目的探索骨质疏松症患者发生脆性骨折的影响因素,并构建骨折风险评估模型。方法纳入912例骨质疏松症患者,分为骨折组595例,无骨折组317例。通过医院电子病历信息系统和骨质疏松患者数据管理平台查阅患者病历资料,获得临床特征、骨密度...目的探索骨质疏松症患者发生脆性骨折的影响因素,并构建骨折风险评估模型。方法纳入912例骨质疏松症患者,分为骨折组595例,无骨折组317例。通过医院电子病历信息系统和骨质疏松患者数据管理平台查阅患者病历资料,获得临床特征、骨密度、实验指标和生活方式等38个变量。对比骨折组与无骨折组的差异,通过Logistic回归分析脆性骨折的影响因素,并建立回归模型。采用Bootstrap法内部验证模型、绘制模型校准曲线及列线图。结果与无骨折组比较,骨折组的年龄更大、碱性磷酸酶(alkaline phosphatase,ALP)更高,有跌倒史和有父母髋部骨折史的发生率更高,运动和日照时间更少,腰椎、股骨颈、全髋骨密度(bone mineral density,BMD)更低,(P<0.05)。Logistic回归分析发现:年龄(OR=1.050,95%CI:1.023~1.078)、过去一年跌倒史(OR=5.738,95%CI:3.119~10.558)、父母髋部骨折史(OR=2.521,95%CI:1.021~6.224)、ALP(OR=1.010,95%CI:1.003~1.017)是发生脆性骨折的独立危险因素,腰椎BMD(OR=0.061,95%CI:0.009~0.396)是保护性因素。利用年龄、过去一年跌倒史、父母髋部骨折史、ALP等4个脆性骨折影响因素建立评估模型,C指数为0.785,拟合优度检验结果P>0.05,提示模型具有较好的校准度与区分度。结论骨质疏松症患者的年龄、过去一年跌倒史、父母髋部骨折史、ALP是骨质疏松症患者发生脆性骨折的危险因素,腰椎BMD是保护因素。研究建立的模型中包含的4个变量均是简单、易获得的指标,无需进行双能X线吸收测量仪(dual energy X-ray absorptiometry,DXA)检测即可判断骨质疏松症患者的脆性骨折风险,在各级别医疗机构都有一定推广价值。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 patient展开更多
Type 2 diabetes(T2D)is a global epidemic disease.The prevalence of T2D in adolescents and young adults is increasing alarmingly.The mechanisms leading to T2D in young people are similar to those in older patients.Howe...Type 2 diabetes(T2D)is a global epidemic disease.The prevalence of T2D in adolescents and young adults is increasing alarmingly.The mechanisms leading to T2D in young people are similar to those in older patients.However,the severity of onset,reduced insulin sensitivity and defective insulin secretion can be different in subjects who develop the disease at a younger age.T2D is associated with different complications,including bone fragility with consequent susceptibility to fractures.The purpose of this systematic review was to describe T2D bone fragility together with all the possible involved pathways.Numerous studies have reported that patients with T2D show preserved,or even increased,bone mineral density compared with controls.This apparent paradox can be explained by the altered bone quality with increased cortical bone porosity and compromised mechanical properties.Furthermore,reduced bone turnover has been described in T2D with reduced markers of bone formation and resorption.These findings prompted different researchers to highlight the mechanisms leading to bone fragility,and numerous critical altered pathways have been identified and studied.In detail,we focused our attention on the role of microvascular