Postmenopausal Osteoporosis and Osteopenia Management with a Combination of Once-Monthly Oral Ibandronate and Cholecalciferol—A Systematic Review

Postmenopausal osteoporosis and osteopenia are chronic and uncurable conditions that invariably lead to an increased risk of vertebral, hip, and femoral neck fracture if left untreated. Clinical guidelines establish, in general, pharmacological combinations allied to lifestyle changes as the mainstay of their management, and also increasing bone marrow density, lowering fracture risk, and improving quality of life are their main therapeutic goals. The objective of this systematic review was to analyze the available data in the scientific medical literature regarding the role of the ibandronate and cholecalciferol combination in postmenopausal osteoporosis and osteopenia management. Based on our results, we concluded that the above combination is safe and feasible for the clinical control of both conditions.

Osteonecrosis of the jaw in a patient taking once-yearly infusion of zoledronic acid for osteopenia

Osteonecrosis of the jaw (ONJ) is an adverse effect of nitrogen-containing bisphosphonates. Advancing age, intravenous administration of zoledronic acid (ZOL), history of dento-alveolar surgery, and concomitant systemic diseases such as diabetes are known as risk factors for developing ONJ. However, despite numerous studies, the exact pathophysiology remains unclear and management strategies are largely anecdotal. Once-yearly intravenously administered 5 mg ZOL was approved by the US Food and Drug Administration in 2007 for the treatment of osteoporosis and its efficacy with 3 year-regimen had been recently proven in preventing new clinical fracture. Although occurrences of ONJ have been reported to be rare with this drug administration, available data is very limited and long-term outcomes are lacking. We present a case of ONJ identified in an osteopenic patient with an intermittent but long standing sore mouth related to exposed mandibular bone. Once-yearly infusion of zoledronic acid used in the treatment of osteopenia may contribute to the spontaneous development of ONJ, especially in those presenting with multiple comorbidity factors. This report suggests the importance of health care professionals keeping abreast of new developments in this area and providing appropriate information to their patients.

The Influence of Health Qigong on the Subjectively Expressed Psychophysical State of Patients with Rheumatoid Arthritis,Rheum,Osteoporosis,Osteopenia

This study assesses the impact of exercise on the health of the Qigong(Jibengong,Health Qigong Ba Duan Jin and Health Qigong Yi Jin Jing)in patients with rheumatoid arthritis,rheumatism,osteoporosis,osteopenia.Through the given questionnaire we have come up with data showing how and how much health qigong affects the patients with rheumatoid arthritis,rheumatism,osteoporosis,osteopenia according to the subjective assessment.

Impaired autophagy activity-induced abnormal differentiation of bone marrow stem cells is related to adolescent idiopathic scoliosis osteopenia

Background:Osteopenia has been well documented in adolescent idiopathic scoliosis(AIS).Bone marrow stem cells(BMSCs)are a crucial regulator of bone homeostasis.Our previous study revealed a decreased osteogenic ability of BMSCs in AIS-related osteopenia,but the underlying mechanism of this phenomenon remains unclear.Methods:A total of 22 AIS patients and 18 age-matched controls were recruited for this study.Anthropometry and bone mass were measured in all participants.Bone marrow blood was collected for BMSC isolation and culture.Osteogenic and adipogenic induction were performed to observe the differences in the differentiation of BMSCs between the AIS-related osteopenia group and the control group.Furthermore,a total RNA was extracted from isolated BMSCs to perform RNA sequencing and subsequent analysis.Results:A lower osteogenic capacity and increased adipogenic capacity of BMSCs in AIS-related osteopenia were revealed.Differences in mRNA expression levels between the AIS-related osteopenia group and the control group were identified,including differences in the expression of LRRC17,DCLK1,PCDH7,TSPAN5,NHSL2,and CPT1B.Kyoto Encyclopedia of Genes and Genomes enrichment analyses revealed several biological processes involved in the regulation of autophagy and mitophagy.The Western blotting results of autophagy markers in BMSCs suggested impaired autophagic activity in BMSCs in the AIS-related osteopenia group.Conclusion:Our study revealed that BMSCs from AIS-related osteopenia patients have lower autophagic activity,which may be related to the lower osteogenic capacity and higher adipogenic capacity of BMSCs and consequently lead to the lower bone mass in AIS patients.

