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BACKGROUND:The incidence of osteoporosis significantly increases in the patients with rheumatoid arthritis,and it remains unclear whether the presence of a large number of immune complexes in serum promotes the onset and development of osteoporosis. OBJECTIVE:To investigate the correlation between serum immune complexes and osteoporosis in patients with rheumatoid arthritis. METHODS:(1)Clinical trial:Serum and clinical data of 50 healthy controls and 50 patients with untreated rheumatoid arthritis were collected and retrospectively analyzed.Total immune complex level in serum was compared between two groups.Correlation of serum total immune complexes with bone mineral density,bone turnover markers and other clinical indicators in patients with rheumatoid arthritis was analyzed.(2)Cell experiment:Peripheral blood mononuclear cells from healthy volunteers were isolated and cultured,and divided into four groups:rheumatoid arthritis group was added with total immune complex suspension from rheumatoid arthritis patients;normal control group was added with total immune complex suspension from healthy medical checkups;positive control group was added with α-MEM medium containing macrophage colony-stimulating factor and receptor activator of nuclear factor-kappa B ligand,and negative control group was added with α-MEM medium.Tartrate-resistant acid phosphatase staining was performed to observe the formation of osteoclasts after 7 days of treatment, RESULTS AND CONCLUSION:(1)Clinical trial:The total immune complex and serum alkaline phosphatase levels in patients with rheumatoid arthritis were significantly higher than those in health controls(P＜0.01,P＜0.05).Pearson correlation analysis showed that serum total immune complex level was positively correlated with erythrocyte sedimentation rate(r=0.330,P=0.019),serum alkaline phosphatase(r=0.545,P=0.001),anti-cyclic citrullinate peptide(r=0.377,P=0.007)and c-terminal telopeptide of type Ⅰ collagen(r=0.738,P=0.001),and negatively correlated with lumbar bone mineral density(r=-0.595,P=0.001)in patients with rheumatoid arthritis.Binary Logistic regression analysis showed that age[odds ratio(OR)=1.086,95%confidence interval(CI)(1.022,1.154),P=0.008],anti-cyclic citrullinate peptide[OR=1.002,95%CI(0.999,1.005),P=0.035],c-terminal telopeptide of type Ⅰ collagen[OR=0.141,95%CI(0.015,8.900),P=0.008]and serum total immune complexes[OR=2.895,95%CI(1.228,6.827),P=0.001]were the influencing factors for abnormal bone mass(reduced bone mass or osteoporosis)in patients with rheumatoid arthritis.(2)Cell experiment:Tartrate-resistant acid phosphatase positive osteoclasts were observed in the positive control group,normal control group and rheumatoid arthritis group,and there were more osteoclasts in the rheumatoid arthritis group than in the normal control group(P＜0.01).To conclude,serum total immune complexes can be used as a potential serologic predictor of rheumatoid arthritis complicated with osteoporosis,and removing immune complexes in serum or interfering with the binding of immune complexes to their receptors may be an effective means for the prevention and treatment of rheumatoid arthritis complicated with osteoporosis.
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Long-term burden of illness and associated medication usage make osteoporosis(OP) a common complication of respiratory diseases. The pathogenic risk factors and treatment strategies for respiratory diseases related OP are similar to primary OP. However, due to differences in the pathogenesis of each disease, there are distinctions in the characteristics of bone loss and treatment approaches. Therefore, targeted diagnostic and therapeutic plans need to be formulated. This article provides a comprehensive review of secondary OP caused by common respiratory diseases in terms of epidemiological characteristics, related risk factors or possible mechanisms, changes in bone metabolic indexes or characteristics of bone damage, and progress in diagnosis and treatment. The aim of this review is to offer insights into the prevention and treatment of secondary OP related to respiratory diseases and promote the development of a multidisciplinary collaborative approach.
