BACKGROUND The correlation between geriatric nutritional risk index(GNRI)and the prognosis of patients with osteoporosis or osteopenia has not been studied.This study aims to explore the relationship between GNRI and ...BACKGROUND The correlation between geriatric nutritional risk index(GNRI)and the prognosis of patients with osteoporosis or osteopenia has not been studied.This study aims to explore the relationship between GNRI and the cardiovascular disease(CVD)and all-cause mortality rates in elderly patients with osteoporosis or osteopenia.METHODS This study included 4756 patients with osteoporosis and osteopenia from five cycles of the National Health and Nutrition Examination Survey(NHANES).We used multivariable Cox regression and subgroup analyses to investigate the correlation between GNRI and mortality rates.The restricted cubic spline analysis was used to assess the dose-response relationship between GNRI and mortality risk.Mediation analysis was conducted to examine the mediating effect of chronic kidney disease on the relationship between nutritional risk and mortality.RESULTS During a median follow-up period of 114 months,a total of 1241 deaths(26.09%)occurred,including 300 deaths due to CVD(6.31%).In the fully adjusted Model 3,compared to the no-risk group,the risk group showed significantly increased all-cause mortality risk(HR=2.05,95%CI:1.74–2.40)and CVD mortality risk(HR=1.88,95%CI:1.30–2.71).The restricted cubic spline analysis indicated a non-linear association between GNRI and all-cause mortality risk as well as CVD mortality risk.The mediation analysis results indicated that chronic kidney disease mediates 16.9%of the effect of nutritional risk on all-cause mortality and 25.3%on CVD mortality risk.CONCLUSIONS GNRI can serve as a predictive factor for all-cause and CVD mortality rates in elderly patients with osteoporosis or osteopenia.展开更多
Postmenopausal osteoporosis and osteopenia are chronic and uncurable conditions that invariably lead to an increased risk of vertebral, hip, and femoral neck fracture if left untreated. Clinical guidelines establish, ...Postmenopausal osteoporosis and osteopenia are chronic and uncurable conditions that invariably lead to an increased risk of vertebral, hip, and femoral neck fracture if left untreated. Clinical guidelines establish, in general, pharmacological combinations allied to lifestyle changes as the mainstay of their management, and also increasing bone marrow density, lowering fracture risk, and improving quality of life are their main therapeutic goals. The objective of this systematic review was to analyze the available data in the scientific medical literature regarding the role of the ibandronate and cholecalciferol combination in postmenopausal osteoporosis and osteopenia management. Based on our results, we concluded that the above combination is safe and feasible for the clinical control of both conditions.展开更多
Osteonecrosis of the jaw (ONJ) is an adverse effect of nitrogen-containing bisphosphonates. Advancing age, intravenous administration of zoledronic acid (ZOL), history of dento-alveolar surgery, and concomitant system...Osteonecrosis of the jaw (ONJ) is an adverse effect of nitrogen-containing bisphosphonates. Advancing age, intravenous administration of zoledronic acid (ZOL), history of dento-alveolar surgery, and concomitant systemic diseases such as diabetes are known as risk factors for developing ONJ. However, despite numerous studies, the exact pathophysiology remains unclear and management strategies are largely anecdotal. Once-yearly intravenously administered 5 mg ZOL was approved by the US Food and Drug Administration in 2007 for the treatment of osteoporosis and its efficacy with 3 year-regimen had been recently proven in preventing new clinical fracture. Although occurrences of ONJ have been reported to be rare with this drug administration, available data is very limited and long-term outcomes are lacking. We present a case of ONJ identified in an osteopenic patient with an intermittent but long standing sore mouth related to exposed mandibular bone. Once-yearly infusion of zoledronic acid used in the treatment of osteopenia may contribute to the spontaneous development of ONJ, especially in those presenting with multiple comorbidity factors. This report suggests the importance of health care professionals keeping abreast of new developments in this area and providing appropriate information to their patients.展开更多
