老年女性服用复方钙剂与骨代谢标志物和骨密度的关系

目的调查老年女性服用维生素D和复方钙剂（简称复方钙剂）与骨转换标志物、骨密度的关系。方法对286例老年女性服用复方钙剂的情况进行调查，并接受骨代谢标志物[包括I型胶原羧基端肽B特殊序列（CTX）、总I型胶原氨基瑞前肽（P1NP）和骨钙素（OC）、25-羟基维生素D3[25（oH）D]和甲状旁腺激素（PTH）]和骨密度（包括髋部和腰椎）的检测，然后分析服用复方钙剂与骨代谢标志物、骨密度的关系。结果与不服用复方钙剂组相比，服用组老年女性血清CTX、P1NP和OC水平较低（P均〈0．01），血清25（0H）D、总髋部和腰椎1—4骨密度较高（P均〈0．05），而在血清PTH和股骨颈骨密度上两组之间差异无统计学意义（P〉0．05）。结论老年女性坚持服用复方钙剂有助于降低其骨转换水平，提高血清25（OH）D水平，维持其总髋部和腰椎1—4的骨密度。

生骨胶囊对大鼠骨折模型的影响研究

目的:研究生骨胶囊对骨折的治疗作用,并对其作用机理作初步探讨。方法:在大鼠股骨中下段1/3交界处造成其骨折,连续给药,分别于给药后10、20及30天测定骨折处矿物密度,病理组织学分析骨折部位修复组织软骨化及骨化的程度,同时研究其血小板、血浆黏度等血液流变学指标。结果:连续给予生骨胶囊10、20及30天后,生骨胶囊组的骨密度增加,与模型组比较有显著性差异;病理组织学结果显示,损伤后骨组织于10、20及30天给药组的组织学形态都有所增生修复,并且骨化程度较好;给药后生骨胶囊可以抑制血小板的聚集性,对全血黏度及血浆黏度无影响。结论生骨胶囊可以加快骨矿沉积速率,提高骨密度,促进大鼠骨损伤的愈合。

1,25-二羟基维生素D3治疗脊髓损伤并发慢性骨质疏松的疗效

目的探讨1,25-二羟基维生素D3治疗脊髓损伤并发慢性骨质疏松的疗效。方法将44例因脊髓损伤而长期瘫痪的患者分为治疗组和对照组,各22例,治疗组按照4 g/d口服1,25-V D3治疗,对照组口服相同剂量安慰剂。在治疗前及治疗后6、12、18和24个月,分别对患者进行骨密度、血清骨钙素和Ⅰ型胶原N末端肽检测。结果治疗6、12、18及24个月后,治疗组骨密度值均较对照组高(均<0.05)。血清中Ⅰ型胶原N末端肽的水平就明显低于对照组(均<0.05),血清中骨钙素水平高于对照组(均<0.05)。结论 1,25-二羟基维生素D3对脊髓损伤的慢性骨质疏松具有治疗作用。

Bone mineral density and disorders of mineral metabolism in chronic liver disease

AIM： To estimate the prevalence and identify the risk factors for metabolic bone disease in patients with cirrhosis. METHODS： The study was performed on 72 Indian patients with cirrhosis （63 male, 9 female; aged 〈 50 years）. Etiology of cirrhosis was alcoholism （n = 37）, hepatitis B （n = 25） and hepatitis C （n = 10）. Twenty-three patients belonged to Child class A, while 39 were in class B and 10 in class C. Secondary causes for metabolic bone disease and osteoporosis were ruled out. Sunlight exposure, physical activity and dietary constituents were calculated. Complete metabolic profiles were derived, and bone mineral density （BMD） was measured using dual energy X ray absorptiometry. Low BMD was defined as a Z score below -2. RESULTS： Low BMD was found in 68% of patients. Lumbar spine was the most frequently and severely affected site. Risk factors for low BMD included low physical activity, decreased sunlight exposure, and low lean body mass. Calcium intake was adequate, with unfavorable calcium： protein ratio and calcium： phosphorus ratio. Vitamin D deficiency was highly prevalent （92%）. There was a high incidence of hypogonadism （41%）. Serum estradiol level was elevated significantly in patients with normal BMD. Insulin-like growth factor （IGF） 1 and IGF binding protein 3 levels were below the age-related normal range in both groups. IGF-1 was significantly lower in patients with low BMD. Serum osteocalcin level was low （68%） and urinary deoxypyridinoline to creatinine ratio was high （79%）, which demonstrated low bone formation with high resorption. CONCLUSION： Patients with cirrhosis have low BMD. Contributory factors are reduced physical activity, low lean body mass, vitamin D deficiency and hypogonadism and low IGF-1 level.

