Objective To determine whether statins has some effects on the treatment of cardio-cerebral vascular diseases or hyperlipdemia increases bone mineral density （BMD）. Methods One hundred and sixty-two patients aged over 60 were identified in the outpatient-department of Geriatrics of West China Hospital from Jan. 1998 to Aug. 2003. Seventy cases were exposed to statins with follow-up for 5 years. BMD of the spine, femoral neck, femoral wards triangle and femoral trochanter was measured by dual-energy X-ray absorptiometry. The multiple regression analysis was used to exclude potential confounders, e.g. age, BMI, comorbidity,etc. Results Those elderly patients with a history of taking statins had higher BMD, such as femoral neck with t =-2. 466 （P =0. 015）, femoral wards triangle with t =-2. 483 （P = 0. 014 ）and femoral trochanter with t =-2. 743 （P =0. 007 ）than the control elderly at the end of follow-up. Conclusions It has been found that HMG-CoA reductase inhibitors （statins ） may prevent bone loss in elderly patients by increasing BMD. Further prospective studies of statins are needed to confirm these observatioris.
ObjectiveTo evaluate the incidence of osteoporosis and relevant factors in the elderly male patients with chronic obstructive pulmonary disease(COPD).Methods Forty elderly male patients with COPD were enrolled and thirty age-matched healthy subjectss were enrolled.The BMD of lumbar vertebrae and proximal end of the femur were measured by dual energy X-ray absorptiometry.Serum levels of osteocalcin （BGP）and lung function were measured while blood-gas analysis of arterial blood was conducted.Results The BMD of lumbar vertebrae and proximal end of the femur(including lumbar 1 to 4，femoral neck，wards triangle，trochanter and shaft) in the COPD group were significantly lower than those in the control subjects(all Plt;0.01).Serum BGP level in the COPD group was higher than that in the control group[(5.67±1.59)ng/mL vs (4.37±1.47)ng/mL，Plt;0.01).The prevalence of osteoporosis among the COPD patients was significantly higher than that among the control subjects（65% vs 40%，50% vs 20%，both Plt;0.05）.BMD in the COPD patients who had a history of smoking was significantly lower than those who did not smoke cigarettes（Plt;0.01 or Plt;0.05）.BMD in the COPD patients treated with glucocorticoid were significantly lower than those who were not receiving glucocorticoid therapy(Plt;0.01 or Plt;0.05).BMD was positively correlated with PaO2，BMI，FEV1%pred and FEV1/FVC(Plt;0.01 or Plt;0.05).Conclusions Compared with age-matched normal controls，BMD in elderly male COPD patients are significantly lower with increased osteoporosis risk.Osteoporosis induced by COPD is high change-over pattern. BMD in patients with COPD may be correlated with hypoxia，lung function，smoking，low body mass index and glucocorticoids therapy.
Objective To investigate the association between the genetic polymorphisms of osteoprotegerin gene and bone mineral density ( BMD) in elderly patients with chronic obstructive pulmonary disease ( COPD) .Methods 178 elderly COPD patients admitted in respiratory department between January 2008 and December 2009 were recruited as a COPD group. 195 elderly healthy subjects without COPD were recruited as a control group. The subjects were all chosen from the Han population in Lanzhou city, Gansu province. Pulmonary function ( FEV1 /FVC, FEV1% pred) , body mass index ( BMI) , serum calcium ( Ca) , serum phosphate ( P) , and alkaline phosphatase ( ALP) were determined in all subjects. The OPG gene polymorphisms were analyzed by polymerase chain reaction and restriction fragment length polymorphism ( PCR-RFLP) . BMD was examined by dual-energy X-ray absorptiometry. Results In the COPD group, the distribution frequency of AAGG, GATA, and GGTT in OPG HTT gene-linked polymorphic region G209A and T245G were 2.5%, 27.2% , and 72.3% , respectively, which in the control group were 2.2% , 26.9% , and 70.9%, respectively. The genotype distribution difference of two groups had no statistical significance ( P gt; 0.05) . There were also no statistical differences in BMI, serum Ca, serum P, serum ALP or BMD between different genotype subgroups in two groups ( P gt;0.05) . In the COPD group, the genotype distribution had no statistical significance between different BMD subgroups( P gt; 0.05) . Conclusion In the elderly patients with COPD from Han population at Lanzhou city, OPG HTT gene-linked polymorphic region and T245G gene polymorphism have no significant correlation with reduced lung function, reduced BMD and bone metabolism which are not likely to be susceptibility loci for osteoporosis in COPD patients.
