人体骨密度与骨质疏松

本文扼要地阐述了骨密度测量的意义和方法,介绍了北京市人群骨密度与骨质疏松的调查情况,提出食用含钙量丰富的食物,增加户外活动,防止人体激素水平下降是预防骨质疏松值得重视的问题之一。     

OPG-RANKL-RANK信号系统与骨质疏松治疗的研究进展

OPG-RANKL-RANK信号系统是介导骨吸收和骨形成之间平衡的重要信号通路。骨质疏松是由于各种原因导致的骨吸收和骨形成紊乱,出现骨量减少、骨密度降低且易发生脆性骨折为基础的一种全身性慢性疾病。在骨质疏松的分子研究中,以OPG-RANKL-RANK为靶标来分析其具体机制,通过大量分子细胞生物学实验和临床试验进行药物研究,此领域得到了越来越多的关注。现总结近年来OPG-RANKLRANK信号系统作为骨质疏松潜在药物靶点的研究结论,探讨该信号系统在骨质疏松治疗中的潜能,为靶向药物的开发及骨质疏松的治疗奠定基础。     

基于光学相干层析术的斑马鱼颅骨密度定量分析方法

斑马鱼广泛地应用于骨退化相关的机制研究和新药开发过程中.目前临床应用检测骨密度(BMD)的方法主要有单光子吸收、双光子吸收、双能X线吸收、定量CT和超声技术等,上述方法均难用于斑马鱼的研究中.本文旨在寻求一种新式的、适用性强和操作简易的定量分析斑马鱼BMD的方法.对采集到的使用125μmol/L泼尼松龙溶液诱导骨质疏松...     

兰州市1907 例不同年龄正常人群骨密度测定综合分析

目的:了解兰州地区正常人群骨密度的变化特点,分析其变化规律,为预防和治疗骨质疏松症提供科学依据。方法:使用天津圣鸿公司SHY-Ⅰ数字式骨密度测定仪对兰州地区1907人进行检测,其中男1381例,女526例,分别做左前臂尺、桡骨测量。年龄20～85岁,每10岁为一年龄组进行统计分析。结果:男、女组骨密度峰值均在30～39岁,峰值后随年龄增加而骨密度下降,女性下降较男性显著。骨量减少及骨质疏松患病率在40岁后随年龄增长而增高,女性高于男性。老年人骨量减少及骨质疏松患病率高于中青年人,老年女性骨质疏松患病率与老年男性比较有明显差异(P<0.05)。结论:兰州地区健康人群骨密度随年龄变化,并与性别有关。骨密度的检测在骨质疏松症的早期预防和治疗中具有重要意义。     

兰州市1907例不同年龄正常人群骨密度测定综合分析

目的：了解兰州地区正常人群骨密度的变化特点,分析其变化规律,为预防和治疗骨质疏松症提供科学依据。方法：使用天津圣鸿公司SHY-I数字式骨密度测定仪对兰州地区1907人进行检测,其中男1381例,女526例,分别做左前臂尺、桡骨测量。年龄20～85岁,每10岁为一年龄组进行统计分析。结果：男、女组骨密度峰值均在30-39岁,峰值后随年龄增加而骨密度下降,女性下降较男性显著。骨量减少及骨质疏松患病率在40岁后随年龄增长而增高,女性高于男性。老年人骨量减少及骨质疏松患病率高于中青年人,老年女性骨质疏松患病率与老年男性比较有明显差异（P〈0．05）。结论：兰州地区健康人群骨密度随年龄变化,并与性别有关。骨密度的检测在骨质疏松症的早期预防和治疗中具有重要意义。     

