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中华骨质疏松和骨矿盐疾病杂志

中华骨质疏松和骨矿盐疾病杂志

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Chinese Journal of Osteoporosis and Bone Mineral Research
《中华骨质疏松和骨矿盐疾病杂志》2008年创刊，为中华医学会骨质疏松和骨矿盐疾病分会专业学术期刊，2017年1月由季刊变更为双月刊，国内外公开发行。主要刊登多学科在骨质疏松和骨矿盐疾病的基础、临床、预防的研究进展、诊疗水平及新技术、新成果，同时介绍国内、外最新进展，促进学术交流，提高我国在该领域研究水平。
  • 发文量：964
  • 被引量：1129
  • H指数：2
  • 开始收录时间：2008,1(1)
  • CNKI综合因子：1.469
  • 维普期刊影响因子： 1.94
  • 万方期刊影响因子：2.56
  • 创刊时间：2008
  • 国内刊号/CN：11-5685/R
    国际刊号/ISSN：1674-2591
  • 发行周期：季刊
    邮发代号：80-743
  • 主管单位：中华人民共和国卫生部
    主办单位：中国医学科学院 中国医学科学院北京协和医院
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  • 地址：北京市东城区帅府园1号
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  • 摘要：骨组织性质评价是认识以骨质疏松为代表的骨退行性疾病的重要手段。在诸多的评价方法中，影像学评价技术具有自身独特的优势，近年来发展迅速，目前已经逐一实现从大体宏观到纳米微观等不同水平，对骨组织形态、结构进行定性、定量分析。影像学评价技术在骨组织结构表征方面具有非常高的实用价值。本文对该类技术，特别是双能X线检测、定量CT、高分辨pQCT、高分辨核磁成像、显微CT、骨组织成分分析等技术的特征、适用范围以及最新研究进展进行综述，以期为骨组织相关的临床及基础研究提供参考。%Evaluation of bone geometry and microarchitecture is of vital importance for understanding pathologi-cal changes of bone degenerative disease, such as osteoporosis.Among various techniques, imaging techniques with their own distinctive advantage have been developing rapidly in recent years.Imaging techniques allow qualitative or quantita-tive analysis of bone geometry and structure from the macroscale to the nanoscale.This techniques show promising accura-cy and practical applicability in bone characterization.This review presents an overview of the relative advantages and dis-advantages of the current available imaging methods, such as dual energy X-ray absorptiometry, quantitative CT, high-resolution peripheral quantitative CT, high-resolution MRI, micro-CT and methods for tissue composition.The combina-tion of the above noninvasive imaging method can provide a comprehensive evaluation of bone tissue for both clinical and basic researches.
  • 摘要：由中华医学会、中华医学会骨质疏松和骨矿盐疾病分会共同主办,郑州大学第一医院承办的第八次骨质疏松和骨矿盐疾病学术会议于2015年11月5日至7日在河南省郑州市召开,会议得到了河南省医学会的大力支持。作为我国骨质疏松和骨代谢领域规模最大的学术会议,共吸引了1000余名从事骨质疏松和骨代谢临床和基础研究的专家学者的热情参与。
  • 摘要：一、《中华骨质疏松和骨矿盐疾病杂志》是由中华人民共和国国家卫生和计划生育委员会主管、中国医学科学院、北京协和医院主办的学术期刊,中华医学会骨质疏松和骨矿盐疾病分会专业学术期刊,中国科技核心期刊,中国科技论文统计源期刊,中国生物医学核心期刊,国内外公开发行,中国统一连续出版物号为：CN 11-5685/R、ISSN 1674-2591,邮发代号80-743。
  • 摘要：目的：通过尾悬吊法建立一种废用性小鼠骨质疏松模型并对其进行评价。方法32只C57BL／6J雄性小鼠，采用随机数表法分为4组，即尾悬吊（ tail－suspension， TS）14 d 组及其对照组（ control 1， C1），尾悬吊14 d后解除悬吊14 d组（tail－suspension＋rest， TS＋R）及其对照组（control 2， C2）。采用显微计算机断层扫描（ computed tomography， CT），生物力学和形态学方法评估小鼠骨质流失情况。结果 TS组和TS＋R组股骨长度较各自对照组分别下降8．23％和7．68％。两悬吊组股骨小梁骨密度与各自对照组相比分别下降26．80％和20．52％，骨体积分数，骨小梁厚度、数目也明显下降，骨小梁间隙显著升高， TS组皮质骨密度较C1组下降8．51％。两悬吊组的股骨最大载荷较其对照组分别下降23．01％和18．54％， TS组弯曲弹性模量较C1组下降21．99％， TS与TS＋R两组的下降程度之间比较，差异有统计学意义（ t＝6．462， P＝0．008）。形态学方面， TS和TS＋R组成骨细胞数比各自对照组低47．76％和41．44％，破骨细胞数较各自对照组高30．06％和16．93％，生长板厚度以及软骨细胞数等明显少于各自对照组， TS组胶原纤维面积较其余3组明显缩小。结论雄性C57小鼠尾悬吊14 d表现出显著骨质疏松，解除悬吊14 d后骨质流失状况未显著改善，尾悬吊法小鼠骨质疏松模型具有造模时间短，效果明显、作用稳定等特点，值得进一步推广运用。%Objective To establish a disuse osteoporosis mouse model by tail-suspension and observe its struc-tural and morphological changes and mechanical properties of mice.Methods Thirty two male C57BL/6J mice were randomly divided into 4 groups.TS group:mice were tail-suspended for 14 days.TS+R group: mice were tail-suspen-ded and rest for 14 days respectively.C1 and C2 groups:mice were normally feed for 14 days or 28 days.All mice were sacrificed at predetermined time points.Then micro-CT, biomechanic tests and morphological observations were comple-ted.Results The femural length of TS-treated groups decreased by 8.23%and 7.68%, and bone mineral density de-creased by 26.80%and 20.52% compared with C1 and C2 groups respectively.The bone volume fraction, trabecular bone thickness and number in TS-treated groups were significantly lower than the control groups, while the trabecular se-peration was higher than the control groups.The cortical BMD of TS group declined by 8.51%compared with C1 group. By biomechanical tests, the maximal load of femur in TS-treated groups dropped by 23.01% and 18.54% respectively, the elastic modulus of TS group failed by 21.99%compared with C1 group, and the diversities between TS and TS+R groups and their respective control groups showed a signifcant difference (t=6.462, P=0.008).The results of biome-chanical parameters showed high risk of fracture in TS-treated groups.By histological observation, the number of osteo-blasts decreased by 47.76% and 41.44%, while number of osteoclasts increased by 30.06% and 16.93% compared with C1 and C2 groups respectively.Furthermore, the number of chondrocytes and thickness of growth plate in TS-treated groups were obviously lower than that in the control groups, and the area of collagen in TS group was less than the other three groups.Conclusion Significant changes of mice femurs were seen in TS group, the trabecular bone structure and biomechanical properties were damaged, and histological degeneration was found.Most of bone-associated parameters in TS+R group were stable, even the mice were released for 14 days.These results demonstrate that it is worthful to pro-mote the new osteoporotic mouse model in the furture, because it is effective, steady and timesaving obviously.
  • 摘要：通过1例Paget’s骨病的治疗分析，探讨其病因、诊断及治疗。 Paget’s骨病临床表现为慢性骨痛、骨畸形，血碱性磷酸酶持续增高， X线片及骨扫描有特异性改变。 Paget’s骨病在我国罕见，排除相关疾病时应想到该病的可能，治疗以双膦酸盐为主，首选唑来膦酸。%Paget’s disease of bone is a rare malady in China.Here we reported a case of 77-year-old female pa-tient suffered from intermittent bone pain complied with dysacousis.Laboratory tests showed sustained increased serum al-kaline phosphatase.The typical radiographic changes were found on her skull and lumbar spine.The diagnosis of PDB was made based on these manifestation.After the treatment with pamidronate, the serum alkaline phosphatase decreased and the bone pain was relieived gradually.The related literature was reviewed.
