Methods of evidence-based medicine were used to discuss the drug treatment of postmenopausal osteoporosis. After clinical problems were put forward, we searched for and assessed the evidence. A rational treatment plan for osteoporosis patients with fractures was developed according to the results of systematic reviews and Meta-analysis.
We investigated the effects and optimal treatment frequency of pulsed electromagnetic fields (PEMFs) on postmenopausal osteoporosis (PMO). A comparison was performed with the cyclical alendronate and a course of PEMFs in the treatment for postmenopausal osteoporosis on bone mineral density (BMD), pain intensity and balance function. There was no significant difference between the two groups on mean percentage changes from baseline of BMD within 24 weeks after random treatments (P≥0.05). However, at the ends of 48 weeks and 72 weeks, the BMD of the PEMFs group were significantly lower than that of the alendronate group (P<0.05). No significant difference was detected between the two groups with regard to treatment effects on Visual Analogue Scale score, the Timed Up & Go Test and Berg Balance Scale score. Compared with cyclical alendronate, a course of PEMFs was as effective as alendronate in treating PMO for at least 24weeks. So its optimal treatment frequency for PMO may be one course per six months.
Hot flashes are a common syndrome in postmenopausal women. The treatment is complex and different for specific patients. A clinical case and hormonal replacement therapy selection are provided to show evidence-based practice in this field.
Postmenopausal osteoporosis is a type of osteoporosis with high bone transformation rate, caused by a decrease of estrogen in the body, which is a systemic bone disease characterized by decreased bone mass and increased risk of fracture. In recent years, as a kind of non-pharmacologic treatment of osteoporosis, defined by whole-body vibration less than 1 g (g = 9.81 m/s2), low magnitude whole-body vibration is widely concerned, mainly because of its small side effects, simple operation and relative safety. Studies have shown that low magnitude whole-body vibration can improve bone strength, bone volume and bone density. But a lot of research found that, the therapeutic effects of low magnitude whole-body vibration are different depending on ages and hormone levels of subjects for animal models or human patients. There has been no definite vibration therapy can be applied to each subject so far. Studies of whole-body and cellular level suggest that low magnitude whole-body vibration stimulation is likely to be associated with changes of hormone levels and directed differentiation of stem cells. Based on the analysis of related literature in recent years, this paper made a review from vibration parameters, vibration effects and the mechanisms, to provide scientific basis and clinical guidance for the treatment of postmenopausal osteoporosis with low magnitude whole-body vibration.
ObjectiveTo explore the role of toremifene in postmenopausal operable patients with luminal subtype of breast cancer in China. MethodsA total of 618 eligible patients diagnosed with luminal subtype of breast cancer from January 2000 to December 2009 in the Cancer Center of Sun Yat-sen University were analyzed. One hundred and fifteen patients were treated with toremifene(toremifene group) and 503 patients were treated with tamoxifen(tamoxifen group) as adjuvant endocrine therapy. Survival was compared by Kaplan-Meier with log-rank test in two groups. Cox analysis was used to compare different prognostic factors. ResultsThe general clinical data had no significant differences between the toremifene group and tamoxifen group (P > 0.05). After a median follow-up of 76 months, there was no statistical difference in the 5-year disease free survival rate and 5-year overall survival rate between the toremifene group and the tamoxifen group (5-year disease free survival rate:78.5% versus 85.5%, P=0.083;5-year overall survival rate:86.4% versus 92.0%, P=0.334). Univariated analysis showed that the histological grade, tumor size, lymph node status, TNM stage, HER-2 positive expression were associated with the disease free survival rate and overall survival rate(P < 0.05). Multivariated analysis showed that the tumor size and lymph node status were the independent risk factors of disease free survival rate and overall survival rate for postmenopausal operable patients with luminal subtype of breast cancer(P < 0.05). HER-2 positive expression was the independent risk factor in predicting disease free survival rate for patients with tamoxifen or toremifene. There was no grade 3 or 4 toxicity for all the patients according to CTC AE 4.0 grade. ConclusionsSimilar benefit is found in disease free survival rate and overall survival rate in Chinese postmenopausal patients with operable luminal subtype of breast cancer between patients receiving toremifene and tamoxifen with tolerable adverse effects. HER-2 status is associated with disease free survival rate.