This study assesses the impact of exercise on the health of the Qigong(Jibengong,Health Qigong Ba Duan Jin and Health Qigong Yi Jin Jing)in patients with rheumatoid arthritis,rheumatism,osteoporosis,osteopenia.Through...This study assesses the impact of exercise on the health of the Qigong(Jibengong,Health Qigong Ba Duan Jin and Health Qigong Yi Jin Jing)in patients with rheumatoid arthritis,rheumatism,osteoporosis,osteopenia.Through the given questionnaire we have come up with data showing how and how much health qigong affects the patients with rheumatoid arthritis,rheumatism,osteoporosis,osteopenia according to the subjective assessment.展开更多
Background:Osteopenia has been well documented in adolescent idiopathic scoliosis(AIS).Bone marrow stem cells(BMSCs)are a crucial regulator of bone homeostasis.Our previous study revealed a decreased osteogenic abilit...Background:Osteopenia has been well documented in adolescent idiopathic scoliosis(AIS).Bone marrow stem cells(BMSCs)are a crucial regulator of bone homeostasis.Our previous study revealed a decreased osteogenic ability of BMSCs in AIS-related osteopenia,but the underlying mechanism of this phenomenon remains unclear.Methods:A total of 22 AIS patients and 18 age-matched controls were recruited for this study.Anthropometry and bone mass were measured in all participants.Bone marrow blood was collected for BMSC isolation and culture.Osteogenic and adipogenic induction were performed to observe the differences in the differentiation of BMSCs between the AIS-related osteopenia group and the control group.Furthermore,a total RNA was extracted from isolated BMSCs to perform RNA sequencing and subsequent analysis.Results:A lower osteogenic capacity and increased adipogenic capacity of BMSCs in AIS-related osteopenia were revealed.Differences in mRNA expression levels between the AIS-related osteopenia group and the control group were identified,including differences in the expression of LRRC17,DCLK1,PCDH7,TSPAN5,NHSL2,and CPT1B.Kyoto Encyclopedia of Genes and Genomes enrichment analyses revealed several biological processes involved in the regulation of autophagy and mitophagy.The Western blotting results of autophagy markers in BMSCs suggested impaired autophagic activity in BMSCs in the AIS-related osteopenia group.Conclusion:Our study revealed that BMSCs from AIS-related osteopenia patients have lower autophagic activity,which may be related to the lower osteogenic capacity and higher adipogenic capacity of BMSCs and consequently lead to the lower bone mass in AIS patients.展开更多
Background:Congenital scoliosis(CS)is a complex spinal malformation of unknown etiology with abnormal bone metabolism.Fibroblast growth factor 23(FGF23),secreted by osteoblasts and osteocytes,can inhibit bone formatio...Background:Congenital scoliosis(CS)is a complex spinal malformation of unknown etiology with abnormal bone metabolism.Fibroblast growth factor 23(FGF23),secreted by osteoblasts and osteocytes,can inhibit bone formation and mineralization.This research aims to investigate the relationship between CS and FGF23.Methods:We collected peripheral blood from two pairs of identical twins for methylation sequencing of the target region.FGF23 mRNA levels in the peripheral blood of CS patients and age-matched controls were measured.Receiver operator characteristic(ROC)curve analyses were conducted to evaluate the specificity and sensitivity of FGF23.The expression levels of FGF23 and its downstream factors fibroblast growth factor receptor 3(FGFr3)/tissue non-specific alkaline phosphatase(TNAP)/osteopontin(OPN)in primary osteoblasts from CS patients(CS-Ob)and controls(CT-Ob)were detected.In addition,the osteogenic abilities of FGF23-knockdown or FGF23-overexpressing Ob were examined.Results:DNA methylation of the FGF23 gene in CS patients was decreased compared to that of their identical twins,accompanied by increased mRNA levels.CS patients had increased peripheral blood FGF23 mRNA levels and decreased computed tomography(CT)values compared with controls.The FGF23 mRNA levels were negatively correlated with the CT value of the spine,and ROCs of FGF23 mRNA levels showed high sensitivity and specificity for CS.Additionally,significantly increased levels of FGF23,FGFr3,OPN,impaired osteogenic mineralization and lower TNAP levels were observed in CS-Ob.Moreover,FGF23 overexpression in CT-Ob increased FGFr3 and OPN levels and decreased TNAP levels,while FGF23 knockdown induced downregulation of FGFr3 and OPN but upregulation of TNAP in CS-Ob.Mineralization of CS-Ob was rescued after FGF23 knockdown.Conclusions:Our results suggested increased peripheral blood FGF23 levels,decreased bone mineral density in CS patients,and a good predictive ability of CS by peripheral blood FGF23 levels.FGF23 may contribute to osteopenia in CS patients through FGFr3/TNAP/OPN pathway.展开更多
