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ObjectiveTo systematically evaluate the distribution of traditional Chinese medicine（TCM） syndromes of primary osteoporosis（POP） in China by using evidence-based medicine methods， and to understand the distribution law of the syndromes. MethodChina National Knowledge Infrastructure（CNKI）， VIP Chinese Science and Technology Journal Database（VIP）， WanFang Data Knowledge Service Platform（WanFang） and China Biology Medicine（CBM） were searched to obtain representative literature， and each database was searched from the 1994 World Health Organization defined diagnostic criteria for osteoporosis until May 1， 2023. Two researchers independently screened literature according to the criteria， extracted data， and cross-checked them. Meta analysis was conducted using R4.1.3， and subgroup analysis was performed. ResultA total of 56 Chinese papers were included， involving 14 415 patients. After standardized classification of syndromes， 11 articles were excluded， and Meta analysis results of the ultimately included 45 Chinese articles showed that the distribution frequencies of liver-kidney Yin deficiency syndrome， spleen-kidney Yang deficiency syndrome and kidney deficiency and blood stasis syndrome in 12 723 patients were 27%［95% confidence interval（CI） 0.24-0.31］， 32%（95% CI 0.29-0.36）， 36%（95% CI 0.30-0.42）. Subgroup analysis showed that there was a statistically significant difference in the distribution of the three TCM syndromes in the north and south（P<0.05）. In addition， the incidence of TCM syndrome fractures in different types of POP was 15%（95% CI 0.09-0.24） for liver-kidney Yin deficiency syndrome， 20%（95% CI 0.12-0.30） for spleen-kidney Yang deficiency syndrome， and 31%（95% CI 0.25-0.39） for kidney deficiency and blood stasis syndrome. ConclusionThe distribution of syndromes in POP patients is mainly kidney deficiency， accompanied by liver and spleen dysfunction. Liver-kidney Yin deficiency syndrome， spleen-kidney Yang deficiency syndrome and kidney deficiency and blood stasis syndrome are all the main syndromes of POP and osteoporotic fractures， and kidney deficiency and blood stasis syndrome is most closely related to the development of osteoporotic fractures. The reference standards for syndrome determination among the included studies are inconsistent， and in the future， it is necessary to focus on their determination standards to obtain consensus research results， at the same time， conduct large-scale syndrome research to obtain representative research results， providing a basis for clinical practice and research.
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ObjectiveTo construct a quantitative differentiation model of traditional Chinese medicine （TCM） syndromes by taking primary osteoporosis （POP） with kidney yang deficiency syndrome as an example， and to provide methodological reference for the standardization of syndrome differentiation. MethodsHigh-frequency clinical features of POP were screened by descriptive statistical analysis， and strong association features of POP were obtained by association rule algorithm. On this basis， a latent structure （latent tree） model was established through latent structure analysis， and the implicit and explicit variables （features） related to POP with kidney yang deficiency syndrome were comprehensively clustered， and the clustering results were interpreted by the indexes of mutual information and cumulative information coverage， to explore the primary and secondary symptoms， and to deduce the categories of POP with kidney yang deficiency syndrome based on the probability of the features appearing in the various latent categories. Based on the categories， the clinical feature scores and identification thresholds were calculated， and the syndrome differentiation model of POP with kidney yang deficiency was initially constructed by combining the comprehensive judgment rules. Finally， the results of TCM professionals' judgment were used as the gold standard to further evaluate the effectiveness of the model in assisting the syndrome differentiation. ResultsThe 32 features strongly associated with POP were obtained， and the Bayes information critedon score of the further constructed latent tree model was -15291.93. Based on the mutual information and the cumulative information coverage， the main symptoms of POP with kidney yang deficiency syndrome were bone weakness， fatigue， pale tongue， clear urine， frequent nocturnal urination， cold limbs， thin pulse， white coating， and secondary symptoms were weakness， loss of libido， loose stool， frequent urination， lumbar and knee weakness， and fear of cold. From the probability of the occurrence of each clinical feature in different latent categories of POP with kidney yang deficiency syndrome， the state was introduced as S0 category （none/mild kidney yang syndrome）/ S1 category （moderate kidney yang syndrome）/ S2 category （severe kidney yang syndrome）. Optimizing the preliminary rules of state identification and refining the state of S1 category， the results showed that among 970 patients with POP， there were 520 patients having no/mild kidney yang deficiency syndrome， 224 patients with moderate to mild kidney yang deficiency syndrome， 81 patients with moderate to severe kidney yang deficiency syndrome， and 145 patients with severe kidney yang deficiency syndrome. During the evaluation and validation process， the correct rate of the model assessment index was 0.8835， while the sensitivity was 0.7181， and the specificity was 0.9437. ConclusionCombined with the latent structure analysis of the association rule， the syndrome differentiation model for POP with kidney yang deficiency could be constructed， and the model shows a good quantitative identification effect， which can provide methodological supports for clinicians to improve the efficiency and accuracy of TCM diagnosis.
