5.373,P <0.001),而正性支撑组和中性支撑组、中性支撑组和负性支撑组间无明显差异 (q =3.145、2.280,P = 0.074、0.246)。术后即刻及术后3个月,正性支撑组患者股骨颈长度均明显长于中性支撑组和负性支撑组(术后即刻: q =6.172、13.920,P 均 <0.001;术后 3 个月: q =16.240、30.600,P 均 < 0.001),且中性支撑组患者股骨颈长度明显长于负性支撑组 (q = 7.887、14.660,P均<0.001);正性支撑组患者颈干角均明显大于中性支撑组和负性支撑组 (术后即刻: q = 3.562、7.839,P =0.037、P <0.001;术后 3 个月: q =12.360、24.860,P 均 <0.001),且中性支撑组患者颈干角明显大于负性支撑组 (q =4.353、12.740,P =0.008、P <0.001)。 术后 6 个月,正性支撑组患者中优 15 例、良 8 例、中 1 例?差 1 例,明显优于中性支撑组患者的优8例、良8例、中7例、差3例以及负性支撑组患者的优 6 例、良 7 例?中 6 例、差6例 (Z = - 2.520、- 3.150,P = 0.012、0.002),而中性支撑组与负性支撑组间无明显差异(Z = -0.917,P =0.359)。正性支撑组患者术后并发症发生率为 4.00%,中性支撑组患者术后并发症发生率为23.08%,负性支撑组患者术后并发症发生率为 28.00%,3 组患者并发症发生情况无明显差异 (χ2 =5.361,P =0.069)。 结论 FIF患者髓内钉内固定术后内侧皮质正性支撑复位稳定性更好,可明显缩短骨折愈合时间,改善股骨颈长度及颈干角,临床疗效较好,术中有意识的获得正性支撑复位非常必要。     

Who will benefit from antiresorptive treatment (bisphosphonates)?

Bisphosphonates are very effective treatments of postmenopausal osteoporosis. They suppress bone turnover, increase bone mineral density (BMD), and maintain or improve structural and material properties of bone, thereby decreasing the risk of fractures. All patients selected for treatment according to current international guidelines can benefit from bisphosphonate therapy independently of their prevalent rate of bone turnover. Long-term extensions (up to 10 years) of pivotal clinical trials with daily bisphosphonate administration showed sustained efficacy with no evidence of adverse effects on bone metabolism and skeletal fragility. Recent studies focus on the resolution of the effects of bisphosphonates on bone metabolism and fracture risk following cessation of long-term treatment. Such studies may help to formulate treatment recommendations according to the risk of the individual patient.     

老年人腰椎和髋部骨密度测定T评分的一致性比较

目的 探讨老年人腰椎和髋部双能X线骨密度(DEXA)测定T评分的一致性及髋部骨密度(BMD)T评分在骨质疏松诊断中的意义。方法 在排除患有影响骨量的疾病及使用影响骨代谢药物者后，选择60-89岁老年人260(其中男123人，女137人)例作为为研究对象。受检者均接受问卷调查、胸腰段脊椎正侧位X线摄片，DEXA测定2-4腰椎(L2-4)椎体前后位和左髋部BMD(若左髋部发生过骨折或存有明显病变则改测右髋部)，并进行有关统计分析。结果 老年男性各年龄组L2-4 BMD T评分比髋部要高(P＜0．01或P＜0.05)；老年女性除在65—69岁、85—89岁年龄组腰椎BMD T评分比髋部要高(P＜0．01和P＜0.05)外，其余各组则差异无显著性。按照WHO标准，以髋部、腰椎和同时以髋部、腰椎BMD T评分为依据，在123例男性中，分别有19、6、5人被诊断为骨质疏松症；在137例女性中，则分别有35、17、14人被诊断为骨质疏松症；单以腰椎和同时以髋部、腰椎BMD T评分为依据所检出的骨质疏松症患者人数均少于单以髋部BMD T评分为依据者(P＜0．01)。结论 在老年人尤其是老年男性，其腰椎BMD T评分明显高于髋部，腰部BMD T评分在骨质疏松诊断中的意义更为重要。     

