目的研究高龄（≥80岁）老年女性骨质疏松患者骨代谢特点及使用双膦酸盐的疗效。方法回顾2005年8月至2013年8月在上海交通大学附属第一人民医院骨质疏松门诊就诊的初诊患者,所有患者均接受双膦酸盐药物治疗≥12个月,用药前后测骨密度（b...目的研究高龄（≥80岁）老年女性骨质疏松患者骨代谢特点及使用双膦酸盐的疗效。方法回顾2005年8月至2013年8月在上海交通大学附属第一人民医院骨质疏松门诊就诊的初诊患者,所有患者均接受双膦酸盐药物治疗≥12个月,用药前后测骨密度（bone mineral density,BMD）和骨转换指标（bone turnover marker,BTM）等,≥80岁的高龄老年女性骨质疏松患者232例（高龄老年组）和47~65岁的绝经后女性骨质疏松患者454例（对照组）。记录所有纳入患者的年龄、身高,体质量、体质量指数（body mass index,BMI）,用药时间,治疗前后骨密度、血钙、血磷、血清25-羟维生素D（25-hydroxy-vitamin D,25OHD）、骨钙素（bone gamma-carboxyglutamic-acid-containing proteins,BGP）和Ⅰ型胶原羧基端肽（Ⅰtype collagen pyridine cross-linked final peptide,β-CTx）等临床资料。结果两组治疗前BMI、血钙、血磷和L1-4BMD差异无统计学意义;高龄老年女性骨质疏松患者的骨转换水平、股骨颈BMD、全髋BMD和25OHD明显低于对照组（P〈0.05）。双膦酸盐治疗12个月后,两组BMD和25OHD水平均增加,骨转换指标均下降。高龄老年组L1-4BMD升高3.29%,股骨颈BMD升高1.24%,全髋关节BMD升高1.00%;对照组L1-4BMD升高3.51%,股骨颈BMD升高1.18%,全髋关节BMD升高1.58%。两组BMD升高程度比较差异无统计学意义（P〉0.05）;老年组BGP下降23.63%,β-CTx下降40.62%,对照组BGP下降36.65%,β-CTx下降60.26%,两者下降程度比较差异有统计学意义（P〈0.05）;老年组25OHD升高17.85%,对照组升高8.97%;双膦酸盐治疗12个月后,两组血钙和血磷比较差异无统计学意义（P〉0.05）。结论高龄老年骨质疏松患者骨转换水平处于低骨转换状态,对于不同骨转换水平的骨质疏松患者,双膦酸盐增加BMD的作用相似,双膦酸盐可以应用于80岁以上的老年骨质疏松患者。展开更多
骨质疏松症（osteoporosis,OP）是一种以骨量低下、骨微结构破坏,导致骨脆性增加、易发生骨折为特征的全身性疾病。双膦酸盐是目前最常用的抗OP药物,它能有效降低OP患者椎体、非椎体和髋部骨折的风险。但是长期使用双膦酸盐类药物会出...骨质疏松症（osteoporosis,OP）是一种以骨量低下、骨微结构破坏,导致骨脆性增加、易发生骨折为特征的全身性疾病。双膦酸盐是目前最常用的抗OP药物,它能有效降低OP患者椎体、非椎体和髋部骨折的风险。但是长期使用双膦酸盐类药物会出现疗效下降,并诱发不典型骨折和下颌骨坏死等严重并发症。目前一般建议连续使用双膦酸盐药物3~5年后,就进入药物假期。在药物假期期间,应注意定期检测骨密度（bone mineral density,BMD）和骨转换标志物（bone turnover markers,BTMs）,并根据两者的变化,来决定下一步治疗方案。一般来说,如BTMs水平较低、BMD稳定,则药物假期继续;如BTMs水平增高、BMD下降,应重新接受抗骨吸收治疗;如BTMs水平较低、BMD下降,则应考虑改用特立帕肽成骨治疗。展开更多
Background：Systemic administration ofbisphosphonates has shown promising results in the treatment ofosteonecrosis of the femoral head （ONFH）.However,few studies have evaluated the efficacy of local zoledronate （ZO...Background：Systemic administration ofbisphosphonates has shown promising results in the treatment ofosteonecrosis of the femoral head （ONFH）.However,few studies have evaluated the efficacy of local zoledronate （ZOL） administration in the treatment of ONFH.The purpose of this study was to investigate whether local administration of bisphosphonate-soaked hydroxyapatite （HA） could improve bone healing in an experimental rabbit model of ONFH.Methods：This experimental study was conducted between October 2014 and June 2015.Forty-five rabbits underwent simulated ONFH surgery.Immediately following surgery,they were divided into three groups：model （untreated,n =15）,HA （treated with HA alone,n =15）,and HA ＋ ZOL （treated with HA soaked in a low-dose ZOL solution,n =15）.Histological,immunohistochemical,and quantitative analyses were performed to evaluate bone formation and resorption 2,4,and 8 weeks after surgery.Results：Gross bone matrix and hematopoietic tissue formation were observed in the HA ＋ ZOL group 4 weeks after surgery.The immunohistochemical staining intensities for 5-bromodeoxyuridine,runt-related transcription factor 2,osteocalcin,osteopontin,and osteoprotegerin were significantly higher in the HA ＋ ZOL group than that in the model （P 〈 0.001,P 〈 0.001,P 〈 0.001,P 〈 0.001,and P =0.018,respectively） and HA groups （P =0.003,P =0.049,P 〈 0.00l,P =0.020,and P =0.019,respectively）,whereas receptor activator of the nuclear factor-κB ligand staining intensity was significantly lower in the HA ＋ ZOL group than that in the model and HA groups （P =0.029 and P =0.015,respectively） 4 weeks after surgery.No significant differences in bone formation or bone resorption marker expression were found between the three groups 2 or 8 weeks after surgery （P 〉 0.05）.Conclusions：Local administration of HA soaked in a low-dose ZOL solution increased new bone formation while inhibiting bone resorption in an animal model of ONFH,which might provide new evidence for j展开更多