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This study aims to provide evidence for clinical practice by systematically reviewing the efficacy and safety of Gusongbao preparation in the treatment of primary osteoporosis(POP). The relevant papers were retrieved from four Chinese academic journal databases and four English academic journal databases(from inception to May 31, 2022). The randomized controlled trial(RCT) of Gusongbao preparation in the treatment of POP was included after screening according to the inclusion and exclusion criteria. The quality of articles was evaluated using risk assessment tools, and the extracted data were subjected to Meta-analysis in RevMan 5.3. A total of 657 articles were retrieved, in which 15 articles were included in this study, which involved 16 RCTs. A total of 3 292 patients(1 071 in the observation group and 2 221 in the control group) were included in this study. In the treatment of POP, Gusongbao preparation+conventional treatment was superior to conventional treatment alone in terms of increasing lumbar spine(L2-L4) bone mineral density(MD=0.03, 95%CI[0.02, 0.04], P<0.000 01) and femoral neck bone mineral density, reducing low back pain(MD=-1.69, 95%CI[-2.46,-0.92], P<0.000 1) and improving clinical efficacy(RR=1.36, 95%CI[1.21, 1.53], P<0.000 01). Gusongbao preparation was comparable to similar Chinese patent medicines in terms of improving clinical efficacy(RR=0.95, 95%CI[0.86, 1.04], P=0.23). Gusongbao preparation was inferior to similar Chinese patent medicines in reducing traditional Chinese medicine syndrome scores(MD=1.08, 95%CI[0.44, 1.71], P=0.000 9) and improving Chinese medicine syndrome efficacy(RR=0.89, 95%CI[0.83, 0.95], P=0.000 4). The incidence of adverse reactions of Gusongbao preparation alone or combined with conventio-nal treatment was comparable to that of similar Chinese patent medicines(RR=0.98, 95%CI[0.57, 1.69], P=0.94) or conventio-nal treatment(RR=0.73, 95%CI[0.38, 1.42], P=0.35), and the adverse reactions were mainly gastrointestinal discomforts. According to the available data, Gusongbao preparation combined with conventional treatment is more effective than conventional treatment alone in increasing lumbar spine(L2-L4) bone mineral density and femoral neck bone mineral density, reducing low back pain, and improving clinical efficacy. The adverse reactions of Gusongbao preparation were mainly gastrointestinal discomforts, which were mild.
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Humans , Bone Density , Low Back Pain , Medicine, Chinese Traditional , Osteoporosis/drug therapyABSTRACT
OBJECTIVE@#To observe the effect of electroacupuncture on motor function and muscle state in patients with primary osteoporosis (POP).@*METHODS@#A total of 60 female patients with POP were randomized into an observation group (30 cases, 1 case dropped off) and a control group (30 cases, 1 case dropped off). On the basis of adjusting lifestyle, caltrate was given orally in the control group, 2 pills a day for 4 weeks. On the basis of the treatment in the control group, electroacupuncture was applied at Zusanli (ST 36), Yanglingquan (GB 34), Ganshu (BL 18), Pishu (BL 20), Shenshu (BL 23), etc. in the observation group, with disperse-dense wave of 2 Hz/10 Hz in frequency, once every other day, 3 times a week for 4 weeks. The time of timed up-and-go test (TUGT) and the value of 10 m maximal walking speed (10 m MWS) before and after treatment were compared in the two groups, and the Young's modulus values of bilateral multifidus muscles in prone position and sitting position before and after treatment were compared by real-time shear wave elastography (SWE) in the two groups.@*RESULTS@#After treatment, the TUGT time was decreased compared before treatment in the observation group (P<0.01), and that in the observation group was shorter than the control group (P<0.01). After treatment, the value of 10 m MWS test was increased compared before treatment in the observation group (P<0.05). After treatment, the Young's modulus values of bilateral multifidus muscles in prone position and sitting position were increased compared before treatment in the observation group (P<0.01); except for the left side in sitting position, the Young's modulus values of multifidus muscles in the observation group were higher than those in the control group (P<0.01, P<0.05).@*CONCLUSION@#On the basis of oral caltrate, electroacupuncture can improve the motor function and muscle state in patients with POP.