目的 检测基质金属蛋白酶13（MMP-13）和组织金属蛋白酶抑制因子1（TIMP-1）的血清含量，分析其在妇女绝经后骨质疏松发病中的作用。 方法 2009年3月－2012年9月选取武汉附近地区129例49～63岁绝经后妇女，根据双能X线吸收法检测的骨密度数值，分为正常组、低骨量组和骨质疏松组。采取酶联免疫吸附试验检测MMP-13、TIMP-1以及雌二醇（E2）、Ⅰ型原胶原N端前肽（PINP）和Ⅰ型胶原交联C末端肽（CTX）、骨保护蛋白（OPG）及其配体（OPGL）的含量，统计MMP-13/TIMP-1比值。 结果 ① 骨质疏松组中血清MMP-13水平[（44.25 ± 1.21） μg/L]高于正常组[（27.08 ± 1.41）μg/L]（P＜0.05）；② 骨质疏松组中血清MMP-13与骨密度、血清E2、OPGL水平存在明显负相关性 （P＜0.05），和OPG、PINP和CTX存在明显正相关性（P＜0.05）；③ 低骨量组中MMP-13略高于骨质疏松组，且两者差异无统计学意义（P＞0.05），但是明显高于正常组（P＜0.05），同时与骨密度和血清E2、OPG、OPGL、PINP和CTX存在明显相关性（P＜0.05）。 结论 血清MMP-13和MMP-13/TIMP-1比值与绝经后骨质疏松症妇女和绝经后低骨量组妇女骨代谢指标具有关联性。两者升高可能为绝经后妇女早期骨代谢尤其是胶原代谢过程增快的表现。
ObjectiveTo compare the clinical effects of pulsed electromagnetic fields (PEMFs) with oral alendronate in the treatment of postmenopausal osteoporosis. MethodsFourty patients diagnosed to have postmenopausal osteoporosis (OP) from September 2009 to September 2010 were included in our study. They were randomly divided into the experimental group and the control group. All patients were administered the same basic drugs:Caltrate 600 mg and Alfacalcidol 0.5 μg per day. For the experimental group, PEMFs were offered 6 times per week for 5 weeks (30 times in total), and patients in this group were followed up for 12 weeks. For the control group, alendronate was given at a dose of 70 mg per week for 12 weeks. Bone mineral density (BMD), visual analogue scale, and manual muscle testing (MMT) scale were evaluated before, 1 week, 5 weeks, and 12 weeks after intervention. ResultsIncreasing of BMD, pain relieving, and improvement of MMT had a trend of increasing values after 5 weeks of treatment in the experimental group (P<0.05), but there was no significant difference between the two groups (P>0.05). However, there was a significant difference between the two groups in patients' lower back muscle strength after treatment (P<0.05). ConclusionPEMFs have the same effect as alendronate in pain relief, and bone mass and muscle strength improvement, and are even advantageous in increasing back muscle strength compared with alendronate.
ObjectiveTo preliminarily explore the effect of Osteoporosis Self-assessment Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX) on predicting osteoporosis and osteoporosis fracture in postmenopausal patients with maintenance hemodialysis (MHD).MethodsThirty-six postmenopausal patients undergoing MHD from August 2017 to October 2018 in Hemodialysis Center of Nephrology Department, West China Hospital of Sichuan University were selected. Relevant data such as age, height, and weight were collected. OSTA index and the 10-year probability of major osteoporotic fractures and 10-year probability of hip fractures of FRAX score were calculated. Bone mineral densities (BMD) of the hip and lumbar spine were measured by dual energy X-ray absorptiometry (DXA) at the same time. The value of OSTA index and FRAX scale in evaluating the risk of osteoporosis predicated on T value ≤−2.5 determined by DXA BMD and fracture in postmenopausal patients with MHD were analyzed.ResultsThe DXA BMD of the 36 patients showed that 50.0% (18/36) had a T value≤−2.5, and 30.6% (11/36) had a fracture history. BMD in postmenopausal patients with MHD was negatively correlated with FRAX score (model without BMD values), and positively correlated with OSTA index. The sensitivity and specificity of OSTA in the prediction of osteoporosis were 94.4% and 61.1%, respectively; and the sensitivity and specificity of FRAX (the model without BMD values) in the prediction of osteoporosis were 88.9% and 50.0%, respectively. The FRAX score with or without BMD had the same clinical value in predicting osteoporosis.ConclusionsPostmenopausal MHD patients have a higher risk of osteoporosis and fracture. Both OSTA index and FRAX scale can predict osteoporosis risk among postmenopausal MHD patients, and the FRAX scale with or without BMD has the same clinical value in predicting osteoporosis risk. In clinical work, for primary hospitals and dialysis centers lacking DXA, preliminary screening of osteoporosis in MHD patients can be performed with OSTA and FRAX scales.
