Bone Mineral Density and Bone Metabolic Markers for Patients with Spinal Cord Injury in Rehabilitation Wards / 中国康复理论与实践

Objective:To analyze the changes of bone mineral density (BMD), the characteristics of bone metabolic markers and related factors in patients with spinal cord injury (SCI). Methods:A total of 78 patients with SCI in our hospital from April, 2018 to May, 2020 were selected and divided into groups according to the injury courses. The people receiving physical examination in the same period were selected as control. BMD of proximal femur was measured by dual energy X-ray absorptiometry. Bone metabolic markers were detected. The correlation between BMD and clinical indicators was analyzed. Results:There was no difference in BMD between the patients within three months and the controls (P > 0.05). BMD at trochanter major, intertrochanteric and total hip in patients three to six months post injury was lower than that in the controls (|t| > 2.242, P < 0.05). The BMD at femoral neck, trochanter major, intertrochanteric and total hip in patients during six to twelve months post injury was lower than that in the controls (|t| > 2.026, P < 0.05). BMD at proximal femur in patients with twelve to 24 months post injury was lower than that in the controls (|t| > 2.189, P < 0.05). The decrease of BMD aggravated with the course of injury. There was no difference in BMD between paraplegia and quadriplegia, complete injury and incomplete injury (P > 0.05). Collagen type I C-terminal telopeptide (CTX) and N-terminal propeptide of type l precollagen (PINP) were higher than the reference range in the course of each injury, increased within three months post injury, reached the peak at three to six months post injury, and decreased to a steady state since seven months post injury. Vitamin D deficiency occurred in 87.5% of the patients. BMD at femoral neck and total hip was negatively correlated with the course of injury (|r| > 0.250, P < 0.05), and positively correlated with body mass index (r > 0.255, P < 0.05). Conclusion:The longer the duration of SCI, the more decrease of BMD. The early bone metabolism of patients with SCI is high conversion type. The rate of vitamin D deficiency in patients with SCI is quite high. It is necessary to detect and evaluate the bone metabolic markers combined with BMD at the early stage of SCI.

Preventive effect and mechanism of puerarin on rat models of disuse osteoporosis / 中国中药杂志

To investigate the preventive effect and possible mechanism of puerarin(Pur) in rat model of disuse osteoporosis(DOP),thirty healthy Wistar female rats of 2 months old were randomly divided into control group(Control), hindlimb suspension group(HLS), and puerarin group(HLS+Pur) in hindlimb suspension, with 10 rats in each group. A disuse osteoporosis model was established by tail suspension method, and 15.4 mg·kg~(-1) puerarin suspension was administered to HLS+Pur group every day, and the same volume of distilled water was administered to Control group and HLS group respectively. After 28 days, the rats were sacrificed by abdominal aorta blood collection, the main organs of the rats were removed, and the bone tissues of the rats were dissected. The organ index of the rats was calculated and the histopathology of the organs was observed under microscope. Bone mineral density test and bone biomechanical experiment were performed. Bone histomorphometry results were observed after bone tissue sectioning, and serum biochemical markers of bone metabolism were determined. There was no significant difference in organ index between the groups. There was no obvious abnormality in the pathological examination of the organs. The results of bone mineral density showed that puerarin could significantly increase the bone density of the tibia and vertebrae caused by hindlimb suspension. The mechanical parameters experiments showed that puerarin could effectively increase the maximum load and elastic modulus of the tibia and vertebrae. Fluorescence labeling showed that the fluorosis interval increased and the bone formation increased during puerarin treatment. The VG staining results showed that compared with the HLS group, in the puerarin group, the number of trabecular bone increased, the thickness of the trabecular bone became thicker, and the bone separation became smaller, which greatly improved the bone microstructure after hindlinb suspension. In addition, serum biochemical indicators showed that puerarin could promote bone formation index bone calcium. The content of osteocalcin(OC) increased and inhibited the formation of tartrate-resistant acid phosphatase 5 b(TRACP 5 b). Puerarin has a preventive effect in the rat model of disuse osteoporosis and its effect is good, and its mechanism may be related to promoting bone formation and inhibiting bone resorption.

