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 mi...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.展开更多
The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of b...The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX<sup>®</sup> tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that are also applied to the patients with osteoporosis. Therefore, a reasonable advice is to consider pharmacological treatment for osteoporosis in those UC patients who already present fragility fractures, which bring a high risk of subsequent fractures. Therapy has also to be considered in patients with a high risk of fracture even if it did not yet happen, and particularly when they had long periods of corticosteroid therapy or cumulative high dosages. In patients without fragility fractures or steroid treatment, a medical decision about treatment could be guided by the FRAX tool to determine the intervention threshold. Among drugs for osteoporosis treatment, the bisphosphonates are the most studied ones, with the best and longest evidence of efficacy and safety. Despite this, several questions are still open, such as the duration of treatment, the necessity to discontinue it, the indication of therapy in young patients, particularly in those without previous fractures. Further, it has to be mentioned that a long-term bisphosphonates use in primary osteoporosis has been associated with an increased incidence of dramatic side-effects, even if uncommon, like osteonecrosis of the jaw and atypical sub-trochanteric and diaphyseal femoral fractures. UC is a long-lasting disease and the majority of patients is relatively young. In this scenario primary prevention of fragility fracture is the best cost-effective strategy. Vitamin D supplementation, adequate calcium intake, suitable physical activity (when possible), removing of risk factors for osteoporosis like smoking, and avoiding falling are the best medical acts.展开更多
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 m...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.展开更多
目的观察穴位贴敷疗法对绝经后骨质疏松患者骨代谢、髋部骨密度的影响,以评价其有效性和安全性。方法将符合要求的80例绝经后骨质疏松患者随机分为试验组及对照组,各40例。以6个月为一个疗程,共两个疗程。试验组予以外用中药穴位贴敷,...目的观察穴位贴敷疗法对绝经后骨质疏松患者骨代谢、髋部骨密度的影响,以评价其有效性和安全性。方法将符合要求的80例绝经后骨质疏松患者随机分为试验组及对照组,各40例。以6个月为一个疗程,共两个疗程。试验组予以外用中药穴位贴敷,内服钙尔奇D片和福善美片治疗,对照组仅予内服钙尔奇D片和福善美片治疗,疗程为12个月。比较2组治疗前、治疗后第6个月及第12个月血骨保护素(osteoprotegerin,OPG)、核因子-κB受体激活配体(receptor activator of nuclear factor-κB ligand,RANKL)含量、髋部骨密度(bone mineral density,BMD)及记录骨折发生情况,所得数据进行统计学分析。结果80例中75例获得完整随访,其中治疗组37例,对照组38例。(1)比较治疗前2组患者血OPG含量(t=1.43,P=0.157)、RANKL含量(t=-1.84,P=0.07),差异无统计学意义;试验组治疗6个月后血OPG含量(t=15.79,P<0.01)与治疗12个月后血OPG含量(t=21.68,P<0.01)均大于对照组;试验组治疗6个月后血RANKL含量测定(t=-0.35,P=0.726)与治疗12个月后血RANKL含量测定(t=-1.15,P=0.253)与对照组相比,差异无统计学意义。(2)治疗前2组患者髋部BMD比较,差异无统计学意义(t=0.26,P=0.791);治疗6个月后,2组患者的髋部BMD均增大,试验组BMD与对照组相比,差异无统计学意义(t=1.06,P=0.292);治疗12个月后,2组患者的髋部BMD仍继续增大,试验组BMD增加值大于对照组(t=2.22,P=0.029)。(3)试验中对照组共累计出现2例患者出现髋部骨折,而试验组只出现1例,经卡方检验,卡方值为0.320,P=0.572,差异无统计学意义,但骨折发生率的比较中,对照组(5.26%)略高于试验组(2.70%)。结论应用穴位贴敷疗法,能有效缓解疼痛、肌痉挛等症状;穴位贴敷使中药在局部发挥作用,加速髋部骨密度增加;提升OPG的血清含量,促进骨骼成骨作用,提高髋部骨量,从而达到防治骨质疏松性髋部骨折的目的。展开更多