disease,advanced glycation end products,the senescence pathway,the Wnt/β-catenin pathway,the osteoprotegerin/receptor-activator of nuclear factor kappa B ligand,osteonectin and fibroblast growth factor 23.The understanding of type 2 myeloid bone fragility is an important issue as it could suggest possible interventions for the prevention of poor bone quality in T2D and/or how to target these pathways when bone disease is clearly evident.展开更多
目的探讨miR-92a-3p在老年骨质疏松症(osteoporosis,OP)中的表达情况及其在髋部脆性骨折中的诊断价值。方法借助美国国家生物技术信息中心(National Center for Biotechnology Information,NCBI)网站检索与OP、miRNA相关的数据集并进行...目的探讨miR-92a-3p在老年骨质疏松症(osteoporosis,OP)中的表达情况及其在髋部脆性骨折中的诊断价值。方法借助美国国家生物技术信息中心(National Center for Biotechnology Information,NCBI)网站检索与OP、miRNA相关的数据集并进行分析与筛选获得目标miRNA。收集2020年1月至2020年6月期间,从山西医科大学第二医院骨科纳入53例OP患者与24例健康人的血清标本,将OP患者分为发生髋部脆性骨折组(OP_F组,30例)和未发生髋部脆性骨折组(OP_WF组,23例),分析受试者的骨密度与血清中的骨代谢标志物测量:钙、磷、甲状旁腺激素、25-羟基维生素D、骨碱性磷酸酶、血清c末端肽。利用qRT-PCR检测血清标本中目标miRNA的表达水平。χ^(2)检验、t检验、斯皮尔曼等级相关、接收者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析miR-92a-3p表达水平与患者临床特征的潜在关系。结果从NCBI网站中分析得出miR-92a-3p在OP患者中表达较健康人水平升高(t=3.41,P=0.007),miR-1304-5p表达水平降低(t=5.13,P<0.001)。qRT-PCR实验证实以上结果,并进一步发现较OP_WF组,OP_F组中miR-92a-3p表达明显升高(t=3.01,P=0.004),但miR-1304-5p在两组间无明显差异(t=0.71,P=0.480)。OP患者组与健康对照组相比,BMI(t=2.71,P=0.008)、骨密度评分(t=29.02,P<0.001)、钙(t=61.20,P<0.001)、磷(t=2.54,P=0.013)、25-羟基维生素D(t=3.01,P=0.004)、骨碱性磷酸酶(t=12.56,P<0.001)、血清c末端肽(t=7.52,P<0.001)水平差异有统计学意义。OP_F组与OP_WF组相比,骨密度评分(t=2.08,P=0.042)、钙(t=15.75,P<0.001)、骨碱性磷酸酶(t=2.02,P=0.049)、血清c末端肽(t=3.39,P=0.001)的水平差异有统计学意义。骨密度评分、骨碱性磷酸酶浓度与miR-92a-3p的表达有关且分别呈负相关(r=-0.403,P=0.027)与正相关(r=0.416,P=0.022)。ROC曲线下面积为0.723,miR-92a-3p水平对诊断髋部脆性骨折具有潜在意义(P=0.006)。结论miR-92a-3p在OP中高表达,�展开更多
目的:对维持性血液透析患者脆性骨折患病情况及骨密度(Bone mass density,BMD)检查情况进行横断面研究。方法:调查108例维持性血液透析患者脆性骨折患病情况,并记录年龄、性别、身高、体重、原发病、进入血液透析时间、女性绝经年龄等...目的:对维持性血液透析患者脆性骨折患病情况及骨密度(Bone mass density,BMD)检查情况进行横断面研究。方法:调查108例维持性血液透析患者脆性骨折患病情况,并记录年龄、性别、身高、体重、原发病、进入血液透析时间、女性绝经年龄等资料。所有患者均采用双能X线吸收仪(Dual energy X-ray absorptiometry,DEXA)进行腰椎、股骨BMD检测。用SPSS软件进行统计学分析。结果:骨折组年龄及进入透析时间明显高于未骨折组,体重及体重指数两组存在显著性差异(P<0.05)。骨折组股骨及腰椎骨丢失率高于未骨折组,T-score明显低于未骨折组。骨折组股骨颈、大转子、Ward's三角BMD明显低于未骨折组,腰椎BMD两组比较无显著性差异。结论:维持性血液透析患者脆性骨折患病率较高,髋部骨折多见,骨丢失率增加及骨密度降低是脆性骨折的重要危险因素,采用DEXA定期评价骨密度对于维持性血液透析患者脆性骨折防治具有重要临床意义。展开更多