Effects of Exercises on Bone Metabolism and OPG-RANKL-RANK System of Osteoclast Differentiation in Rats with Disuse Osteoporosis / 中国运动医学杂志

Objective To explore the effect of treadmill exercises on disuse osteoporosis and the media effect of OPG-RANKL-RANK system of osteoclast differentiation in the process.Methods Forty six-week-old male Sprague-Dawley rats were randomly divided into a normal control group,a disuse model group,a normal recovery group and an exercise recovery group,each of 10.The normal control group were sacrificed 4 weeks later without receiving any special treatment.The disuse model group were sacrificed after 4 weeks of tail suspension.The normal recovery group were sacrificed after 4 weeks of tail suspension and keeping quiet for 4 weeks.The exercise recovery group were sacrificed after 4 weeks of tail suspension and another 4 weeks of treadmill exercises.The indicators of bone mineral density (BMD),bone histomorphometry,bone tissue TRACP-5b staining,bone metabolism and cytokines related to the osteoclast differentiation OPG-RANKL-RANK system were tested immediately after the rats were sacrificed.Results The BMD,trabecular bone volume percentage (TBV),trabecular bone width (Tb.Wi),concentration of serum alkaline phosphatase (ALP) and the gene expression of bone marrow oculopneumoplethysmograph (OPG) of the disuse model goup were significantly lower than those of the normal control group (P＜0.01),while the trabecular bone spacing (Tb.Sp),average positive staining area percentage (APSAP) of tartrate-resistant acid phosphatase (TRACP)-5b,concentration of serum Ca2+ and TRACP-5b and the gene expression of bone marrow cytokines including RANKL,macrophage colony-stinulating factor (M-CSF),RANK,interleukin (IL)-6 and tumor necrosis factor (TNF)-α of the disuse model goup were significantly higher than those of the normal control group (P＜0.01).The BMD,TBV,Tb.Wi,concentration of serum ALP and the gene expression of bone marrow OPG of the exercise recovery group were significantly higher than those of the normal recovery group (P＜0.05 or P＜0.01).The Tb.Sp,APSAP,concentration of serum Ca2+ and TRACP-5b and the gene expression of RANKL,M-CSF,RANK,IL-6 and TNF-α of the exercise recovery group were significantly lower than those of the normal recovery group (P＜0.05 or P＜0.01).Conclusion The 4-week tail suspension can lead to disuse osteoporosis in rats.Treadmill exercise can promote the recovery of rats with the disuse osteoporosis.The occurrence of disuse osteoporosis and the effect of exercises on disuse osteoporosis were related with the expressing of OPG-RANKL-RANK system-related cytokines of osteoclast differentiation in bone marrow microenvironment.

Efeitos da terapia combinada com ácido zoledrônico e propranolol na resistência mecânica em um modelo de rato com osteoporose por desuso / Effect of combined treatment with zoledronic acid and propranolol on mechanical strength in an rat model of disuse osteoporosis

Resumo Objetivos: Investigar os efeitos aditivos do agente antirreabsorção ácido zoledrônico (ZOL), isolado e em combinação ao propranolol (PRO), em um modelo de rato com osteoporose por desuso. Métodos: Usou-se um modelo de pata traseira direita de rato privada de descarga de peso para estudar as consequências da falta de descarga de peso sobre o esqueleto durante várias condições, como missões espaciais e repouso prolongado no leito em idosos. Ratos Wistar machos de três meses de idade foram submetidos à imobilização da pata traseira direita (IPTD) por 10 semanas para induzir à osteopenia; em seguida, foram divididos aleatoriamente em quatro grupos: 1 – IPTD para controle positivo; 2 – IPTD mais ZOL (50 μg/kg, dose única intravenosa); 3 – IPTD mais PRO (0,1 mg/kg, via subcutânea, cinco dias na semana); 4 – IPTD mais PRO (0,1 mg/kg, via subcutânea, cinco dias na semana) mais ZOL (50 μg/kg, dose única intravenosa) por outras 10 semanas. Um grupo de ratos não imobilizados foi usado como controle negativo. No fim do tratamento, os fêmures foram removidos e testaram-se a porosidade do osso e suas propriedades mecânicas, além do peso seco e das cinzas do osso. Resultados: No que diz respeito à melhoria da resistência mecânica da diáfise femoral média, a terapia combinada com ZOL mais PRO foi mais eficaz do que a monoterapia com ZOL ou PRO. Além disso, a terapia combinada com ZOL mais PRO foi mais eficaz na melhoria do peso seco do osso e preservou melhor a porosidade do osso cortical do que a monoterapia com ZOL ou PRO em ratos submetidos à imobilização da pata traseira direita. Conclusões: Esses dados sugerem que a terapia combinada com ZOL mais PRO deve ser recomendada para o tratamento da osteoporose por desuso.