Promotion effect of FGF23 on osteopenia in congenital scoliosis through FGFr3/TNAP/OPN pathway

Background:Congenital scoliosis(CS)is a complex spinal malformation of unknown etiology with abnormal bone metabolism.Fibroblast growth factor 23(FGF23),secreted by osteoblasts and osteocytes,can inhibit bone formation and mineralization.This research aims to investigate the relationship between CS and FGF23.Methods:We collected peripheral blood from two pairs of identical twins for methylation sequencing of the target region.FGF23 mRNA levels in the peripheral blood of CS patients and age-matched controls were measured.Receiver operator characteristic(ROC)curve analyses were conducted to evaluate the specificity and sensitivity of FGF23.The expression levels of FGF23 and its downstream factors fibroblast growth factor receptor 3(FGFr3)/tissue non-specific alkaline phosphatase(TNAP)/osteopontin(OPN)in primary osteoblasts from CS patients(CS-Ob)and controls(CT-Ob)were detected.In addition,the osteogenic abilities of FGF23-knockdown or FGF23-overexpressing Ob were examined.Results:DNA methylation of the FGF23 gene in CS patients was decreased compared to that of their identical twins,accompanied by increased mRNA levels.CS patients had increased peripheral blood FGF23 mRNA levels and decreased computed tomography(CT)values compared with controls.The FGF23 mRNA levels were negatively correlated with the CT value of the spine,and ROCs of FGF23 mRNA levels showed high sensitivity and specificity for CS.Additionally,significantly increased levels of FGF23,FGFr3,OPN,impaired osteogenic mineralization and lower TNAP levels were observed in CS-Ob.Moreover,FGF23 overexpression in CT-Ob increased FGFr3 and OPN levels and decreased TNAP levels,while FGF23 knockdown induced downregulation of FGFr3 and OPN but upregulation of TNAP in CS-Ob.Mineralization of CS-Ob was rescued after FGF23 knockdown.Conclusions:Our results suggested increased peripheral blood FGF23 levels,decreased bone mineral density in CS patients,and a good predictive ability of CS by peripheral blood FGF23 levels.FGF23 may contribute to osteopenia in CS patients through FGFr3/TNAP/OPN pathway.

基于健康体检人群分析青年骨量异常的现状及影响因素

目的分析北京市参加健康体检人群中的青年骨量异常患者的特点及影响因素,为骨量减少和骨质疏松的防治提供依据和参考。方法收集2023年1-7月在首都医科大学附属北京友谊医院健康体检行骨密度检查且年龄≤40岁人群共973人,其中,骨量异常青年人群348人,骨量正常青年人群625人,选取潜在相关指标分析青年体检人群的骨量异常发生情况及可能影响因素。结果青年体检人群骨量异常发生率为35.77%,其中,骨量减少人群占91.67%,骨质疏松症人群占8.33%,男性占57.47%,女性占42.53%。通过单变量分析,骨量异常的发生与多种因素有关,包括性别、年龄、体重、身体质量指数、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血尿酸,吸烟与饮酒等(P<0.05);进一步的多变量Logistic回归分析表明,年龄(OR=1.045)、较低的身体质量指数(OR=0.761)、甘油三酯(OR=2.828)、血尿酸(OR=1.007)、饮酒(OR=5.238)、吸烟(OR=1.853)是发生骨量异常的危险因素(P<0.05)。结论青年人群骨量减少和骨质疏松检出率呈上升趋势,应重视健康体检,并积极进行骨密度早期筛查。

Hepatocellular carcinoma and musculoskeletal system: A narrative literature review