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【Objective】 To investigate the level of serum bone metabolism and biochemical markers and bone density of plasmapheresis donors, and to provide scientific basis for ensuring the health and safety of plasmapheresis donors in China. 【Methods】 A total of 437 plasmapheresis donors from Linwu plasmapheresis station in Hunan Province from July 1 to September 30, 2022 were recruited to determine the levels of total serum calcium, albumin, serum 25-hydroxyvitamin D (25OHD), serum type I procollagen N-terminal propeptide (P1NP), and collagen type 1 crosslinked carboxyl-terminal peptide (β-CTX). Dual-energy X-ray method was used to measure the bone density of the anteroposterior lumbar spine (L1-L4) and bilateral femoral neck bone density of plasmapheresis donors. Plasmapheresis donors were grouped according to the type of plasma donation (first-time and repeat plasmapheresis donors) and the total number of plasma donations to assess the differences in bone density and serum bone metabolism biochemical markers between groups. The dose-response relationship between the total number of plasmapheresis donations and biochemical indexes was analyzed by limiting cubic spline, and the influencing factors of different indexes were explored by multiple linear regression. 【Results】 A total of 437 plasmapheresis donors were included in this study, including 187 first-time plasmapheresis donors and 250 repeat plasmapheresis donors. There were no significant differences in bone density and prevalence of osteoporosis between first-time donors and repeat donors (P>0.05). There was also no significant difference in bone density levels between groups of total number of plasmapheresis donations. The levels of albumin and 25OHD decreased with the increase of the total number of plasma donations, while the serum P1NP level was positively correlated with the total number of plasma donations. The results of the restriction cubic spline showed that the total number of plasmapheresis donations had a nonlinear dose-response relationship with 25OH and P1NP (P<0.05). The results of multiple linear regression showed that the frequency of plasmapheresis donation was the influencing factor of 25OHD, and the total number of plasmapheresis donation was the influencing factor of P1NP. 【Conclusion】 Plasmapheresis donation does not affect the bone health of donors and increase the risk of osteoporosis due to the use of long-term anticoagulants, but it will increase the osteogenic activity of plasmapheresis donors. It is recommended that middle-aged and elderly plasmapheresis donors supplement vitamin D appropriately.
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Objective:To investigate the effect of self-made Bushen Jiangu Decoction on bone transformation markers in elderly patients with osteoporotic vertebral compression fracture after operation, and to evaluate the clinical efficacy.Methods:Prospective cohort study. A total of 92 patients with osteoporotic vertebral compression fracture after operation in Fangshan Hospital of Beijing University of Chinese Medicine from April 2020 to December 2021 who met the inclusion criteria were divided into 2 groups by random drawing method, with 46 in each group. The control group was treated with routine western medicine after operation, and the observation group was treated with self-made Bushen Jiangu Decoction on the basis of the control group. Both groups were treated for 3 months. TCM symptom scores were performed before and after treatment, and the prognosis of the patients was evaluated with the Chinese Osteoporosis Quality of Life (COQOL), VAS scale, and the Oswestry Dysfunction Index (ODI). The levels of amino terminal propeptide (PINP), cross-linked terminal peptide β special sequence (β-CTX) and bone morphogenetic protein 6 (BMP6) of type Ⅰ procollagen were determined by contrast chromogenic method with o-benzaldehyde. The adverse reactions during treatment were recorded and the clinical efficacy was evaluated.Results:The total effective rate was 95.7% (44/46) in the observation group and 82.6% (38/46) in the control group, and there was a significant difference between the two groups ( χ 2=4.04 , P=0.044). After treatment, the scores of fracture nonunion, pain in back and loin, chilliness and lassitude, and pallor in the observation group were significantly lower than those in the control group ( t values were 4.84, 4.09, 4.87, 4.14, respectively, P<0.01). The scores of COQOL, VAS and ODI in the observation group were significantly lower than those in the control group ( t values were 6.26, 10.57 and 6.15, respectively, P<0.01). The levels of PINP [(44.93±5.86)μg/L vs. (49.76±6.02)μg/L, t=3.90] and β-CTX [(0.49±0.17) μg/L vs. (0.68±0.20) μg/L, t=4.91] in observation group were significantly lower than those in the control group after treatment ( P<0.05). The level of BMP6 [(81.23±9.14) μg/L vs. (75.14±8.25) μg/L, t=3.36] in observation group was significantly higher than that of the control group ( P<0.05). During the treatment,the incidence of adverse reactions in the observation group was 13.0% (6/46), while that in the control group was 8.7% (4/46), and there was no significant difference between the two groups ( χ 2=0.45, P=0.503). Conclusion:The self-made Bushen Jiangu Decoction combined with conventional western medicine therapy can adjust the level of bone transformation markers in elderly patients with osteoporotic vertebral compression fractures, improve the lumbar function and quality of life, and improve the clinical efficacy.