Bisphosphonate class of drugs, the most commonly prescribed for the treatment of osteoporosis, is effective in preventing and treating bone loss and fractures. However, the treatment duration and the applicability of ...Bisphosphonate class of drugs, the most commonly prescribed for the treatment of osteoporosis, is effective in preventing and treating bone loss and fractures. However, the treatment duration and the applicability of “drug holidays” for bisphosphonates need optimization in order to minimize long-term exposure. Drug holidays may prevent potential adverse events while still maintaining some degree of antifracture efficacy via residual antiresorptive activity by retained bisphosphonates. Patients receiving bisphosphonates, who are at low-moderate risk of fracture, are potential candidates for a drug holiday. However, for high-risk patients or patients with previous history of fragility fractures, the benefits of continuing bisphosphonate therapy considerably out-weigh their potential harm. Evidence-based guidelines regarding starting and stopping a drug holiday are not available;therefore, it is appropriate to monitor patients on a drug holiday to assess a declining antiresorptive effect. In case of a significant rise in bone turnover markers or significant decrease in bone mineral density, it may be time to restart therapy.展开更多
目的妊娠和哺乳期骨质疏松症(pregnancy and lactation-associated osteoporosis,PLO)是发于妊娠期和哺乳期的一种特发性的罕见的骨质疏松症,是多种因素影响骨代谢的结果。分析PLO的典型临床特征,以期进行早期的预防干预及诊疗。方法对...目的妊娠和哺乳期骨质疏松症(pregnancy and lactation-associated osteoporosis,PLO)是发于妊娠期和哺乳期的一种特发性的罕见的骨质疏松症,是多种因素影响骨代谢的结果。分析PLO的典型临床特征,以期进行早期的预防干预及诊疗。方法对在山东省中医院就诊的两名典型PLO患者的临床特点及治疗进行归纳总结,并结合文献对其临床特点、发病机制等方面进行分析。结果两名PLO患者均是在产后无明显诱因出现腰椎的剧烈腰痛,活动受限,并伴有腰椎的压缩性骨折,明确诊断后建议立即停止哺乳,两名患者均拒绝,予以中药、钙剂、维生素D等药物治疗,治疗后两名患者的症状均有明显改善。结论在妊娠和哺乳期间,未受明显外力的情况下出现突发性的严重腰痛患者应考虑PLO的可能,在确诊为PLO后,应建议立即停止哺乳,并予以中药、钙剂、维生素D、双膦酸盐类等药物治疗。展开更多
文摘目的探索骨质疏松症患者发生脆性骨折的影响因素,并构建骨折风险评估模型。方法纳入912例骨质疏松症患者,分为骨折组595例,无骨折组317例。通过医院电子病历信息系统和骨质疏松患者数据管理平台查阅患者病历资料,获得临床特征、骨密度、实验指标和生活方式等38个变量。对比骨折组与无骨折组的差异,通过Logistic回归分析脆性骨折的影响因素,并建立回归模型。采用Bootstrap法内部验证模型、绘制模型校准曲线及列线图。结果与无骨折组比较,骨折组的年龄更大、碱性磷酸酶(alkaline phosphatase,ALP)更高,有跌倒史和有父母髋部骨折史的发生率更高,运动和日照时间更少,腰椎、股骨颈、全髋骨密度(bone mineral density,BMD)更低,(P<0.05)。Logistic回归分析发现:年龄(OR=1.050,95%CI:1.023~1.078)、过去一年跌倒史(OR=5.738,95%CI:3.119~10.558)、父母髋部骨折史(OR=2.521,95%CI:1.021~6.224)、ALP(OR=1.010,95%CI:1.003~1.017)是发生脆性骨折的独立危险因素,腰椎BMD(OR=0.061,95%CI:0.009~0.396)是保护性因素。利用年龄、过去一年跌倒史、父母髋部骨折史、ALP等4个脆性骨折影响因素建立评估模型,C指数为0.785,拟合优度检验结果P>0.05,提示模型具有较好的校准度与区分度。结论骨质疏松症患者的年龄、过去一年跌倒史、父母髋部骨折史、ALP是骨质疏松症患者发生脆性骨折的危险因素,腰椎BMD是保护因素。研究建立的模型中包含的4个变量均是简单、易获得的指标,无需进行双能X线吸收测量仪(dual energy X-ray absorptiometry,DXA)检测即可判断骨质疏松症患者的脆性骨折风险,在各级别医疗机构都有一定推广价值。