Objective To observe the influence on adjacent lumbar bone density after strengthening of T12, L1 segment vertebral osteoporotic compression fracture by percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in postmenopausal female. Methods Between January 2008 and June 2011, 59 patients with T12, L1 segment thoracolumbar osteoporotic compression fracture were treated with PVP in 29 cases (PVP group) and PKP in 30 cases (PKP group), who were in accordance with the inclusion and exclusion criteria. No significant difference was found in gender, duration of menopause, disease druation, causes of injury, fractured vertebral body, and vertebral fracture classification between 2 groups (P gt; 0.05). The kyphosis Cobb angle of surgical area was measured at preoperation, 1 week after operation, and last follow-up; the lower three lumbar spine bone mineral density (BMD) of the surgical area, the femoral neck BMD, and body mass index (BMI) of patients were measured at perioperative period and last follow-up to find out the statement of anti-osteoporosis; FRAX online tools were used to evaluate the probability of major osteoporotic fracture and hip fracture of the next 10 years. Results The average follow-up was 25.5 months (range, 12-48 months) in 2 groups. There was significant difference in kyphosis Cobb angle of T12, L1 between preoperation and last follow-up in 2 groups (P lt; 0.05); the Cobb angle of PKP group was significantly less than that of PVP group at 1 week after operation and last follow-up (P lt; 0.05). No significant difference was found in BMI between 2 groups, and between perioperative period and last follow-up in the same group (P gt; 0.05). The lower three lumbar spine BMD of the surgical area and its T value at last follow-up was improved significantly when compared with BMD at perioperative period (P lt; 0.05); there was no significant difference in the lower three lumbar spine BMD and its T value between 2 groups at perioperative period (P gt; 0.05), but significant difference was found between two groups at last follow-up (P lt; 0.05). Difference was not significant in the femoral neck BMD and its T value between 2 groups, and between perioperative period and last follow-up in the same group (P gt; 0.05). The probability of major osteoporotic fracture and hip fracture of the next 10 years was not significantly different between 2 groups and between perioperative period and last follow-up in the same group (P gt; 0.05). Conclusion The increased BMD of adjacent lumbar spine can improve the strength of the vertebral body and reduce the incidence of adjacent vertebral fracture in patients with T12, L1 segment vertebral osteoporotic compression fracture after PVP/PKP, and PKP is superior to PVP increasing BMD of adjacent lumbar spine.
Objective To explore the significance and the relationshi p between osteoporosis and the mRNA expressions of vascular endothel ial growth factor (VEGF) and bone morphogenetic protein 2 (BMP-2) in nontraumatic avascular necrosis of the femoral head (NONFH), so as to provide a theoretical basis for the pathogenesis and the cl inical treatment of NONFH. Methods Sixty-nine specimens of femoral head were collected from voluntary donators undergoing total hi p arthroplasty, including 37 cases of NONFH (NONFH group) and 32 cases of fresh femoral neck fracture (control group). In NONFH group, there were 26 males and 11 females with an average age of 57.3 years (range, 43-75 years), including 19 cases of steroid-induced avascular necrosis of the femoral head (ANFH), 16 cases of alcohol ic ANFH, and 2 cases of idiopathicANFH; according to Ficat staging system, there were 23 cases at stage III and 14 cases at stage IV. In control group, there were 23 males and 9 females with an average age of 58.6 years (range, 46-79 years). The NO level of serum, the Q value of femur, and the bone mineral density (BMD) of weight-bearing area were measured firstly. The bone tissues were harvested from weightbearing necrosis area and healthy area. The pathological change was observed by HE staining, the percentage of empty bone lacuna and the percentage of trabecular bone area were calculated. The mRNA expressions of VEGF and BMP-2 in femoral head were detected through in situ hybridization technique. Results There were significant differences (P lt; 0.05) in the NO level of serum, the Q value of femur, and the BMD between NONFH group and control group. In NONFH group, the femoral head showed irregular shape, the articular cartilage exfol iated and collapsed. In weight-bearing necrosis area, the bone trabeculae were sparse and non-intact with a great number of empty lacuna; necrotic bone trabeculae were decomposed and absorbed; no obvious bone regeneration and repair were observed. In weight-bearing healthy area, the fat cells in bone marrow showed prol iferation and hypertrophy. In control group, the femoral head had normal appearance, intact articular cartilage, and intact bone trabeculae with a regular arrange, and osteocytes were clearly seen. There were significant differences in the percentage of empty bone lacuna and the percentage of trabecular bone area between NONFH group and control group (P lt; 0.05). The mRNA expressions of VEGF and BMP-2 were positive in 2 groups. The positive area ratio, the absorbance value, and integral absorbancevalue of VEGF mRNA and BMP-2 mRNA in NONFH group were significantly lower than those in control group (P lt; 0.05);the grey scales of VEGF mRNA and BMP-2 mRNA in NONFH group were significantly higher than that in control group (P lt;0.05). Conclusion The pathological stage of osteoporosis may play an important role in the mechanism of the NONFH. The decrease of mRNA expressions of VEGF and BMP-2 in femoral head of NONFH is important reason that affect its bone mass, osteoporosis, rehabil itation, and reconstruction. It may be benefit to the reparative process of the necrosis femoral head to increase the mRNA expressions of VEGF and BMP-2 in the femoral head.