超声空化强度测量的研究进展

近几十年来,超声波已经广泛应用于生物学和医学领域,在医学领域中超声波可以作为信息载体用于探测人体的病变信息,并且可以用一定剂量的超声波作用于人体病变组织,并通过它对组织的作用达到一定的治疗目的。作为一种无创、非介入性外科技术,它的疗效和安全性越来越被人们所关注。超声波与人体组织的相互作用有三种,分别是机械机制,热学机制,和空化机制。对于机械机制和热机制人们比较熟悉,而对于空化机制则相对陌生。随着超声空化在医学中的应用越来越广泛,其安全性越来越受到人们的关心。要么是其强度迭不到治疗效果,要么是其强度过大损伤人体,因此其强度已成为人们关心的主要主题。本文主要介绍超声空化的主要探讨了几种测量方法及对超声空化有影响的几种参量,并对超声空化的发展进行了展望。     

骨关节炎患者全膝关节置换前骨质疏松相关因素的分析

为探讨骨关节炎患者全膝关节置换前骨质疏松情况及其相关因素,本研究选取2014年3月至2016年6月本院收治的90例膝骨关节炎患者进行骨密度测定。根据骨密度结果将患者分为骨质疏松组和非骨质疏松组,记录两组患者的年龄、性别、BMI、伴发疾病及t值和Z值,并分析骨密度与观察指标的相关性。研究显示,在全膝关节置换前的膝骨关节炎患者中,女性患者的骨质疏松发生率显著高于男性患者(p0.05);年龄和肥胖是髋骨密度独立的危险因素,髋骨密度与BMI呈正相关关系、与年龄呈负相关关系。因此,对于年龄≥65岁、BMI25 kg/m~2的患者,尤其是女性患者,全膝关节置换前要进行必要的骨密度检测,以掌握其骨质疏松程度。     

超声弹性成像技术在乳腺肿块诊断中的研究进展及应用

超声弹性成像技术(UE)是一种新的超声成像技术,能够根据组织硬度进行成像,估计出组织内部的弹性信息,从而反映它的结构特点,该技术较传统触诊检查更加客观,在乳腺肿块的鉴别诊断中有较高的价值,其临床应用广泛并且得到了快速的发展。现就国内外文献对UE技术的原理、图像分析方法、技术研究进展及其在乳腺肿块鉴别诊断中的应用进行综述。     

胰岛素对2型糖尿病骨质疏松大鼠血清与骨OPG、RANKL表达的影响

目的:探讨胰岛素对2型糖尿病骨质疏松大鼠血清及骨OPG(osteoprotegerin)、RANKL(OPG receptor activator nuclear factork B)表达水平的影响。方法:以高脂高糖饲料喂养4周同时饮用3%果糖水导致胰岛素抵抗小鼠,再以小剂量链脲佐菌素(30mg/kg)腹腔注射1次,2周后诱导建立2型糖尿病小鼠模型。对照组动物则给予正常饲料及饮用水进行喂养。模型建立成功后,对模型2组大鼠进行胰岛素治疗,分别采用OPG和RANKLelisa试剂盒对正常动物模型和糖尿病动物模型血清和骨组织中OPG,RANKL含量进行比较分析,采用血糖分析仪对不同组动物的血糖进行比较分析,采用骨密度分析仪对动物的骨密度进行分析,了解高血糖对于骨密度及血清,骨组织中OPG,RANKL含量的影响以及胰岛素对高血糖骨质疏松造成的结果的影响。结果:相较于正常组大鼠,模型组大鼠血清及髂骨中OPG、血糖、糖化血红蛋白、髂骨密度表达显著下调(P0.05),而RANKL表达显著上调(P0.05),胰岛素处理的模型大鼠血清及骨中OPG含量较模型组大鼠显著升高,血清及骨组织中RANKL表达显著下调(P0.05)。结论:胰岛素能够显著降低2型糖尿病骨质疏松大鼠血清及骨组织中RANKL的表达,显著上调OPG的表达。     