  • 摘要：美国骨矿盐研究学会（American Society For Bone And Mineral Research,ASBMR）2015年年会于2015年10月9-12日在美国西雅图举办,来自全球的医生和研究者分享了骨矿盐相关领域的最新研究进展,本文对此次会议的热点部分做一荟萃,分为基础和临床两大部分进行阐述。本文中所有参考文献均来源于Abstract of ASBMR 2015 Annual Meeting的摘要。
  • 摘要：目的：调查和分析门诊类风湿关节炎患者骨质疏松症患病及治疗情况。方法选择类风湿关节炎患者141例（年龄均＞50岁），女性106例，男性35例。采用双光能X射线骨密度测量仪测定股骨颈和腰椎1～4骨密度，同时记录患者基础资料、疾病特征和类风湿关节炎治疗情况，评价疾病活动性，并对所有患者进行现场调查，内容包括是否有脆性骨折病史，以及预防性或治疗性应用骨质疏松药物情况。结果确诊骨质疏松症43例，患病率为30．5％。其中男性6例，患病率为17．1％；女性37例，患病率为34．9％。女性、老龄、病程长、临床的疾病活动指数（ Clinical Disease Activity Index， CDAI）高分是类风湿关节炎患者发生骨质疏松的危险因素；应用改善病情药物对类风湿关节炎进行规范治疗是保护性因素。并发骨质疏松症的类风湿关节炎患者中近1年内未接受骨质疏松药物治疗23例，占53．5％；6例有脆性骨折病史，占14．0％，其中3例未曾接受过骨质疏松药物治疗。结论类风湿关节炎合并骨质疏松症发生率高，但是超过半数的患者未接受正规抗骨质疏松药物治疗或者治疗不规范。%Objective To investigate the prevalence and treatment for osteoporosis in patients with rheuma-toid arthritis.Methods Totally 141 cases with rheumatoid arthritis ( aged over 50 years) were included in the in-vestigation, including 106 cases of female and 35 cases of male.Bone mineral density of femoral neck ( 1-4 ) and lumbar spine was measured by dual energy X-ray absorptiometry.The basic data, characteristics and the treatment of rheumatoid arthritis were recorded and the disease activity was evaluated.All patients accepted the investigation about the history of brittle fracture and prophylactic or therapeutic application of drugs for osteoporosis.Results Fourty three patients (30.5%) were diagnosed with osteoporosis, of which 6 patients were male and 37 patients were female.The incidence of osteoporosis is 17.1% in male and 34.9% in female.Female, old age, long dis-ease course, high score of Clinical Disease Activity Index ( CDAI) are the risk factors of osteoporosis in patients with rheumatoid arthritis.The regular treatment of disease modifying anti-rheumatic drugs ( DMARDs) for rheumatoid ar-thritis is a protective factor.23 cases (53.5%) did not receive any drug for osteoporosis during nearly one year;6 patients (14.0%) had brittle fracture;3 patients had never received therapy for osteoporosis.Conclusion The in-cidence of osteoporosis in rheumatoid arthritis is high, but more than half of the patients do not receive the regular anti-osteoporosis treatment.
  • 摘要：目的：研究硫辛酸对体外培养的H2 O2处理后的小鼠前成骨细胞MC3T3－E1骨形成的影响，并初步探讨硫辛酸促成骨细胞骨形成的作用机制。方法在体外培养的MC3T3－E1培养基中分别加入不同浓度（0．1、0．2和0．4 mmol／L）的硫辛酸作用20 h，接着加入1 mmol／L H2 O2作用4 h，用MTT法检测药物对成骨细胞活力的影响；用碱性磷酸酶（alkaline phosphatase， ALP），细胞丙二醛（malondialdehyde， MDA），超氧化物歧化酶（superoxide dismutase， SOD），乳酸脱氢酶（lactate dehydrogenase， LDH）试剂盒检测成骨细胞内ALP、 SOD、 LDH活性和MDA含量；用Von Kossa染色法检测矿化结节数目；用real time－PCR方法检测成骨细胞内Ⅰ型胶原（ collagen－Ⅰ， COL－Ⅰ）、骨钙素（ osteocalcin， OCN）、转录因子Osterix、骨形态发生蛋白2（bone morphogenetic protein－2， BMP－2）、 NADPH氧化酶4（NADPH oxidase4， Nox4）、护骨素（osteoprotegerin， OPG）、细胞核因子κB受体活化因子配基（ receptor activator nuclear factor－kappa B ligand， RANKL） mRNA表达，用流式细胞仪检测细胞内活性氧（ reactive oxygen species， ROS）水平。结果硫辛酸可增加ALP活力和矿化结节数目，促进骨形成相关指标COL－Ⅰ、 Osterix、 BMP－2和OCN mRNA表达（ P＜0．05）；硫辛酸提高H2 O2损伤后MC3T3－E1细胞活力，上调细胞内SOD活性并降低细胞中MDA含量和上清中LDH活性；硫辛酸上调MC3T3－E1细胞OPG／RANKL比值及下调ROS和Nox4 mRNA表达水平（P＜0．05）。结论硫辛酸在一定浓度范围内（0．1～0．4 mmol／L）促进H2 O2处理后MC3T3－E1细胞的骨形成过程，这种促进作用是通过下调Nox4和ROS水平，降低氧化应激发挥抗氧化作用上调OPG／RANKL实现的。%Objective To investigate the effect of alpha-lipoic acid ( ALA) on osteoblastic bone formation in H2 O2-treated pre-osteoblast MC3T3-E1 cell in vitro for analyzing the osteoblast-promoting mechanisms of ALA.Methods MC3T3-E1 osteoblasts cultured in vitro were treated by different concentrations of ALA for 20 h before treated with 1 mmol/L H2 O2 for 4 h, then MTT method was used to observe the proliferation of MC3T3-E1.The activities of alkaline phosphatase ( ALP) , superoxide dismutase ( SOD) , lactate dehydrogenase ( LDH) and the contents of MDA were de-tected by corresponding assay kits.Von Kossa staining was used to detect mineralized nodules.The mRNA expressions of osteoprotegerin ( OPG) , receptor activator nuclear factor-kappa B ligand ( RANKL) , collogen Ⅰ ( COL-Ⅰ) , osteocal-cin (OCN), transcription factor Osterix, bone morphogenetic protein-2 (BMP-2) and NADPH oxidase-4 (Nox4) were quantified by real time-PCR.Intracellular ROS level was detected by flow cytometer.Results It showed that ALA obvi-ously promoted the expression of OPG, COL-Ⅰ, OCN, Osterix, BMP-2 mRNA, increased the ALP, SOD activity and the cell viability as well as decreased the content of MDA and the activity of LDH ( P<0.05 ) .ALA also obviously de-creased the expression of Nox4, RANKL mRNA and intracellular ROS level as well as enhanced the mineral ability of MC3T3-E1.Meanwhile, ALA upgraded the ratio of OPG/RANKL (P<0.05).Conclusion The suitable concentration of ALA (0.1-0.4 mmol/L) could promote osteoblastic formation via exerting anti-oxidative by down-regulating Nox4 and ROS level, as well as increasing the ratio of OPG/RANKL in H2 O2-treated MC3T3-E1 cells.
  • 摘要：3D打印属于快速成型技术的一种，即以数字模型文件为基础，运用粉末状金属或塑料等可黏合材料通过逐层堆叠累积的方式制造三维实体的先进技术。近年来，随着该技术的不断发展，其已成为骨科领域的研究热点，并逐渐应用于临床中。本文综述了3D打印技术的发展历史与其在术前规划、术中导航、个性化假体和骨组织工程等骨科相关领域的相关应用，并结合其不足对其未来的发展做出技术展望。%3D printing, a kind of rapid prototyping, it’s a technology that uses powder of metal or plastic to cre-ate three-dimensional solid state through the method of additive manufacturing basing on digital model file.In recent years, with the development of the technology, it has become a hot research topic in the field of orthopeadics.In this ar-ticle, we introduce the development history of 3D printing technology, its application in preoperative planning, intraoper-ative navigation, individualized prosthesis, bone tissue engineering and other related applications of orthopaedics.Moreo-ver according to the limits of this technology, we make a technical perspective about its development in the future.