To observe the effect of pulsed electromagnetic fields (PEMFs) of different treatment time on bone mineral density of femur in ovariectomized rats, so as to find out the treatment time for the best therapeutic efficacy. Methods Fifty female SD rats were randomly divided into 5 groups: sham-ovariectomized (SHAM) group (no PEMFs treatment), ovariectomy (OVX) control group (no PEMFs treatment), OVX I, II and III groups (PEMFs treatment at 8 Hz frequency with 3. 8 ×10-10A/m intensity 20, 40, and 60 minutes daily for 30 days, respectively). All rats were given bilateral ovariectomy except those in the SHAM control group. Bone mineral density (BMD) of femur was assessed at 30 days after PEMFs treatment. Results In OVX control group, hypotrichosis, hypoactivity and l istlessness were observed after operation; and in SHAM group, OVX I group, OVX II group and OVX III group, pilus, psyche and activity were normal. The BMD values were (0.226 ± 0.011), (0.210 ± 0.011), (0.231 ± 0.013), (0.231 ± 0.017) and (0.229 ± 0.013) g/cm2 in SHAM group, OVX control group, OVX I group, OVX II group and OVX III group respectively, showing significant differences between OVX control group and other groups (P lt; 0.05), but showing no significant differences between other 4 groups (P gt; 0.05). Conclusion P EMFs of the three different treatment times can maintain the BMD in ovariectomized rats. It shows that PEMFs have the same effect of maintaining BMD with increasing of treatment time at the range of 20-60 minutes in ovariectomized rats.
Objective To establish an osteoporosis screening tool for Chinese40-years-old or above women. Methods The T-score was calculated based on the mean bone mineral density(BMD) of 20-39 years women. Considering the result of dualenergy X-ray absorptiometry(DXA) as the golden criteria, the Bayes discriminant analysis was employed to explore the function. Results The formula of the screening tool for Chinese 40-years-old or above women as following:osteoporosis screenig tool for Chinese(OSTC):Weight-2×age+50. OSTC≤0was classified into high risk, OSTCgt;0 was low risk. The hit rate of OSTC was 75.78%.The sensitivity is 76.8%. The specificity is 75.1%, Kappa value was 0.51(P=0.000).That means the consistency of diagnosis result between OSTC and DXA was relatively good. Conclusion OSTC is a simple tool. Just based on age and weight, it can evaluate the osteoporosis risk of Chinese 40-years-old or above women. But the effect of OSTC has not been proved by other datasetand should be tested further.