文摘目的研究高龄（≥80岁）老年女性骨质疏松患者骨代谢特点及使用双膦酸盐的疗效。方法回顾2005年8月至2013年8月在上海交通大学附属第一人民医院骨质疏松门诊就诊的初诊患者,所有患者均接受双膦酸盐药物治疗≥12个月,用药前后测骨密度（bone mineral density,BMD）和骨转换指标（bone turnover marker,BTM）等,≥80岁的高龄老年女性骨质疏松患者232例（高龄老年组）和47~65岁的绝经后女性骨质疏松患者454例（对照组）。记录所有纳入患者的年龄、身高,体质量、体质量指数（body mass index,BMI）,用药时间,治疗前后骨密度、血钙、血磷、血清25-羟维生素D（25-hydroxy-vitamin D,25OHD）、骨钙素（bone gamma-carboxyglutamic-acid-containing proteins,BGP）和Ⅰ型胶原羧基端肽（Ⅰtype collagen pyridine cross-linked final peptide,β-CTx）等临床资料。结果两组治疗前BMI、血钙、血磷和L1-4BMD差异无统计学意义;高龄老年女性骨质疏松患者的骨转换水平、股骨颈BMD、全髋BMD和25OHD明显低于对照组（P〈0.05）。双膦酸盐治疗12个月后,两组BMD和25OHD水平均增加,骨转换指标均下降。高龄老年组L1-4BMD升高3.29%,股骨颈BMD升高1.24%,全髋关节BMD升高1.00%;对照组L1-4BMD升高3.51%,股骨颈BMD升高1.18%,全髋关节BMD升高1.58%。两组BMD升高程度比较差异无统计学意义（P〉0.05）;老年组BGP下降23.63%,β-CTx下降40.62%,对照组BGP下降36.65%,β-CTx下降60.26%,两者下降程度比较差异有统计学意义（P〈0.05）;老年组25OHD升高17.85%,对照组升高8.97%;双膦酸盐治疗12个月后,两组血钙和血磷比较差异无统计学意义（P〉0.05）。结论高龄老年骨质疏松患者骨转换水平处于低骨转换状态,对于不同骨转换水平的骨质疏松患者,双膦酸盐增加BMD的作用相似,双膦酸盐可以应用于80岁以上的老年骨质疏松患者。
文摘骨质疏松症（osteoporosis,OP）是一种以骨量低下、骨微结构破坏,导致骨脆性增加、易发生骨折为特征的全身性疾病。双膦酸盐是目前最常用的抗OP药物,它能有效降低OP患者椎体、非椎体和髋部骨折的风险。但是长期使用双膦酸盐类药物会出现疗效下降,并诱发不典型骨折和下颌骨坏死等严重并发症。目前一般建议连续使用双膦酸盐药物3~5年后,就进入药物假期。在药物假期期间,应注意定期检测骨密度（bone mineral density,BMD）和骨转换标志物（bone turnover markers,BTMs）,并根据两者的变化,来决定下一步治疗方案。一般来说,如BTMs水平较低、BMD稳定,则药物假期继续;如BTMs水平增高、BMD下降,应重新接受抗骨吸收治疗;如BTMs水平较低、BMD下降,则应考虑改用特立帕肽成骨治疗。
文摘Background：Systemic administration ofbisphosphonates has shown promising results in the treatment ofosteonecrosis of the femoral head （ONFH）.However,few studies have evaluated the efficacy of local zoledronate （ZOL） administration in the treatment of ONFH.The purpose of this study was to investigate whether local administration of bisphosphonate-soaked hydroxyapatite （HA） could improve bone healing in an experimental rabbit model of ONFH.Methods：This experimental study was conducted between October 2014 and June 2015.Forty-five rabbits underwent simulated ONFH surgery.Immediately following surgery,they were divided into three groups：model （untreated,n =15）,HA （treated with HA alone,n =15）,and HA ＋ ZOL （treated with HA soaked in a low-dose ZOL solution,n =15）.Histological,immunohistochemical,and quantitative analyses were performed to evaluate bone formation and resorption 2,4,and 8 weeks after surgery.Results：Gross bone matrix and hematopoietic tissue formation were observed in the HA ＋ ZOL group 4 weeks after surgery.The immunohistochemical staining intensities for 5-bromodeoxyuridine,runt-related transcription factor 2,osteocalcin,osteopontin,and osteoprotegerin were significantly higher in the HA ＋ ZOL group than that in the model （P 〈 0.001,P 〈 0.001,P 〈 0.001,P 〈 0.001,and P =0.018,respectively） and HA groups （P =0.003,P =0.049,P 〈 0.00l,P =0.020,and P =0.019,respectively）,whereas receptor activator of the nuclear factor-κB ligand staining intensity was significantly lower in the HA ＋ ZOL group than that in the model and HA groups （P =0.029 and P =0.015,respectively） 4 weeks after surgery.No significant differences in bone formation or bone resorption marker expression were found between the three groups 2 or 8 weeks after surgery （P 〉 0.05）.Conclusions：Local administration of HA soaked in a low-dose ZOL solution increased new bone formation while inhibiting bone resorption in an animal model of ONFH,which might provide new evidence for j