  • 摘要：目的：根据健康汉族男女性血清Ⅰ型原胶原氨基端肽（ procollagen type 1 N－terminal propeptide， P1NP）和Ⅰ型胶原羧基端肽交联（βcross－linked C－telopeptide of type 1 collagen，β－CTX）浓度，按照不同年龄段进行分层再分析，建立简便的参考范围。方法纳入位于中国不同纬度5个城市的健康汉族受试者，采用化学发光法检测血清骨形成指标P1NP及骨吸收指标β－CTX浓度，并检测骨代谢调节激素甲状旁腺素（ parathyroid hormone， PTH）及25羟维生素D （25 hydroxy vitamin D，25OHD）水平。采用自动分析仪检测肝肾功能及血清钙、磷浓度。按照＜30岁；男性：30～50岁，女性：30岁～绝经前；男性：51～70岁，女性：绝经～70岁；＞70岁不同年龄段，分层分析男女性β－CTX和P1NP浓度范围。结果纳入健康受试者1436人，其中女性936人（65．18％），男性500人（34．82％）。受试者平均年龄（50．6±19．6）岁（15～110岁）。血清P1NP及β－CTX浓度呈非正态分布，总人群P1NP和β－CTX浓度中位数分别是49．36 ng／mL （95％ CI：18．79～155．55 ng／mL）及0．37 ng／mL （95％CI：0．11～0．90 ng／mL）。女性按30岁～绝经前作为正常参考人群，血清P1NP及β－CTX浓度范围95％CI分别为17．10～102．15及0．08～0．72 ng／mL；以30～50岁男性为正常参考人群，血清P1NP及β－CTX浓度95％CI分别是20．29～110．53及0．11～0．83 ng／mL。结论在健康汉族大样本男女性建立不同年龄段血清P1NP及β－CTX浓度的正常范围，30岁以下男女性及女性绝经后20年骨转换处于较高水平。%Objective To investigate the serum P1NP andβ-CTX reference range in healthy Chinese according to different age stratification from the previous study.Methods We included healthy volunteers in 5 Chinese cities at dif-ferent latitudes.Serum levels of procollagen type 1 N-terminal propeptide ( P1NP) , βcross-linked C-telopeptide of type 1 collagen (β-CTX), parathyroid hormone (PTH) and 25 hydroxy vitamin D (25OHD) were measured by chemilumi-nescence assay.Serum levels of calcium and phosphorus, hepatic and renal function were detected by automatic biochem-ical analyzer.Serum P1NP andβ-CTX levels were assessed by stratification of age and gender.Results A total of 1 436 subjects ( M∶F=500∶936) with average age of 50.6 ±19.6 (15-110) years were enrolled.They exhibited non-normally distributed P1NP andβ-CTX.The median P1NP and β-CTX levels were 49.36 (95% CI:18.79-155.55) ng/mL and 0.37 (95%CI: 0.11-0.90) ng/mL, respectively.In women between 30 years old to menopause, 95%confidence in-terval of serum P1NP andβ-CTX concentrations were 17.10-102.15 ng/mL and 0.08-0.72 ng/mL.In men between 30-50 years old, 95%confidence interval of serum P1NP andβ-CTX levels were 20.09-110.53 and 0.11-0.83 ng/mL. Conclusions We established reference ranges for serum P1NP and β-CTX in healthy Chinese individuals.Higher bone turnover level was found in women and men less than 30 years old and women within 20 years since menopause.
  • 摘要：目的：从老年人髋关节置换手术骨髓中抽取内皮祖细胞，研究分析内皮祖细胞数量及分布与骨密度和钙磷代谢的相关性，并比较骨质疏松和非骨质疏松老年人骨髓内皮祖细胞数量及分布的差异。方法收集11例股骨颈脆性骨折和8例骨关节炎患者，行人工髋关节置换手术，用箱型骨刀在股骨颈截骨平面截取松质骨骨块，体外培养液冲洗得到骨髓混悬液，分离骨髓内皮祖细胞，并进行流式细胞检测，比较两组患者的年龄、体质量指数、骨髓内皮祖细胞数量及分布、骨密度、骨代谢标志物等临床参数，并分析各临床指标与骨髓内皮祖细胞数量及分布的关系。结果两组老人年龄比较，差异无统计学意义（ P＞0．05），脆性骨折组的骨髓内皮祖细胞总数量及成熟的内皮祖细胞数量明显少于骨关节炎组（0．48±0．35 vs．1．80±1．01， P＝0．001和52．28±21．20 vs．77．13±19．15， P＝0．042），且前者的股骨颈、全髋骨密度（0．54±0．14 g／cm2 vs．0．76±0．21 g／cm2， P＝0．021和0．65±0．14 g／cm2 vs．0．84±0．15 g／cm2， P＝0．026）和血25羟维生素D （25 hy－droxy vitamin D，25OHD）水平（4．50±1．56 ng／mL vs．23．80±2．88 ng／mL， P＝0．033）明显低于后者，而血甲状旁腺素（parathyroid hormone， PTH）水平（73．60±1．84 ng／L vs．32．20±0．98 ng／L， P＝0．035）明显高于后者，差异均具有统计学意义（ P＜0．05）。年龄与骨髓分化成熟内皮祖细胞数量存在显著性负相关（ r＝－0．594， P＝0．015），而股骨颈和全髋骨密度与骨髓分化成熟内皮祖细胞数量呈显著性正相关（ r＝0．847， P＝0．008和r＝0．925， P＝0．034），全髋骨密度与骨髓分化早期内皮祖细胞数量呈显著性负相关（r ＝－0．817， P＝0．047）。结论老年人骨髓内皮祖细胞的数量及成熟分化与骨密度呈显著性正相关，提示骨髓内皮祖细胞可能直接或间接地调节骨组织新陈代谢而影响老年人的骨量。%Objective To isolate endothelial progenitor cells ( EPCs) from bone marrow during orthopaedic surgery, studying the correlation between number and population of EPCs with bone mass, bone metabolism, and trying to figure out the differences of number and population of EPCs in elderly patients with or without osteoporosis.Methods Trabecu-lar bone near trochanter were extracted from 11 patients with fragility fracture and 8 patients with osteoarthritis during arti-ficial hip replacement surgery, and EPCs separated from bone marrow were prepared for flow cytometry analysis.All the patients took dual energy X-ray absorptiometry ( DXA) scan and bone metabolism marker detection.We compared the age, body mass index ( BMI) , number and population of bone marrow EPCs, bone mass and bone metabolism between fragility fracture and osteoarthritis patients, and analyzed the impact of clinical data such as age, BMI, bone mass and bone metabolism markers on the number and population of bone marrow EPCs in the elderly.Results There was no sig-nificant difference of age and BMI between fragility fracture patients and osteoarthritis patients.The total number of bone marrow EPCs and number of mature EPCs in fragility fracture patients were significantly less than that in osteoarthritis pa-tients (0.48 ±0.35 vs.1.80 ±1.01, P=0.001; 52.28 ±21.20 vs.77.13 ±19.15, P=0.042), and the bone mass of femur neck and total hip ( 0.54 ±0.14 g/cm2 vs.0.76 ±0.21 g/cm2 , P=0.021; 0.65 ±0.14 g/cm2 vs.0.84 ± 0.15 g/cm2 , P=0.026) as well as serum 25 hydroxy vitamin D (25OHD) level (4.50 ±1.56 ng/mL vs.23.80 ± 2.88 ng/mL, P=0.033) in fragility fracture patients were significantly lower than those in osteoarthritis patients, howev-er serum PTH level (73.60 ±1.84 ng/L vs.32.20 ±0.98 ng/L, P=0.035) was significantly higher in fragility fracture patients than that in osteoarthritis patients.There were significantly negative correlation between age with number of ma-ture EPCs (r=-0.594, P=0.015), and positive correlation between bone mass in femoral neck and total hip with number of mature EPCs ( r=0.847, P=0.008;r=0.925, P=0.034) , and negative correlation between bone mass in total hip with number of premature EPCs (r=-0.817, P=0.047).However, BMI, serum alkaline phosphatase, 25OHD and PTH didn’t show any correlation with number of bone marrow EPCs.Conclusion The number of bone mar-row total EPCs and mature differentiated EPCs were significantly correlated with bone mass, which suggested that bone marrow EPCs could influence bone mass via regulating bone metabolism directly or indirectly in the elderly.
