Cardiovascular Safety and Effectiveness of Bisphosphonates: From Intervention Trials to Real-Life Data

Both osteoporosis with related fragility fractures and cardiovascular diseases are rapidly outspreading worldwide. Since they are often coexistent in elderly patients and may be related to possible common pathogenetic mechanisms, the possible reciprocal effects of drugs employed to treat these diseases have to be considered in clinical practice. Bisphosphonates, the agents most largely employed to decrease bone fragility, have been shown to be overall safe with respect to cardiovascular diseases and even capable of reducing cardiovascular morbidity in some settings, as mainly shown by real life studies. No randomized controlled trials with cardiovascular outcomes as primary endpoints are available. While contradictory results have emerged about a possible BSP-mediated reduction of overall mortality, it is undeniable that these drugs can be employed safely in patients with high fracture risk, since no increased mortality has ever been demonstrated. Although partial reassurance has emerged from meta-analysis assessing the risk of cardiac arrhythmias during bisphosphonates treatment, caution is warranted in administering this class of drugs to patients at risk for atrial fibrillation, possibly preferring other antiresorptives or anabolics, according to osteoporosis guidelines. This paper focuses on the complex relationship between bisphosphonates use and cardiovascular disease and possible co-management issues.     

Osteoporosis in COPD patients: Risk factors and pulmonary rehabilitation

ObjectivesTo present a review on the pathogenesis, risk factor and treatment of chronic obstructive pulmonary disease complicated with osteoporosis and provide new ideas for the diagnosis and treatment.Data sourceA systematic search is carried out using keywords as chronic obstructive pulmonary disease, osteoporosis, risk factors, and pulmonary rehabilitation.ResultsPatients with chronic obstructive pulmonary disease have a high prevalence of osteoporosis and a high risk of fracture. The mechanisms of osteoporosis in COPD patients are associated with general risk factors, such as smoking, reduced physical activity, low weight, and disease‐specific risk factors, such as systemic inflammatory, Vitamin D deficiency, use of glucocorticoid, anemia, hypoxemia, and hypercapnia. The treatment of osteoporosis in COPD emphasizes comprehensive intervention, which mainly include basic treatment and anti‐osteoporosis drugs. Noticeably, pulmonary rehabilitation program is an important part of treatment.ConclusionsThis work summarizes the pathogenesis, risk factor, prevention, and treatment of chronic obstructive pulmonary disease complicated with osteoporosis, and the latest progress of studies on chronic obstructive pulmonary disease and osteoporosis is discussed.     

糖疏康对糖尿病骨质疏松大鼠VDR、TGF-β1、CaBp-D9K mRNA表达影响的实验研究

目的观察糖疏康对糖尿病性骨质疏松（DOP）大鼠维生素D受体（VDR）mRNA、转移生长因子-β1（TGF-β1）mRNA、钙结合蛋白（CaBp-D9K）mRNA表达水平的影响。方法采用腹腔注射链脲佐菌素造模。Wistar大鼠50只．10只作空白对照组,余大鼠腹腔内注射链脲佐菌素造糖尿病模型,测血糖后将符合诊断标准的30只糖尿病大鼠随机分成治疗组、西药对照组与病理组。分别给予糖疏康、碳酸钙阿法迪三和生理盐水灌胃给药。12周后取材,切片,进行维生素D受体（VDR）mRNA、转移生长因子-β1（TGF-β1）mRNA、钙结合蛋白（CaBp-D9K）mRNA原位杂交实验。结果糖疏康组与碳酸钙阿法迪三对照组治疗后提高VDRmRNA、CaBp-D9KmRNA与骨TGF-β1mRNA表达水平,且两组之间有显著差异（P〈0．01）。结论糖疏康能够调节DOP大鼠小肠VDRmRNA、CaBp-D9KmRNA与骨TGF-β1mRNA表达水平,影响VDR、CaBp-D9K与TGF-β1的合成与分泌,进而促进肠钙吸收与成骨细胞活性。     

妊娠和哺乳相关的骨质疏松症病例分享

妊娠和哺乳相关的骨质疏松症(pregnancy and lactation-associated osteoporosis, PLO)是一种罕见的临床特殊骨质疏松症,大多数病例出现在初产妇的妊娠晚期或产后早期,但是也会发生于经产妇中。PLO患者主要表现为在妊娠晚期以及产后初期严重的下背部疼痛、身高下降和脆性骨折,尤其是椎骨骨折。迄今为止,全球报道的PLO患者患病率仅有120余例。目前尚缺乏PLO治疗的指南与共识,各报告病例中指出双膦酸盐、钙和维生素D的补充是治疗PLO的一线疗法,此外特立帕肽、雷奈酸锶、地舒单抗也被证明有助于增加骨密度(bone density, BMD)。本文通过回顾分析两例PLO患者的临床资料,并对相关文献进行复习,以提高对PLO疾病的认识。     