This study explored the application value of iterative decomposition of water and fatwith echo asymmetry and least-squares estimation(IDEAL-IQ)technology in the early diagnosis of ageing osteoporosis(OP).172 participa...This study explored the application value of iterative decomposition of water and fatwith echo asymmetry and least-squares estimation(IDEAL-IQ)technology in the early diagnosis of ageing osteoporosis(OP).172 participants were enrolled and underwentmagnetic resonance imaging(MRI)examinations on a 3.0T scanner.100 cases were included in the normal group(50 males and 50 females;mean age:45 years;age range:20e84 years).33 cases were included in the osteopenia group(17 males and 16 females;mean age:55 years;age range:43e83 years).39 caseswere includedintheOP group(19males and20females;meanage:58years;age range:48 e82 years).Conventional T1WI and T2WI were first obtained,followed by 3D-IDEAL-IQ-acqui-sition.Fat fraction(FF)and apparent transverse relaxation rate(R2*)resultswere automatically calculated from IDEAL-IQ-images on the console.Based on T1Wand T2W-images,300 ROIs for each participantweremanually delineated in L1-L5 vertebral bodies of five middle slices.In each age group of all normal subjects,each parameter was significantly correlated with gender.In male participants from the normal,osteopenia,and OP groups,statistical analysis revealed F values of 11319.292 and 180.130 for comparisons involving FF and R2*values,respectively(all p<0.0001).The sensitivity and specificity of FF values were 0.906 and 0.950,0.994 and 0.997,0.865 and 0.820,respectively.For R2*,they were 0.665 and 0.616,0.563 and 0.519,0.571 and 0.368,respectively.In female participants from the normal,osteopenia,and OP-groups,statis-tical analysis revealed F values of 12461.658 and 548.274 for comparisons involving FF and R2*values,respectively(all p<0.0001).The sensitivity and specificity of FF values were 0.985 and 0.991,0.996 and 0.996,0.581 and 0.678,respectively.For R2*,they were 0.698 and 0.730,0.603 and 0.665,0.622 and 0.525,respectively.Significant differences were indicated in the quanti-tative values among the three groups.FF value had good performance,while R2*value had poor performance indiscriminatingosteopenia andOP-groups.Overall,the IDEAL-IQ techniqueoffers specific reference indices that enable noninvasive and quantitative assessment of lumbar vertebrae bone metabolism,thereby providing diagnostic information for OP.展开更多
BACKGROUND Hypophosphatasia(HPP)is a rare metabolic disorder caused by low tissue-nonspecific alkaline phosphatase(ALP)activity,presenting symptoms from bone demineralization to tooth loss.It affects multiple systems ...BACKGROUND Hypophosphatasia(HPP)is a rare metabolic disorder caused by low tissue-nonspecific alkaline phosphatase(ALP)activity,presenting symptoms from bone demineralization to tooth loss.It affects multiple systems and is diagnosed based on clinical symptoms,radiological findings,and lab tests.This case report empha-sizes considering HPP in patients with unexplained bone pain and low ALP levels,especially with underlying osteopenia or osteoporosis.It highlights the importance of genetic testing and counseling for early diagnosis and treatment,aiming to raise clinician awareness.CASE SUMMARY We present a case of a 65-year-old female patient who was referred to our endoc-rinology clinic for complaints of generalized bone pain and hypothyroidism.Initial evaluation revealed osteopenia,managed with calcium and vitamin D supplementation.Persistently low ALP levels and elevated vitamin B6 levels led to the diagnosis of HPP,confirmed by genetic testing identifying a pathogenic ALPL gene variant[c.119C>T(p.Ala40Val)].Despite conservative treatment,her bone density declined,although remaining in the osteopenic range.The Fracture Risk Assessment score indicated a low risk of major osteoporotic and hip fractures,not warranting immediate treatment.Plans are underway to initiate enzyme replacement therapy with asfotase alfa.CONCLUSION Recognizing HPP is crucial,as early diagnosis and treatment can significantly improve patient outcomes and prevent complications.展开更多
