绝经后骨质疏松合并骨折患者外周血清瘦素表达水平

目的观察绝经后骨质疏松（OP）合并骨折患者外周血瘦素表达水平。方法连续选择21例绝经后OP合并骨折患者（OP合并骨折组）、26例绝经后OP组和30例绝经后正常骨密度女性（对照组）,入选对象均在开始治疗前接受了腰椎骨质密度（BMD）、双侧股骨上端BMD、血清瘦素（LEP）、骨钙素（BGP）和碱性磷酸酶（AKP）等指标测定。结果 OP合并骨折组和OP组的血清LEP、BGP和AKP浓度均明显高于对照组,而OP合并骨折组上述3个骨代谢指标测定值也同时低于OP组（均P〈0.01~0.05）。OP合并骨折组和OP组的腰椎L1~L4和左、右股骨颈的BMD测定值均明显少于对照组,而OP合并骨折组上述3个部位BMD测定值也同时低于OP组（均P〈0.01~0.05）。结论绝经后OP合并骨折患者存在明确外周血LEP高水平表达。

BONE MASS, RATES OF OSTEOPOROTIC FRACTURES, AND PREVENTION OF FRACTURES: ARE THERE DIFFERENCES BETWEEN CHINA AND WESTERN COUNTRIES?

Fractures are one of the most common causes of disability in older women. The quantity and density of bone decreases with age. Most types of fractures increase as bone density declines. But most of the knowledge about causes and prevention of fractures comes from studies performed in Western countries. Asian women appear to have similar or slightly lower bone density that may be a result of their smaller size. They appear to have a lower risk of hip fracture than Whites, which may be a result of their shorter hip axis. The risks of other types of fractures in Chinese women is less well defined and reasons for differences in the rates of osteoporotic fractures between China and Western countries remain to be explored. A study is underway in Beijing to describe the risks and potential causes of fractures among older women in urban China. Randomized trials in Western countries have demonstrated that calcium and vitamin D, estrogen, calcitonin,or bisphosphonates can reduce the rate of fractures. Increased intake of calcium and vitamin D may be the most effective approach to preventing fractures in China, but this should be tested in a randomized trial.

SENILE OSTEOPOROSIS AND HIP FRACTURE

A randomized block design was used to compare the Singh index, the cortical index of the femoral neck and the lateral cortical width of the femur of a group of patients with femoral neck fracture, a group with intertrochanteric fracture, and a normal control group among a total of 102 postmenopausal women.The three indices in fracture group were very significantly (P<0.01) or significantly (P<0.05) different from those in the normal control subjects. The importance of osteoporosis in hip fracture of the aged is con firmed. Radiographic measurement of bone mass was found to have some predictive value for the risk of hip fracture.

AN ULTRASTRUCTURE INVESTIGATION OF OSTEOPORO-SIS FRACTURE HEALING IN OVARIECTOMIZED RAT

Objective To elucidate the influence of osteoporosis on the fracture healing in ovariectomized rat. Methods 24 females 8-month-old SD rats were divided randomly into two groups.12 were sham-operated(Sham)and 12 were bilaterally ovariectomized(OVX) 3 months later.The femoral fracture model were made in both groups,the healing process was observed by transmission electron microscopy(TEM) on d3,d7,d14,d21,d28,and d42 after making fracture in control groups(Sham) and the osteoporosis group(OVX). Results According to the TEM findings,the types of fracture healing cells,their ultrastructure changes and functional states were almost identical in both groups till d21 after making fracture.In OVX group,the calcified cartilage was not resorbed and replaced by new woven bone,a lot of necrosis chondrocytes were found being embedded in a calcified chondroid matrix on d28;after this period,osteoclastic bone resorption become severe gra- dually accompanied by osteocytic osteolysis during d28 to d42 of fracture healing. Conclusion Osteoporosis greatly affect the fracture healing in the later period of healing proess.It demonstrated as endochondral bone formation delayed and increased osteoclastic bone resorption which was made even more severed by osteocytic osteolysis during the period of bone callus remodelling.