东乡族成人低骨量与肌少症相关的肌肉质量下降的相关性研究

目的 分析甘肃省东乡族成人骨量与骨骼肌量变化规律,探讨骨量降低与肌少症相关的肌肉质量下降之间的关系。方法 对甘肃省东乡族432例(男性198例,女性234例)成人骨密度、骨强度及四肢骨骼肌量进行测量及数据分析,不同年龄段多组比较采用单因素方差分析,组间两两比较采用LSD法,相关性分析采用Pearson相关分析。结果 (1)东乡族成年男性骨强度指数及骨骼肌质量指数峰值出现在40～岁、女性出现在20～岁年龄组。(2)东乡族成人不同年龄段均出现低骨量与肌少症相关的肌肉质量下降情况。(3)骨量减少会导致骨强度指数及骨骼肌质量指数降低。(4)骨量异常情况下肌少症相关的肌肉质量下降明显。(5)骨量降低与年龄、骨强度指数、骨骼肌质量指数显著相关。结论 骨量减少与肌少症相关的肌肉质量下降显著相关,骨量异常是肌少症前期发生的一个危险因素。     

H型血管在骨质疏松症中的研究进展

骨质疏松症是一种全身性骨病,具有骨微结构退化、骨密度低的特点,在世界范围内发病率较高。随着我国人口逐渐进入老龄化,骨质疏松症的发病率日益上升,已经成为威胁老年人群生活质量的重要因素,给公共卫生系统带来了难以预料的挑战。近年来,许多文献报道骨内特殊型血管——H型血管生成与骨生成之间存在耦合,为骨质疏松症的治疗提供了新的研究目标。本文就H型血管的结构及功能、参与H型血管生成与成骨的细胞因子以及其他因素做一综述。     

女性系统性红斑狼疮患者骨代谢异常的危险因素分析

目的 探讨骨代谢、骨密度与外周血淋巴细胞亚群的关系,初步探索免疫细胞在系统性红斑狼疮(systemic lupus erythematosus, SLE)骨代谢异常中的作用。方法 采用双能X线吸收法(dual energy X-ray absorptiometry, DEXA)检测SLE患者的骨密度,同日检测患者的外周血淋巴细胞亚群分布。结果 共纳入92名SLE女性患者,患者的平均年龄及病程分别为(42.1±14.1)岁、(84.4±73.0)个月。有62.0%(n=57)患者存在骨代谢异常,其中44.6%(n=41)患者为骨量减少,17.4%(n=16)患者并发骨质疏松症,后者还包括9.8%(n=9)发生脆性骨折的患者。全身骨密度最低值与年龄(r=-0.291,P=0.005)、病程(r=-0.239,P=0.022)、绝经状态(r=-0.288,P=0.005)及碱性磷酸酶(r=-0.221,P=0.033)均呈负相关。Logistics分析显示绝经状态(OR=13.0,P<0.001,95%CI 3.43～49.5)、LDL-C(OR=5.74,P=0.002,95%CI ...     

武汉地区FES患者骨质疏松状况及危险因素分析

目的 研究分析武汉地区首发精神分裂症(first-episode schizophrenia, FES)患者患骨质疏松症(osteoporosis, OP)状况及危险因素。方法 将2020年1月至2021年6月于武汉地区精神科专科联盟机构就诊的450例FES患者纳入观察组;另选择同期健康体检的443例正常人作为对照组。统计观察组患者OP发生情况,比较观察组与对照组骨密度测量结果和骨代谢指标水平,分析影响FES患者OP发生的危险因素。结果 观察组骨量正常比例低于对照组,骨量减少及OP比例高于对照组(P<0.05);骨代谢指标水平低于对照组(P<0.05);血糖指标水平高于对照组(P<0.05),两组血脂指标比较差异无统计学意义(P>0.05);单因素分析结果显示性别、年龄、精神分裂症病程、体质量指数(body mass index, BMI)、吸烟史、日均运动时长、合并糖尿病、高血脂、冠心病均与首发精神分裂症患者OP的发生相关(P<0.05);多因素Logistic回归分析结果显示女性、年龄≥60岁、精神分裂症病程≥2年、BMI≥24 kg/m^2<...     

Dried Plum’s Polyphenolic Compounds and Carbohydrates Contribute to Its Osteoprotective Effects and Exhibit Prebiotic Activity in Estrogen Deficient C57BL/6 Mice

Evidence of dried plum’s benefits on bone continues to emerge. This study investigated the contribution of the fruit’s polyphenol (PP) and carbohydrate (CHO) components on a bone model of postmenopausal osteoporosis to explore their prebiotic activity. Osteopenic ovariectomized mice were fed diets supplemented with dried plum, a crude extract of dried plum’s polyphenolic compounds, or the PP or CHO fraction of the crude extract. The effects of treatments on the bone phenotype were assessed at 5 and 10 weeks as well as the prebiotic activity of the different components of dried plum. Both the CHO and PP fractions of the extract contributed to the effects on bone with the CHO suppressing bone formation and resorption, and the PP temporally down-regulating formation. The PP and CHO components also altered the gut microbiota and cecal short chain fatty acids. These findings demonstrate that the CHO as well as the PP components of dried plum have potential prebiotic activity, but they have differential roles in mediating the alterations in bone formation and resorption that protect bone in estrogen deficiency.