Objective To explore the relationship between periodontitis and postmenopausal osteoporosis.Methods Databases were electronically searched from PubMed (1966 to December, 2010), EMbase (1974 to December, 2010), CBM (1978 to December, 2010), VIP (1989 to December, 2010), CNKI (1979 to December, 2010) and WanFang Data (January, 2007 to December, 2010), and the references listed in all papers were also retrieved. The literature was screened according to the inclusion and exclusion criteria by two reviewers independently; the methodology quality was evaluated after data abstraction; and then the RevMan 5.0 software was used for meta-analyses. Results Four trials were included. Among the total 678 patients involved, 263 were postmenopausal osteoporosis patients, while the other 415 were non-osteoporosis patients. The results of meta-analyses showed that: a) Clinical attachment loss (CAL) of the postmenopausal osteoporosis patients was significantly higher than that of the non-osteoporosis patients (WMD=0.60, 95%CI 0.23 to 0.96); b) The level of gingival recession of the postmenopausal osteoporosis patients was significantly higher than that of the non-osteoporosis patients (WMD=0.78, 95%CI 0.41 to 1.14); c) There were no significant differences in plaque index (PI), gingival index (GI) and periodontal probing depth (PPD) between the two groups (WMD=0.17, 95%CI 0.00 to 0.35; WMD=0.05, 95%CI –0.09 to 0.19; and WMD=–0.08, 95%CI –0.24 to 0.09); d) The results of one study indicated that the rate of periodontitis in the postmenopausal osteoporosis patients was higher than that of the non-osteoporosis patients (OR=2.45, 95%CI 1.38 to 4.34, Plt;0.01); the severe alveolar crest height loss was related to osteoporosis (OR=4.20, 95%CI 1.57 to 11.22, Plt;0.01). Conclusion Postmenopausal osteoporosis patients are more prone to suffer from periodontitis or turn to the worse stage of periodontitis. In consideration of the factors such as small scales and incomplete measure indexes of the included studies, which have influences on the intensity and comprehensiveness of this conclusion, more high-quality studies are required.
目的 探讨独活寄生汤联合唑来膦酸治疗绝经后肝肾亏虚型骨质疏松症（PO）的疗效。 方法 选取2009年2月－2012年12月收治的210例绝经后肝肾亏虚型PO患者，且所有患者均愿意接受研究。采用随机对照试验法，将患者分为A、B、C 3组各70例。A组采用独活寄生汤联合唑来膦酸治疗；B组采用唑来膦酸治疗；C组采用独活寄生汤治疗。观察3组患者治疗前后骨密度、骨源性碱性磷酸酶（NBAP）、骨钙素（BGP）、雌二醇（E2）变化，疗效及不良反应。 结果 骨密度、NBAP、BGP、E2各项指标，治疗前3组患者比较差异无统计学意义（P＞0.05）；治疗后A组各项指标明显优于B组、C组（P＜0.05）；B组与C组对比，差异无统计学意义（P＞0.05）；治疗后A组总有效率为97.14%，与B组、C组对比，差异有统计学意义（P＜0.05）。3组均未见严重不良反应。 结论 独活寄生汤联合唑来膦酸治疗绝经后肝肾亏虚型PO疗效显著，可有效提高患者骨密度、BGP、E2含量，降低骨源性碱性磷酸酶含量，缓解骨质疏松，且无严重不良反应发生，值得临床推广。