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Objective:Both type 1 diabetes and type 2 diabetes are associated with abnormal bone metabolism, but they have different pathogenic mechanisms. Sclerostin(SOST), Dickkopf-related protein 1(DKK-1), and irisin are newly discovered factors involved in the regulation of bone metabolism. This study aims to compare the differences in serum levels of SOST, DKK-1, and irisin between patients with type 1 diabetes and type 2 diabetes.Methods:This cross-sectional study included 101 patients with type 1 diabetes who visited the Endocrinology Department of Peking Union Medical College Hospital from 2017 to 2019, as well as 55 patients with type 2 diabetes and 59 individuals with normal glucose tolerance who were confirmed through an oral glucose tolerance test as part of the Beijing Changping Community Type 2 Diabetes Management Program from 2014 to 2015. Enzyme-linked immunosorbent assay(ELISA) was used to measure the levels of SOST, DKK-1, and irisin.Results:There were more female participants than male participants, with an average age of 49 years. The group with type 1 diabetes had a longer duration of illness( P<0.001) and higher HbA 1C levels( P<0.001) compared to the group with type 2 diabetes, and there was no statistical difference in age between the two groups. Both the type 1 diabetes and type 2 diabetes groups had lower levels of serum procollagen type 1 N-terminal propeptide(P1NP) compared to the control group [(8 579±400)pg/mL, (7 268±552)pg/mL vs(10 051±618)pg/mL, P=0.039, P=0.001]; But the β isomer of C-terminal cross-linking telopeptide of type 1 collagen(β-CTX) showed no statistical difference compared to the control group. Patients with type 1 diabetes and type 2 diabetes had higher SOST than controls [(129.7±6.8)pg/mL, (104.8±6.8)pg/mL vs(85.9±5.3)pg/mL, P<0.001, P=0.030], the differences between the type 1 diabetes group and the control group lost statistical significance after adjusting for factors such as fasting blood glucose and lipid levels. There was no significant difference in SOST between type 1 diabetes and type 2 diabetes groups. There was no significant difference in DKK-1 among three groups, but DKK-1 in type 1 diabetes group was lower or tended to be lower than that in type 2 diabetes group. Serum irisin in patients with type 1 diabetes was higher than that in controls and patients with type 2 diabetes[(16.6±0.7)ng/mL vs (9.6±0.6)ng/mL, (9.8±0.6)ng/mL, both P<0.001], but there was no significant difference in irisin level between type 2 diabetes and controls. Conclusions:Patients with both type 1 and type 2 diabetes showed inhibition of the bone formation marker P1NP, while the bone resorption marker β-CTX did not significantly change. SOST levels were elevated or showed an increasing trend in both type 1 and type 2 diabetes patients, which may be related to the inhibition of bone formation. Additionally, type 1 diabetes patients had increased levels of irisin, which may be involved in abnormal bone turnover.
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Objective:To explore the changes of bone turnover markers and geometric parameters of hip bone in overweight postmenopausal women with metabolic syndrome(MS), as well as the influence of MS components. To analyze the association of these factors with the risk of fracture.Methods:A total of 505 overweight postmenopausal female patients who underwent health check-up in Lianhu Community Service Center, Danyang City, Jiangsu Province from January to December 2017 were selected. According to the MS diagnostic criteria of the International Diabetes Federation(2009), the patients were divided into MS group( n=331)and non-MS group( n=174). Blood samples were collected to determine the level of procollagen type 1 N-terminal propeptide(P1NP)and carboxy-terminal cross-linked telopeptide of type 1 collagen(CTX). Bone mineral density and hip bone geometry parameters were tested with dual-energy X-ray absorptiometry and hip structural analysis software. Results:The incidence of osteoporotic fracture and hip fracture in MS group was significantly higher than that in non-MS group(21.1% vs 13.8%, 4.8% vs 1. 1%, P<0.05). However, the bone mineral density of lumbar vertebra 1-4, femoral neck, and total hip in MS group was significantly higher than that in non-MS group, which remained after adjusting for age( P<0.05), but the difference disappeared after further adjustment for body mass index( P>0.05). The P1NP, CTX, femur strength index(FSI), section modulus(SM), and cross-sectional area(CSA)of MS group were significantly lower than those of non-MS group, the buckling ration(BR)was significantly higher than that in non-MS group, and the differences were still statistically significant after adjusting for age and body mass index( P<0.05). There was no significant difference in bone mineral density of lumbar vertebra 1-4, femoral neck, total hip, P1NP, and CTX between fracture group and non-fracture group in patients with MS. But FSI, SM, cross-sectional moment of inertia(CSMI), and CSA were significantly lower, BR was significantly higher( P<0.05) and femur strength decreased in patients with fracture. Regression analysis showed that high BR was an independent risk factor for fracture risk, while high FSI, SM, CSMI, and CSA were protective factors. Multivariate linear regression analysis showed that wasit circumference, diastolic blood pressure, and fasting plasma glucose were the main MS components affecting bone mineral density, bone turnover indexes, and hip bone geometry parameters. Conclusions:Overweight postmenopausal MS patients had decreased bone turnover rate, femoral strength, and relatively poor bone quality. Hip bone geometry parameters can be used as one of the methods to assess fracture risk in MS patients. Waist circumference, diastolic blood pressure, and fasting blood glucose are the important MS components affecting bone mass and bone quality.
