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Objective The aims of this study were to evaluate the morbidity of osteoporosis and the relationship between bone mineral density ( BMD ) and bone metabolic markers in the patients with spine degeneration disease needing surgery, at the same time to observe the influence of type 2 diabetes mellitus on bone metabolism and BMD.Methods This retrospective analysis included 139 patients suffered by spine degeneration disease needing surgery from the October 2013 to October 2014 in Beijing Jishuitan Hospital. Lumbar BMD was measured by quantitative computed tomography ( QCT) before surgery.Serum N-terminal propeptide of type I procollagen ( PINP) , βC-terminal cross-linked telopeptide of type I collagen (β-CTX), osteocalcin (OC) , 25-hydroxyvitamin D[25(OH)D], parathyroid hormone (PTH), calcium and phosphorus were quantified simultaneously.The relationship between the results of lumbar BMD measured by QCT and bone metabolic markers was analyzed by partial correlation.The differences of bone metabolic markers among three groups classified according to BMD were performed by one-way ANOVA and analysis of covariance.The influence factors of lumbar BMD measured by QCT were analyzed by multifactor linear regression.T-test was used to analyze the differences of BMD and bone metabolic markers between two groups with and without type 2 diabetes mellitus.Results The average age of 139 patients was(62.74 ± 6.83) years old.Lumbar BMD revealed that the percentage of osteoporosis, osteopenia and normal BMD were 40.2%(56/139) , 43.8% (61/139) and 16% (22/139) separately.The percentage was 47%(66/139) in subjects with 25(OH)D below 30 nmol/L.The percentage of subjects with the concentrations of 25 ( OH ) D between 30-50 nmol/L was 40% ( 55/139 ) , while the percentage of subjects with the concentrations of 25(OH)D between 50-125 nmol/L was only 13% (18/139).Partial correlation analysis revealed that lumbar BMD measured by QCT was negatively correlated with PINP ( r=-0.352, P<0.01) ,β-CTX ( r=-0.356, P<0.01 ) and OC ( r=-0.276, P=0.001 ) with gender and type 2 diabetes mellitus as covariates.Along with the age of patients increasing and BMD reducing, the levels of PINP,β-CTX and OC increased gradually and the differences were statistically significant ( F=11.575, P<0.01;F=11.550, P<0.01; F=9.738, P<0.01).Multiple linear regression analysis revealed that age and PINP were the main factors that influenced the change of BMD in the patients with spine degeneration disease needing surgery (β=-1.863, t=-5.425, P<0.01;β=-0.393, t=-2.061, P=0.041) .Subjects were divided into diabetes group and non-diabetes group according to the clinical diagnosis and whether having abnormal serum glucose.The levels of PINP (36.56 ±14.56 versus 49.51 ±16.68μg/L) ,β-CTX (0.39 ±0.20 versus 0.52 ±0.21 μg/L) and OC (14.21 ±5.13 versus 20.74 ±6.84 μg/L) in serum between two groups had significant differences (t=3.648, P<0.01;t=2.754, P<0.01;t=4.573, P<0.01) .Conclusions There was prevalence of osteoporosis, osteopenia and vitamin D deficiency in the patients with spine degeneration disease needing surgery.The patients with high level of PINP and age were more prone to appear lower BMD which increasing the risk of osteoporosis.The patients combined with type 2 diabetes mellitus had suppressed bone markers which maybe the risk factor, independent of BMD, increasing fracture risk.
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Objective To explore the findings of diaphysial osteosarcoma in long bone on X-ray,CT and MRI, and discuss their clinical features and manifestations for differential diagnosis. Methods Twenty-eight cases with diaphysial osteosarcoma in long bone proved by surgery and pathology were reviewed retrospectively. Eighteen tumors were located in the femur, 4 in fibula, 4 in humerus and 2 in tibia. All of the patients were examined by X-ray, CT and MRI. The imaging manifestations on X-ray, CT and MRI were analyzed, and the relationship of the imaging features with the pathological types was also observed. The imaging signs were correlated with the pathologic findings with a double blind method. Results Of the 28 cases, there were 16 cases with large bone destruction, 22 cases with periosteal reaction on X-ray and CT. On X-ray, 18 cases showed soft tissue mass and 12 cases with neoplastic bone and tumor calcification.While on CT, 22 cases showed soft tissue mass on plain scan and 2 more cases displayed soft tissue mass after the injection of contrast mediun. Sixteen cases showed neoplastic bone and tumor calcification on CT.On MRI, there were 10 cases with bone destruction and periosteal reaction with iso- and hypo-intense on T1WI and iso- signals on T2WI. Twenty-six cases showed soft tissue edema and bone marrow on MRI. The soft mass were iso-signals on T1 WI and iso-hyperintense signals on T2 WI or STIR. The soft tissue edema was found hyperintense signals on T2WI or STIR. The lesions had heterogeneous enhancement especially in bone marrow with edema and adjcent soft tissue. Conclusion The X-ray, CT and MRI can reflect the pathological changes of diaphysial osteosarcoma in long bone from different aspects. Lower incidence, large bone destruction and no pathological fracture were the features of diaphysial osteosarcoma. The osteogenic type is diagnosed easily, but the osteolytic lesion should be differentiated from Ewing sarcoma, malignant giant cell tumor of bone and so on.