Musculoskeletal alterations in hepatocellular carcinoma(HCC)are less common than liver-related complications.However,they can significantly impact the quality of life and overall prognosis of patients with HCC.The main obstacle in the clinical assessment of HCC-induced musculoskeletal alterations is related to effective and timely diagnosis because these complications are often asym-ptomatic and unapparent during routine clinical evaluations.This narrative literature review aimed to provide a comprehensive overview of the contem-porary literature related to the changes in the musculoskeletal system in patients with HCC,focusing on its clinical implications and underlying etiopathogenetic mechanisms.Osteolytic bone metastases are the most common skeletal alterations associated with HCC,which could be associated with an increased risk of low-trauma bone fracture.Moreover,previous studies reported that osteopenia,sarcopenia,and myosteatosis are associated with poor clinical outcomes in patients with HCC.Even though low bone mineral density and sarcopenia are consistently reported as reliable predictors of pretransplantation and post-transplantation mortality in HCC patients,these complications are frequently overlooked in the clinical management of patients with HCC.Taken together,contemporary literature suggests that a multidisciplinary approach is essential for early recognition and clinical management of HCC-associated musculoskeletal alterations to improve patient prognosis.Further research into the mechanisms and treatment options for musculoskeletal complications is warranted to enhance our understanding and clinical management of this aspect of HCC.

达格列净与阿卡波糖对2型糖尿病伴骨量减少患者骨代谢和骨密度的影响比较

目的比较达格列净与阿卡波糖对2型糖尿病伴骨量减少患者骨代谢和骨密度的影响。方法选取2017年2月—2021年6月就诊于福建医科大学附属泉州第一医院内分泌科的2型糖尿病伴骨量减少患者150例,根据随机数字表法分为阿卡波糖组和达格列净组,各75例。其中阿卡波糖组脱落或失访7例,达格列净组9例,最终阿卡波糖组纳入68例,达格列净组纳入66例。阿卡波糖组给予阿卡波糖片,达格列净组给予达格列净片,2组均治疗并随访1年。比较2组治疗前及治疗1年后体质量、BMI、腰围、臀围、收缩压、舒张压、血糖、血钙、血磷、估算肾小球滤过率(eGFR)、骨代谢指标、骨密度、不良反应。结果治疗1年后,达格列净组腰围低于治疗前,且达格列净组腰围、舒张压低于阿卡波糖组(P<0.05或P<0.01);2组空腹血糖、餐后2 h血糖、糖化血红蛋白低于治疗前(P<0.01);达格列净组eGFR、血清骨碱性磷酸酶水平高于治疗前及阿卡波糖组(P<0.05或P<0.01);2组腰椎、股骨颈、髋关节骨密度比较,差异无统计学意义(P>0.05)。达格列净组不良反应总发生率高于阿卡波糖组(12.12%vs.1.47%,χ^(2)=4.483,P=0.034)。结论达格列净与阿卡波糖治疗2型糖尿病伴骨量减少均可有效降低血糖,但达格列净可改善患者骨代谢,对骨密度的影响较小,但不良反应较多。

血清性激素及甲状腺激素水平与绝经期女性2型糖尿病患者骨密度、骨质疏松或骨量减少的相关性研究

目的 研究绝经后女性2型糖尿病(T2DM)患者血清性激素、甲状腺相关激素与骨密度和骨质疏松或骨量减少风险间的相关性。方法 回顾性将2019年3月至2022年3月安徽省安庆市第一人民医院收治的100例绝经后女性T2DM患者纳入本次研究。采用双能X线骨密度仪测定腰椎(L_(1-4))、股骨颈和全髋部的骨密度T值,将3个部位骨密度最小T值>-1.0的患者设为正常骨密度组(n=22),T值≤-1.0为骨量减少,T值≤-2.5为骨质疏松,纳入骨质疏松或骨量减少组(n=78)。检测并比较两组患者性激素[血清雌二醇、黄体生成素(LH)、卵泡刺激素(FSH)、孕酮、总睾酮、催乳素]、甲状腺相关激素[促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、总三碘甲状腺原氨酸(TT3)和总甲状腺素(TT4)]、骨密度T值(L_(1-4)、股骨颈、全髋关节)及3个部位的最小骨密度T值、骨折风险评估工具(FRAX)的主要部位骨折的概率(MOF)评分及FRAX髋部骨折的概率(HF)评分。采用多变量线性回归和Logistic回归分析绝经后女性T2DM患者的雌二醇、TSH与L_(1-4)、股骨颈、全髋关节骨密度T值及3个部位最小T值、FRAX MOF和FRAX HF评分的相关性。结果 骨质疏松/骨量减少组的血清雌二醇、TSH分别为(18.45±6.09) pmol/L和(2.09±0.44) mU/L,均显著低于正常骨密度组[(23.95±6.85) pmol/L和(2.77±0.514) mU/L],差异均有统计学意义(P<0.05);两组其他性激素和甲状腺相关激素差异均无统计学意义(P>0.05)。骨质疏松或骨量减少组的腰椎L2-4、股骨颈、全髋关节骨密度T值及3个部位的最小骨密度T值分别为-3.25±0.75、-2.85±0.70、-2.48±0.61、-2.14±0.62,均显著低于正常骨密度组(-0.06±0.62、-0.12±0.51、0.15±0.51、-0.49±0.26),FRAX MOF评分及FRAX HF评分分别为(4.47±2.10)、(1.50±1.23)分,均显著高于正常骨密度组[(2.28±0.51)、(0.20±0.15)分],差异均有统计学意义(P<0.05)。多变量线性回归和Logistic回归分析显示,血清雌二醇、TSH与腰椎L_(1-4)和3个部位的骨密度T值呈正相关(P<0.05),与FRAX MOF和FRAX HF评分呈负相关(P<0.05)。结论 绝经后女性T2DM患者骨质疏松/骨量减少的患病率较高,其血清雌二醇、TSH较正常骨密度患者显著降低,雌二醇、TSH与骨密度T值、FRAX评分及骨质疏松或骨量减少的风险显著相关。