Effect of dynamic hip system blade on the treatment of femoral neck fractures in elderly patients with osteoporosis

Objective：To discuss the curative effect of the dynamic hip system blade （DHS-blade） on the treatment of femoral neck fractures in elderly patients with osteoporosis.Methods：A retrospective study was conducted to analyse the clinical data of 60 elderly patients with osteoporosis who had been treated for femoral neck fractures with DHS-blade in our department between September 2012 and February 2014.There were 22 males and 38 females with a mean age of （66.8±3.2） years.According to the Singh Index Classification,all the patients＇ Singh index was below level 3.The Harris criterion and function recovery after operation were analysed.Results：All patients were followed up for 12-17 months （mean 14 months）.No femoral head necrosis,femoral neck shortening,internal fixation loosening or backing out of the nails occurred.Bone nonunion was found in one case and he had a good recovery after total hip arthroplasty.The time for fracture healing ranged from 3-6 months （average 3.5 months）.According to Harris criterion,35 cases were rated as excellent,22 good,2 fair and 1 poor.The Harris scale was significantly improved from 28.46±2.35 preoperatively to 91.98±3.26 at 6 months postoperatively （P＜0.05）.Conclusion：DHS-blade,being minimally invasive,allowing earlier postoperative exercise and avoiding the complications elicited by traditional internal fixation,is advisable for treatment of femoral neck fractured patients with osteoporosis.

Effects of recombinant human growth hormone (r-hGH) on experimental osteoporotic fracture healing

Objective:: To observe the effect of recombinant human growth hormone (r-hGH) on osteoporotic fracture healing in rats, and to provide an effective therapy for osteoporotic fracture. Methods: Thirty-six female 8-month-old SD rats were randomized into two groups: therapy group and control group. After the experimental model of osteoporotic fracture was established, the therapy group was treated with r-hGH of 2.7 mg/kg body weigh/day (1 mg=3 IU) for 10 days continuously by daily subcutaneous injection; whereas the control group was treated with equivalent saline. Plasma insulin-like growth factor I concentration was detected and bone mineral density (BMD) as well as biomechanical strength of callus were measured at 2, 4, 8 weeks. Results: Plasma insulin-like growth factor I concentration in the therapy group was higher than that in the control group (P< 0.005 ) at 2nd week and began to decline at 4th week. At 8th week, there was no significant difference between the two groups. At 4th week, callus area and BMD in therapy group were higher than those in the control group, but at 8th week, they were lower and BMD had a significant difference between the two groups (P< 0.001 ). Biomechanical testing of callus showed that torsional strength of the therapy group was higher than that of the control group at 4th or 8th week, meanwhile maximum torsional angle had a significant difference between the two groups (P< 0.005 ).Conclusions: The results show that exogenous r-hGH can stimulate osteoporotic fracture healing in rats.

Warm needling moxibustion plus PKP for vertebral compression fracture due to kidney deficiency and blood stasis:a randomized controlled trial

Objective:To explore the efficacy and mechanism of warm needling moxibustion plus percutaneous kyphoplasty(PKP)for osteoporotic vertebral compression fracture(OVCF)due to kidney deficiency and blood stasis.Methods:A total of 70 OVCF patients were randomized into a control group and an observation group,with 35 cases in each group.The control group was given PKP treatment,and the observation group was treated with warm needling moxibustion on the basis of the treatment in the control group.The visual analog scale(VAS)and Oswestry disability index(ODI)were scored and the Cobb angle of fractured vertebrae was measured before and after treatment.The re-fracture rate of the adjacent vertebrae was recorded at 1-year follow-up.The serum levels of transforming growth factor(TGF)-β1 and omentin-1 were measured before and after treatment.Results:After treatment,the VAS and ODI scores in both groups decreased(all P<0.05),and all the scores in the observation group were lower than those in the control group(both P<0.05).After treatment,the Cobb angle of fractured vertebrae in both groups decreased(both P<0.05),and the Cobb angle in the observation group was smaller than that in the control group(P<0.05).At 1-year follow-up,the re-fracture rate of the adjacent vertebrae in the observation group was lower than that in the control group(P<0.05).After treatment,the serum levels of TGF-β1 and omentin-1 in both groups increased significantly(all P<0.05),and the serum levels of TGF-β1 and omentin-1 in the observation group were higher than those in the control group(both P<0.05).Conclusion:The treatment of warm needling moxibustion plus PKP can relieve pain,improve dysfunction,promote healing of the injured vertebrae,and reduce the re-fracture rate of the adjacent vertebrae in patients with OVCF due to kidney deficiency and blood stasis,which may be related to the increase of serum TGF-β1 and omentin-1 levels.