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Female , Humans , Acupuncture Points , Electroacupuncture , Life Style , Osteoporosis/therapy , Paraspinal MusclesABSTRACT
OBJECTIVE@#To compare the therapeutic effect of thunder-fire moxibustion combined with vibration training and simple vibration training on low back pain of primary osteoporosis by 's modulus of ultrasonic wave, and seek an objective evaluating method.@*METHODS@#A total of 60 patients were randomized into an observation group and a control group, 30 cases in each one. The patients in the two groups were treated with vibration training using whole body vibration treatment bed. In the observation group, thunder-fire moxibustion was applied at Yaoyangguan (GV 3), Mingmen (GV 4), Ganshu (BL 18), Shenshu (BL 23) and Dachangshu (BL 25). The treatment was given once every other day, 3 times a week for 4 weeks. The visual analogue score (VAS), real-time shear wave elastography (RTSWE) and medical outcomes study 36-item short-form hearth survey (SF-36) were used to evaluate pain intensity, multifidus muscle tone ('s modulus) and quality of life before treatment, after 4-week treatment and 1 month after treatment.@*RESULTS@#Compared before treatment, the VAS scores, 's modulus of multifidus muscle and 5 dimensions of SF-36 (physical condition, body pain, general health, social function and mental health) after 4-week treatment and 1 month after treatment were significantly improved in the two groups (all <0.05), the physiological role in the observation group after 4-week treatment and 1 month after treatment were improved (both <0.05). In the observation group, the VAS scores, 's modulus of multifidus muscle and 3 dimensions of SF-36 (physiological role, body pain and general health) after 4-week treatment and 1 month after treatment were superior to the control group (all <0.05).@*CONCLUSION@#The therapeutic effect of thunder-fire moxibustion combined with vibration training is superior to simple vibration training in relieving low back pain intensity and multifidus muscle tone, and improving quality of life for primary osteoporosis. RTSWE technique can be an objective examination method to evaluate pain.
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Humans , Acupuncture Points , Low Back Pain , Therapeutics , Moxibustion , Osteoporosis , Quality of Life , Treatment Outcome , VibrationABSTRACT
BACKGROUND: Physical exercise can significantly reduce bone mass loss, relieve pain and improve bone metabolism in osteoporosis patients, but there is no evidence-based evidence. OBJECTIVE: To investigate the effect of different physical exercises on the treatment of primary osteoporosis. METHODS: Randomized controlled clinical trials regarding the therapeutic effect of physical exercise on primary osteoporosis were screened. The physical exercise group was subjected to physical exercise, and the control group had no regular exercise during the test. The main outcome measures included bone mineral density of lumbar spine L2-L4, visual analog scale score, bone metabolism index (osteocalcin, total type 1 procollagen amino terminal peptide, urine pyridinium/creatinine, blood calcium, blood phosphorus). The included outcome indicators were meta-analyzed using the Review Manager 5.3 software. RESULTS AND CONCLUSION: A total of 25 randomized controlled trials were included. Meta-analysis results showed that physical exercise could effectively improve the bone mineral density of L2-L4 segments in primary osteoporosis patients (mean difference=0.06, 95% confidence interval [0.04-0.08], P 0.05). Physical exercise significantly reduced the pain as determined by the visual analog scale in osteoporosis patients (mean difference=-0.93, 95% confidence interval [-1.08 to -0.79], P 0.05). The results of Egger’s and Begg’s tests indicated that publication bias of the included studies was at a low level. All these findings indicate that physical exercise has significant interventional effects on bone mineral density and pain in patients with primary osteoporosis.