目的:观察补肾填精方联合施氏十二字养生功治疗骨量减少肝肾不足证的临床疗效,并初步探讨其作用机制。方法:采用随机、对照、多中心临床试验,纳入600例骨量减少肝肾不足证患者,每组300例。健康宣教组采用健康宣教方式进行干预,联合干预...目的:观察补肾填精方联合施氏十二字养生功治疗骨量减少肝肾不足证的临床疗效,并初步探讨其作用机制。方法:采用随机、对照、多中心临床试验,纳入600例骨量减少肝肾不足证患者,每组300例。健康宣教组采用健康宣教方式进行干预,联合干预组在健康宣教基础上口服补肾填精方联合施氏十二字养生功锻炼,共干预3个月。评价指标包括腰椎和左髋骨密度T值、血清Ⅰ型前胶原氨基末端肽(typeⅠprocollagen amino-terminal peptide,PⅠNP)含量、血清骨钙素(osteocalcin,OC)含量、血清Ⅰ型胶原交联羧基末端肽β特殊序列(β-isomerized carboxy-terminal telopeptide collagen typeⅠ,β-CTX)含量、血清25-羟维生素D3[25-hydroxyvitamin D3,25(OH)D3]含量、血清甲状旁腺激素(parathyroid hormone,PTH)含量、腰背痛视觉模拟量表(visual analogue scale,VAS)评分、中医证候积分、16条目骨质疏松症患者健康相关生存质量评估(16-item assessment of health-related quality of life in osteoporosis,ECOS-16)问卷评分及综合疗效。结果:①骨密度T值。干预3个月后,联合干预组的腰椎和左髋部骨密度T值均高于健康宣教组(Z=-3.145,P=0.002;Z=-2.048,P=0.041)。联合干预组干预3个月后的腰椎和左髋部骨密度T值均较干预前增高(Z=-10.244,P=0.000;Z=-3.782,P=0.000);健康宣教组干预3个月后的腰椎骨密度T值较干预前降低(Z=-2.451,P=0.014),干预前后左髋部骨密度T值的差异无统计学意义(Z=-0.686,P=0.493)。②骨代谢指标。干预3个月后,2组的血清PⅠNP、25(OH)D3含量比较,组间差异均无统计学意义(Z=-0.494,P=0.622;Z=-0.744,P=0.457);联合干预组的血清OC含量高于健康宣教组(Z=-3.645,P=0.000),血清β-CTX、PTH含量均低于健康宣教组(Z=-6.617,P=0.000;Z=-2.614,P=0.009)。联合干预组干预3个月后的血清PⅠNP、OC、25(OH)D3含量均较干预前增高(Z=-4.800,P=0.000;Z=-10.065,P=0.000;Z=-3.898,P=0.000),血清β-CTX、PTH含量均较干预前降低(Z=-7.167,P=0.000;Z=-3.707,P=0.000);健康宣教组干预3个月后的血清OC、β-CTX、25(OH)D3含量均较干预前增高(Z=-3.724,P=0.000;Z=-2.716,P=0.007;Z=-2.405,P=0.016),血清PⅠNP、PTH含量干预前后的差异均无统计学意义(Z=-1.421,P=0.155;Z=-1.159,P=0.247)。③腰背痛VAS评分。2组腰背痛VAS评分随时间变化均呈逐渐降低的趋势(F=750.707,P=0.000;F=499.655,P=0.000);干预1、2、3个月后及干预结束后6个月,联合干预组的腰背痛VAS评分均低于健康宣教组(t=43.508,P=0.000;t=88.074,P=0.000;t=99.590,P=0.000;t=74.462,P=0.000)。④中医证候积分。2组中医证候积分随时间变化均呈逐渐降低的趋势(F=11680.902,P=0.000;F=2279.014,P=0.000);干预1、2、3个月后及干预结束后6个月,联合干预组的中医证候积分均低于健康宣教组(t=133.453,P=0.000;t=661.673,P=0.000;t=1440.622,P=0.000;t=2019.873,P=0.000)。⑤ECOS-16问卷评分。2组ECOS-16问卷评分随时间变化均呈逐渐降低的趋势(F=1798.683,P=0.000;F=1900.262,P=0.000);干预1、2、3个月后及干预结束后6个月,联合干预组的ECOS-16问卷评分均低于健康宣教组(t=34.331,P=0.000;t=166.937,P=0.000;t=409.169,P=0.000;t=565.344,P=0.000)。⑥综合疗效。干预3个月后和干预结束后6个月,联合干预组的综合疗效均优于健康宣教组(R_(联合干预组)=234.90,R_(健康宣教组)=366.10,Z=-10.552,P=0.000;R_(联合干预组)=231.28,R_(健康宣教组)=369.72,Z=-11.192,P=0.000)。结论:在健康宣教基础上口服补肾填精方联合施氏十二字养生功锻炼治疗骨量减少肝肾不足证,可延缓骨量减少、改善临床症状、提高生活质量,效果优于单纯健康宣教,其作用可能与其能够调节骨代谢有关。展开更多
目的探讨非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比率(the non-high-density to high-density lipoprotein cholesterol ratio,NHHR)与腰椎骨量减少风险之间的关系。方法基于2011年-2018年美国国家健康和营养调查(National Health an...目的探讨非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比率(the non-high-density to high-density lipoprotein cholesterol ratio,NHHR)与腰椎骨量减少风险之间的关系。方法基于2011年-2018年美国国家健康和营养调查(National Health and Nutrition Examination Survey,NHANES)数据库,纳入8176名参与者。双能X射线吸收测定法(DXA)测量腰椎骨密度,并计算T值以判定腰椎骨量减少状态。NHHR由总胆固醇减去高密度脂蛋白胆固醇(HDL-C)后再除以HDL-C计算得出。参与者按NHHR分为四分位组,并收集其人口学特征、生活方式(如饮酒、吸烟、体力活动)和临床变量[如体质量指数(body mass index,BMI)、高血压、糖尿病等]。通过多元线性回归分析评估NHHR与腰椎骨量减少的关系,并利用限制性三次样条探讨NHHR与腰椎骨量减少及腰椎骨密度(bone mineral density,BMD)之间的关系。结果腰椎骨量减少组的NHHR显著高于非腰椎骨量减少组(P<0.001)。未调整模型中,NHHR升高与腰椎骨量减少呈正相关(OR:1.11,95%CI:1.07~1.16,P<0.001);调整年龄、性别、BMI等混杂因素后,相关性减弱但仍显著(OR:1.08,95%CI:1.03~1.13,P=0.004)。全面调整腰椎BMD及血脂水平后,NHHR与腰椎骨量减少的关联性不再显著(OR:0.99,P=0.931)。此外,限制性三次样条显示NHHR与腰椎骨量减少间存在非线性关系,J型曲线表明NHHR升高显著增加腰椎骨量减少风险(P<0.05)。NHHR与腰椎BMD呈负相关,拟合模型显示NHHR每增加1单位,腰椎BMD降低0.01 g/cm^(2)。结论NHHR可能作为预测腰椎骨量减少的潜在风险指标,但其与腰椎骨量减少的关联在全面调整后减弱,提示需要进一步研究以明确其机制及临床应用价值。展开更多
目的构建基于健康体检数据的骨密度状况三阶段模型,并在此基础上简化模型参数得到骨质疏松(osteoporosis,OP)与骨量低下(osteopenia,OST)的三阶段预测(triple-stage osteoporosis and osteopenia prediction,TOOP)指数,用于中老年人群...目的构建基于健康体检数据的骨密度状况三阶段模型,并在此基础上简化模型参数得到骨质疏松(osteoporosis,OP)与骨量低下(osteopenia,OST)的三阶段预测(triple-stage osteoporosis and osteopenia prediction,TOOP)指数,用于中老年人群骨量异常风险的初筛、预测与评估。方法回顾性收集2019年1月至2021年12月在黔南州人民医院体检中心完成双能骨密度检查的40岁及以上体检者8021例,按1∶1随机划分为拟合集与验证评估集。利用条件概率原理将三阶段预测问题转化为OP和OST的独立预测问题,并将两者结合构成TOOP指数。采用准确率、灵敏度、特异度、检出率等指标与OSTA指数进行比较验证。结果性别、年龄和体重是OP的三个主要预测因子,年龄和体重是OST的两个主要预测因子。TOOP指数的预测准确率为0.70(95%CI:0.68~0.71),高于OSTA指数(P<0.001)。TOOP指数预测OP和OST的灵敏度分别为0.46(95%CI:0.40~0.53)和0.56(95%CI:0.53~0.60),均高于OSTA指数(OP:P<0.001,OST:P<0.001);特异度分别为0.96(95%CI:0.95~0.97)和0.79(95%CI:0.77~0.81),略低于OSTA指数(OP:P<0.001,OST:P<0.001)。TOOP指数对骨量异常人群的送检率(42.0%)与检出率(32.7%)均高于OSTA指数(P<0.001),漏检率(12.4%)低于OSTA指数(P<0.001)。结论TOOP指数为中老年人群骨质疏松与骨量低下的风险初筛提供了良好的预测工具。展开更多
目的了解广西南宁市绝经后女性骨质疏松症的患病情况及相关影响因素,为进一步预防干预提供理论依据。方法选取我院健康体检的216名绝经后女性作为研究对象,测定髋部及第1~4腰椎的骨密度,同时进行问卷调查。结果骨质疏松、骨量减少及骨...目的了解广西南宁市绝经后女性骨质疏松症的患病情况及相关影响因素,为进一步预防干预提供理论依据。方法选取我院健康体检的216名绝经后女性作为研究对象,测定髋部及第1~4腰椎的骨密度,同时进行问卷调查。结果骨质疏松、骨量减少及骨量正常分别占38.89%、43.06%、18.05%,随着年龄增加,骨质疏松患病率明显升高(χ2=17.56,P=0.000);骨质疏松组年龄、体重指数(body mass index,BMI)、绝经年限、足月妊娠次数、户外活动次数、每次运动时间、活动程度、奶制品摄入及钙剂摄入情况与另外两组比较,差异均有统计学意义(P<0.05),Logistics多因素回归分析表明,年龄、绝经年限与骨质疏松症呈正相关(OR=3.419,P=0.000;OR=2.569,P=0.016);而BMI、运动次数、饮牛奶及钙剂摄入与其呈负相关性(OR=0.517,P=0.000;OR=0.684,P=0.024;OR=0.589,P=0.021;OR=0.266,P=0.000)。结论广西南宁市区绝经后女性骨质疏松及骨量减少患病率高。BMI增高、运动次数多、饮牛奶及钙剂摄入是其保护因素,应加强宣教,从而预防和延缓骨质疏松的发生。展开更多