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Objective:To determine possible risk factors of developing HBS after parathyroidectomy for PHPT.Methods:The clinical data of 104 patients with PHPT who were hospitalized in the First Affiliated Hospital of Chongqing Medical University and underwent PTX surgery from Apr. 2014 to Apr. 2022 were retrospectively analyzed.There were 36 males and 68 females. 105 patient were divided into two groups: HBS group ( n=29) and non-HBS group ( n=75) according to whether HBS occurred after PTX. The clinical related data of the two groups were collected and analyzed with SPSS 22.0 software to determine the risk factors of HBS. Results:Serum albumin, blood magnesium, blood phosphorus, 25 (OH) D and hip bone mineral density in HBS group were lower than those in non HBS group; Preoperative blood calcium, blood PTH, bone turnover markers (BALP, OC, PINP β- CTX) were higher than those in non HBS group ( P<0.05). The preoperative serum calcium, BALP, and PINP levels in the HBS group and non HBS group were: (3.37±0.58) vs (2.91±0.28) mmol/L; 38.37 (15.59, 58.79) vs 18.21 (11.28, 25.57) μg/L; 256.25 (139.95, 527.95) vs 79.72 (50.64, 120.33) ng/ml. Preoperative serum calcium ( OR=15.006, P<0.001), PTH ( OR=1.002, P<0.001), BALP ( OR=1.055, P<0.001), OC ( OR=1.019, P<0.001), PINP ( OR=1.008, P<0.001), β-CTX ( OR=1.816, P=0.006) were positively correlated with HBS, while serum albumin ( OR=0.850, P=0.011), magnesium ( OR=0.012, P=0.002), 25 (OH) D ( OR=0.844, P=0.001) and hip BMD ( OR=0.00, P=0.019) were negatively correlated with HBS. Preoperative serum calcium ( OR=36.689, P=0.009), PINP ( OR=1.019, P=0.022) and BALP ( OR=1.049, P=0.031) were independent risk factors for HBS. The ROC curves showed that the AUC values were 0.7368, 0.8326, and 0.7605, respectively, with sensitivities of 55.2%, 75.9%, and 72.4%; the specificities were 88.0%, 81.3% and 78.7%. The amount of intravenous calcium supplement in HBS patients was related to preoperative blood BALP and PINP ( P=0.035) . Conclusions:Patients with PHPT have a significantly increased risk of postoperative HBS when preoperative blood calcium>3.22 mmol/L, P1N P>138.80 ng/ml, or BAL P>26.08 (μg/L). For patients with significantly elevated preoperative blood P1NP, postoperative calcium supplementation can be appropriately increased.
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Objective:To investigate the correlation between the level of thyrotropin receptor antibody(TRAb) and bone turnover markers(BTMs) in the patients with newly-diagnosed Graves′ disease(GD).Methods:The clinical data of GD patients who were newly-diagnosed in the First Affiliated Hospital of Zhengzhou University from October 2016 to June 2021 were collected, including free triiodothyronine(FT 3), free thyroxine(FT 4), thyroid stimulating hormone, thyroid related antibodies, N-terminal procollagen of type I collagen(PINP), N-terminal osteocalcin(N-MID), β-cross-linked C-telopeptide of type I(β-CTX), blood lipid and renal function, etc. Results:There were 618 GD patients with an average age of(43.7±13.2) years(male∶female=1∶1.99). The PINP and β-CTX level in male GD patients were significantly higher than those in female(all P<0.05). Spearman correlation analysis showed that PINP, N-MID and β-CTX were positively correlated with FT 3, FT 4, TRAb, serum calcium and serum phosphorus; and negatively correlated with body mass index and low density lipoprotein cholesterol(all P<0.05). Linear regression analysis showed that TRAb was positively correlated with lg-PINP, lg-N-MID and sqrt-β-CTX in the univariate model of total GD patients( β were 0.006, 0.005, and 0.006, respectively; all P<0.001); positive correlation remained after adjusting for thyroid function(all β=0.004, all P<0.001); and for multiple confounding factors(model 3 and 4, all P<0.05). Results of univariate and adjusted thyroid function models with GD in different genders were consistent with the total patients(all P<0.05). Conclusion:TRAb is a risk factor for accelerated bone turnover in GD patients which is independent of thyroid function.