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OBJECTIVE@#To observe the effects of acupuncture on bone mineral density (BMD), bone metabolism and intestinal function in elderly patients of primary osteoporosis with intestinal dysfunction.@*METHODS@#A total of 128 elderly patients of primary osteoporosis with intestinal dysfunction were randomly divided into an observation group and a control group, 64 cases in each group. Patients in the control group were treated with oral administration of vitamin D calcium chewable tablets (0.6 g, once a day) and calcitriol capsules (0.25 μg, three times a day); the treatment was given for 6 months. On the basis of the treatment in the control group, patients in the observation group were additionally treated with acupuncture at Shenshu (BL 23), Mingmen (GV 4), Pishu (BL 20), Dachangshu (BL 25), Tianshu (ST 25) and Zusanli (ST 36), etc. for 30 min each time, once a day. After 1-week treatment, the patients took a rest for 2 days; the treatment was given for 6 months. Before and after treatment, the BMD of lumbar spine, femoral neck and femoral trochanter was detected by dual energy X-ray absorptiometry, and the serum levels of bone alkaline phosphatase (NBAP), osteocalcin (OC), matrix metalloproteinase-2 (MMP-2) and calcitonin (CT) were detected by ELISA method. The primary symptom scores of intestinal function, serum diamine oxidase (DAO) and D-lactic acid (D-Lac) levels were compared between the two groups before and after treatment, and the clinical efficacy of the two groups was evaluated.@*RESULTS@#The total effective rate was 85.9% (55/64) in the observation group, which was higher than 71.9% (46/64) in the control group (<0.05). After treatment, BMD were increased (<0.05), and serum bone metabolism indexes were improved in the two groups (<0.05); the BMD and serum bone metabolism indexes in the observation group were better than those in the control group (<0.05). After treatment, the primary symptom scores of intestinal function, serum DAO and D-Lac levels in the observation group were decreased (<0.05), and the indexes in the observation group were lower than those in the control group (<0.05).@*CONCLUSION@#The adjuvant therapy of acupuncture could increase BMD, improve bone metabolism and regulate intestinal function in elderly patients of primary osteoporosis with intestinal dysfunction.
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Resumen La osteoporosis es una enfermedad esquelétita caracterizada por compromiso en la fuerza ósea, que predispone a fracturas de fragilidad. El diagnóstico de la osteoporosis se establece tanto por fracturas de bajo impacto, así como por medio de la densitometría ósea.
Abstract Osteoporosis is a skeletal disorder characterized by compromised bone strenght, which predisposes to the development of fragility fractures. The diagnosis of osteoporosis is established by the presence of a true fragility or, in patients who have never sustained a fragility fracture, by measurement of bone mineral density.
Subject(s)
Humans , Osteoporosis/diagnostic imaging , Bone Density , Osteoporosis, Postmenopausal , Densitometry , Osteoporotic FracturesABSTRACT
Objective To investigate the change rules of the lumbar vertebral bone marrow fat fraction(FF)and T2* values at different bone mineral density(BMD)groups,and their relevances and the applications on the diagnosis of the primary osteoporosis. Methods The patients who underwent the dual energy X-ray absorptiometry(DXA)and the routine lumbar MRI scan,mDIXON-Quant scan were collected,and the BMD,T-score,FF and T2* values of L1-L4 were measured.According to the T-score,the vertebral bodies were divided into the normal group,the osteopenia group and the osteoporosis group.The differences of the FF,T2* values and BMD between each group were analyzed by one-way analysis of variance,and their correlations with BMD were analyzed by Pearson correlation,the diagnostic effects of them were evaluated by receiver operating characteristic curve(ROC curve).Results The differences of the FF ,T2 * values and BMD among the three groups were statistically significant (P < 0 .05) .The correlations of the FF and T2 * values with BMD were negative (r = - 0 .628 ,P < 0 .05 and r = - 0 .468 ,P < 0 .05 ,respectively) .The area under curve (AUC) of the FF and T2 * values were 0 .82 ± 0 .03 ,0 .79 ± 0 .03 ,respectively .Conclusion mDIXON-Quant which can accuratly quantify fat content could evaluate the lumbar vertebral bone marrow fat content ,reflect the changes of the bone quality ,provide valuable information for the diagnosis of osteoporosis ,and is helpful to predict the risks of the lumbar fragility fracture.