系统性硬化症并发骨质疏松患者的临床特征及危险因素分析

目的探讨系统性硬化症(systemic sclerosis,SSc)患者并发骨质疏松的发生率及其临床特征及相关危险因素。方法收集2021年1月至2022年4月就诊的SSc患者临床资料48例,回顾性分析患者一般情况、临床特征、骨密度及治疗史等,采用SPSS 23.0统计软件进行统计学分析。结果48例SSc患者中有16例(33.3%)患者存在骨质疏松,17例(35.4%)患者存在骨量减少。腰椎、股骨颈及髋部骨质疏松或骨量减少的发生率差异无统计学意义(P>0.05)。高龄是SSc患者并发骨质疏松的独立危险因素。SSc患者中仅有10.4%接受抗骨质疏松药物治疗。结论SSc患者合并骨质疏松发生率高,高龄是SSc发生骨质疏松的危险因素。SSc患者骨质疏松的预防、筛查及治疗值得临床医生进一步重视。

影响男性2型糖尿病中老年患者骨量减少的因素分析

目的探讨影响男性2型糖尿病(T2DM)中老年患者骨量减少的因素。方法选取2022年4月1日至2023年4月1日湖州市第一人民医院内分泌科住院治疗的268例男性T2DM中老年患者。收集患者年龄、糖尿病病程、吸烟史和饮酒史等基本资料;同时检测患者的血液生化免疫指标,包括糖化血红蛋白(HbA1c)、血肌酐(Scr)、同型半胱氨酸(Hcy)、降钙素(CT)和β-胶原特殊序列(β-CTx)等。通过双能X线吸收仪对所有患者进行骨密度检测,根据检测结果将患者分为骨量正常组和骨量减少组,比较两组患者的一般情况和检测指标,采用二元logistic回归分析影响男性T2DM中老年患者骨量减少的危险因素。结果骨量正常组167例,骨量减少组101例。与骨量正常组比较,骨量减少组患者年龄更大,β-CTx和Hcy水平较高,BMI较低(均P<0.05)。二元logistic回归分析结果显示高年龄、高β-CTx水平、低BMI为男性T2DM中老年患者骨量减少的危险因素(均P<0.05)。结论男性T2DM中老年患者骨量减少与其年龄、BMI、β-CTx、Hcy相关,高年龄、高β-CTx水平、低BMI为男性T2DM中老年患者骨量减少的危险因素。

急性骨丢失与骨质疏松症的关系研究进展

急性骨丢失是指当患者因病情需要制动数日,甚至更长时间,而出现的局部和全身骨量快速降低的现象。临床上常因其发展隐匿、表现不明显、医师重视程度不足而缺乏早期干预,最终导致骨质疏松症、脆性骨折等并发症。急性骨丢失的发生、发展与骨质疏松症关系密切,该文旨在探讨急性骨丢失与骨质疏松症之间的关系,提高临床医师对急性骨丢失现象的重视程度,倡导急性骨丢失的早期防治,从而提高患者的生存质量,节省医疗资源。