肌少症和骨质疏松对类风湿关节炎患者脊柱骨质疏松性骨折的协同影响

目的探讨肌少症和骨质疏松(OP)对RA患者脊柱骨质疏松性骨折(OPF)发生的协同影响.方法选择389例住院的RA患者和同期156例年龄、性别相匹配的健康人,采用双能X线吸收测量(DEXA)法测定腰椎和髋部的骨密度(BMD),采用生物电阻抗法测定四肢骨骼肌质量,摄脊柱X线正侧位片并以半定量法进行脊柱骨折的判定.统计学方法:2组间计量资料比较采用t检验,组间率的比较采用x2检验,2项分类资料的多元回归分析采用Logistic回紧(backward LR法)分析.结果RA患者各测定部位BMD均低于对照组(P<0.01),RA组骨质疏松发生率(128/389,32.9%)高于对照组[(20/156,12.8%),χ^2=22.706,P<0.01];RA患者脊柱OPF发生率为21.6%(84/389),高于对照组中[(3.8%,6/156),χ^2=25.439,P<0.01].RA患者中肌少症的发生率为54.8%,高于对照组[(9.6%,15/156),χ^2=93.241,P<0.01];RA组肌少症合并骨质疏松的发生率(28.5%)高于对照组[(5.8%),χ^2=118.110,P<0.01 ].不同骨量(骨量正常、骨量减少、骨质疏松)分组间RA患者脊柱OPF发生率的差异有统计学意义(χ^2=43.373,P<0.01),且呈现出随着骨量逐渐降低,脊柱OPF发生率逐渐升高的趋势(χ^2=43.003,P<0.01).伴肌少症的RA患者脊柱OPF发生率(27.2%,58/213)高于无肌少症的RA患者[(14.8%,26/176),χ^2=8.833,P=0.003].根据骨质疏松和肌少症分组的3组间(1=无肌少症和骨质疏松;2=单纯肌少症或骨质疏松;3=肌少症合并骨质疏松)RA患者脊柱OPF发生率的差异有统计学意义(χ^2=33.832,P<0.01),且从第1组到第3组脊柱OPF的发生率有逐渐增高的趋势(χ^2=37.164,P<0.01).与未服用糖皮质激素(GC)组相比,服用GC组的RA患者具有更高的肌少症发生率(χ^2=7.136,P=0.008)、OP发生率(CI=10.900,P=0.004)和脊柱OPF发生率(χ^2=20.673,P<0.01).Logistic回归分析显示:高龄[OR(95%CI)=1.069(1.038,1.101),P<0.01]、服用GC[OR(95%CI)=3.169(1.679,5.984),P<0.01]、肌少症和骨质疏松[OR(95%CI)=2.113(1.430,3.124),P<0.01]的同时存在为RA患者发生脊柱OPF的危险因素.结论RA患者肌少症、骨质疏松和脊柱OPF的发生率均明显增高,且肌少症和骨质疏松对RA患者脊柱OPF的发生具有协同作用.     

The differential effects of bisphosphonates,SERMS (selective estrogen receptor modulators), and parathyroid hormone on bone remodeling in osteoporosis

Osteoporosis is a skeletal metabolic disease characterized by a compromised bone fragility, leading to an increased risk of developing spontaneous and traumatic fractures. Osteoporosis is considered a multifactorial disease and fractures are the results of several different risk factors both extra- and intraskeletal. Thus bone fragility can be the end point of several different causes: a) failure to reach an optimal peak bone mass during growth; b) excessive bone resorption resulting in decreased bone mass and microarchitectural deterioration; c) inadequate formation upon an increased resorption during the process of bone remodeling. The pharmacological therapeutical options, available to date, are directed on prevention of fractures. The aim of this paper is to describe the activities and the mechanisms of action, as known at present, of the most used therapies for osteoporosis and their clinical implications. Improvement of knowledge in this field will allow us to further improve therapeutical choices and pharmacological interventions.     

Food groups and bone health

Studies aimed at determining the relationship between key nutrients (especially calcium) and bone health have examined directly the effect of a specific nutrient (or, in some cases, various nutrients) commonly consumed in the human diet. Consideration of the foods man actually consumes rather than the nutrients contained within them is an alternative strategy that has been adopted in other disciplines examining the relationship between diet and disease. Two studies indicate that a high fruit and vegetable, intake is protective for the skeleton, whereas high candy consumption is associated with lower bone mass, irrespective of gender. These data also suggest that a high intake of fatty, sugary foods is detrimental to bone health around the time of menopause. Because milk and milk products provide greater than 50% of the total calcium in the Western diet as well as a number of other key nutrients including phosphorus, magnesium, and zinc, they have a fundamental role in bone health determination. Milk supplementation also improves the nutritional quality of postmenopausal women's diets to a greater extent than calcium. Data for alcohol consumption are also intriguing. Recently, a positive association was noted between tea drinking and bone mass in postmenopausal women and may point to the influence of flavonoids contained in tea on bone health.