Mutifactorial analysis of risk factors for reduced bone mineral density in patients with Crohn’s disease

AIM: To determine the prevalence of osteoporosis in a cohort of patients with Crohn’s disease (CD) and to identify the relative significance of risk factors for osteoporosis. METHODS: Two hundred and fifty-eight unselected patients (92 M, 166 F) with CD were studied. Bone mineral density (BMD) was measured at the lumbar spine and hip by dual X-ray absorptiometry. Bone formation was assessed by measuring bone specific alkaline phosphatase (BSAP) and bone resorption by measuring urinary excretion of deoxypyridinoline (DPD) and N-telopeptide (NTX). RESULTS: Between 11.6%-13.6% patients were osteoporotic (T score < -2.5) at the lumbar spine and/or hip. NTX levels were significantly higher in the patients with osteoporosis (P < 0.05) but BSAP and DPD levels were not significantly different. Independent risk factors for osteoporosis at either the lumbar spine or hip were a low body mass index (P < 0.001), increasing corticosteroid use (P < 0.005), and male sex (P < 0.01). These factors combined accounted for 23% and 37% of the reduction in BMD at the lumbar spine and hip respectively. CONCLUSION: Our results confirm that osteoporosis is common in patients with CD and suggest that increased bone resorption is the mechanism responsible for thebone loss. However, less than half of the reduction in BMD can be attributed to risk factors such as corticosteroid use and low BMI and therefore remains unexplained.

Effect of proximal femoral osteoporosis on cementless hip arthroplasty: A short-term clinical analysis

Objective： The aim of this retrospective investigation was to explore the influence of femoral osteoporosis on short-term curative effects ofcementless hip arthroplasty and to evaluate the femoral metaphyseal bone mineral density （BMD） for femoral osteoporosis in order to guide prosthesis choice and rehabilitation. Methods： We performed 127 total arthroplasty operations between June 1999 to February 2003 and investigated 49 cementless hip replacements with the Metalcancellous cementless Lubeck Ⅱ system being used in all hips. There were twenty men and twenty-nine women whose mean age at the time of the operation was 60 years （range, 52-81 years）. The patients were divided into osteoporosis or normal groups according to the femoral metaphyseal BMD measured preoperatively. The average duration of follow-up was 30 months （range, 8-52 months）. We evaluated all of the patients from a clinical standpoint with use of a standard-terminology questionnaire with respect to the short-term curative effects and patients＇ satisfaction. Hip pain status and functional ability were important indicators of treatment efficacy. Results： Harris hip score and patients＇ satisfaction in femoral osteoporosis patients who underwent noncemented hip arthroplasty were lower （P=0.004, P=0.03） while the incidence of thigh pain was higher （P=0.03） than the patients with non-osteoporosis. Conclusion： The higher incidence of pain, as well as the decrease in function experienced by the patients in osteoporosis group, supports the case that cementless arthroplasty is not a better choice for those patients and that we had better select prosthesis based on the femoral metaphyseal BMD.

Height and weight are correlated with lumbar spinal bone mineral contents and densities in Chinese adolescents with early ankylosing spondylitis