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Chronic non-infectious diseases (hereinafter referred to as "chronic disease") have become a serious public health problem which affect the physical and mental health. Its prevention and control is urgent. Primary osteoporosis is a common chronic disease, which has complex causes, long duration, protracted illness, and poor prognosis, and is often accompanied by fracture and other serious complications. Control strategies of TCM are identify the risk factors of TCM and assess the risk of illness; follow the clinical practice guidelines in Western medicine and TCM and attach great importance to the high-quality evidence of TCM; collect TCM information of study population and established the biobank through long-term follow-up study. The specific method was: according to the TCM theory of "treat pre-disease", the clinical epidemiological investigation and experimental research methods are combined to carry out disease prevention and control work. In the stage of normal bone mass or osteopenia, the clinical efficacy of TCM program in improving bone mineral density were mainly evaluated. In the stage of osteoporosis (fracture has not yet occurred), the main object was to verify efficacy and safety of TCM or integrative programs preventing the fracture. In osteoporotic fracture phase, the focus was to evaluate whether the combination therapy programs could promote healing, prevent recurrence of the fracture and improve the quality of life, thus reducing morbidity and mortality.
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Objective To observe the efficacy and safety of Bushen Huoxue Prescription in the treatment of kidney deficiency and blood stasis type primary osteoporosis. Methods Totally 50 patients with kidney deficiency and blood stasis type primary osteoporosis were collected. They were given Bushen Huoxue Prescription granules twice a day, taking with water, for 12 weeks. Before and after treatment, the femoral neck, Ward's area, L1–4 bone mineral density (BMD) were measured. VAS and TCM syndrome integrals were evaluated before and 4, 8 and 12 week of treatment. The level of serum osteocalcin (OC), β-C-terminal telopeptides of type I collagen (β-CTX) and osteoprotegerin (OPG) were detected before and after treatment. Hematuria routine, liver and kidney function were under safety testing before and after treatment. Results Bushen Huoxue Prescription could significantly increase BMD of left femoral neck and Ward's triangle (P=0.001, P=0.044). L1–4 BMD increased, without statistical significance (P=0.172). The total effective rate was 60.870% (28/46) for L1–4 and left femoral neck and 58.696% (27/46) for Ward's triangle. The VAS and TCM syndrome integral decreased significantly 4 weeks treatment compared with that before the treatment (P<0.01), and the scores decreased significantly with the prolongation of treatment time (F=159.690, P<0.001; F=163.970, P<0.001). After 12 weeks, treatment, the total effective rate for TCM syndromes was 78.26% (36/46). Serum levels of OC and β-CTX showed a tendency to increase, while serum levels of OPG showed a tendency to decrease, without statistical significance (P=0.087, P=0.091, P=0.419). There was no serious adverse reaction in hematuria routine and liver and kidney function. Conclusion Bushen Huoxue Prescription has obvious clinical efficacy for kidney deficiency and blood stasis type primary osteoporosis, which can improve the patients' BMD, improve bone metabolism, relive bone pain, with high level of safety.
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Nourishing kidney-yin (NKY) granules and warming kidney-yang (WKY) granules represent one of the prescriptions that prescribed in treating primary osteoporosis (POP) in light of tonifying kidney and nourishing essence principle as well as the theory of "treating both the disease and traditional Chinese medicine (TCM) syndrome".Both granules were created through the systematic analysis of clinic prescriptions by Professor Shi Qi.Consequently clinical investigations have well established that NKY granules significant improved bone mineral density (BMD) as well as relieved the kidney-yin deficiency syndromes in POP patients.Meanwhile,WKY granules relieve kidney-yang deficiency syndrome and the quality of life (QOL).What is more,pharmacological study established the application of common cnidium fruit,and fructus ligustri lucidi alleviated bone loss in OVX-induced mice.In addition,investigation with effective components identified that both NKY and WKY granules play systematic pharmacological effects on bone remodeling by regulating the expression of BMP/Smad,Wnt/β-catenin,RANKL/RANK/OPG axis,and Notch.The drug discovery was performed by the lead of traditional Chinese medicine (TCM) theory.It is one successful transformation investigation based on pharmacological effects,clinical intervention,animal model,cell culture and molecular investigation.