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 patient
文摘Type 2 diabetes(T2D)is a global epidemic disease.The prevalence of T2D in adolescents and young adults is increasing alarmingly.The mechanisms leading to T2D in young people are similar to those in older patients.However,the severity of onset,reduced insulin sensitivity and defective insulin secretion can be different in subjects who develop the disease at a younger age.T2D is associated with different complications,including bone fragility with consequent susceptibility to fractures.The purpose of this systematic review was to describe T2D bone fragility together with all the possible involved pathways.Numerous studies have reported that patients with T2D show preserved,or even increased,bone mineral density compared with controls.This apparent paradox can be explained by the altered bone quality with increased cortical bone porosity and compromised mechanical properties.Furthermore,reduced bone turnover has been described in T2D with reduced markers of bone formation and resorption.These findings prompted different researchers to highlight the mechanisms leading to bone fragility,and numerous critical altered pathways have been identified and studied.In detail,we focused our attention on the role of microvascular disease,advanced glycation end products,the senescence pathway,the Wnt/β-catenin pathway,the osteoprotegerin/receptor-activator of nuclear factor kappa B ligand,osteonectin and fibroblast growth factor 23.The understanding of type 2 myeloid bone fragility is an important issue as it could suggest possible interventions for the prevention of poor bone quality in T2D and/or how to target these pathways when bone disease is clearly evident.
文摘目的探讨miR-92a-3p在老年骨质疏松症(osteoporosis,OP)中的表达情况及其在髋部脆性骨折中的诊断价值。方法借助美国国家生物技术信息中心(National Center for Biotechnology Information,NCBI)网站检索与OP、miRNA相关的数据集并进行分析与筛选获得目标miRNA。收集2020年1月至2020年6月期间,从山西医科大学第二医院骨科纳入53例OP患者与24例健康人的血清标本,将OP患者分为发生髋部脆性骨折组(OP_F组,30例)和未发生髋部脆性骨折组(OP_WF组,23例),分析受试者的骨密度与血清中的骨代谢标志物测量:钙、磷、甲状旁腺激素、25-羟基维生素D、骨碱性磷酸酶、血清c末端肽。利用qRT-PCR检测血清标本中目标miRNA的表达水平。χ^(2)检验、t检验、斯皮尔曼等级相关、接收者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析miR-92a-3p表达水平与患者临床特征的潜在关系。结果从NCBI网站中分析得出miR-92a-3p在OP患者中表达较健康人水平升高(t=3.41,P=0.007),miR-1304-5p表达水平降低(t=5.13,P<0.001)。qRT-PCR实验证实以上结果,并进一步发现较OP_WF组,OP_F组中miR-92a-3p表达明显升高(t=3.01,P=0.004),但miR-1304-5p在两组间无明显差异(t=0.71,P=0.480)。