【摘要】 目的 觀察重組人甲狀旁腺激素（1-34）[rhPTH（1-34）]治療骨質疏松癥患者骨密度的療效和安全性。 方法 采用自身前后對照臨床研究，納入2008年3-5月就診的原發性骨質疏松癥患者共39例，予rhPTH（1-34） 20 μg 1次/d皮下注射，療程18個月。治療期間均同時口服鈣制劑600 mg/d及維生素D3 125 U/d作為基礎治療。患者治療前采用雙能X線檢測腰2~4椎體（L2~4）和股骨頸骨密度（BMD）、肝腎功能、血鈣、血磷，治療后6、12、18個月復查BMD和上述生化指標改變，記錄患者不良事件，對患者治療前后L2~4、股骨頸BMD變化進行對比分析。 結果 35例患者完成全療程治療，其中男2例，女33例；平均年齡65歲，平均病程6.5年；治療6、12、18個月時L2~4 BMD均較治療前明顯提高（Plt;0.01），而股骨頸BMD在治療6、12個月時改善不明顯（Pgt;0.05），18個月時表現出較治療前明顯增加（Plt;0.01）；腰椎平均BMD增長率為12.27%，股骨頸BMD增長率為4.11%；治療期間不良反應少，均不需特殊處理而自行好轉。 結論 rhPTH（1-34）治療原發性骨質疏松癥安全有效，對改善椎體BMD療效迅速明顯，對改善股骨頸BMD起效慢；適用于絕經后骨質疏松和老年性骨質疏松癥患者。【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.
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.
ObjectiveTo explore the effects of pilose antler blood wine on bone mineral density and T-lymphocyte subsets of ovariectomized female Sprague Dawley (SD) rats.
MethodsSixty female SD rats were randomly divided into six groups:normal control group, osteoporosis model group, pure ethylalcohol group, high dose of pilose antler blood wine group, medium dose of pilose antler blood wine group and low dose of pilose antler blood wine group. Normal control group and osteoporosis model group were given saline with the dose of 9.1 g/(kg·d). Pure ethylalcohol group was given pure ethylalcohol with the dose of 9.1 g/(kg·d). The doses of pilose antler blood wine were 4.5, 9.1 and 13.6 g/(kg·d) respectively in low, medium and high dose of pilose antler blood wine group. After the feeding of pilose antler blood wine for 30 days, the bone mineral density and T-lymphocyte subsets of rats were assessed.
ResultsThe difference in bone mineral density among the three pilose antler blood wine groups was significant (P<0.05); the most obvious improvement of one mineral density was found in low and medium dose of pilose antler blood wine groups (P<0.05). The CD4+ T cells and CD4+/CD8+ significantly increased and CD8+ T cells proportion decreased significantly in pilose antler blood wine group compared with those in the osteoporosis model group (P<0.05). CD4+ T cells in medium dose group increased obviously compared with that in the high dose group (P<0.05). CD4+/CD8+ in low and medium dose groups obviously increased compared with that in high dose group (P<0.05). CD4+ T cells of medium dose group obviously increased compared with that in pure ethylalcohol group (P<0.05). CD8+ T cells in medium and low dose groups obviously decreased compared that in pure ethylalcohol group (P<0.05). CD4+/CD8+ in the three dose groups increased significantly compared with that in pure ethylalcohol group (P<0.05).
ConclusionTree different doses of pilose antler blood wine could prevent the osteoporosis and improve the immune function. The effects of medium and low dose of groups were more obvious.
Alveolar bone reconstruction simulation is an effective means for quantifying orthodontics, but currently, it is not possible to directly obtain human alveolar bone material models for simulation. This study introduces a prediction method for the equivalent shear modulus of three-dimensional random porous materials, integrating the first-order Ogden hyperelastic model to construct a computed tomography (CT) based porous hyperelastic Ogden model (CT-PHO) for human alveolar bone. Model parameters are derived by combining results from micro-CT, nanoindentation experiments, and uniaxial compression tests. Compared to previous predictive models, the CT-PHO model shows a lower root mean square error (RMSE) under all bone density conditions. Simulation results using the CT-PHO model parameters in uniaxial compression experiments demonstrate more accurate prediction of the mechanical behavior of alveolar bone under compression. Further prediction and validation with different individual human alveolar bone samples yield accurate results, confirming the generality of the CT-PHO model. The study suggests that the CT-PHO model proposed in this paper can estimate the material properties of human alveolar bone and may eventually be used for bone reconstruction simulations to guide clinical treatment.