Abstract Objectives: A model that uses right hind-limb unloading of rats is used to study the consequences of skeletal unloading during various conditions like space flights and prolonged bed rest in elderly. This study was aimed to investigate the additive effects of antiresorptive agent zoledronic acid (ZOL), alone and in combination with propranolol (PRO) in a rat model of disuse osteoporosis. Methods: In the present study, 3-month-old male Wistar rats had their right hind-limb immobilized (RHLI) for 10 weeks to induce osteopenia, then were randomized into four groups: (1) RHLI positive control, (2) RHLI plus ZOL (50 μg/kg, i.v. single dose), (3) RHLI plus PRO (0.1 mg/kg, s.c. 5 days per week), (4) RHLI plus PRO (0.1 mg/kg, s.c. 5 days per week) plus ZOL (50 μg/kg, i.v. single dose) for another 10 weeks. One group of non-immobilized rats was used as negative control. At the end of treatment, the femurs were removed and tested for bone porosity, bone mechanical properties, and bone dry and ash weight. Results: With respect to improvement in the mechanical strength of the femoral mid-shaft, the combination treatment with ZOL plus PRO was more effective than ZOL or PRO monotherapy. Moreover, combination therapy using ZOL plus PRO was more effective in improving dry bone weight and preserved the cortical bone porosity better than monotherapy using ZOL or PRO in RHLI rats. Conclusions: These data suggest that this combined treatment with ZOL plus PRO should be recommended for the treatment of disuse osteoporosis.

Efeito combinado do ácido zoledrônico e do alfacalcidol no tratamento da osteoporose por desuso em ratos / Additive effect of zoledronic acid and alfacalcidol in the treatment of disuse osteoporosis in rats

Objetivos: O desuso pelo repouso no leito, pela imobilização de membros ou por missões espaciais provoca a perda óssea rápida. Fez-se este estudo para investigar os efeitos terapêuticos do ácido zoledrônico (ZOL), isoladamente e em combinação ao alfacalcidol (ALF), em um modelo de rato com osteoporose por desuso. Métodos: Ratos Wistar machos de três meses foram submetidos à imobilização da pata traseira direita (IPTD) por 10 semanas para induzir a osteopenia; em seguida, foram divididos em quatro grupos: 1 – IPTD para controle positivo; 2 – IPTD mais ZOL (50 µg/kg, dose única intravenosa); 3 – IPTD mais ALF (0,5 µg/kg, via oral diariamente); 4 – IPTD mais ALF (0,5 µg/kg, via oral diariamente) mais ZOL (50 µg/kg, dose única intravenosa) por outras 10 semanas. Um grupo de ratos não imobilizados foi usado como controle negativo. No fim do tratamento, os fêmures foram removidos e testaram-se a porosidade do osso e suas propriedades mecânicas, além do peso seco e das cinzas do osso. Resultados: A terapia combinada com ZOL mais ALF foi mais eficaz em reduzir a porosidade do osso do que a monoterapia com um dos fármacos administrado isoladamente em ratos submetidos à IPTD. No que diz respeito à melhoria da resistência mecânica da diáfise femoral média, o tratamento combinado com ZOL mais ALF foi mais eficaz do que a monoterapia com um dos fármacos administrado isoladamente. Além disso, a terapia combinada com ZOL mais ALF foi mais eficaz na melhoria do peso seco e das cinzas do osso do que a monoterapia com ZOL ou ALF em ratos submetidos à IPTD. Conclusões: Esses dados sugerem que a terapia combinada com ZOL mais ALF representa uma opção terapêutica potencialmente útil para o tratamento da osteoporose por desuso. .

Objectives: Disuse by bed rest, limb immobilization or space flight causes rapid bone loss. We conducted the present study to investigate the therapeutic effects of zoledronic acid (ZOL), alone and in combination with alfacalcidol (ALF) in a rat model of disuse osteoporosis. Methods: In the present study, 3-month-old male Wistar rats had their right hind-limb immobilized (RHLI) for 10 weeks to induce osteopenia, then were divided into four groups: 1 – RHLI positive control; 2 – RHLI plus ZOL (50 µg/kg, i.v. single dose); 3 – RHLI plus ALF (0.5 µg/kg, oral gauge daily); 4 – RHLI plus ALF (0.5 µg/kg, oral gauge daily) plus ZOL (50 µg/kg, i.v. single dose) for another 10 weeks. One group of non-immobilized rats was used as negative control. At the end of the treatment, the femurs were removed and tested for bone porosity, bone mechanical properties, and bone dry and ash weight. Results: Combination therapy with ZOL plus ALF was more effective in decreasing bone porosity than each drug administered as monotherapy in RHLI rats. With respect to improvement in the mechanical strength of the femoral mid-shaft, the combination treatment of ZOL plus ALF was more effective than each drug administered as a monotherapy. Moreover, combination therapy using ZOL plus ALF was more effective in improving dry bone and ash weight, than single-drug therapy using ZOL or ALF in RHLI rats. Conclusions: These data suggest that combination therapy with ZOL plus ALF represents a potentially useful therapeutic option for the treatment of disuse osteoporosis. .