男性骨密度变化的相关影响因素分析

目的探讨中老年男性骨密度(BMD)变化的影响因素。方法回顾性分析2020年1月至2021年12月于张家界市人民医院就诊的1606名体检者的临床资料,其中中老年男性803例,收集患者年龄、体重指数(BMI)、血压等数据,测量血常规、肝功能、肾功能、糖化血红蛋白A1c(HbA1c)、血脂等生化指标,采用双能X线骨密度仪测量检测BMD,根据BMD水平分为骨量正常组(n=251)与骨量减少组(n=552)。比较两组临床资料及生化指标,采用Pearson相关性分析分析骨量减少与各指标的相关性,采用单因素及多因素Logistic回归分析骨量减少的影响因素。结果骨量正常组年龄低于骨量减少组,收缩压(SBP)、血尿素(UREA)、高密度脂蛋白胆固醇(HDL-C)、HbA1c水平均低于骨量减少组,谷氨酰转氨酶(GGT)、尿酸(UA)、甘油三酯(TG)、血红蛋白(Hb)水平均高于骨量减少组,差异有统计学意义(P<0.05)。Pearson相关性分析结果显示,骨量减少与年龄、SBP、UREA、HDL、HbA1c呈正相关(r>0,P<0.05),与GGT、UA、TG、Hb呈负相关(r<0,P<0.05)。多因素Logistic回归分析结果显示,年龄增长与低UREA水平是骨量减少的独立危险因素(P<0.05)。结论男性随年龄的增长骨量呈减少趋势,年龄、UREA水平是男性发生骨质疏松的独立危险因素。

Burden of bone disease in chronic pancreatitis:A systematic review and meta-analysis

BACKGROUND Bone disease is an under-recognized cause of morbidity in chronic pancreatitis(CP).Over the past decade,publications of original studies on bone disease in CP has warranted synthesis of the evidence to ascertain the true burden of the problem.AIM To quantify the prevalence of osteopenia,osteoporosis,and fragility fractures in CP patients and investigate the associated clinical features and outcomes.METHODS A systematic search identified studies investigating bone disease in CP patients from Cochrane Library,Embase,Google Scholar,Ovid Medline,PubMed,Scopus,and Web of Science,from inception until October 2022.The outcomes included prevalence of osteopenia,osteoporosis,and fragility fractures,which were metaanalyzed using a random-effects model and underwent metaregression to delineate association with baseline clinical features.RESULTS Twenty-one studies were included for systematic review and 18 studies were included for meta-analysis.The pooled prevalence of osteopenia and osteoporosis in CP patients was 41.2%(95%CI:35.2%-47.3%)and 20.9%(95%CI:14.9%-27.6%),respectively.The pooled prevalence of fragility fractures described among CP was 5.9%(95%CI:3.9%-8.4%).Metaregression revealed significant association of pancreatic enzyme replacement therapy(PERT)use with prevalence of osteoporosis[coefficient:1.7(95%CI:0.6-2.8);P<0.0001].We observed no associations with mean age,sex distribution,body mass index,alcohol or smoking exposure,diabetes with prevalence of osteopenia,osteoporosis or fragility fractures.Paucity of data on systemic inflammation,CP severity,and bone mineralization parameters precluded a formal metaanalysis.CONCLUSION This meta-analysis confirms significant bone disease in patients with CP.Other than PERT use,we observed no patient or study-specific factor to be significantly associated with CP-related bone disease.Further studies are needed to identify confounders,at-risk population,and to understand the mechanisms of CP-related bone disease and the implications of treatment response.