老年男性教师骨密度的调查

目的 为了解老年性骨质疏松情况,用超声骨密度仪对150例老年男性教师做跟骨超振幅衰减值的测试研究。方法：用DMS公怀UBIS5000型骨密度超声仪检查跟骨,研究受检者的年龄、体重、身高和巳患病咎与测得超声振幅衰减值（BUA）,声速（SOS）,骨硬度（STI）和相对骨折危险性（RRF）等参数之间的关系。结果：本仪器输出3种结果供医师参考：1.一幅灰阶图,2.一幅彩色图和曲线图,3.感兴趣区所测得的参数,受检者的平均BUA为63.87dB/MHz,SOS为1485.21m/s,本文数据经Statpal软件处理,得出回归公式：体重=189.1417 0.2062BUA-0.0224SOS,R=0.0466,P值有显著意义。结论：BUA值为主要参数,SOS为补充参数,作为评估老年男性教师的骨密度情况,假如BUA值突然下降则提示近期可能发生骨质疏松。     

Microdamage evaluation in human trabecular bone based on nonlinear ultrasound vibro-modulation (NUVM)

The primary aim of this work is to investigate the potential of nonlinear ultrasound for microdamage detection in human bone. Microdamage evaluation in human bone is of great importance, because it is considered a significant parameter for characterizing fracture risk. Experiments employing nonlinear acoustic vibro-modulation were carried out in human femoral trabecular specimens removed during surgery. A frequency mixing (inter-modulation) was observed between an ultrasound wave, propagating in the bone, and a low-frequency vibration applied directly to the bone specimens. The appearance of side frequencies, which are related to the vibrational excitation, around the fundamental ultrasound frequency manifests the modulation nonlinear phenomenon. Instead of inducing microdamage by mechanical fatigue loading, specimens with different degree of osteoporosis were used. The experiments demonstrated that osteoporotic bone exhibits stronger nonlinearity compared to healthy bone presenting significant increase of the modulation amplitude with increasing degree of osteoporosis. The obtained results indicate that, in contrast to conventional hysteretic nonlinearity, dissipative acoustic nonlinearity can be of significance in the generation of nonlinear modulation effects. In the proposed technique the size and the shape of samples are not crucial compared to nonlinear resonant ultrasound spectroscopy (NRUS). Furthermore, the method is sensitive to the presence of microdamage, non-invasive, easy to implement and most important, it can be proved valuable tool for in vivo bone damage characterization.     

Osteoporosis in neurodegeneration

Osteoporosis affects bone microarchitecture and reduces bone mass. There are more than 200 million people with osteoporosis worldwide, and the prevalence is slowly increasing. The highest prevalences are found in Scandinavia and USA, also slowly increasing. A parallel increase in neurodegenerative disorders such as Alzheimer's disease, Parkinson's disease, Amyotrophic lateral sclerosis, and multiple sclerosis has been noted since the middle of this century. Osteoporosis is more common in patients with each of these neurodegenerative conditions than in the general population. Several metals with neurotoxic properties accumulate in bone and can substitute for calcium in hydroxyapatite, the main mineral component of bone. Especially cadmium, but also lead, aluminum and arsenic affect bone mineral density negatively. Metals with neurotoxic properties have also been found in brain and cerebrospinal fluid from patients with Alzheimer's disease, Parkinson's disease, Amyotrophic lateral sclerosis, and multiple sclerosis, and markers for neurodegeneration such as amyloid beta peptide and amyloid precursor protein have been detected in bone tissue from patients with osteoporosis. A common mechanism contributing to the pathogenesis of both neurodegeneration and osteoporosis can be suspected. The hypothesis that neurodegenerative disorders are associated with osteoporosis is presented and discussed.     