Effect of Chronic Foot Disease to Bone Mineral Density of the Affected Lower Limb / 대한족부족관절학회지

PURPOSE: Pain or discomfort caused by foot diseases may lead to abnormal gait, resulting in decreased bone mineral density (BMD) of the affected lower limb. We analyzed the effect of foot affection to BMD and its clinical significance. MATERIALS AND METHODS: Bilateral hip BMD was evaluated in 93 patients with unilateral chronic foot disease. To minimize statistical errors, we excluded patients with medical histories that had influence on BMD. Analysis was based on the results of BMD tests at the first visit. All patients denied past medical intervention for osteoporosis. The difference in density between bilateral limbs was determined by comparing BMDs of the neck, upper neck, trochanter and total area of hip. RESULTS: Test results revealed the decrease of BMD in the lower limb with the affected foot, compared to the unaffected side. This decrease was significant in the area of the trochanter (p<0.05). There was no marked difference of BMD in relation with duration of affection, underlying disease or age. Pertaining the location of foot affection, the hindfoot group showed significant decrease in BMD compared to the forefoot group. The group with affection in bone and joint also showed a marked decrease in BMD compared to the soft tissue group (p<0.05). CONCLUSION: Pain and discomfort caused by chronic foot diseases can lead to a decrease in the BMD of the affected lower limb. This may increase the risk of complications such as osteoporotic fracture and muscular atrophy.

The influence of passive movement and electric stimulation on the bone BGP and TRACP in rats with denervation / 重庆医科大学学报

Objective:To discuss the preventive function of passive movement and electric stimulation on rats with disuse osteoporosis. Methods:Through cutting the sciatic nerve and femoral nerve of experimental rats,we made an animal model of disuse osteoporosis,and divided them into five groups:the pseudo operation group,the denervation group(DG),denervation with passive movement group(PMG), denervation with electric stimulation group(ESG),and denervation with passive movement and electric stimulation group(PMESG).Then the changes of biochemistry indicators of bone metabolism were observed in all groups.Results:Compared with sham group,the Bone gla protein(BGP)value in the other groups were markedly lower(P0.05).Compared with DNG,the BGP value in the other groups increased,especially that the BGP in the PMESG was significantly increased(P

Effects of pulsed electromagnetic fields on BMD and TGF-?_1 in disuse osteoporosis rats / 第三军医大学学报

Objective To investigate the effects of pulsed electromagnetic fields(PEMF)on the bone mineral density(BMD)and serum level of transforming growth factor-beta 1(TGF-?1)in the disuse osteoporosis(DOP)rats.Methods Eighty 4-month-old female SD rats were randomly divided into 4 matched groups according to their weight:control group(INT group),DOP group,calcitonin group(CT group)and PEMF group.Rats in INT group were raised with the average amount of food consumed by the DOP rats.Right hindlimbs of rats in DOP,CT and PEMF groups were immobilized by tibia-tail fixation to establish DOP model as Zarzhevsky described.Rats in CT group were injected with calcitonin(2 IU/kg,i.p,once a day),and rats in group PEMF were irradiated with PEMF(8 Gs,15 Hz,a pulse time of 8 ms)immediately after operation.The rats(5 animals per time of each group)were killed at 1,2,4 and 8 weeks after operation and their right hindlimbs were resected.The BMD and serum TGF-?1 concentration were measured with a dual energy X-ray bone densitometer and ELISA respectively.Results Significant difference was observed in the femur proximal BMD between rats with right hindlimb immobilization(DOP group)and INT group 2 weeks later(P

A Comparative Study of Osteocalcin Measured by Radioimmunoassay in Normal / 대한정형외과학회잡지

Osteocalcin is the major noncollagenous protein of the bone matrix and has been described as a sensitive marker reflecting bone turn-over rate. It's believed to play a role in the process of mineralization. The level of osteocalcin is considered to be influenced by other calcium regulating hormones. To obtain the normal value of osteocalcin in Korean young adults and to clarify the usefulness of osteocalcin as a marker reflecting bone turn-over in suspicious disuse-osteporotic patient, author measured the level of osteocalcin by radioimmunoassay. The results are; 1. The mean circulation osteocalcin level in healthy young adults was 4.43+ 1.09ng/ml. 2. In normal Korean male, the serum osteocalcin level was 4.38±1.16ng/ml and in normal Korean female, 4.48±1.02ng/ml. There was no significant difference in both sexes, but the serum osteocalcin level in female reveals some tendency of elevation when compared with male. 3. In suspicious disuse-osteoporotic patients, the mean serum osteocalcin level was 4.21±1.30ng/ml and this result shows no difference from that of normal young adults. 4. The level of osteocalcin measured in the normal young Korean adults shows no difference from the prerecorded INC level measured in the Western people. 5. In conclusion, the normal value of osteocalcin in normal young Korean adults is similar that of western people, and the measurement of osteocalcin in suspicious disuse-osteoporotic patients could not be used as a sensitive marker reflecting bone turn-over.