Objective To summarize the advances in MRI-based bone quality scoring systems and their clinical applications. Methods A comprehensive literature review was conducted on recent studies related to the MRI-based bone quality scoring system, focusing on measurement methods, influencing factors, and clinical significance. Results Osteoporosis has a high incidence in China, significantly impacting patients’ quality of life and the postoperative outcomes of related orthopedic surgeries. Early identification of osteoporosis holds important clinical significance. In recent years, both domestic and international research has enriched the MRI-based bone quality scoring systems, which includes vertebral bone quality scoring, endplate bone quality scoring, and pedicle bone quality scoring. Compared to the “gold standard” of bone density measurement, dual-energy X-ray absorptiometry, the bone quality scoring systems demonstrate good efficacy in identifying abnormal bone mass and predicting postoperative complications, while being less influenced by degenerative changes in the lumbar spine, indicating its important clinical application value. ConclusionThe MRI-based bone quality scoring systems have good value in clinical applications. However, current studies are mostly retrospective cohort and case-control studies, which carry a risk of bias. The clinical application value needs further clarification through meta-analysis and large-scale prospective studies.
Trabecular microstructure is an important factor in determining bone strength and physiological function. Normal X-ray and computed tomography (CT) cannot accurately reflect the microstructure of trabecular bone. High-resolution peripheral quantitative computed tomography (HR-pQCT) is a new imaging technique in recent years. It can qualitatively and quantitatively measure the three-dimensional microstructure and volume bone mineral density of trabecular bone in vivo. It has high precision and relative low dose of radiation. This new imaging tool is helpful for us to understand the trabecular microstructure more deeply. The finite element analysis of HR-pQCT data can be used to predict the bone strength accurately. We can assess the risk of osteoporosis and fracture with three-dimensional reconstructed images and trabecular microstructure parameters. In this review, we summarize the technical flow, data parameters and clinical application of HR-pQCT in order to provide some reference for the popularization and extensive application of HR-pQCT.
ObjectiveTo analyze the relationship between the bone mineral density (BMD) and lumbar intervertebral disc degeneration in rhesus macaques by using T1ρ-MRI.
MethodsTwenty female rhesus macaques at the age of 10.9 years on average (rang, 4-20 years) were selected. The lumbar intervertebral discs were classified by Pfirrmann grading system and the T1ρ relaxation time (T1ρ value) was examined by using MRI (Philips 1.5 Tesla), and then BMD values of the L4,5 vertebrae and femoral ward's triangle were detected by using Osteocore dual energy X-ray absorptiometry. Finally, the relationship of T1ρ value of the lumbar intervertebral discs and Pfirrmann grading with age, weight, BMD of lumbar vertebrae and femoral ward's triangle was analyzed.
ResultsThe BMD values of lumbar vertebrae and femoral ward's triangle were (0.64±0.17) g/cm2 and (0.67±0.19) g/cm2 respectively, showing no significant difference (t=2.893, P=0.128). According to Pfirrmann grading system, there were 7 cases of grade I, 8 cases of grade Ⅱ, and 5 cases of grade Ⅲ at L4,5 intervertebral discs. The T1ρ value of the lumbar intervertebral disc was (104.08±18.65) ms; the T1ρ values of grades I, Ⅱ, and Ⅲ were (121.31±13.44), (104.73±15.01), and (77.41±11.87) ms, respectively. There was a negative correlation between T1ρ value and the age and the BMD of lumbar vertebrae and femoral ward's triangle. There was a positive correlation between Pfirrmann grading and the variables as listed above. Significant negative linear correlation was also observed between T1ρ value and Pfirrmann grading.
ConclusionThe T1ρ value is a reliable index when quantifying lumbar intervertebral disc degeneration, and there is a significant positive correlation between BMD and lumbar intervertebral disc degeneration in rhesus macaques.