  • 摘要：目的：探讨基于磁共振波谱成像（ magnetic resonance spectroscopy， MRS）评估绝经后女性腰椎骨髓脂肪含量的变化规律及其与骨密度（bonemineraldensity，BMD）的关联性。方法42例绝经后女性分别行MRS扫描计测L3椎体骨髓脂肪分数（ fat fraction， FF）及双能X线吸收检测（ dual－energy X－ray absorptiom－etry， DXA）扫描获取腰椎（ L1－4） T值及BMD值，按T值分为正常骨量组、低骨量组及骨质疏松（ osteoporo－sis， OP）组。采用协方差分析及偏相关分析组间FF变化规律及FF值与BMD的相关性。结果正常骨量组、低骨量组及OP组FF分别为51．28±11．03、59．73±10．09、69．96±11．42。协方差分析，校正年龄、绝经年龄、 BMI混杂因素后，不同骨量组间FF值差异仍存在统计学意义（F＝4．14， P＝0．005）。 FF与BMD存在中度负相关性（r＝－0．557， P＝0．000），校正上述混杂因素，其相关性依然存在（r＝－0．510， P＝0．001）。结论绝经后妇女骨受损伴随着骨髓脂肪增多， FF对OP的诊疗有一定评估价值。%Objective Basing on magnetic resonance spectroscopy ( MRS) , to assess variation in lumbar bone marrow fat content and its association with bone mineral density ( BMD) in postmenopausal women.Methods Forty twoe post-menopausal women were performed MRS scans to measure 13 vertebral marrow fat fraction ( FF) and dual-energy X-ray absorptiometry ( DXA) scans to obtain lumbar spine ( L1-4 ) T score and BMD values.FF variation and its correlation with BMD values of FF was analyzed by covariance analysis and partial correlation analysis.Results Among normal bone mass group, low bone mass group and OP group, FF were 51.28 ±11.03, 59.73 ±10.09, 69.96 ±11.42.Covar-iance analysis, adjusting for age, menopausal age, BMI confounding factors, indicating different groups of bone mass had significant differences FF (F=4.14, P=0.005).FF had moderate negative correlation with BMD (r=-0.557, P=0.000).After adjusting affecting factors, the correlation still existed (r=-0.51, P=0.001).Conclusion Post-menopausal women were accompanied with increased bone marrow fat and bone damage, so FF had a certain value to as-sess osteoporosis.
  • 摘要：目的：探讨铁鳌合剂地拉罗司（ deferasirox， DFS）体外对成骨细胞增生、分化、矿化和细胞内铁离子的影响。方法小鼠前成骨样细胞MC3T3－E1在37℃条件下体外培养，在10 mmol／L β－甘油磷酸和50 mg／L抗坏血酸的诱导作用下，分化为成骨细胞，同时用不同浓度（10、20、40μmol／L ） DFS 干预，用CCK－8法检测细胞的增生，碱性磷酸酶（ alkaline phosphatase， ALP）活性试剂盒检测细胞ALP活性， Von kos－sa染色法行细胞钙结节染色，实时定量PCR检测细胞膜转铁蛋白受体（ transferrin receptor， TfR） mRNA的表达。结果 MC3T3－E1细胞增生结果显示， DMSO溶剂组、对照组（0μmol／L）、10、20、40μmol／L组A值分别为1．41±0．09、1．41±0．09、1．01±0．01、0．79±0．04、0．67±0．04； ALP 活性检测结果显示，对照组（0μmol／L）、10、20、40μmol／L组ALP活性值分别为0．73±0．03、0．65±0．02、0．54±0．03、0．35±0．04；钙结节检测结果显示，对照组（0μmol／L）、10、20、40μmol／L组TfR mRNA钙化面积比值分别为4．22±0．12、3．29±0．14、1．40±0．20、0．86±0．21； TfR mRNA表达检测结果显示，对照组（0μmol／L）、10、20、40μmol／L组TfR mRNA表达比分别为1、1．52±0．23、1．91±0．17、2．98±0．14。 MC3T3－E1细胞的增生、ALP活性、钙结节和钙化面积随DFS干预浓度的增加呈剂量依赖性降低（ P＜0．05）， TfR mRNA的表达随DFS干预浓度的增加呈剂量依赖性升高（P＜0．05）。结论 DFS可能通过螯合成骨细胞内的铁离子抑制其增生、分化和矿化。%Objective To investigate the effects of deferasirox ( DFS) on proliferation, differentiation, miner-alization and intracellular iron of osteoblast in vitro.Methods Murine preosteoblast MC3T3-E1 cells were incubated in a medium supplemented with different concentrations (10, 20, 40 μmol/L) of DFS under induction of of 10 mmol/L β-glycerophosphate and 50 mg/L L-ascorbic acid.Proliferation of MC3T3-E1 cells was evaluated by CCK-8 assay.Alkaline phosphatase ( ALP) activity was measured using ALP viability kit.Mineralization was evaluated by von-kossa staining as-say.Transferrin receptor (TfR) mRNA was detected by real-time PCR.Results The proliferation in MC3T3-E1 cells of DMSO, control, 10, 20, 40μmol/L groups were 1.41 ±0.09, 1.41 ±0.09, 1.01 ±0.01, 0.79 ±0.04, and 0.67 ± 0.04, respectively; the ALP activity of control, 10, 20, 40 μmol/L groups were 0.73 ±0.03, 0.65 ±0.02, 0.54 ± 0.03, and 0.35 ±0.04, respectively; the minerlalized surface area and number of mineralized nodules of control, 10, 20, 40 μmol/L groups were 4.22 ±0.12, 3.29 ±0.14, 1.40 ±0.20, and 0.86 ±0.21, respectively; the expression of TfR mRNA were 1, 1.52 ±0.23, 1.91 ±0.17, and 2.98 ±0.14, respectively.Statistical analysis revealed that pro-liferation, ALP activity, minerlalized surface area and number of mineralized nodules were decreased by DFS in a con-centration-dependent manner (P<0.05), and the expression of TfR mRNA was up-regulated by DFS in a concentration-dependent manner (P<0.05).Conclusion DFS can significantly inhibit proliferation, differentiation and mineraliza-tion of osteoblasts and the mechanism behind inhibition may involve decreased levels of intracellular iron.
  • 摘要：Glucocorticoid-induced bone disease is one of the more common and serious side effects of glu-cocorticoids, of which pathogenesis is not yet clear.A large number of vitro and vivo studies have indicated that the re-lated cell damage and regulatory factors are the main causes of the disease.It often lead to osteoporosis, osteonecrosis and growth retardation and they have some common pathogenesis.However, the macroscopic symptom of the lesions are different, so the internal mechanism of the disease has its own characteristics.We review new progress glucocorticoid-induced bone disease.%骨骼病变是糖皮质激素应用过程中较为常见且严重的不良反应之一，其发病机制目前尚未明确，大量体内外研究表明相关细胞损伤及调控因子失调是其发生的主要原因。糖皮质激素所致骨骼病变常表现为骨质疏松、骨坏死及骨骼生长发育障碍，三者具有某些共同的发病基础，但各病变宏观表现有所不同，故其内在发病机制又各具特点。本文综述近年来有关糖皮质激素所致骨骼病变发病机制的研究进展。
  • 摘要：为减少脆性骨折后再次骨折的发生，2012年国际骨质疏松基金会倡导的“攻克骨折”行动得到了广泛响应，通过落实了骨折联络服务（ Fracture Liaison Service， FLS）项目在全球的推行。近期效果评价显示FLS项目的实施，不但能有效地提高脆性骨折患者骨质疏松症的检出率、治疗率和药物依从性，还可有效减少再发骨折，提高患者生活质量。 FLS是一项效价比高的骨质疏松骨折服务体系，值得在我国建立和推广。%In order to reduce the incidence of the secondary fracture after fragility fracture, International Oste-oporosis Foundation advocated ‘Capture the Fracture Campaign’ through the implementation of ‘Fracture Liaison Ser-vices ( FLS) ’ .The evaluation for FLS shows that the implementation of FLS can effectively improve the rate of osteopo-rosis diagnosis, treatment, and medication adherence in fracture patients.FLS also effectively reduce the secondary fracture, and improve quality adjusted life years ( QALYs) of the patients.FLS is a cost/effective system in post-frac-ture management.