目的:研究原发性骨质疏松和骨量低下患者下肢肌肉力量与平衡功能的相关性。方法:入组患者为57名通过GE Express超声波跟骨骨密度仪检测诊断为原发性骨质疏松或骨量低下的绝经期女性患者;采用美国Biodex Medical Systems公司生产的Biodex...目的:研究原发性骨质疏松和骨量低下患者下肢肌肉力量与平衡功能的相关性。方法:入组患者为57名通过GE Express超声波跟骨骨密度仪检测诊断为原发性骨质疏松或骨量低下的绝经期女性患者;采用美国Biodex Medical Systems公司生产的Biodex System 4多关节等速测试系统测试下肢肌力;采用单腿站立平衡检测(single leg balance test,SLBT)结果反映患者平衡功能,所得数据应用spss15.0软件进行Pearson线性相关分析,得出线性回归方程。结果:原发性骨质疏松患者优势腿单腿站立时间与慢速屈肌群相对峰力矩的相关系数r=0.540(P=0.000),与中速屈肌群相对峰力矩的相关系数r=0.523(P=0.000),与慢速伸肌群相对峰力矩相关系数r=0.378(P=0.004),与中速伸肌群相对峰力矩的相关系数r=0.282(P=0.034)。结论:原发性骨质疏松患者优势腿伸肌肌力和屈肌肌力与平衡功能均呈正相关,其中屈肌肌力对平衡功能的影响大于伸肌肌力。展开更多
文摘BACKGROUND The correlation between geriatric nutritional risk index(GNRI)and the prognosis of patients with osteoporosis or osteopenia has not been studied.This study aims to explore the relationship between GNRI and the cardiovascular disease(CVD)and all-cause mortality rates in elderly patients with osteoporosis or osteopenia.METHODS This study included 4756 patients with osteoporosis and osteopenia from five cycles of the National Health and Nutrition Examination Survey(NHANES).We used multivariable Cox regression and subgroup analyses to investigate the correlation between GNRI and mortality rates.The restricted cubic spline analysis was used to assess the dose-response relationship between GNRI and mortality risk.Mediation analysis was conducted to examine the mediating effect of chronic kidney disease on the relationship between nutritional risk and mortality.RESULTS During a median follow-up period of 114 months,a total of 1241 deaths(26.09%)occurred,including 300 deaths due to CVD(6.31%).In the fully adjusted Model 3,compared to the no-risk group,the risk group showed significantly increased all-cause mortality risk(HR=2.05,95%CI:1.74–2.40)and CVD mortality risk(HR=1.88,95%CI:1.30–2.71).The restricted cubic spline analysis indicated a non-linear association between GNRI and all-cause mortality risk as well as CVD mortality risk.The mediation analysis results indicated that chronic kidney disease mediates 16.9%of the effect of nutritional risk on all-cause mortality and 25.3%on CVD mortality risk.CONCLUSIONS GNRI can serve as a predictive factor for all-cause and CVD mortality rates in elderly patients with osteoporosis or osteopenia.
文摘Postmenopausal osteoporosis and osteopenia are chronic and uncurable conditions that invariably lead to an increased risk of vertebral, hip, and femoral neck fracture if left untreated. Clinical guidelines establish, in general, pharmacological combinations allied to lifestyle changes as the mainstay of their management, and also increasing bone marrow density, lowering fracture risk, and improving quality of life are their main therapeutic goals. The objective of this systematic review was to analyze the available data in the scientific medical literature regarding the role of the ibandronate and cholecalciferol combination in postmenopausal osteoporosis and osteopenia management. Based on our results, we concluded that the above combination is safe and feasible for the clinical control of both conditions.
文摘Osteonecrosis of the jaw (ONJ) is an adverse effect of nitrogen-containing bisphosphonates. Advancing age, intravenous administration of zoledronic acid (ZOL), history of dento-alveolar surgery, and concomitant systemic diseases such as diabetes are known as risk factors for developing ONJ. However, despite numerous studies, the exact pathophysiology remains unclear and management strategies are largely anecdotal. Once-yearly intravenously administered 5 mg ZOL was approved by the US Food and Drug Administration in 2007 for the treatment of osteoporosis and its efficacy with 3 year-regimen had been recently proven in preventing new clinical fracture. Although occurrences of ONJ have been reported to be rare with this drug administration, available data is very limited and long-term outcomes are lacking. We present a case of ONJ identified in an osteopenic patient with an intermittent but long standing sore mouth related to exposed mandibular bone. Once-yearly infusion of zoledronic acid used in the treatment of osteopenia may contribute to the spontaneous development of ONJ, especially in those presenting with multiple comorbidity factors. This report suggests the importance of health care professionals keeping abreast of new developments in this area and providing appropriate information to their patients.
文摘This study assesses the impact of exercise on the health of the Qigong(Jibengong,Health Qigong Ba Duan Jin and Health Qigong Yi Jin Jing)in patients with rheumatoid arthritis,rheumatism,osteoporosis,osteopenia.Through the given questionnaire we have come up with data showing how and how much health qigong affects the patients with rheumatoid arthritis,rheumatism,osteoporosis,osteopenia according to the subjective assessment.