Osteoporosis: the current status of mesenchymal stem cell-based therapy

Osteoporosis, or bone loss, is a progressive, systemic skeletal disease that affects millions of people worldwide. Osteoporosis is generally age related, and it is underdiagnosed because it remains asymptomatic for several years until the development of fractures that confine daily life activities, particularly in elderly people. Most patients with osteoporotic fractures become bedridden and are in a life-threatening state. The consequences of fracture can be devastating, leading to substantial morbidity and mortality of the patients. The normal physiologic process of bone remodeling involves a balance between bone resorption and bone formation during early adulthood. In osteoporosis, this process becomes imbalanced, resulting in gradual losses of bone mass and density due to enhanced bone resorption and/or inadequate bone formation. Several growth factors underlying age-related osteoporosis and their signaling pathways have been identified, such as osteoprotegerin (OPG)/receptor activator of nuclear factor B (RANK)/RANK ligand (RANKL), bone morphogenetic protein (BMP), wingless-type MMTV integration site family (Wnt) proteins and signaling through parathyroid hormone receptors. In addition, the pathogenesis of osteoporosis has been connected to genetics. The current treatment of osteoporosis predominantly consists of antiresorptive and anabolic agents; however, the serious adverse effects of using these drugs are of concern. Cell-based replacement therapy via the use of mesenchymal stem cells (MSCs) may become one of the strategies for osteoporosis treatment in the future.     

退休教师骨密度的超声研究

目的：了解老年教师骨质疏松病的情况,用超声骨密度仪对813例老年教师做跟骨超声振幅衰减值研究。方法：超声测量是一种新技术,利用不同密度的物体衰减值不同及穿过不同密度物体声速不同等特性对跟骨进行成像,并计算最具说明性区域的一系列数据。参数中BUA值为最主要的参数,三根等距离曲线的形态和宽度能直观分析出年龄与骨量变化的关系。结果：本文男性平均BUA为63.87dB/MHz,得出回归公式：体重=189.1417 0.2062BUA-0.0224SOS。女性平均BUA为58.9dB/MHz,各年龄分组的BUA值与参考值很接近,统计学显示无意义。结论：调查发现男性和女性的骨质不同,男性BUA骨峰值比女性高。BUA值与其体重有密切关系。在60岁以后（或绝经1-5年后）年龄增长与BUA值无明显关系,说明随着年龄的增加骨量减少很小或不减少。利用这种关系,假如BUA值突然下降则提示近期发生骨质疏松。     

骨质疏松症的发病机理及其治疗

骨质疏松症是一种常见的老年性疾病,全世界发病率已超过25%,特别是在亚洲。一方面它给人类的健康造成极大的危害,例如骨折,另一方面它还给社会带来很大的经济负担。尽管骨质疏松症有许多发病因素,但是已得到确认骨质疏松症是一种骨重构过程失衡的结果。目前有两类治疗骨质疏松症的药物:一类是抑制骨吸收,如钙,维生素D(VitD),雌激素,降钙素,二膦酸盐等,另一类是刺激骨形成,如氟化物,甲状旁腺激素,锶盐等,然而至今尚无特效药,因此骨质疏松症重在预防。本文就其发病机理、危害、药物治疗及新药开发前景这几方面进行了综述。     

Osteoporosis,calcium and physical activity.

Sales of calcium supplements have increased dramatically since 1983, as middle-aged women seek to prevent or treat bone loss due to osteoporosis. However, epidemiologic studies have failed to support the hypothesis that larger amounts of calcium are associated with increased bone density or a decreased incidence of fractures. The authors examine the evidence from controlled trials on the effects of calcium supplementation and physical activity on bone loss and find that weight-bearing activity, if undertaken early in life and on a regular basis, can increase the peak bone mass of early adulthood, delay the onset of bone loss and reduce the rate of loss. All of these factors will delay the onset of fractures. Carefully planned and supervised physical activity programs can also provide a safe, effective therapy for people who have osteoporosis.     

Osteoporosis,falls, and age in fracture of the proximal femur.

The relative importance of osteoporosis and risk of falling in causing hip fracture is not known. Femoral neck bone mass was measured in 708 elderly people, all of whom had fallen and injured a hip. Below 75 years of age there was a steep increase in relative risk of fracture with reduced bone mass, measured by Singh grade. Above that age the increase in risk was small, and neuromuscular responses which protect the skeleton against trauma may be more important than bone mass.     