Early period of fracture healing in ovariectomized rats

Objective: To evaluate the effect of osteoporosis on fracture healing through observing the histomorphological changes, bone mineral density of callus and expression and distribution of transforming growth factor beta 1 (TGF β1),basic fibroblast growth factor (bFGF) and bone morphogenetic protein 2 (BMP 2) in ovariectomized rats. Methods: Sixty female Sprague Dawley rats (aged 12 weeks and weighing 235 g on average) were randomly divided into an ovariectomized (OVX) group (n=30) and a sham operated (SO) group (n=30). Ovariectomy was performed in the OVX rats and same incision was made in the SO rats. Three months later, fracture of femoral shaft was made on all the rats. Then they were killed at different time points. Callus formation was observed with histological and immunohistochemical methods. Results: A reduction in callus and bone mineral density in the healing femur and a decrease of osteoblasts expressing TGF β1 near the bone trabecula were observed in the OVX rats 3 4 weeks after fracture. Histomorphological analysis revealed a higher content of soft callus in the OVX rats than that in the SO rats. Immunohistochemistry results showed that no remarkable difference in expression and distribution of BMP 2 and bFGF between the OVX and SO groups was found. Conclusions: Osteoporosis influences the quantity and quality of callus during the early period of fracture healing. The effect of osteoporosis on fracture healing has no relationship with the expression of BMP 2 or bFGF. The decreased expression of TGF β1 in osteoblasts may cause a decrease in quality of facture healing after osteoporosis.

Analysis on the risk factors of second fracture in osteoporosis-related fractures

Objective： To explore the clinical characteristics and risk factors of refracture in patients suffering from osteoporosis-related fractures as well as effective interventions. Methods： From January 2006 to January 2008, both out-patients and in-patients in our hospital who were over 50 years old and suffered from osteoporosis-related fractures were selected for this research. They were divided into fracture group and refracture group. The refracture rate was followed up for 2 years, during which 11 patients developed refracture, thus were included in the refracture group. Therefore, 273 patients, 225 first-fracture cases, aged （67.7± 8.5） years, and 48 refracture cases, aged （72.7±9.5） years, were included in this study. General data including age and sex, fracture types, femoral neck bone mineral density （BMD） T-scores tested by dual-energy X-rays absorptiometry （DEXA）, Charlson index, time-frame between two fractures as well as mobility skill assessment were collected and analyzed by single-factor and multivariate statistical methods. Results： Females accounted for 70.2% of the fracture group and 77.1% of the refracture group. The most common refracture type was vertebral fracture for the first time and femoral neck fracture for the second time during the followup. The second fracture happened 3.7 years after the first one on average. The refracture rate was 2.12% within one year, and 4.66% within two years. Risk factors for a second fracture in osteoporotic fracture patients included age （〉75 years, HR=1.23, 95%CI 1.18-1.29; 〉85 years, HR=1.68, 95% CI 1.60-1.76）, female sex （HR=1.36, 95%CI 1.32-1.40）, prior vertebral fractures （HR= 1.62, 95%CI 1.01-2.07）, prior hip fractures （HR=1.27, 95%CI 0.89-2.42）, BMD T-score〈-3.5 （HR-1.38, 95%CI 1.17-1.72） and weakened motor skills （HR=1.27, 95%CI 1.09-1.40）. Conclusions： The risks of second fracture among patients with initial brittle fracture are substantial. There is adequate time between the first and second fractures for interventions to reduce the risks of refracture, especially for the old women with a vertebral or hip fracture. Medication, motor functional rehabilitation and fall-down prevention training are helpful.

Clinical study on abdominal acupuncture for osteoporotic vertebral compression fracture