基金National Natural Science Foundation of China(No.82072390)Natural Science Foundation of Hunan,China(No.2020JJ4873)
文摘Background:Osteopenia has been well documented in adolescent idiopathic scoliosis(AIS).Bone marrow stem cells(BMSCs)are a crucial regulator of bone homeostasis.Our previous study revealed a decreased osteogenic ability of BMSCs in AIS-related osteopenia,but the underlying mechanism of this phenomenon remains unclear.Methods:A total of 22 AIS patients and 18 age-matched controls were recruited for this study.Anthropometry and bone mass were measured in all participants.Bone marrow blood was collected for BMSC isolation and culture.Osteogenic and adipogenic induction were performed to observe the differences in the differentiation of BMSCs between the AIS-related osteopenia group and the control group.Furthermore,a total RNA was extracted from isolated BMSCs to perform RNA sequencing and subsequent analysis.Results:A lower osteogenic capacity and increased adipogenic capacity of BMSCs in AIS-related osteopenia were revealed.Differences in mRNA expression levels between the AIS-related osteopenia group and the control group were identified,including differences in the expression of LRRC17,DCLK1,PCDH7,TSPAN5,NHSL2,and CPT1B.Kyoto Encyclopedia of Genes and Genomes enrichment analyses revealed several biological processes involved in the regulation of autophagy and mitophagy.The Western blotting results of autophagy markers in BMSCs suggested impaired autophagic activity in BMSCs in the AIS-related osteopenia group.Conclusion:Our study revealed that BMSCs from AIS-related osteopenia patients have lower autophagic activity,which may be related to the lower osteogenic capacity and higher adipogenic capacity of BMSCs and consequently lead to the lower bone mass in AIS patients.
基金National Natural Science Foundation of China(No.82072390)Natural Science Foundation of Hunan,China(No.2020JJ4873)
文摘Background:Congenital scoliosis(CS)is a complex spinal malformation of unknown etiology with abnormal bone metabolism.Fibroblast growth factor 23(FGF23),secreted by osteoblasts and osteocytes,can inhibit bone formation and mineralization.This research aims to investigate the relationship between CS and FGF23.Methods:We collected peripheral blood from two pairs of identical twins for methylation sequencing of the target region.FGF23 mRNA levels in the peripheral blood of CS patients and age-matched controls were measured.Receiver operator characteristic(ROC)curve analyses were conducted to evaluate the specificity and sensitivity of FGF23.The expression levels of FGF23 and its downstream factors fibroblast growth factor receptor 3(FGFr3)/tissue non-specific alkaline phosphatase(TNAP)/osteopontin(OPN)in primary osteoblasts from CS patients(CS-Ob)and controls(CT-Ob)were detected.In addition,the osteogenic abilities of FGF23-knockdown or FGF23-overexpressing Ob were examined.Results:DNA methylation of the FGF23 gene in CS patients was decreased compared to that of their identical twins,accompanied by increased mRNA levels.CS patients had increased peripheral blood FGF23 mRNA levels and decreased computed tomography(CT)values compared with controls.The FGF23 mRNA levels were negatively correlated with the CT value of the spine,and ROCs of FGF23 mRNA levels showed high sensitivity and specificity for CS.Additionally,significantly increased levels of FGF23,FGFr3,OPN,impaired osteogenic mineralization and lower TNAP levels were observed in CS-Ob.Moreover,FGF23 overexpression in CT-Ob increased FGFr3 and OPN levels and decreased TNAP levels,while FGF23 knockdown induced downregulation of FGFr3 and OPN but upregulation of TNAP in CS-Ob.Mineralization of CS-Ob was rescued after FGF23 knockdown.Conclusions:Our results suggested increased peripheral blood FGF23 levels,decreased bone mineral density in CS patients,and a good predictive ability of CS by peripheral blood FGF23 levels.FGF23 may contribute to osteopenia in CS patients through FGFr3/TNAP/OPN pathway.
基金supported by the Planned Project Grant(Grant No.3502Z20199064)from the Science and Technology Bureau of Xiamen(CN)the training project(Grant No.2020GGB067)of the youth and middle-aged talents of Fujian Provincial Health Commission(CN).
文摘This study explored the application value of iterative decomposition of water and fatwith echo asymmetry and least-squares estimation(IDEAL-IQ)technology in the early diagnosis of ageing osteoporosis(OP).172 participants were enrolled and underwentmagnetic resonance imaging(MRI)examinations on a 3.0T scanner.100 cases were included in the normal group(50 males and 50 females;mean age:45 years;age range:20e84 years).33 cases were included in the osteopenia group(17 males and 16 females;mean age:55 years;age range:43e83 years).39 caseswere includedintheOP group(19males and20females;meanage:58years;age range:48 e82 years).Conventional T1WI and T2WI were first obtained,followed by 3D-IDEAL-IQ-acqui-sition.Fat fraction(FF)and apparent transverse relaxation rate(R2*)resultswere automatically calculated from IDEAL-IQ-images on the console.Based on T1Wand T2W-images,300 ROIs for each participantweremanually delineated in L1-L5 vertebral bodies of five middle slices.In each age group of all normal subjects,each parameter was significantly correlated with gender.In male participants from the normal,osteopenia,and OP groups,statistical analysis revealed F values of 11319.292 and 180.130 for comparisons involving FF and R2*values,respectively(all p<0.0001).The sensitivity and specificity of FF values were 0.906 and 0.950,0.994 and 0.997,0.865 and 0.820,respectively.For R2*,they were 0.665 and 0.616,0.563 and 0.519,0.571 and 0.368,respectively.In female participants from the normal,osteopenia,and OP-groups,statis-tical analysis revealed F values of 12461.658 and 548.274 for comparisons involving FF and R2*values,respectively(all p<0.0001).The sensitivity and specificity of FF values were 0.985 and 0.991,0.996 and 0.996,0.581 and 0.678,respectively.For R2*,they were 0.698 and 0.730,0.603 and 0.665,0.622 and 0.525,respectively.Significant differences were indicated in the quanti-tative values among the three groups.FF value had good performance,while R2*value had poor performance indiscriminatingosteopenia andOP-groups.Overall,the IDEAL-IQ techniqueoffers specific reference indices that enable noninvasive and quantitative assessment of lumbar vertebrae bone metabolism,thereby providing diagnostic information for OP.