目的了解老年骨质疏松患者髋部骨折术后骨转换生化标志物的变化规律,并比较骨代谢标志物在股骨颈骨折和股骨粗隆间骨折的异同。方法收集在北京积水潭医院老年髋部骨折病房住院的髋部骨折患者138例,其中女性106例,男性32例;股骨粗隆间骨...目的了解老年骨质疏松患者髋部骨折术后骨转换生化标志物的变化规律,并比较骨代谢标志物在股骨颈骨折和股骨粗隆间骨折的异同。方法收集在北京积水潭医院老年髋部骨折病房住院的髋部骨折患者138例,其中女性106例,男性32例;股骨粗隆间骨折68例,股骨颈骨折70例;明确骨折日期、手术日期,检测术前、术后血清碱性磷酸酶ALP(alkaline phosphatase,ALP)、1型前胶原氨基末端前肽(Npropeptide of type 1 collagen,P1NP)、1型胶原羧基末端肽交联(C-terminal crosslinking telopeptides of type 1 collagen,CTX)、25羟维生素D(25 hydroxy vitamine D,25OHD)水平以及骨密度(bone mineral density,BMD)。结果 (1)髋部骨折以女性居多;(2)骨折后1周内术前男性、女性之间,以及两种髋部骨折之间的骨代谢标志物均未见明显差异,骨折术后40~50 d骨代谢标志物均有明显上升;(3)股骨颈骨折人工股骨头置换术组和股骨粗隆间骨折髓内钉内固定组,术后40~50 d女性患者的P1NP上升约3倍,男性患者P1NP上升达到4倍左右;CTX及ALP上升幅度均在1.5倍左右;(4)在股骨颈骨折空心钉内固定组,P1NP上升约1.5倍,CTX变化不明显;(5)女性股骨颈骨折人工股骨头置换组中部分患者术后CTX呈下降趋势,与基线血磷水平呈负相关。结论老年髋部骨折后骨代谢标志物的变化有一定规律,骨折类型不同会影响骨代谢标志物变化总体变化趋势,研究标志物变化规律有助于评估骨折术后骨愈合的进程。展开更多
基金Project (No. 419200-584602) supported by the Start Foundation for Introducing Talent of Zhejiang University, China
文摘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.
文摘The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX<sup>®</sup> tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that are also applied to the patients with osteoporosis. Therefore, a reasonable advice is to consider pharmacological treatment for osteoporosis in those UC patients who already present fragility fractures, which bring a high risk of subsequent fractures. Therapy has also to be considered in patients with a high risk of fracture even if it did not yet happen, and particularly when they had long periods of corticosteroid therapy or cumulative high dosages. In patients without fragility fractures or steroid treatment, a medical decision about treatment could be guided by the FRAX tool to determine the intervention threshold. Among drugs for osteoporosis treatment, the bisphosphonates are the most studied ones, with the best and longest evidence of efficacy and safety. Despite this, several questions are still open, such as the duration of treatment, the necessity to discontinue it, the indication of therapy in young patients, particularly in those without previous fractures. Further, it has to be mentioned that a long-term bisphosphonates use in primary osteoporosis has been associated with an increased incidence of dramatic side-effects, even if uncommon, like osteonecrosis of the jaw and atypical sub-trochanteric and diaphyseal femoral fractures. UC is a long-lasting disease and the majority of patients is relatively young. In this scenario primary prevention of fragility fracture is the best cost-effective strategy. Vitamin D supplementation, adequate calcium intake, suitable physical activity (when possible), removing of risk factors for osteoporosis like smoking, and avoiding falling are the best medical acts.
文摘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.