Objective： To explore the efficacy of abdominal acupuncture in treating patients with osteoporotic vertebral compression fracture （OVCF）. Methods： Forty-five eligible OVCF patients were randomized into an abdominal acupuncture （AA） group, a body acupuncture （BA） group and a medication group according to the random numbers generated by the SPSS 22.5 version software, 15 subjects in each group. Patients in the medication group were intervened by Ossotide injection （intravenous injection）, Caltrate （oral administration）, Alfacalcidol （oral administration）, and Salcatonin injection （muscular injection）. In addition to the intervention given to the medication group, patients in the AA group additionally received acupuncture at Zhongwan （CV 22）, Xiawan （CV 20）, Qihai （CV 6）, Guanyuan （CV 4）, Shuifen （CV 9）, and Huaroumen （ST 24）; while patients in the BA group additionally received acupuncture at Jiaji （EX-B 2, superior and inferior to the affected area） points, Ashi points, Weizhong （BL 40） and Chengshan （BI. 57）. For the AA and BA groups, the acupuncture treatment was given once a day, 6 d per week, for 3 weeks in total. Prior to the intervention, and respectively after 1-week treatment, 2-week treatment and 3-week treatment, visual analogue scale （VAS） and Barthel index （BI） were adopted to evaluate pain degree and activities of daily living （ADL）. Results： After intervention, the VAS and BI scores were significantly changed in the three groups （P〈0.05）. Respectively after 2-week, 2-week and 3-week treatment, the VAS and BI scores in the two acupuncture groups were significantly different from those in the medication group at the same time point （P〈0.02）. After 2-week and 2-week treatment, the improvements of VAS and BI scores in the AA group were more significant than those in the BA group（P〈0.05）; after 3-week treatment, there was no significant difference in comparing the VAS score between the two acupuncture groups （P〉0.05）, but a significant difference was found in comparing the BI score （P〈0.05）. Conclusion： Abdominal acupuncture can produce a more significant effect in improving VAS and BI scores in OVCF patients than body acupuncture and pure medication treatment, and it＇s efficient and causes few sufferings.

Treatment of osteoporotic vertebral compressive fractures with percutaneous kyphoplasty and oral Zishengukang

OBJECTIVE:To observe the therapeutic effect of percutaneous kyphoplasty(PKP) and oral Zishengukang(ZSGK) for the treatment of osteoporotic vertebral compression fractures(OVCFs).METHODS:Seventy patients were randomly divided into a control group(PKP group) and an experimental group(PKP plus ZSGK group).The 35 patients in the experimental group were prescribed 6 g oral ZSGK three times a day for 90 days after PKP.Visual analog pain scale(VAS),Oswestry functional score,vertebral height and Cobb's angle were recorded and compared before treatment and at one week,one month and three months after treatment.RESULTS:Vertebral height and Cobb's angle significantly improved and VAS and Oswestry functional score were significantly lower in both groups after PKP than pre-operatively(P<0.01).Three months after treatment,VAS and Oswestry functional score in the experimental group were lower than controls(P<0.05),even though vertebral height and Cobb's angle were comparable(P>0.05).CONCLUSION:PKP combined with oral ZSGK provide superior short-term and long-term symptom control after OVCF than PKP alone.

Two kinds of posterior approach for Kummell＇s disease after osteoporotic thoracolumbar fracture

Objective： To compare the surgical results of two kinds of posterior approach for osteoporotic thoracolumbar Ktimmell＇s disease. Methods： Clinical and radiographic results of 1-segmental pedicle screw fixation combined with vertebroplasty （Group A, n=12） or posterior shortening osteotomy （Group B, n=16） for osteoporotic thoracolumbar Kummell＇s disease were analyzed retrospectively. Japanese orthopedic association （JOA） and visual analogue scale （VAS） scores were used for clinical evaluation. Neurological status was judged by Frankel grades. X-ray was used to evaluate the radiographic results. Complications related to operation and devices were also considered. Results： The follow-up period was 12-54 months （average 29 months）. Pre- and post-operative VAS were 9.3 and 3.2 in Group A, 8.9 and 2.5 in Group B, respectively. The mean JOA score at the final follow-up was significantly higher than that of pre-operation （t=-5.306, P〈0.001）. There was no significant difference between Groups A and B （t=0.618,P〉0.05）. The kyphosis were corrected from preoperative 33.9°（A）/ 37.3°（B） to postoperative 10.3°（A）/6.5°（B）, and 15.3° （A）/13.7°（B） at the final follow-up. There was a significant difference between the two groups at the final follow-up. Frankel grade was improved from grade C preoperatively to postoperatively grade D or E in 7 cases of Group A and 5 cases of Group B, from grade D to E in 5 cases of Group A and 11 cases of Group B. The mean improvement was 1.6 and 1.7 grades for Groups A and B, respectively. There were no serious complications related to internal fixation. Conclusions： The similar clinical results can be obtained by the two kinds of posterior surgical methods for osteoporotic Kummell＇s disease. Posterior spinal shortening is a better choice for patients with serious kyphosis combined with neurological deficit than the other.