  • 摘要：医学术便函[2016]第004号由中华医学会、中华医学会骨质疏松和骨矿盐疾病分会主办的中华医学会第八次中青年骨质疏松和骨矿盐疾病学术会议将于2016年5月26-28日在山东省济南市召开。这个会议是中华医学会骨质疏松和骨矿盐疾病分会举办的重要年度学术会议,此次会议将涵盖骨质疏松以及其他代谢性骨病领域最新的研究成果和发展趋势,并将对本领域所面临的新问题和新挑战进行广泛而充分的学术交流。
  • 摘要：Objective To analyze bone turnover markers in postmenopausal women with type 2 diabetes mellitus ( T2DM) and osteoporosis.Methods Eighty postmenopausal women were divided into postmenopausal osteoporosis group ( OP, n=40) and postmenopausal women with T2DM and osteoporosis group ( DM/OP, n=40) .The human N-MID os-teocalcin (N-MID), tartrate-resistant acid phosphatase (TRAP-5b), C-terminal telopeptides of type 1 collagen (CTX) and relative indicators were compared between two groups.Analyze the related factors of bone turnover markers in DM/OP group.Results There were no obvious differences between two groups in N-MID, CTX levels.In DM/OP group, TRAP-5b level were higher than that in OP group (P=0.020).TRAP-5b has negative correlation with L2-4 BMD (r=-0.746, P=0.044).Regression analysis showed that TRAP-5b was affected by HbA1c.Conclusion Diabetes may affect bone metabolism mainly through increasing the activity of osteoclasts.TRAP-5b may become a specific index for monitoring the changes of bone metabolisms in postmenopausal women with T2DM and osteoporosis.%目的：探讨绝经后2型糖尿病（ type 2 diabetes mellitus， T2DM）并发骨质疏松患者骨转换标志物的变化及相关因素。方法选取绝经后女性80例，根据1998年世界卫生组织（ WHO）骨质疏松诊断标准和1999年WHO糖尿病诊断标准分为绝经后骨质疏松组（ osteoporosis， OP）40例，绝经后T2DM并发骨质疏松组（ DM／OP）40例。比较两组间N端中段骨钙素（ N－MID osteocalcin， N－MID）、抗酒石酸酸性磷酸酶（ tartrate re－sistant acid phosphatase， TRAP－5b）、1型胶原羧基端交联肽（c－terminal telopeptides of type 1 collagen， CTX）及相关资料的差异，并对DM／OP组的骨转换标志物进行相关分析。结果两组间N－MID、 CTX比较，差异无统计学意义（P＞0．05）；DM／OP组TRAP－5b高于OP组（P＝0．020）；相关分析显示TRAP－5b与L2－4骨密度（bone mineral density， BMD）呈负相关（r＝－0．746， P＝0．044）；回归分析显示TRAP－5b水平受糖化血红蛋白（glycosylated hemoglobin， HbA1c）影响。结论糖尿病可能主要通过增加破骨细胞活性影响骨代谢， TRAP－5b可能成为绝经后T2 DM并发骨质疏松患者监测骨代谢变化的特异性指标。
  • 摘要：骨质疏松症是一种以骨密度减少、骨折风险增高为特征的全身代谢性骨病。骨质疏松症的病因探讨一直是研究的热点，其中遗传因素起到最重要作用。基因甲基化作为表观遗传学的一个重要组成，参与了骨质疏松相关基因表达的调控，与骨质疏松的发病具有相关性。本文通过回顾骨质疏松相关基因甲基化水平的研究，从骨转换调节的维生素D内分泌途径、雌激素内分泌途径、 Wnt／β－catenin信号通路和OPG／RANKL／RANK系统等4条通路的相关基因及其他基因的甲基化水平等5个方面进行综述，并探讨进一步研究方向。%Osteoporosis is a systemic metabolic osteopathy characterized by low bone mineral density, leading to an increased risk of fractures.Study on the etiology of osteoporosis is a research hotspot, and genetic factors play the most important role of the etiology.As an important component of epigenetic genetics, gene methylation is involved in the regu-lation of the expression of the genes related to osteoporosis, which is related to the incidence of osteoporosis.The study about the gene methylation level of the vitamin D endocrine pathway, the estrogen endocrine pathway, the Wnt/β-catenin signaling pathway and the OPG/RANKL/RANK pathway related genes and other genes were reviewed to explore further research directions.
  • 摘要：目的：调查不同地区和级别医院中不同科室临床医生参与骨质疏松管理工作现状，从医生角度了解目前防治骨质疏松的缺口，为学术界和卫生管理部门制定和完善骨质疏松防治策略提供依据。方法由参加调研医院自行选择本院参与骨质疏松诊疗相关科室的医生进行问卷调查，每个中心调查30～35人。结果来自11家三级甲等医院和6家二级医院的568名临床医生完成问卷，其中骨科和内分泌科医生最多。对所在医院是否开设骨质疏松门诊及是否有双能 X 线吸收检测法（ dual-energy X-ray absorptiometry ， DXA）测量骨密度，二级医院医生知晓率低于三级医院医生（二级医院知晓率分别为81.3％和90.2％，三级医院分别为89.1％和95.5％）；骨科（96.9％）和内分泌科（98.2％）医生对本院是否有DXA的知晓率高于其他专科医生（89.4％）。各专业对钙剂和／或维生素D、选择性雌激素受体调节剂（ selective estrogen receptor modulators， SERMs）知晓率差异无统计学意义（P＜0.05），内分泌专业对于活性维生素D、双膦酸盐、降钙素类、雌激素类、锶盐知晓率高于其他专业，妇产科对于中药知晓率（54.5％）低于其他专业。骨质疏松工作的参与度调查显示，多数医生参与骨质疏松防治工作占全部业务工作的比例在30％以下，三级医院（16.5％）、骨科专业医生（21.9％）工作比例在30％以上者相对较高，每周诊治骨质疏松症患者例数较多者多见于骨科和内分泌科。结论中国骨质疏松防治事业在设备配置、医生知晓率和参与程度上均存在不足，同时获得省市17家医院临床医生对国内骨质疏松症患者管理提出的问题和建议，为我国骨质疏松防治策略制定和完善提供了一定的依据。
  • 摘要：Objective To investigate the aged-related changes in body composition , body mass index ( BMI) , and bone mineral density ( BMD) , and to analyze the relationship between body composition and BMD in elderly men over 50-year-old.Methods The present study was a retrospective analysis of the body composition , BMI, and BMD of 358 Chinese male outpatients over 50 years of age who were recruited from our hospital between 2009 and 2011 .Qualified subjects were stratified according to age and BMI .To compare the differences of body composition among different groups , and to analyze the impact of BMD according to the changes of body composition .Results Although there were no signifi-cant differences in BMI among the age groups , there was a significant decline in height and weight according to age ( both P=0.000 ) .The LMI ( Lean mass index ) and FFMI ( Fat free mass index ) also declined with age ( both P=0.000 ) whereas the FMI increased ( P=0.015 ) .Although the absolute values of BMC and LM declined with age ( P=0.003 and P=0.000 , respectively ) , there was no significant difference in FM .There was an increase in %FM ( P=0.000 ) and a decrease in %LM (P=0.000) with age.The femoral neck (FN) and total hip (TH) BMD significantly declined with age ( P=0.000 and P=0.003 , respectively ) .BMD increased at all sites ( all P<0.01 ) as BMI increased but there were declines in the detection rates of osteoporosis and osteopenia ( both P=0.000 ) .Logistic regression revealed that a decline in BMI was an independent risk factor of osteoporosis or osteopenia , while an increase in BMI was a protective factor for BMD.At the same time, BMD in L1-4 exhibited a significant positive correlation with FMI (P=0.000) and the femoral neck and total hip BMDs had significant positive correlation with FFMI and LMI , respectively ( both P=0.000 ) .Conclusion These data indicated that in elderly males older than 50 years, an increased BMI was protective for BMD while FMI were protective for BMD in L1-4 , LMI and FFMI were protective for BMD in the femoral neck and total hip.