OP患者组与健康对照组相比,BMI(t=2.71,P=0.008)、骨密度评分(t=29.02,P<0.001)、钙(t=61.20,P<0.001)、磷(t=2.54,P=0.013)、25-羟基维生素D(t=3.01,P=0.004)、骨碱性磷酸酶(t=12.56,P<0.001)、血清c末端肽(t=7.52,P<0.001)水平差异有统计学意义。OP_F组与OP_WF组相比,骨密度评分(t=2.08,P=0.042)、钙(t=15.75,P<0.001)、骨碱性磷酸酶(t=2.02,P=0.049)、血清c末端肽(t=3.39,P=0.001)的水平差异有统计学意义。骨密度评分、骨碱性磷酸酶浓度与miR-92a-3p的表达有关且分别呈负相关(r=-0.403,P=0.027)与正相关(r=0.416,P=0.022)。ROC曲线下面积为0.723,miR-92a-3p水平对诊断髋部脆性骨折具有潜在意义(P=0.006)。结论miR-92a-3p在OP中高表达,�
文摘目的:对维持性血液透析患者脆性骨折患病情况及骨密度(Bone mass density,BMD)检查情况进行横断面研究。方法:调查108例维持性血液透析患者脆性骨折患病情况,并记录年龄、性别、身高、体重、原发病、进入血液透析时间、女性绝经年龄等资料。所有患者均采用双能X线吸收仪(Dual energy X-ray absorptiometry,DEXA)进行腰椎、股骨BMD检测。用SPSS软件进行统计学分析。结果:骨折组年龄及进入透析时间明显高于未骨折组,体重及体重指数两组存在显著性差异(P<0.05)。骨折组股骨及腰椎骨丢失率高于未骨折组,T-score明显低于未骨折组。骨折组股骨颈、大转子、Ward's三角BMD明显低于未骨折组,腰椎BMD两组比较无显著性差异。结论:维持性血液透析患者脆性骨折患病率较高,髋部骨折多见,骨丢失率增加及骨密度降低是脆性骨折的重要危险因素,采用DEXA定期评价骨密度对于维持性血液透析患者脆性骨折防治具有重要临床意义。
文摘Bisphosphonate class of drugs, the most commonly prescribed for the treatment of osteoporosis, is effective in preventing and treating bone loss and fractures. However, the treatment duration and the applicability of “drug holidays” for bisphosphonates need optimization in order to minimize long-term exposure. Drug holidays may prevent potential adverse events while still maintaining some degree of antifracture efficacy via residual antiresorptive activity by retained bisphosphonates. Patients receiving bisphosphonates, who are at low-moderate risk of fracture, are potential candidates for a drug holiday. However, for high-risk patients or patients with previous history of fragility fractures, the benefits of continuing bisphosphonate therapy considerably out-weigh their potential harm. Evidence-based guidelines regarding starting and stopping a drug holiday are not available;therefore, it is appropriate to monitor patients on a drug holiday to assess a declining antiresorptive effect. In case of a significant rise in bone turnover markers or significant decrease in bone mineral density, it may be time to restart therapy.
文摘目的妊娠和哺乳期骨质疏松症(pregnancy and lactation-associated osteoporosis,PLO)是发于妊娠期和哺乳期的一种特发性的罕见的骨质疏松症,是多种因素影响骨代谢的结果。分析PLO的典型临床特征,以期进行早期的预防干预及诊疗。方法对在山东省中医院就诊的两名典型PLO患者的临床特点及治疗进行归纳总结,并结合文献对其临床特点、发病机制等方面进行分析。结果两名PLO患者均是在产后无明显诱因出现腰椎的剧烈腰痛,活动受限,并伴有腰椎的压缩性骨折,明确诊断后建议立即停止哺乳,两名患者均拒绝,予以中药、钙剂、维生素D等药物治疗,治疗后两名患者的症状均有明显改善。结论在妊娠和哺乳期间,未受明显外力的情况下出现突发性的严重腰痛患者应考虑PLO的可能,在确诊为PLO后,应建议立即停止哺乳,并予以中药、钙剂、维生素D、双膦酸盐类等药物治疗。