【摘要】 目的 评价亚洲骨质疏松自我评价工具（OSTA）和我国妇女骨质疏松筛选工具（OSTC）与四川地区围绝经期和绝经后汉族妇女骨密度的关系，比较两种工具对骨质疏松症的筛检能力，探讨其临床应用价值。 方法 2010年7—10月筛选获得356名45岁以上妇女的双能X线骨密度仪腰椎、股骨颈和全髋骨密度数据，利用体重和年龄分别计算OSTA指数与OSTC指数，并进行比较。 结果 OSTA指数与OSTC指数和各部位骨密度值均呈正相关（r=0.458~0.593和r=0.440~0.599，Plt;0.001），两种筛选指数之间呈正相关（r=0.956，Plt;0.001）。按两级危险程度分类界值进行判定，OSTA和OSTC的灵敏度分别为78.2%、93.5%，特异度为67.2%、43.0%，受试者工作特征曲线下面积为0.792、0.798，Kappa系数为0.452、0.357。 结论 OSTA与OSTC应用于四川地区围绝经期和绝经后妇女骨质疏松症的筛查效果均不理想，临床应用价值受限。【Abstract】 Objective To evaluate the relationship between osteoporosis self-assessment tool for asians (OSTA), osteoporosis self-assessment tool for Asians (OSTC) and bone mineral density in Sichuan perimenopausal and postmenopausal women of Han nationality, and discuss the value of their clinical application through comparison of the screening ability of the two tools in predicting osteoporosis and low bone mass. Methods With the data of bone mineral density at lumbar spine, femoral neck and total proximal femur measured by DXA of 356 women aged 45 years old and above, OSTA and OSTC risk indexes of each subject were calculated based on their weight and age, and were then compared. Results The bone mineral density of above-mentioned locations were positively correlated with OSTA and OSTC indexes (r=0.458-0.593 and r=0.440-0.599,Plt;0.001), and these two indexes were also correlated positively (r=0.956, Plt;0.001). According to the two risk levels by these cutoffs, OSTA and OSTC indexes could diagnose osteoporosis with the sensitivity of 78.2% and 93.5%, the specificity of 67.2% and 43%, the area under ROC curve of 0.792 and 0.798, and the Kappa value of 0.452 and 0.357, respectively. Conclusion Both OSTA and OSTC were not ideal tools for screening osteoporosis in perimenopausal and postmenopausal women in Sichuan province.
【摘要】 目的 观察重组人甲状旁腺激素（1-34）[rhPTH（1-34）]治疗骨质疏松症患者骨密度的疗效和安全性。 方法 采用自身前后对照临床研究，纳入2008年3-5月就诊的原发性骨质疏松症患者共39例，予rhPTH（1-34） 20 μg 1次/d皮下注射，疗程18个月。治疗期间均同时口服钙制剂600 mg/d及维生素D3 125 U/d作为基础治疗。患者治疗前采用双能X线检测腰2~4椎体（L2~4）和股骨颈骨密度（BMD）、肝肾功能、血钙、血磷，治疗后6、12、18个月复查BMD和上述生化指标改变，记录患者不良事件，对患者治疗前后L2~4、股骨颈BMD变化进行对比分析。 结果 35例患者完成全疗程治疗，其中男2例，女33例；平均年龄65岁，平均病程6.5年；治疗6、12、18个月时L2~4 BMD均较治疗前明显提高（Plt;0.01），而股骨颈BMD在治疗6、12个月时改善不明显（Pgt;0.05），18个月时表现出较治疗前明显增加（Plt;0.01）；腰椎平均BMD增长率为12.27%，股骨颈BMD增长率为4.11%；治疗期间不良反应少，均不需特殊处理而自行好转。 结论 rhPTH（1-34）治疗原发性骨质疏松症安全有效，对改善椎体BMD疗效迅速明显，对改善股骨颈BMD起效慢；适用于绝经后骨质疏松和老年性骨质疏松症患者。【Abstract】 Objective To observe the therapeutic effect of recombinant human parathyroid hormone (1-34) [rhPTH(1-34)] on the improvement of bone mineral density (BMD) in patients with primary osteoporosis. Methods A before and after self control study was performed on 39 patients with primary osteoporosis from March to May 2008. The patients underwent the subcutaneous injection with rhPTH (1-34) 20 μg/d for 18 months. All patients were given oral calcium (Ca 600 mg+Vit D3 125 U per day) as primary drug treatment. BMD of lumbar spine (L2-L4) and femur neck, serum calcium, and serum phosphate were measured before and 6, 12, and 18 months after the treatment. All of the adverse reactions were recorded. Results A total of 35 patients finished the trial,including two males and 33 females with the average age of 65 years and the course of disease of (6.54±4.30) years. BMD of lumbar spine (L2-L4) significantly increased 6, 12, and 18 months after treatment (Plt;0.01). There was no significant difference of femur neck BMD 6 and 12 months after treatment (Pgt;0.05), whereas by the end of the treatment, it improved significantly (Plt;0.01). The average increase rate was 12.27% in lumbar spine (L2-L4) and was 4.11% in femur neck BMD. There were a few adverse reactions during the therapeutic process, most of which were tolerable and self-restored. Conclusion rhPTH(1-34) is an effective and safe drug in treating primary osteoporosis. It can increase lumbar spine BMD rapidly and raise femur neck BMD gradually. It is applicable for postmenopausal osteoporosis and senile osteoporosis.
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.