%目的：探讨50岁以上老年男性随增龄，体质成分（ body composition ）、体质量指数（ body mass index， BMI）和骨密度（ bone mineral density ， BMD）的变化趋势及其相互关系。方法分析中国人民解放军总医院2009－2011年度门诊358例50岁以上老年男性患者的体质成分及BMD测定资料，根据年龄和BMI分组，比较各年龄组间体质成分的差别，分析体质成分的变化对BMD的影响。结果（1）该人群身高、体质量随增龄而降低（ P＝0.000），但BMI各组间差异无统计学意义（ P＞0.05）；瘦体质量指数（ lean mass in-dex， LMI）及非脂肪体质量指数（fat free mass index， FFMI）随增龄而下降（P均＝0.000），而脂肪体质量指数（fat mass index， FMI）随增龄而增加（P＝0.015）；骨矿含量（bone mass content， BMC）及瘦体质量（lean mass， LM）的绝对值随增龄而降低（P＝0.003， P＝0.000），而脂肪含量（fat mass， FM）各年龄组间差异无统计学意义（ P＞0.05）；从体质成分比例上看，随增龄％FM升高，而％LM降低（ P均＝0.000）。（2）随增龄股骨颈（femoral neck， FN）和全髋骨（total hip， TH） BMD降低（P＝0.000， P＝0.003），而腰椎1-4（L1-4） BMD无明显变化。（3）按BMI分组，随着BMI增加，各部位BMD增高（P均＜0.01），而骨质疏松症及骨量减少的检出率相应减少（P均＜0.01）。（4）将20≤BMI＜24 kg／m2设为1，以骨质疏松症检出率为结局，采用回归分析，提示BMI降低是骨量减少及骨质疏松症的独立危险因素， BMI增加是BMD的保护因素。（5）分别以FMI、 LMI和FFMI四分位统计，随FMI增高， L1-4部位BMD增高（P＝0.000），而FN和HP的BMD则随着LMI和FFMI的增加而增加（P均＝0.000）。结论50岁以上老年男性，BMI过低更易患骨质疏松症，而体质成分中FMI是腰椎的保护因素， LMI和FFMI是髋部BMD的保护因素。
  • 摘要：Objective To observe the effects of 17β-E2 and Wnt/β-catenin signaling pathways on the expres-sion of matrix Gla protein (MGP) in osteosarcoma cells (MG63), to investigate the potential role and the possible mechanism of MGP in osteoporosis.Methods MG63 cells were intervened by 17β-E2 (10 -10 , 10 -8 , 10 -6 ) mol/L, the inhibitor of estrogen receptor ICI 10 -7 mol/L for 48 h.MG63 cells were intervened by 17β-E2 10 -8 mol/L, (Dickkopf1) DKK-1 200 ng/mL, 17β-E2 10 -8 mol/L +DKK 1 200 ng/mL for 48 h.MG63 cells were inter-vened by 17β-E2 10 -8 mol/L, Warfarin 10 -5 mol/mL, 17β-E2 10 -8 mol/L +warfarin 10 -5 mol/mL for 48 h, then total RNA and protein was extracted.Real-time quantitative ( RT-PCR) and Western blotting were used to de-tectMGP,β-catenin,Runx2,LRP5geneandproteinexpression.Results 17β-E2couldup-regulatetheex-pression of MGP, at the concentration of 10 -10 , 10 -8 , 10 -6 mol/L.MGP mRNA expression were 4.63-fold, 7.16-fold, 2.95-fold, and MGP protein expression was 1.17-fold, 1.58-fold, 1.28-fold, compared with the control (P<0.05).At the concentration of 10 -8 mol/L, the effects of the 17 β-E2 was more obvious.The modu-lating effect of MGP by 17β-E2 was blocked after (Faslodex) ICI was used (P<0.05).17β-E2 increased the ex-pression of mRNA and protein of Wnt-associated proteinβ-catenin and LRP5.The Wnt/β-catenin signaling pathway inhibitor, DKK-1 could block the upregulation effect of MGP by 17β-E2 significantly ( P<0.05 ) .Warfarin de-creased the expression of MGP and block the upregulation effect of β-catenin, LRP5, Runx2 by 17β-E2 significant-ly ( P<0.05) .Conclusion It is maybe the mechanism of osteoporosis that 17β-E2 modulated the expression of MGP through Wnt/β-catenin signaling pathways.%目的：观察17β-雌二醇（17β-E217β-estradiol）对骨肉瘤细胞（osteosarcoma MG 63）基质Gla蛋白（MGP Matrix GLA protein）表达的影响及Wnt／β-catenin信号通路在其中的作用，探讨MGP在骨质疏松症发病过程中的可能机制。方法17β-E210－10、10－8、10－6mol／L及雌激素受体抑制剂氟维司群（Faslodex简称ICI）10－7 mol／L， ICI 10－7 mol／L ＋17β-E210－8 mol／L干预MG63细胞48 h。用10－8 mol／L的17β-E2及200 ng／mL Wnt／β-catenin信号通路阻断剂Dickkopf1分泌蛋白-1（ DKK-1）干预MG63细胞48 h。用10－8 mol／L 17β-E2及MGP抑制剂华法林10μmol／L干预MG63细胞48 h。干预后的细胞提取蛋白及总RNA，后用荧光定量PCR及Westernblotting观察MGP、β-catenin、Runx2、LRP5蛋白及基因的表达。结果17β-E2能上调MGP的表达，10－10、10－8、10－6 mol／L 17β-E2干预后， MGP mRNA的表达是对照组的4.63、7.16、2.95倍（ P＜0.05）， MGP蛋白的表达分别是对照组的1.17、1.58、1.28倍（ P＜0.05），以10－8 mol／L 17β-E2的作用最明显。 ICI 能阻断17β-E2对MGP的上调作用，与单用17β-E2相比，差异有统计学意义（ P＜0.05）。17β-E2能增加Wnt／β-catenin经典信号通路中相关蛋白的表达，β-catenin及Runx2 mRNA及蛋白的表达与对照组相比，差异有统计学意义（ P＜0.05）。DKK-1则阻断17β-E2对MGP、β-catenin、 Runx2、 LRP5的上调作用，与对照组相比，差异有统计学意义（ P ＜0.05）。华法林可阻断17β-E2的作用，与对照组相比 MGP、β-catenin、Runx2、LRP5的表达均下调，差异有统计学意义（P＜0.05）。结论17β-E2调节成骨肉瘤细胞内Wnt／β-catenin信号通路同时也调节MGP表达，该作用可能是骨质疏松症发病的机制之一。
  • 摘要：Primary hyperparathyroidism ( PHPT) is far less common in the children and adolescents than in the adult population .PHPT appears to be a more aggressive disorder in children and adolescents than that in adults .Unlike a-dult patients , most children and adolescents with PHPT are symptomatic .Characteristics of PHPT in children and adoles-cents are different from adults in many aspects .The purpose of this review is to improve the understanding of this rare dis-ease in the children and adolescents population .%原发性甲状旁腺功能亢进症（以下简称甲旁亢）在儿童和青少年的发病率远低于成人。儿童和青少年甲旁亢常比成人严重，成人患者以无症状性甲旁亢居多，而大多数儿童和青少年患者为有症状性甲旁亢。儿童和青少年甲旁亢在很多方面有别于成人甲旁亢患者。本文旨在提高对儿童和青少年甲旁亢的认识。