Objective: To explore the possible factors influencing lumbar spinal bone mineral contents and bone mineral densities in Chinese adolescents with early ankylosing spondylitis(AS). Methods: Thirty-one male Chinese adolescent outpatients with early AS were included and compared with 31 age-matched male controls. Age (year), height (cm), total body weight (kg) together with body mass index (BMI, kg/m 2) of all subjects and disease duration (month), BASMI, BASFI, BASDAI, SASSS as well as ESR (mm/h) of AS patients were obtained. Lumbar 2-4 bone mineral content (L 2-4BMC, g) and lumbar 2-4 areal bone mineral density (L 2-4 BMD, g/cm 2) were evaluated using dual-energy X-ray absorptiometry (DEXA) with Lunar DPX-IQ device and lumbar 2-4 volumetric bone mineral apparent density (L 2-4 BMAD, g/cm 3) was subsequently calculated. Correlation and multiple regression analyses were performed. Results: Compared with 31 age-matched male controls, AS patients had significantly lower L 2-4BMD [(0.984±0.142) g/cm 2 vs (1.055±0.137) g/cm 2, P=0.049] and L 2-4BMAD [(0.1527±0.0173) g/cm 3 vs (0.1630±0.0195) g/cm 3, P=0.032]. In AS patients, multiple regression analysis identified that only the factor of height was significantly correlated with L 2-4BMC (R=0.673, P=0.000) and the factor of weight had predominant influences on L 2-4BMD (R=0.620, P=0.000) as well as L 2-4BMAD (R=0.510, P=0.003). Conclusion: The young patients with early AS had marked reduction in lumbar spine bone mineral densities, which indicated an important primary event leading to osteoporosis. Positive effects of height and weight on lumbar spine bone mass and densities could expectantly make favorable contributions to early prevention of AS associated bone loss and subsequent osteoporosis.

Skeletal events of Anastrozole versus Tamoxifen on bone mineral density and bone biomarker osteocalcin in postmenopausal women with early breast cancer

Objective： Postmenopausal women with breast cancer are at increased risk of bone loss because of age related estrogen deficiency face which accelerated with the use of aromatase inhibitors （AIs）. We aimed to study the effect on bone mineral density （BMD） and bone formation biomarker osteocalcin level in postmenopausal breast cancer patients, for the first three years of adjuvant hormonal treatment of both groups Tamoxifen versus Anastrozol. Methods： One-hundered postmenopausal breast cancers were prospectively randomized to receive either Tamoxifen 20 rag/day （n = 50） or Anastrozole 10 mg （n = 50）. Both BMD and osteocalcin were assessed initially before treatment and then at regular intervals for both groups. Results： Use of Tamoxifen was associated with significant annual decrease in osteocalcin （P = 0.001）, whereas Anastrozole group had gradual increase of the annual levels （P 〈 0.01）. BMD decreased significantly in Anastrozole versus Tamoxifen groups （2.6% vs. 0.4%, P 〈 0.001）. Osteoporosis T 〈 -2.5 was reported significantly higher in Anastrozole group （P 〈 0.01）. Women with initial osteopenia in Anastrozole group showed significant decrease in BMD （P 〈 0.05）. The addition of bisphosphonate for patients with early osteoporosis markedly improved both osteocalcin level and BMD. Conclusion： Tamoxifen preserves BMD in postmenopausal breast cancer patients, whereas Anastrozole accelerates age associated fall in BMD especially in the first year of therapy, moreover, the addition of bisphosphonate can help to decrease the skeletal related events associated with treatment to ensure better quality of life with treatment.

VITAMIN-D RECEPTOR GENE POLYMORPHISM AND ITS RELATIONSHIP WITH BONE MINERAL DENSITY IN POSTMENOPAUSAL OSTEOPOROTIC WOMEN IN SHANGHAI

Objective To examine the relationship between the vitamin D receptor(VDR) gene polymorphism and osteoporosis in postmenopausal women in Shanghai. Methods 102 postmenopausal women recruited from Ruijin Hospital were osteoporotic. We measured the lumbar vertebrae and femur of all patients with a modal dual-energy X-ray absorptionmetry, and also the serum osteocalcin by ELISA. The VDR gene was amplified using a polymerase chain reaction (PCR). The VDR genotypes were determined by the PCR-RFLP. Results bb, aa and TT genotype were found mainly in these osteoporosis patients, only one BB and two tt were found among these patients. No significant association was observed among three subgroups of bb, Bb and BB. Conclusion The rareness of B and t alleles suggested that it is unlikely that they are important factors for the heredity of osteoporosis in Chinese women. Thus VDR gene typing may be of little value in assessing the osteoporosis risk in Chinese population.