文摘BACKGROUND Hypophosphatasia(HPP)is a rare metabolic disorder caused by low tissue-nonspecific alkaline phosphatase(ALP)activity,presenting symptoms from bone demineralization to tooth loss.It affects multiple systems and is diagnosed based on clinical symptoms,radiological findings,and lab tests.This case report empha-sizes considering HPP in patients with unexplained bone pain and low ALP levels,especially with underlying osteopenia or osteoporosis.It highlights the importance of genetic testing and counseling for early diagnosis and treatment,aiming to raise clinician awareness.CASE SUMMARY We present a case of a 65-year-old female patient who was referred to our endoc-rinology clinic for complaints of generalized bone pain and hypothyroidism.Initial evaluation revealed osteopenia,managed with calcium and vitamin D supplementation.Persistently low ALP levels and elevated vitamin B6 levels led to the diagnosis of HPP,confirmed by genetic testing identifying a pathogenic ALPL gene variant[c.119C>T(p.Ala40Val)].Despite conservative treatment,her bone density declined,although remaining in the osteopenic range.The Fracture Risk Assessment score indicated a low risk of major osteoporotic and hip fractures,not warranting immediate treatment.Plans are underway to initiate enzyme replacement therapy with asfotase alfa.CONCLUSION Recognizing HPP is crucial,as early diagnosis and treatment can significantly improve patient outcomes and prevent complications.
文摘目的:观察补肾填精方联合施氏十二字养生功治疗骨量减少肝肾不足证的临床疗效,并初步探讨其作用机制。方法:采用随机、对照、多中心临床试验,纳入600例骨量减少肝肾不足证患者,每组300例。健康宣教组采用健康宣教方式进行干预,联合干预组在健康宣教基础上口服补肾填精方联合施氏十二字养生功锻炼,共干预3个月。评价指标包括腰椎和左髋骨密度T值、血清Ⅰ型前胶原氨基末端肽(typeⅠprocollagen amino-terminal peptide,PⅠNP)含量、血清骨钙素(osteocalcin,OC)含量、血清Ⅰ型胶原交联羧基末端肽β特殊序列(β-isomerized carboxy-terminal telopeptide collagen typeⅠ,β-CTX)含量、血清25-羟维生素D3[25-hydroxyvitamin D3,25(OH)D3]含量、血清甲状旁腺激素(parathyroid hormone,PTH)含量、腰背痛视觉模拟量表(visual analogue scale,VAS)评分、中医证候积分、16条目骨质疏松症患者健康相关生存质量评估(16-item assessment of health-related quality of life in osteoporosis,ECOS-16)问卷评分及综合疗效。结果:①骨密度T值。干预3个月后,联合干预组的腰椎和左髋部骨密度T值均高于健康宣教组(Z=-3.145,P=0.002;Z=-2.048,P=0.041)。联合干预组干预3个月后的腰椎和左髋部骨密度T值均较干预前增高(Z=-10.244,P=0.000;Z=-3.782,P=0.000);健康宣教组干预3个月后的腰椎骨密度T值较干预前降低(Z=-2.451,P=0.014),干预前后左髋部骨密度T值的差异无统计学意义(Z=-0.686,P=0.493)。②骨代谢指标。干预3个月后,2组的血清PⅠNP、25(OH)D3含量比较,组间差异均无统计学意义(Z=-0.494,P=0.622;Z=-0.744,P=0.457);联合干预组的血清OC含量高于健康宣教组(Z=-3.645,P=0.000),血清β-CTX、PTH含量均低于健康宣教组(Z=-6.617,P=0.000;Z=-2.614,P=0.009)。联合干预组干预3个月后的血清PⅠNP、OC、25(OH)D3含量均较干预前增高(Z=-4.800,P=0.000;Z=-10.065,P=0.000;Z=-3.898,P=0.000),血清β-CTX、PTH含量均较干预前降低(Z=-7.167,P=0.000;Z=-3.707,P=0.000);健康宣教组干预3个月后的血清OC、β-CTX、25(OH)D3含量均较干预前增高(Z=-3.724,P=0.000;Z=-2.716,P=0.007;Z=-2.405,P=0.016),血清PⅠNP、PTH含量干预前后的差异均无统计学意义(Z=-1.421,P=0.155;Z=-1.159,P=0.247)。③腰背痛VAS评分。2组腰背痛VAS评分随时间变化均呈逐渐降低的趋势(F=750.707,P=0.000;F=499.655,P=0.000);干预1、2、3个月后及干预结束后6个月,联合干预组的腰背痛VAS评分均低于健康宣教组(t=43.508,P=0.000;t=88.074,P=0.000;t=99.590,P=0.000;t=74.462,P=0.000)。④中医证候积分。2组中医证候积分随时间变化均呈逐渐降低的趋势(F=11680.902,P=0.000;F=2279.014,P=0.000);干预1、2、3个月后及干预结束后6个月,联合干预组的中医证候积分均低于健康宣教组(t=133.453,P=0.000;t=661.673,P=0.000;t=1440.622,P=0.000;t=2019.873,P=0.000)。