Approach to discovering novel therapeutic agents for osteoporosis based on integrin receptor blockade

On a global scale, osteoporosis is a major and growing public health problem. In the United States, osteoporosis is present in 24 million people (mostly women) and contributes to more than 1.3 million fractures/year. Serious morbidity and mortality result from these fractures. Current therapies for osteoporosis are few, efficacy is limited, and side effects problematic. Fundamental to the pathophysiology of osteoporosis is an imbalance between the tightly coupled processes of bone resorption and bone formation that characterize normal bone remodeling. Our laboratory is engaged in a research effort focused on elucidating the role of the osteoclast integrin in bone resorption, defining the nature of ligand–integrin interactions, and developing antagonists for cell surface adhesion molecules, particularly the α_ν, β₃ vitronectin-like integrin receptor present on the surface of human osteoclasts. Peptides containing the internal arginine-glycine-aspartic acid (RGD) motif have been shown to inhibit osteoclast-mediated bone resorption in vivo. We are now designing more potent and selective inhibitors of bone resorption as a potential new mechanism-based therapeutic approach to osteoporosis based on a novel mechanism. In an effort to rapidly identify the highest affinity ligands for the human α_νβ₃ integrin, we have generated combinatorial peptide libraries containing substantial structural diversity. For instance, based on all possible sequence combinations of extracellular matrix proteins known to bind α_νβ₃, we recently synthesized and chemically analyzed a library of 360,000 peptides, all of which contain RGD. Human α_νβ₃ receptors are now available in a clonal cell line that expresses high levels of recombinant receptor, these cells can serve as a very important research tool in this project because of the limited number of bone-derived osteoclasts that can be harvested for experimentation. The library of peptides will be screened by “affinity selection”: the highest binding affinity peptide(s) will be isolated and microsequenced. Receptor-favored sequences will be synthesized and evaluated in a battery of in vitro and in vivo bioassays. Through these investigations, insight will be gained into the role of integrins in bone biology and patho-physiology, and new directions will be developed for the design of potent human α_νβ₃-selective antagonists for the treatment of osteoporosis. © 1994 John Wiley & Sons, Inc.     

A review of anabolic therapies for osteoporosis

Osteoporosis results from a loss of bone mass and bone structure such that the bone becomes weak and fractures with very little trauma. Until recently, the approved osteoporosis therapies prevented more bone loss by altering osteoclast activity and lifespan. Recently, attention has turned away from osteoclast inhibition to agents that can stimulate the osteoblast to form new bone, or anabolic agents. This article reviews both approved and experimental anabolic agents that improve bone mass by improving osteoblast activity, or increasing osteoblast number. The use of the anabolic agents to improve bone mass and strength followed by agents that prevent the new bone mass from being lost may offer the ability to cure osteoporosis and reduce bone fracture healing time.     

Quantitative Ultrasound Assessment of Cortical Bone Properties Beyond Bone Mineral Density

The development of quantitative ultrasound (QUS) technologies to measure bone is motivated by the need to overcome the limitations of X-ray based methods, measuring bone mineral density (BMD) which is the gold standard to date for the diagnosis of osteoporosis. Because it uses mechanical waves, the ultrasound modality is a particularly relevant means to probe bone mechanical resistance. The vast majority of QUS technologies commercialized to date merely aim to provide surrogate markers for BMD. During the past decade, innovative QUS approaches have emerged to assess bone beyond BMD. This may be achieved by (1) specifically assessing the cortical bone compartment, independently of trabecular bone, and (2) providing intrinsic bone properties such as cortical bone thickness and material properties. One specific motivation is to estimate intracortical porosity, a quantity reflected in material properties. This article aims at an overview of recent QUS developments to measure cortical bone properties. We also draw a picture of the current knowledge on bone material properties of interest for bone QUS. We discuss the potential of ultrasound to provide novel biomarkers of bone health through the assessment of material properties.