文摘目的观察穴位贴敷疗法对绝经后骨质疏松患者骨代谢、髋部骨密度的影响,以评价其有效性和安全性。方法将符合要求的80例绝经后骨质疏松患者随机分为试验组及对照组,各40例。以6个月为一个疗程,共两个疗程。试验组予以外用中药穴位贴敷,内服钙尔奇D片和福善美片治疗,对照组仅予内服钙尔奇D片和福善美片治疗,疗程为12个月。比较2组治疗前、治疗后第6个月及第12个月血骨保护素(osteoprotegerin,OPG)、核因子-κB受体激活配体(receptor activator of nuclear factor-κB ligand,RANKL)含量、髋部骨密度(bone mineral density,BMD)及记录骨折发生情况,所得数据进行统计学分析。结果80例中75例获得完整随访,其中治疗组37例,对照组38例。(1)比较治疗前2组患者血OPG含量(t=1.43,P=0.157)、RANKL含量(t=-1.84,P=0.07),差异无统计学意义;试验组治疗6个月后血OPG含量(t=15.79,P<0.01)与治疗12个月后血OPG含量(t=21.68,P<0.01)均大于对照组;试验组治疗6个月后血RANKL含量测定(t=-0.35,P=0.726)与治疗12个月后血RANKL含量测定(t=-1.15,P=0.253)与对照组相比,差异无统计学意义。(2)治疗前2组患者髋部BMD比较,差异无统计学意义(t=0.26,P=0.791);治疗6个月后,2组患者的髋部BMD均增大,试验组BMD与对照组相比,差异无统计学意义(t=1.06,P=0.292);治疗12个月后,2组患者的髋部BMD仍继续增大,试验组BMD增加值大于对照组(t=2.22,P=0.029)。(3)试验中对照组共累计出现2例患者出现髋部骨折,而试验组只出现1例,经卡方检验,卡方值为0.320,P=0.572,差异无统计学意义,但骨折发生率的比较中,对照组(5.26%)略高于试验组(2.70%)。结论应用穴位贴敷疗法,能有效缓解疼痛、肌痉挛等症状;穴位贴敷使中药在局部发挥作用,加速髋部骨密度增加;提升OPG的血清含量,促进骨骼成骨作用,提高髋部骨量,从而达到防治骨质疏松性髋部骨折的目的。
文摘目的了解老年骨质疏松患者髋部骨折术后骨转换生化标志物的变化规律,并比较骨代谢标志物在股骨颈骨折和股骨粗隆间骨折的异同。方法收集在北京积水潭医院老年髋部骨折病房住院的髋部骨折患者138例,其中女性106例,男性32例;股骨粗隆间骨折68例,股骨颈骨折70例;明确骨折日期、手术日期,检测术前、术后血清碱性磷酸酶ALP(alkaline phosphatase,ALP)、1型前胶原氨基末端前肽(Npropeptide of type 1 collagen,P1NP)、1型胶原羧基末端肽交联(C-terminal crosslinking telopeptides of type 1 collagen,CTX)、25羟维生素D(25 hydroxy vitamine D,25OHD)水平以及骨密度(bone mineral density,BMD)。结果 (1)髋部骨折以女性居多;(2)骨折后1周内术前男性、女性之间,以及两种髋部骨折之间的骨代谢标志物均未见明显差异,骨折术后40~50 d骨代谢标志物均有明显上升;(3)股骨颈骨折人工股骨头置换术组和股骨粗隆间骨折髓内钉内固定组,术后40~50 d女性患者的P1NP上升约3倍,男性患者P1NP上升达到4倍左右;CTX及ALP上升幅度均在1.5倍左右;(4)在股骨颈骨折空心钉内固定组,P1NP上升约1.5倍,CTX变化不明显;(5)女性股骨颈骨折人工股骨头置换组中部分患者术后CTX呈下降趋势,与基线血磷水平呈负相关。结论老年髋部骨折后骨代谢标志物的变化有一定规律,骨折类型不同会影响骨代谢标志物变化总体变化趋势,研究标志物变化规律有助于评估骨折术后骨愈合的进程。