成年男性骨质疏松和骨量减少与心血管疾病危险因素的关系

目的探究成年男性骨质疏松和骨量减少与心血管疾病危险因素的关系,提高对成年男性人群骨质疏松症的重视。方法选取2018年12月至2021年12月于本院体检科进行骨密度检测的284例成年男性(18~60岁),根据骨密度检测结果分为骨量正常组(190例)和骨量异常组(94例,包括骨量减少和骨质疏松),收集心血管疾病危险因素指标(年龄、BMI、高血压、空腹血糖、同型半胱氨酸、血脂、血尿酸、脂肪肝、吸烟史、饮酒史等),分析其相关性。结果本院体检的成年男性骨量异常的检出率为33.10%,其中骨量减少的检出率(29.58%)高于骨质疏松(3.52%)。骨量异常组肥胖的比例显著低于骨量正常组;骨量异常组的年龄、空腹血糖、同型半胱氨酸、总胆固醇水平以及合并高血压的比例均高于骨量正常组;两组脂肪肝、吸烟史、饮酒史、血尿酸、甘油三酯、高密度脂蛋白和低密度脂蛋白比较,差异均无统计学意义(P>0.05)。结论体检的成年男性中,骨密度水平与多种心血管疾病危险因素(年龄、BMI、高血压、空腹血糖、同型半胱氨酸、总胆固醇)相关,应及早重视,针对性预防成年男性骨质疏松与心血管疾病的发生。

老年慢性肾病患者血清25-羟基维生素D水平与骨量减低相关性研究

目的 探讨老年慢性肾病(CKD)患者血清25-羟基维生素D[25(OH)D]水平与骨量减低相关性。方法 基于美国国家健康与营养检查调查(NHANES)数据,以年龄≥60岁参与者为研究对象。应用加权Logistic回归,通过调整可能的混杂因素(年龄、性别、种族、体质量指数、休闲运动、吸烟、血糖、总胆固醇、甘油三酯、高血压、糖尿病、心血管疾病),分析25(OH)D水平与骨量减低的相关风险,以及CKD对这种相关关系的修饰效应。结果 最终6 851例参与者纳入研究,CKD患者1 502例,非CKD患者5 349例。CKD患者骨量减低患病率高于非CKD患者,差异有统计学意义(P<0.05)。与25(OH)D缺乏组(水平<50 nmol/L)比较,25(OH)D不足组(50~75 nmol/L)和25(OH)D充足组(水平≥75 nmol/L)均与较低的骨量减低率相关(OR=0.82,95%可信区间:0.69~0.97;OR=0.81,95%可信区间:0.68~0.98),这种相关性在CKD组和非CKD人群同样适用,交互作用P值为0.292。结论 与非CKD老年患者相比较,合并CKD老年患者骨量减低发生率更普遍。较高25(OH)D水平与较低的骨量减低发生率相关。

骨质疏松高危人群的患病现状及其影响因素分析

目的研究中老年人骨质疏松高危人群的患病现状及其相关影响因素,为预防骨质疏松症的发生提供理论依据。方法将行骨密度检查的850例体检人员作为调查对象,根据骨密度值将调查对象分骨量减少组296例和骨量正常组554例,采用双能X线骨密度仪测定调查对象的正位脊柱L1-L4骨密度值,应用自行设计的骨量减少调查问卷收集调查对象的一般资料、生活习惯、既往病史、家族史、日光照射时间、运动时间及睡眠情况等。通过描述性分析、单因素及多因素Logistic回归分析调查对象的骨量减少患病现状及其相关影响因素。结果骨质疏松高危人群中骨量减少患病率为34.8%,其中男性患病率为31.6%,女性为38.9%,,各年龄段以55~65岁患病率最高,占骨量减少总人数的40%。体重指数与骨量减少患病率呈负相关,体重指数越小,骨量减少患病率越高,体重指数偏低者患病率高达80%。单因素分析显示,年龄、体重指数、家族史、喝牛奶、久坐、运动、日光照射、睡眠时间与骨量减少有关,P<0.05;多因素Logistic回归分析显示,体重指数、家族史、喝牛奶、运动、睡眠时间与骨量减少密切相关(P<0.05)。结论中老年人骨量减少患病率高,且女性明显高于男性。家族史是骨量减少的独立危险因素,喝牛奶、体重指数大、多参与运动和充足睡眠可有效降低骨量减少的发生。