Objective
To ananlyze the relationship between bone mineral density and sex hormone in male patients with obstructive sleep apnea hypopnea syndrome (OSAHS).
Methods
The study recruited 88 male patients with OSAHS aged 45-60 years in our hospital from October 2014 to October 2016 as an OSAHS group, and 30 healthy subjects without OSAHS as a control group. The general information and PSG parameters were recorded, the bone metabolic markers and bone mineral density of lumbar spine 1-4 (L1-4) and femoral neck (Neck) were measured, and the expressions of serum sex hormone (E2, P, T, FSH, LH and PRL) were determined by chemical luminescence immunity analyzer. The differences in above indexes between two groups and their correlation with bone mineral density were analyzed.
Results
Smoking rate, drinking rate, neck circumference and body mass index (BMI) of the OSAHS group were significantly higher than those of the control group. Compared with the control group, beta crosslaps (β-CTX, a bone metabolic marker) was significantly higher [(0.53±0.14) ng/ml vs. (0.47±0.15) ng/ml], the bone mineral density of L1-4 and Neck was significantly lower [(0.92±0.12) g/cm2 vs. (1.08±0.08) g/cm2, (0.91±0.11) g/cm2 vs. (1.06±0.13) g/cm2], and the serum testosterone was significantly lower in the OSAHS group [(267.32±89.56) ng/dlvs. (315.68±78.49) ng/dl] (all P<0.05). The result of Pearson correlation analysis showed that apnea hypopnea index (AHI) was negatively correlated with bone mineral density of L1-4 and Neck (bothP<0.001), lowest oxygen saturation (LSaO2) and testosterone were positively correlated with bone mineral density of L1-4 and Neck (all P<0.01).
Conclusions
The risk of suffering from osteoporosis is higher in male OSAHS patients and it is closely related to the degree of hypoxia. The decrease of testosterone may be one of the mechanisms.
Objective To analyze the trends in the burden of osteoporosis-related disease in China and worldwide from 1990 to 2023, and to further estimate the attributable burden of key determinants, so as to inform the formulation of prevention and control strategies for osteoporosis. Methods Based on the 2023 Global Burden of Disease (GBD) study database, the data on mortality, disability adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) attributable to low bone mineral density (LBMD) among individuals aged 40 years and older in China and globally from 1990 to 2023 were collected. Metrics focused primarily on age-standardized rates, and data were stratified by age group and gender. Joinpoint regression models were employed to estimate the annual percentage change (APC) and average annual percentage change (AAPC) to assess trends in the burden. An age-period-cohort analysis was conducted to characterize age, period, and birth cohort effects. Additionally, the Das Gupta decomposition method was applied to decompose the changes in the number of LBMD-attributable deaths in China from 1990 to 2023, quantifying the contributions of population growth, population aging, and changes in age-specific mortality rates. Results From 1990 to 2023, DALYs rates and YLLs rates attributable to LBMD showed an overall decreasing trend in both China and the world. DALYs rates declined from 311.54/100 000 to 268.55/100 000 in China and from 288.85/100 000 to 265.11/100 000 globally. In China, the YLDs rate increased from 170.42/100 000 to 197.91/100 000, whereas the global YLDs rate remained relatively stable. The burden of LBMD-related disease was consistently higher in women than in men. Falls were the leading cause of LBMD-attributable deaths and DALYs, followed by road injuries, while other types of injuries accounted for a relatively small proportion. Gupta decomposition showed that the number of LBMD-attributable deaths increased by 62.88% in men and 138.25% in women, primarily driven by population growth (contributing 108.33% in men and 138.98% in women) and population aging (contributing 42.26% in men and 70.59% in women), while changes in age-specific mortality rates offset the increase by 87.72% in men and 71.32% in women. Conclusion From 1990 to 2023, the mortality burden attributable to LBMD in China has decreased overall, but the disability burden has continued to rise, suggesting a shift in osteoporosis-related disease burden from lethality toward disability. Falls are the main attributable cause, and the burden is particularly high among older adults and women. Strengthening bone mineral density screening, fall prevention, and secondary fracture prevention and management is essential to reduce the long-term health losses associated with osteoporosis.