  • 摘要：目的：探讨2型糖尿病（type 2 diabetes mellitus， T2DM）患者肌少症与性别、年龄、25羟基维生素D （25-hydroxyvitamin D，25OHD）及病程的关系。方法选取2014年8月至2015年6月于安徽省立医院内分泌科住院的T2 DM患者132例，以同期体检的60例正常人为对照，采用双能X线吸收检测法（ dual energy X-ray absorptiometry， DXA）对人体组织成分进行测定，并应用电化学发光法测定体内25OHD水平。根据Baumgartner诊断标准诊断肌少症，比较T2DM组与对照组肌少症发生率，再分别比较两组男女性别发病情况。根据年龄分别将两组研究对象分为5组，比较各年龄段肌少症发生率；根据25 OHD水平分为维生素D严重缺乏组（＜10 ng／mL ）、缺乏组（≥10且＜20 ng／mL ）、不足组（≥20且＜30 ng／mL ）、充足组（≥30 ng／mL），比较各组肌少症发生率。根据糖尿病病程将T2DM组研究对象分为5组，比较各组肌少症发病情况。结果（1） T2DM组肌少症发生率（24.2％）高于对照组（11.7％）；（2）两组男性肌少症发生率均大于女性（ T2 DM组：32.8％vs.15.4％；对照组：23.1％vs.2.9％， P均＜0.05）；（3）80岁以上年龄段组肌少症发生率最高（ T2 DM组：50.0％，对照组：42.9％），且肌少症患者的平均年龄均大于肌量正常者（ P＜0.05）；（4）25OHD严重缺乏组肌少症患病人数多（T2DM组：41.7％，对照组：30.0％），且肌少症患者的25 OHD水平较肌量正常者低（ P＜0.05）；（5）糖尿病患者中，病程20年以上患肌少症（61.1％）最多，肌少症患者的糖尿病病程较肌量正常者长（P＜0.05）。结论2型糖尿病、老龄化是肌少症发病的危险因素，糖尿病病程越长，发病率越高；男性发病率高于女性；低25OHD水平可能与肌少症发生有关。%Objective To investigate the relationship between sarcopenia , gender, age, 25-hydroxyvitamin D (25OHD) level and diabetic duration in type 2 diabetes mellitus (T2DM) patients.Methods Sixty controls, one hun-dred thirty-two patients with T2DM were enrolled in the study .All the subjects underwent body composition measurement by dual-energy X-ray absorptiometry (DXA), and the serum 25OHD level were measured by electrochemiluminescence method.Sarcopenia was diagnosed by the Baumgartner diagnostic criteria .The prevalence of sarcopenia in T2DM group and the control group was compared , and in different gender respectively .The subjects in the two groups were divided in-to five subgroups according to age .Afterwards, these subgroups were divided into vitamin D severe deficiency ( <10 ng/mL), deficiency (≥10 and <20 ng/mL), insufficiency (≥20 and <30 ng/mL) and sufficiency group (≥30 ng/mL).T2DM group was divided into a-e groups according to the diabetic duration .The prevalence of sarcopenia in each group was compared .Results Compared with the control group (11.7%), the prevalence of sarcopenia in T2DM group (24.2%) was higher.The prevalence of sarcopenia in men was higher than in women ( T2DM group: 32.8%/15.4%; the control group: 23.1%/2.9%, P<0.05 ) .The prevalence of sarcopenia in subjects older than 80 years old (T2DM group: 50.0%, the control group: 42.9%) was the highest, and the subjects with sarcopenia was older than those without sarcopenia (P<0.05).The prevalence of sarcopenia in vitamin D severe deficiency group (T2DM group: 41.7%; the control group: 30.0%) was higher, and the 25OHD level of subjects with sarcopenia was lower than those without sarcopenia ( P<0.05 ) .The prevalence of sarcopenia in diabetic duration more than 20 years group (61.1%) was higher, and the diabetic duration of subjects with sarcopenia was longer than those without sarcopenia (P<0.05).Conclusion Aging, gender, T2DM and diabetic duration are risk factors for sarcopenia .Low serum 25OHD level may be related to sarcopenia .
  • 摘要：目的：探讨生活方式对上海社区老年人跟骨定量超声骨密度（ quantitative ultrasound-bone min-eral density ， QUS-BMD）的影响。方法采用自行设计的调查问卷对上海社区自愿参加跟骨定量超声检查的14814例老年人进行生活方式的调查，并使用跟骨定量超声仪对受试者右侧跟骨的骨密度（ bone mineral den-sity， BMD）进行测量。结果随着年龄的增加，老年男性和女性的BMD水平均逐渐下降（ P均＜0.05）；男性BMD水平高于女性（0.441 g／cm2 vs．0.377 g／cm2， P均＜0.05）；随着教育程度的提高， BMD水平逐渐升高（P均＜0.05）；每天锻炼≥30 min者BMD水平明显高于不锻炼者或每天锻炼＜30 min者（0.415 g／cm2 vs．0.404 g／cm2或0.409 g／cm2， P均＜0.05）；每天饮用乳制品≥250 mL者BMD水平明显高于不饮用乳制品或每天饮用＜250 mL者（0.418 g／cm2 vs．0.405 g／cm2或0.405 g／cm2， P均＜0.05）；体质量指数（body mass index， BMI）低于21.77 kg／m2组BMD水平明显低于BMI高于21.77 kg／m2的其他3组（0.396 g／cm2 vs．0.412 g／cm2和0.411 g／cm2、0.418 g／cm2， P均＜0.05）。结论上海社区老年人跟骨定量超声骨密度与生活方式及膳食营养状况密切相关，教育程度、户外锻炼、饮用奶制品、 BMI等因素为上海社区老年人QUS-BMD的保护性因素，而高龄、女性等因素是上海社区老年人QUS-BMD的不利因素，良好的生活方式和膳食习惯对老年人骨健康至关重要。%Objective To analyze the influence of lifestyle factors on bone mass among elderly population in Shanghai community .Methods Totally 14 814 volunteer aged over 65 years from Shanghai communities were investiga-ted using a self-designed questionnaire to survey their lifestyles , then bone mineral density (BMD) of right calcaneus were measured by quantitative ultrasound system ( QUS) .Results The BMD showed a significant decreasing trend with aging , both in men and women (all P<0.05).Men had greater BMD than women (0.441 g/cm2 vs.0.377 g/cm2, all P<0.05 ) .The level of BMD increased significantly with the improvement of education level ( all P<0.05 ); BMD levels of people who exercised≥30 min/d were significantly higher than those of people who did not exercise or exercised <30 min/d (0.415 g/cm2 vs.0.404 g/cm2 or 0.409 g/cm2, both P<0.05); BMD levels of people who drank milk≥250 mL/d were significantly higher than those of people who did not drink milk or drank <250 mL/d (0.418 g/cm2 vs. 0.405 g/cm2 or 0.405 g/cm2 , both P<0.05 ); BMD levels of people whose BMI below 21.77 kg/m2 were higher than those of people whose BMI above 21.77 kg/m2 (0.396 g/cm2 vs.0.412 g/cm2 , 0.411 g/cm2 , 0.418 g/cm2 , all P<0.05 ) .Conclusion BMD of calcaneal quantitative ultrasound in elderly people of Shanghai community was closely re -lated to lifestyle and diet nutrition .Education level , outdoor exercises , milkconsumption , BMI, type 2 diabetes were protective factors of BMD .While high age , female gender , type 1 diabetes were adverse factors of BMD .Good lifestyle and dietary habits are essential for bone health of elderly .