围绝经期及绝经后女性血红蛋白和血脂与骨质疏松的相关性

目的 研究围绝经期及绝经后女性体内血红蛋白和血脂水平(TG、LDL-c、HDL-c)与骨质疏松症的关系。方法 选取2016年1月至2020年1月在淄博市市级机关医院老年医学科住院的围绝经期及绝经后患者68例,按照骨密度检测结果分为骨质疏松组、骨量减少组、正常组;用方差分析和非参数检验分析的方法比较各组之间的差异。结果 骨量减少组的平均血红蛋白水平最高,骨质疏松组次之,正常组最低;骨量减少组与正常组和骨质疏松组之间的血红蛋白水平均存在显著差异(P<0.05);但正常组和骨质疏松组之间的平均血红蛋白水平不存在显著性差异(P>0.05)。血脂指标比较中,甘油三酯(TG)具有最大的组间差异性(P<0.01);其中骨量减少组的甘油三酯水平最高,其次是骨质疏松组,正常组最低。经非参数检验分析,正常组的甘油三酯水平与骨量减少组和骨质疏松组相比,仍然具有非常明显的显著性差异。甘油三酯低密度脂蛋白胆固醇(LDL-c)和高密度脂蛋白胆固醇(HDL-c)均没有明显的组间差异。结论 血红蛋白水平可能与骨质疏松相关,但呈双向作用,对围绝经期及绝经后女性人群来说,过高的血红蛋白水平所带来的铁负载增高,可能会增加骨质疏松症的发生。人体血脂水平对骨质疏松也有影响,本研究发现主要是甘油三酯的水平与骨质疏松呈明显的正相关,但没有发现低密度脂蛋白胆固醇和高密度脂蛋白胆固醇水平的高低对骨质疏松有明显的影响。

肌少—骨质疏松症研究现状及展望

骨质疏松症和肌少症作为增龄性骨骼肌肉疾病,与一系列不良身体和代谢结果相关,两者共存将形成肌少-骨质疏松症,有学者称之为21世纪的老年病巨头。肌少-骨质疏松症是一种多因素、多病因的进行性疾病,其病理生理机制可能与衰老导致的遗传、机械、内分泌紊乱相关,出现肌肉或骨骼问题的患者均应进行全面的筛查与评估以及早进行运动锻炼、营养支持、药物治疗等干预,以降低共病状态下的众多负面影响。目前对于肌少-骨质疏松症研究才刚刚起步,对新的综合征的认识还需更多探索和思考,“肌为骨用、肌骨并重”应是肌肉骨骼疾病研究和发展的重要思路。

改良Dixon(mDixon)定量法对异常骨密度和骨质疏松症的预测价值

目的探讨改良Dixon(mDixon)定量法对异常骨密度(bone mineral density,BMD)和骨质疏松症的预测价值。方法自2021年1月~6月纳入本市18~75岁的281例受试者作为研究对象,均行定量计算机断层扫描(quantitative computed tomography,QCT)和mDixon检查,采用Spearman相关分析mDixon检测骨髓脂肪分数(bone marrow fat fraction,BMFF)与BMD的相关性,采用偏相关平衡影响因素;以QCT为金标准,绘制BMFF预测骨质疏松和骨量减少的ROC曲线。结果正常骨量组、骨量减少组和骨质疏松组受试者的年龄、BMD、BMFF差异存在显著性(P<0.05);BMI的组间差异无统计学意义(P>0.05)。进一步两两比较显示,骨量减少组的年龄和BMFF高于正常骨量组(P<0.05),BMD低于正常骨量组(P<0.05);骨质疏松组的年龄和BMFF高于骨量减少组和骨量正常组(P<0.05),BMD低于正常骨量组和骨量减少组(P<0.05)。椎体BMFF和BMD之间存在强负相关(r=-0.817,P<0.001),在控制了年龄、性别、BMI后,相关性仍具有统计学意义(r=-0.604,P<0.001);BMFF与年龄呈正相关(r=0.610,P<0.001),偏相关分析显示,BMFF与BMI或性别不存在相关性(r=0.135、0.149,P=0.280、0.218)。BMD与年龄呈显著负相关(r=-0.715,P<0.001),但与性别和BMI无相关性(r=0.072和0.054,P=0.394和0.641)。ROC结果显示,BMFF对骨量异常和骨质疏松诊断的AUC均为>0.9。结论mDixon在骨质量预测中具有较高的应用价值,有望用于骨量异常的筛查。