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OBJECTIVE:To systematically review the efficacy and safety of reinforcing kidney and invigorating spleen princi-ple in the treatment of primary osteoporosis (POP) in middle and elderly aged patients,and provide evidence-based reference for clinic. METHODS:Retrieved from VIP,Wanfang Database,CJFD,Medline,PubMed,Elsevier,Springer,Web of Science and Ovid,randomized control trials (RCT) about reinforcing kidney and invigorating spleen principle (test group) versus other meth-ods(no reinforcing kidney and invigorating spleen principle,control group)in the treatment of POP were collected. Meta-analysis was performed by using Rev Man 5.3 software provided by Cochrane after data extraction and quality evaluation modified by Jadad scale. RESULTS:Totally 28 RCTs were enrolled,involving 2849 patients. Results of Meta-analysis showed,the total effective rate [OR=3.80,95%CI(2.76,5.23),P<0.001],BGP level [MD=2.23,95%CI(1.80,2.66),P<0.001],BMD level of femoral neck [MD=0.04,95%CI(0.00,0.08),P=0.05] and BMD level of lumbar spine [MD=0.07,95%CI(0.03,0.11),P=0.001] in test group were significantly higher than control group,ALP level [MD=-5.59,95%CI(-10.51,-0.66),P=0.03] and VAS score [MD=-1.38,95%CI(-1.87,-0.89),P<0.001] were significantly lower than control group,with statistical significance. There were no significant differences in U-Ca/Cr [MD=-0.07,95%CI(-0.17,0.02),P=0.12] and serum Ca2+ level [MD=0.16,95%CI (-0.07,0.39),P=0.17] in 2 groups. CONCLUSIONS:Reinforcing kidney and invigorating spleen principle can improve patients' osteogenesis during bone metabolism,reduce the activity of the osteoclastic process and relief patients'pain in the treatment of POP.
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Objective: To evaluate the efficacy and safety of rhPTH (1-34) vs. elcatonin. Methods: Sixty patients with primary OP were randomly divided into two groups according to the ratio of 3:1. rhPTH (1-34) group (PTH group) was treated with subcutaneous injection of rhPTH (1-34) 20 μ g daily for 18 months, and the elcatonin group (CT group) was treated with intramuscular injection of elcatonin 20 U weekly for 12 months. Bone mineral density (BMD) of the lumbar spine 2-4 (L2-4) and femoral neck, serum calcium and phosphorus, urinary calcium, serum bone specific alkaline phosphatase (BSAP), and urinary c-terminal telopeptides of type I collagen/creatinine (uCTX-I/Cr) were tested at baseline, and 6, 12, and 18 months after treatment. Results: In PTH group, BMD of L2-4 at 6, 12, and 18 months, BDM of femoral neck at 18 month, BSAP at 6 and 12 months and uCTX- I/Cr at 6, 12 and 18 months were all significantly raised. In CT group, BMD of L2-4 at 12 month and that of femoral neck at 12 and 18 months were significantly elevated, while BSAP was significantly decreased at 12 and 18 months, and no significant difference on CTX- I/Cr was observed. When BMD growth and growth rate between two groups were compared, PTH group had better improvement in L2-4 BMD and growth rate than CT group at 6, 12, and 18 months. BMD growth and growth rate of femoral neck at 12 month and its growth at 18 month in CT group were higher than in PTH group, but there was no significant difference between two groups regarding the growth rates at 18 month. Besides, there were no significant differences regarding the rates of adverse reactions between two groups. Conclusions: rhPTH (1-34), is safe and effective in the treatment of primary OP. It is superior to elcatonin in improving vertebral BMD at onset time, growth rate and growth range, but inferior to elcatonin at BMD of femoral neck.
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OBJECTIVE@#To evaluate the efficacy and safety of rhPTH (1-34) vs. elcatonin.@*METHODS@#Sixty patients with primary OP were randomly divided into two groups according to the ratio of 3:1. rhPTH (1-34) group (PTH group) was treated with subcutaneous injection of rhPTH (1-34) 20 μ g daily for 18 months, and the elcatonin group (CT group) was treated with intramuscular injection of elcatonin 20 U weekly for 12 months. Bone mineral density (BMD) of the lumbar spine 2-4 (L2-4) and femoral neck, serum calcium and phosphorus, urinary calcium, serum bone specific alkaline phosphatase (BSAP), and urinary c-terminal telopeptides of type I collagen/creatinine (uCTX-I/Cr) were tested at baseline, and 6, 12, and 18 months after treatment.@*RESULTS@#In PTH group, BMD of L2-4 at 6, 12, and 18 months, BDM of femoral neck at 18 month, BSAP at 6 and 12 months and uCTX- I/Cr at 6, 12 and 18 months were all significantly raised. In CT group, BMD of L2-4 at 12 month and that of femoral neck at 12 and 18 months were significantly elevated, while BSAP was significantly decreased at 12 and 18 months, and no significant difference on CTX- I/Cr was observed. When BMD growth and growth rate between two groups were compared, PTH group had better improvement in L2-4 BMD and growth rate than CT group at 6, 12, and 18 months. BMD growth and growth rate of femoral neck at 12 month and its growth at 18 month in CT group were higher than in PTH group, but there was no significant difference between two groups regarding the growth rates at 18 month. Besides, there were no significant differences regarding the rates of adverse reactions between two groups.@*CONCLUSIONS@#rhPTH (1-34), is safe and effective in the treatment of primary OP. It is superior to elcatonin in improving vertebral BMD at onset time, growth rate and growth range, but inferior to elcatonin at BMD of femoral neck.