Assessment of volumetric bone mineral density of the femoral neck in postmenopausal women with and without vertebral fractures using quantitative multi-slice CT

Objective： To demonstrate the validity and reliability of volumetric quantitative computed tomography （vQCT） with multi-slice computed tomography （MSCT） and dual energy X-ray absorptiometry （DXA） for hip bone mineral density （BMD） measurements, and to compare the differences between the two techniques in discriminating postmenopausal women with osteoporosis-related vertebral fractures from those without. Methods： Ninety subjects were enrolled and divided into three groups based on the BMD values of the lumbar spine and/or the femoral neck by DXA. Groups 1 and 2 consisted of postmenopausal women with BMD changes 〈-2SD, with and without radiographically confirmed vertebral fracture （n= 11 and 33, respectively）. Group 3 comprised normal controls with BMD changes 〉-ISD （n-46）. Post-MSCT （GE, LightSpeed16） scan reconstructed images of the abdominal-pelvic region, 1.25 mm thick per slice, were processed by OsteoCAD software to calculate the following parameters： volumetric BMD values of trabecular bone （TRAB）, cortical bone （CORT）, and integral bone （INTGL） of the left femoral neck, femoral neck axis length （NAL）, and minimum cross-section area （mCSA）. DXA BMD measurements of the lumbar spine （AP-SPINE） and the left femoral neck （NECK） also were performed for each subject. Results： The values of all seven parameters were significantly lower in subjects of Groups 1 and 2 than in normal postmenopausal women （P〈0.05, respectively）. Comparing Groups 1 and 2, 3D-TRAB and 3D-INTGL were significantly lower in postmenopausal women with vertebral fracture（s） [（109.8±9.61） and （243.3±33.0） mg/cm^3, respectively] than in those without [（148.9±7.47） and （285.4±17.8） mg/cm^3, respectively] （P〈0.05, respectively）, but no significant differences were evident in AP-SPINE or NECK BMD. Conclusion： the femoral neck-derived volumetric BMD parameters using vQCT appeared better than the DXA-derived ones in discriminating osteoporotic postmenopausal women with vertebral fractures from those without, vQCT might be useful to evaluate the effect of osteoporotic vertebral fracture status on changes in bone mass in the femoral neck.

Therapeutic observation on point-toward-point needling at points on the low back regions for residual back pain after percutaneous kyphoplasty

Objective: To observe the effect of point-toward-point needling at points on the low back regions on residual back pain after percutaneous kyphoplasty (PKP), thoracolumbar function and quality of life (QOL) in patients with osteoporotic vertebral compression fracture (OVCF). Methods: A total of 72 patie nts with OVCF and residual back pain after PKP were in eluded and allocated into a treatme nt group (n=36) and a control group (n=36) by the random number table. Cases in the control group received salmon calcitonin injection (miacalcic), for 1 mL each time, once a day, and oral intake of calcium carbonate D3 pill, 600 mg each time, once a day, whereas cases in the treatment group received point-toward-point needling at points on the low back regions and electroacupuneture (EA) for 30 min each time, once a day and 6 times a week on the basis of the treatment in the control group. Treatment in both groups lasted for 2 weeks. Therapeutic efficacy indicators including visual analog scale (VAS), Oswestry disability index (ODI) and Barthel index (Bl) were evaluated before and after treatment and at follow-up visit (1 month after treatment). Results: The total effective rate was 94.4% and 88.9% in the treatment group after treatment and at the follow-up visit, respectively, higher than 77.8% and 69.4% in the control group, and the between-group differences were statistically significant (both P<0.05). After treatment and at the follow-up visit, the VAS and ODI scores decreased, and Bl scores in creased in both groups, and the in tra-group differe nces were statistically sign ifica nt (all P<0.05). After treatme nt and at the follow-up visit, between-group differences of VAS, ODI and Bl scores were statistically significant (all P<0.05). Conclusion: On the basis of conventional medication treatment, point-toward-point needling at points on the low back regions has a good therapeutic effect in relieving residual back pain after PKR improving thoracolumbar function and QOL, better than conventional medication treatment alone.

Implant-induced microdamage in osteoporotic bone

With the increase of elderly population, more and more implant operations need to be performed in osteoporotic bone, while different forms of microdamage will be produced in peri-implant bone intraoperatively, including high- and low-density diffuse damages, as well as linear cracks. The length and location of the microcracks are the main factors in affecting the biomechanical performance of bone. Suppression of bone remodeling by bisphosphonates may lead to microdamage accumulation, which is often accompanied with the decrease of bonestrength and the increase of bone fragility. Microdamage can be repaired by bone remodeling or mineralization to maintain the strength and structural integrity. Both remodeling and mineralization can affect the bone quality and long-term implant stability, In this paper, we make a brief summary of some important issues and research progresses in this field.