⑤ECOS-16问卷评分。2组ECOS-16问卷评分随时间变化均呈逐渐降低的趋势(F=1798.683,P=0.000;F=1900.262,P=0.000);干预1、2、3个月后及干预结束后6个月,联合干预组的ECOS-16问卷评分均低于健康宣教组(t=34.331,P=0.000;t=166.937,P=0.000;t=409.169,P=0.000;t=565.344,P=0.000)。⑥综合疗效。干预3个月后和干预结束后6个月,联合干预组的综合疗效均优于健康宣教组(R_(联合干预组)=234.90,R_(健康宣教组)=366.10,Z=-10.552,P=0.000;R_(联合干预组)=231.28,R_(健康宣教组)=369.72,Z=-11.192,P=0.000)。结论:在健康宣教基础上口服补肾填精方联合施氏十二字养生功锻炼治疗骨量减少肝肾不足证,可延缓骨量减少、改善临床症状、提高生活质量,效果优于单纯健康宣教,其作用可能与其能够调节骨代谢有关。
文摘目的探讨非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比率(the non-high-density to high-density lipoprotein cholesterol ratio,NHHR)与腰椎骨量减少风险之间的关系。方法基于2011年-2018年美国国家健康和营养调查(National Health and Nutrition Examination Survey,NHANES)数据库,纳入8176名参与者。双能X射线吸收测定法(DXA)测量腰椎骨密度,并计算T值以判定腰椎骨量减少状态。NHHR由总胆固醇减去高密度脂蛋白胆固醇(HDL-C)后再除以HDL-C计算得出。参与者按NHHR分为四分位组,并收集其人口学特征、生活方式(如饮酒、吸烟、体力活动)和临床变量[如体质量指数(body mass index,BMI)、高血压、糖尿病等]。通过多元线性回归分析评估NHHR与腰椎骨量减少的关系,并利用限制性三次样条探讨NHHR与腰椎骨量减少及腰椎骨密度(bone mineral density,BMD)之间的关系。结果腰椎骨量减少组的NHHR显著高于非腰椎骨量减少组(P<0.001)。未调整模型中,NHHR升高与腰椎骨量减少呈正相关(OR:1.11,95%CI:1.07~1.16,P<0.001);调整年龄、性别、BMI等混杂因素后,相关性减弱但仍显著(OR:1.08,95%CI:1.03~1.13,P=0.004)。全面调整腰椎BMD及血脂水平后,NHHR与腰椎骨量减少的关联性不再显著(OR:0.99,P=0.931)。此外,限制性三次样条显示NHHR与腰椎骨量减少间存在非线性关系,J型曲线表明NHHR升高显著增加腰椎骨量减少风险(P<0.05)。NHHR与腰椎BMD呈负相关,拟合模型显示NHHR每增加1单位,腰椎BMD降低0.01 g/cm^(2)。结论NHHR可能作为预测腰椎骨量减少的潜在风险指标,但其与腰椎骨量减少的关联在全面调整后减弱,提示需要进一步研究以明确其机制及临床应用价值。
文摘目的构建基于健康体检数据的骨密度状况三阶段模型,并在此基础上简化模型参数得到骨质疏松(osteoporosis,OP)与骨量低下(osteopenia,OST)的三阶段预测(triple-stage osteoporosis and osteopenia prediction,TOOP)指数,用于中老年人群骨量异常风险的初筛、预测与评估。方法回顾性收集2019年1月至2021年12月在黔南州人民医院体检中心完成双能骨密度检查的40岁及以上体检者8021例,按1∶1随机划分为拟合集与验证评估集。利用条件概率原理将三阶段预测问题转化为OP和OST的独立预测问题,并将两者结合构成TOOP指数。采用准确率、灵敏度、特异度、检出率等指标与OSTA指数进行比较验证。结果性别、年龄和体重是OP的三个主要预测因子,年龄和体重是OST的两个主要预测因子。TOOP指数的预测准确率为0.70(95%CI:0.68~0.71),高于OSTA指数(P<0.001)。TOOP指数预测OP和OST的灵敏度分别为0.46(95%CI:0.40~0.53)和0.56(95%CI:0.53~0.60),均高于OSTA指数(OP:P<0.001,OST:P<0.001);特异度分别为0.96(95%CI:0.95~0.97)和0.79(95%CI:0.77~0.81),略低于OSTA指数(OP:P<0.001,OST:P<0.001)。TOOP指数对骨量异常人群的送检率(42.0%)与检出率(32.7%)均高于OSTA指数(P<0.001),漏检率(12.4%)低于OSTA指数(P<0.001)。结论TOOP指数为中老年人群骨质疏松与骨量低下的风险初筛提供了良好的预测工具。
文摘目的了解广西南宁市绝经后女性骨质疏松症的患病情况及相关影响因素,为进一步预防干预提供理论依据。方法选取我院健康体检的216名绝经后女性作为研究对象,测定髋部及第1~4腰椎的骨密度,同时进行问卷调查。结果骨质疏松、骨量减少及骨量正常分别占38.89%、43.06%、18.05%,随着年龄增加,骨质疏松患病率明显升高(χ2=17.56,P=0.000);骨质疏松组年龄、体重指数(body mass index,BMI)、绝经年限、足月妊娠次数、户外活动次数、每次运动时间、活动程度、奶制品摄入及钙剂摄入情况与另外两组比较,差异均有统计学意义(P<0.05),Logistics多因素回归分析表明,年龄、绝经年限与骨质疏松症呈正相关(OR=3.419,P=0.000;OR=2.569,P=0.016);而BMI、运动次数、饮牛奶及钙剂摄入与其呈负相关性(OR=0.517,P=0.000;OR=0.684,P=0.024;OR=0.589,P=0.021;OR=0.266,P=0.000)。结论广西南宁市区绝经后女性骨质疏松及骨量减少患病率高。BMI增高、运动次数多、饮牛奶及钙剂摄入是其保护因素,应加强宣教,从而预防和延缓骨质疏松的发生。
文摘目的:研究原发性骨质疏松和骨量低下患者下肢肌肉力量与平衡功能的相关性。方法:入组患者为57名通过GE Express超声波跟骨骨密度仪检测诊断为原发性骨质疏松或骨量低下的绝经期女性患者;采用美国Biodex Medical Systems公司生产的Biodex System 4多关节等速测试系统测试下肢肌力;采用单腿站立平衡检测(single leg balance test,SLBT)结果反映患者平衡功能,所得数据应用spss15.0软件进行Pearson线性相关分析,得出线性回归方程。结果:原发性骨质疏松患者优势腿单腿站立时间与慢速屈肌群相对峰力矩的相关系数r=0.540(P=0.000),与中速屈肌群相对峰力矩的相关系数r=0.523(P=0.000),与慢速伸肌群相对峰力矩相关系数r=0.378(P=0.004),与中速伸肌群相对峰力矩的相关系数r=0.282(P=0.034)。结论:原发性骨质疏松患者优势腿伸肌肌力和屈肌肌力与平衡功能均呈正相关,其中屈肌肌力对平衡功能的影响大于伸肌肌力。