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Objective:To evaluate the efficacy and safety of rhPTH(1-34)vs. elcatonin.Methods:Sixty patients with primaryOP were randomly divided into two groups according to the ratio of3:1. rhPTH(1-34) group(PTH group) was treated with subcutaneous injection of rhPTH(1-34)20 μg daily for18 months, and the elcatonin group(CT group) was treated with intramuscular injection of elcatonin20U weekly for12 months.Bone mineral density(BMD) of the lumbar spine2-4(L2-4) and femoral neck, serum calcium and phosphorus, urinary calcium, serum bone specific alkaline phosphatase(BSAP), and urinary c-terminal telopeptides of type Ⅰ collagen/creatinine(uCTX-Ⅰ/Cr) were tested at baseline, and6,12, and18 months after treatment.Results:InPTH group, BMD ofL2-4 at6,12, and18 months,BDM of femoral neck at18 month,BSAP at6 and12 months and uCTX-Ⅰ/Cr at6,12 and18 months were all significantly raised.InCT group,BMD ofL2-4at 12 month and that of femoral neck at12 and18 months were significantly elevated, whileBSAP was significantly decreased at12 and18 months, and no significant difference onCTX-Ⅰ/Cr was observed.WhenBMD growth and growth rate between two groups were compared,PTH group had better improvement inL2-4BMD and growth rate thanCT group at6,12, and18 months.BMD growth and growth rate of femoral neck at12 month and its growth at18 month inCT group were higher than inPTH group, but there was no significant difference between two groups regarding the growth rates at18 month.Besides, there were no significant differences regarding the rates of adverse reactions between two groups.Conclusions: rhPTH(1-34), is safe and effective in the treatment of primaryOP.It is superior to elcatonin in improving vertebralBMD at onset time, growth rate and growth range, but inferior to elcatonin atBMD of femoral neck.
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Primary osteoporosis (POP) is one of the most common diseases in the elderly people resulting in high risk of fracture and poor quality of life. In addition to the pathological changes in bone mass, most of the POP patients also suffer from Chinese medicine (CM) syndromes of Shen (Kidney) essence deficiency. Shen essences are highly related to bone. Shen essence deficiency plays an important part in the development of POP and a better diagnosis of POP could be made by combining CM syndromes with Western medicine risk factors. Treatments of POP should aim at both increasing the bone mass and relieving the syndromes of Shen essence deficiency. Clinical study confirmed that treating POP patients with Shen-tonifying herbs could increase the bone mass and relieve the CM syndromes of POP patients. Basic researches clarified the mechanism by which Shen-tonifying herbs increased bone mass in animal models. The mechanisms by which Shentonifying herbs relieve the CM syndromes are still in investigation.
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Animals , Humans , Aging , Pathology , Bone and Bones , Pathology , Drugs, Chinese Herbal , Therapeutic Uses , Kidney , Pathology , Medicine, Chinese Traditional , Osteoporosis , Drug TherapyABSTRACT
Objective To investigate the biological characteristics of primary osteoporosis syndrome types from the perspective of mitochondrial DNA ( mtDNA) , thus to reveal the nature of osteoporosis and its traditional Chinese medical syndrome types. Methods A total of 210 osteoporosis women patients meeting the diagnostic criteria, inclusion criteria and exclusion criteria were collected from July of 2011 to October of 2013. The osteoporosis patients were differentiated into the syndrome types of yin deficiency of liver and kidney ( N=67) , yang deficiency of spleen and kidney ( N=70) and qi stagnation and blood stasis ( N=73) . And a total of 69 age-matched post-menopause non-osteoporosis patients were chosen as the control group, which were classified into the syndrome of harmony of Qi and blood. The peripheral blood was sampled for detecting mtDNA copy number with fluorescent quantitatitation PCR and for examining 8-hydroxy-2’-deoxyguanosine ( 8-OHdG) content by enzyme-linked immunosorbent assay (ELISA) . Statistical methods was used to analyze the correlation of bone mineral density (BMD) with mtDNA copy number and 8-OHdG content in different groups. Results The difference of mtDNA copy number was significant between the osteoporosis patients and non-osteoporosis patients (P<0.05), and was also significant among the three syndrome types of osteoporosis patients (P<0.05) . And 8-OHdG content showed the same features between the osteoporosis patients and non-osteoporosis patients (P<0.05) and among the three syndrome types of osteoporosis patients (P<0.05) . The correlation analysis results showed that mtDNA copy number was positively correlated with BMD, while 8-OHdG was negatively correlated with BMD in each group. Conclusion The mtDNA copy number and 8-OHdG content are correlated with the syndrome types of primary osteoporosis patients, and close correlation is shown between spleen-kidney yang deficiency and 8-OHdG, and between liver-kidney yin deficiency and mtDNA copy number.