  • 摘要：Objective To improve the understanding of diagnosis and treatment for Paget's disease through clin-ical analysis of 1 case with Paget's disease of bone ( PDB) who have been misdiagnosed .Methods The clinical symp-toms, biochemical markers , X-ray features and pathological characteristics of a case with PDB were analyzed .And the effect of zoledronic acid treatment was evaluated .Results The bone pain was significantly reduced after treatment .The values of serum ALP and t-P1NP were significantly decreased at 3 months after treatment and continue to decrease . Conclusion Intravenous infusion of zoledronic acid is effective .Improving the understanding of PDB is beneficial means to avoid misdiagnosis .The long-term follow-up is important .%目的：分析1例Paget 骨病（ Paget's disease of bone ， PDB）患者诊治经过，以期提高临床医生对该病的认识，减少误诊及提高及时治疗率，减少其致残率。方法整理1例PDB患者的临床资料、实验室检查、 X线片特征及病理特征，给予单次静脉注射唑来膦酸盐5 mg，3、6、9个月后观察相关指标变化，评价治疗效果。结果 PDB患者经唑来膦酸盐治疗后，临床症状缓解，血清碱性磷酸酶、总Ⅰ型前胶原氨基端延长肽、β胶原特殊序列显著持续下降。结论单次静脉给予唑来膦酸盐是治疗PDB的良好选择。提高医生对PDB的认识是避免误诊的最佳手段。加强长期随访是治疗的重要一部分。
  • 摘要：There are many causes of hypercalcemia , such as primary hyperparathyroidism , maligancy and vit-main D intoxication et al .Immobilization-an infrequent and overlooked risk factor-may be the underlying causes .Immobi-lization due to fractures, burns, paralysis, or other causes is known to induce hypercalcemia .Prolonged immobilization uncouples bone remodeling because of the lack of mechanical stress and bone destruction exceeds formation .Calcium is released into the extracellular fluid , and the excess calcium is excreted mainly by way of the kidney .When the kidney is unable to excrete the increased quantity of calcium as rapidly as it is formed , hypercalcemia occurs .Volume expansion and diuretics, rehabilitative exercises , and bone resorption inhibitor can be used to correct this problem .This review de-scribed incidence , mechanism and treatment of immobilization hypercalcemia .%高钙血症病因众多，如原发性甲状旁腺功能亢进症、恶性肿瘤和维生素D中毒等，其中制动是其中一种比较少见的原因，常被忽视。制动性高钙血症常见于骨折、脊柱损伤、四肢瘫痪、大面积烧伤等需要长期制动的患者。长期制动时，由于缺乏机械刺激，骨转换失衡，骨吸收率超过骨形成率，骨钙释放入血，当超过肾脏排泄钙的能力时导致高钙血症的发生。可通过恢复负重活动，积极扩容、利尿、抑制骨吸收等措施降低血钙。本文就制动性高钙血症的发生率、常见人群、发生机制及治疗等作一综述。
  • 摘要：目的：了解老年骨质疏松人群的跌倒风险现状，并对跌倒的危险因素进行相关分析。方法选取2014年8月至2015年12月骨科门诊老年骨质疏松患者210例，平均年龄（68.55±5.92）岁。采集基本信息，用社区老年人跌倒风险评估工具（falls risk for older people-community setting， FROP-Com）、跌倒效能量表（modified falls efficacy scale， MFES）评估跌倒风险。手持式测力仪（hand-held dynamometer， HHD）测试肌力，记录简易躯体能力测试（ short physical performance battery ， SPPB）结果。测定骨密度、血钙、血磷、血肌酐、1型前胶原氨基末端肽、Ⅰ型胶原羧基末端肽、全段甲状旁腺激素和25-羟基维生素D （25-hydroxy vitamin D）。统计跌倒发生情况，对FROP-Com跌倒低风险组和高风险组组间差别进行单因素方差分析和卡方检验。以多重线性回归分析跌倒的危险因素。结果1年内发生过跌倒的83例（39.5％），其中跌倒两次及以上的23例（11.0％）。 FROP-Com平均得分（10.22±9.50）分， MFES平均得分（9.27±0.87）分，跌倒风险处于较高水平。 FROP-Com 低风险组和高风险组相比， HHD （ F ＝55.795， P ＝0.000）、 SPPB （ F ＝48.009， P＝0.000）、血钙（ F＝0.497， P＝0.000）和25 OHD （ F＝20.501， P＝0.000）明显较高，差异具有统计学意义，骨质疏松治疗史差异也具有统计学意义（χ2＝21.567， P＝0.000）。多重线性回归分析显示跌倒的危险因素，按影响从大到小依次为SPPB、 HHD、血钙、25OHD，差异具有统计学意义（F＝91.80， P＝0.000）。结论老年骨质疏松人群存在较高的跌倒风险，应该给予综合干预措施，以降低其跌倒风险。%Objective To investigate the risk of falls among elderly patients with osteoporosis , and analyze its risk factors.Methods From 2014.8 to 2015.12, totally 210 outpatient elderly osteoporosis patients were involved in this study, age 68.55 ±5.92 years.We collect basic information and assessment of falls risk by falls risk for older peo-ple-community setting (FROP-Com) and modified falls efficacy scale (MFES).We test muscle strength by hand-held dy-namometer (HHD), and record short physical performance battery (SPPB) results.We get the results of bone mineral density, serum calcium, serum phosphorus, serum creatinine, type 1 procollagen amino terminal peptide , typeⅠcol-lagen carboxyl terminal peptide , parathyroid hormone , 25-hydroxy vitamin D , and record the history of falls .Single fac-tor analysis of variance and chi square test were perform to get the different between FROP -Com low risk group and high risk group.Multiple linear regression analysis was used to analyze the risk factors of falls .Results Over the past year , 83 patients (39.5%) have fallen, and 23 patients (11.0%) fell two or more than two times.The average of FROP-Com was 10.22 ±9.50 , and the average MFES was 9.27 ±0.87 , the fall risk was at a high level .The HHD ( F=55.795 , P=0.000), SPPB (F=48.009, P=0.000), serum calcium (F=0.497, P=0.000) and 25OHD (F=20.501, P=0.000 ) results of low risk group were significantly higher than those of high risk group .The proportion of osteoporosis treatment group was also higher in low risk group (χ2 =21.567 , P =0.000 ) .The risk factors for falls was SPPB , HHD, serum calcium and 25OHD, regression equation has significant statistical significance (F=91.80, P=0.000). Conclusion Elderly patients with osteoporosis have a higher risk of fall , so they should be given comprehensive meas-ures to reduce falls , to prevent osteoporosis fracture .
  • 摘要：原发性甲状旁腺功能亢进（primary hyperparathyroidism,PHPT）是甲状旁腺自身因素造成甲状旁腺素过度分泌而导致的全身性疾病。原发性甲状旁腺功能亢进骨病（PHPT骨病）是一种比较常见的甲状旁腺外器官的并发症,以骨病为首发症状的PH门在临床常常被忽视或被误诊为肿瘤或其他骨原发性病变，病理活检诊断困难且误诊率高，可能导致治疗延误、过度或错误。
  • 摘要：Tumor induced osteomalacia ( TIO) is acquired metabolic bone disease , due to the tumorous hyper-secretion of fibroblast growth factor-23 ( FGF-23 ) , characterized by renal phosphate wasting induced hypophosphatemia and defective mineralization of bones .Clinical manifestation present as progressive skeletal pain , physical inactivity and fatigue, as well as osteomalacia symptoms .The tumor mainly stem from osseous tissue or soft tissue , pathologically were considered as phosphaturic mesenchymal tumor ( PMT) .Under a microscope , the neoplastic cells were usually spindled to stellate in shape , with a well-developed capillary network , arises from mesenchymal tissues , and the presence of nu-merous osteoclast-like giant cells, osteoid-like matrix, chondrocyte-like cells seen arranged in a storiform or fascicular pattern.Granular, cytoplasmic staining with the FGF-23 positive was seen in most cases .The another pathological char-acter of MPT was rich in vascular vessel , especially abnormal thick-walled vessels .At present , the mechanism of genesis and development of PMT was not clear yet , and they may be affected by multiple factors .For one thing , endothelial-mes-enchymal transition ( EndMT) has been implicated in cancer development , heterotopic ossification and gain ability of in-vasiveness .For another , over-activation of FGFR was related with tumorigenesis .FGFR gene fusions associated with breast cancer and prostatic cancer .There is few research focus on FGFR and bone tumor , but study verified a novel FN 1-FGFR1 genetic fusion frequently occurred in PMT .Moreover, activation of FGR1 promote expression of FGF-23.All the mechanism may be related to tumor induced osteomalacia .%肿瘤性骨软化症（ tumor induced osteomalcia ， TIO）是一种代谢性骨病，是由于肿瘤分泌成纤维细胞生长因子23（ FGF-23），导致肾磷排出增加、骨矿化障碍，以进行性骨痛、乏力、骨软化为临床表现。TIO肿瘤主要来自于骨组织及软组织，被称之为磷酸盐尿性间叶组织肿瘤（ phosphaturic mesenchymal tumor ， PMT）。主要病理表现为镜下可见的大量梭形细胞，间叶组织来源，血管丰富，可见破骨样细胞、骨及软骨样结构，可见钙化，免疫组化染色表达FGF-23。其特点在于丰富的血管，尤其是畸形厚壁血管。目前，对于PMT发生，产生FGF-23的机制不明。肿瘤发生、发展具有多种因素影响，一方面，目前研究认为内皮细胞-间充质细胞转化（ endothelial-to-mesenchymal transformation ， EndMT ）是肿瘤发展，具有侵袭性的可能机制之一，参与多种肿瘤的发展过程。另一方面， FGFR的过度激活与肿瘤的发生相关， FGFR的融合基因可与乳腺癌，前列腺癌等相关。 FGFR与骨肿瘤的研究很少，但有研究表明FGFR1与纤维连接蛋白1（ fibronectin1， FN1）的融合基因在PMT肿瘤中多见。另外， FGFR1激活后可促进FGF-23表达。这些机制可能与TIO肿瘤有关。

    中华骨质疏松和骨矿盐疾病杂志的期刊信息

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