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La osteoporosis es un problema de salud pública a nivel mundial, particularmente en mujeres posmenopáusicas, jugando la deficiencia de vitamina D un importante rol en su génesis. Objetivo: Determinar los niveles de Vitamina D en mujeres posmenopáusicas con osteoporosis primaria. Material y métodos: Estudio descriptivo tipo serie de casos. Se incluyeron 40 mujeres posmenopáusicas con diagnóstico de osteoporosis primaria; se excluyeron las que habían recibido suplemento de calcio o vitamina D, terapia para osteoporosis o tenían alguna causa de osteoporosis secundaria. A todas las mujeres incluidas se les determinó el nivel sérico de 25 OH vitamina D. Resultados: La edad promedio fue 65,9 ± 10,22 años, y el promedio del Score T L1-L4 fue -2,82 ± 0,71, Score T en Cadera Total -1,59 ±1,05 y el Score T en radio 33% -3,10 ± 0,97 en la densitometría ósea. El nivel de vitamina D sérico fue 13,98 ± 5,95 ng/ml; 87,5% (35 pacientes) tuvieron niveles de vitamina D deficientes, 7,5% (3 pacientes) tenían niveles insuficientes y sólo 2 pacientes tuvieron niveles normales de vitamina D. Conclusión: La mayoría de mujeres posmenopáusicas con osteoporosis primaria tuvieron niveles de vitamina D en rangos de deficiencia e insuficiencia. Podría ser necesario dar suplementos de calcio y vitamina D a todas las pacientes posmenopáusicas con osteoporosis.
Osteoporosis is a public health problem in the world, mostly in postmenopausal women, low levels of vitamin D play an important role in its origin. Objective: To get the levels of vitamin D in postmenopausal women with primary osteoporosis. Material and methods: Descriptive study case series. We included a total of 40 postmenopausal women with diagnosis of primary osteoporosis, we excluded those women who received calcium and/or vitamin D supplement, treatment for osteoporosis or those women with a secondary osteoporosis. The serum level of 25 OH vitamin D was determined in all women. Results: 40 patients with primary osteoporosis were included, average age was 65.9 ± 10.22 years old, and with average T score L1-L4 of -2.82 ±0.71, T Score in total hip of -1.59 ±1.05 and a T score in radius 33% of -3.10 ± 0.97 by bone densitometry. The average level of serum vitamin D was 13.98 ± 5.95 ng/ml, 87.5% (35 patients) had deficient levels of vitamin D, 7.5% (3 patients) had insufficient levels and only the 5% (2 patients) had normal levels of vitamin D. Conclusion: Most postmenopausal women with primary osteoporosis had low levels of vitamin D; 87.5%. It could be necessary to supplement with calcium and vitamin D to all postmenopausal women patients with osteoporosis.
Subject(s)
Humans , Female , Middle Aged , Vitamin D Deficiency , Osteoporosis, Postmenopausal , Epidemiology, DescriptiveABSTRACT
Objective To evaluate reliability and validity to perfect the syndrome questionnaire of osteoporosis. Methods The reliability was evaluated with Cronbach alpha and Guttman Split-half, the construct and content validity of the questionnaire was evaluated with factor analysis. Results The Cronbach alpha is from 0.365 4 to 0.852 5. The Guttman Split-half is from 0.542 9 to 0.746 5. The factor analysis had extracted 12 common factors which initial eigenvalues bigger than one. The Cumulative Proportion is 66.24%. The factors cover all the main facets of the questionnaire. Conclusion The questionnaire has its reliability and validity, and should be revised and perfected in future study.