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Objective:To explore the correlation between plasma sclerostin (SOST) and bone turnover markers and inflammatory factors in hemodialysis patients.Methods:One hundred and eight patients admitted to Changsha Central Hospital Affiliated to Nanhua University from January 2018 to May 2019 were selected. The levels of plasma SOST at admission and at 3, 6 and 12 months of dialysis were determined by enzyme-linked immunosorbent assay. They were divided into low- SOSTgroup (56 cases) and high- SOSTgroup (52 cases) based on the mean value of SOST. The levels of serum bone turnover markers β-Ⅰ collagen carboxy-terminal peptide (β-CTX) and osteocalcin (OC), propeptide of type Ⅰ procollagen (PINP), full parathyroid hormone (iPTH), N-terminal osteocalcin (N-MID-OC), inflammatory factors interleukin-1β (IL-1β), interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) were compared between the two groups, abdominal aortic calcification (ACC) score was performed, and Pearson linear correlation analysis was used to analyze the relationship between SOST level of hemodialysis patients and bone turnover markers, inflammatory factors and ACC scores.Results:The baseline levels of β-CTX, OC, PINP, iPTH, and N-MID-OC in the low- SOST group were higher than those in the high- SOST group: (976.03 ± 205.27) ng/L vs. (781.34 ± 150.45) ng/L, (175.31 ± 50.49) ng/L vs. (125.75 ± 40.17) ng/L, (321.45 ± 82.14) μg/L vs. (259.41 ± 75.36) μg/L, (345.26 ± 102.65) ng/L vs. (198.52 ± 45.71) ng/L, (19.96 ± 5.01) μg/L vs. (17.41 ± 4.23) μg/L, the differences were statistically significant ( P<0.05). The baseline levels of IL-1β, IL-6, CRP, TNF-α and ACC scores in the low- SOST group were higher than those in the high- SOST group: (19.31 ± 6.01) ng/L vs. (15.23 ± 4.75) ng/L, (76.85 ± 20.34) ng/L vs. (57.98 ± 15.02) ng/L, (8.15 ± 2.36) mg/L vs. (7.23 ± 1.79) mg/L, (178.37 ± 55.52) ng/L vs. (157.42 ± 10.15) ng/L, (5.96 ± 1.78) scores vs. (5.11 ± 1.15) scores, the differences were statistically significant ( P<0.05). After treated for 3, 6 and 12 months, the levels of β-CTX, OC, PINP, iPTH, N-MIC-OC in hemodialysis patients were increased, the level of SOST was decreased, the levels of IL-1β, IL-6, CRP, TNF-α increased and ACC scores were increased, the differences were statistically significant ( P<0.05). The Pearson linear correlation analysis showed that SOST level and bone turnover markers β-CTX ( r = -0.465, P<0.001), OC( r = -0.498, P<0.001), PINP( r = -0.511, P<0.001), iPTH ( r = -0.396, P = 0.012), N-MID -OC ( r = -0.323, P = 0.031) and inflammatory factors IL-1β( r = -0.305, P = 0.046), IL-6( r = -0.318, P = 0.041), CRP( r = -0.327, P = 0.034) and TNF-α( r = -0.378, P = 0.024) in hemodialysis patients were negatively correlated, and negatively correlated with abdominal aortic calcification scores ( r = -0.301, P = 0.048). Conclusions:Plasma SOST level in hemodialysis patients is lower, which is negatively correlated with bone turnover markers, inflammatory factors, and calcification scores. Low SOST level can induce vascular calcification by mediating bone metabolism disorders and aggravating the body′s inflammatory response, and increase the risk of hemodialysis vascular calcification.
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Objective:To study the effects of a simulated plateau environment on fracture healing in rats.Methods:A rat model of mid-femoral fracture was established by hacksaw truncation and intramedullary fixation with Kirschner wires in 60 male Wistar rats which were divide into 2 groups ( n=30) by the random number table method. The rats in the control group were raised in the animal experiment center of The 940 Hospital of Joint Logistic Support Force of Chinese PLA at an altitude of 1,400 m, while the rats in the plateau group were placed in an animal experimental cabin in a simulated plateau environment at a simulated altitude of 5,000 m. The body weight was weighed once a week and X-ray films were taken every 2 weeks. Blood samples were collected after 4 weeks for detection of biochemical indicators of bone metabolism. After 8 weeks, the femurs of the surgical side were taken for bone biomechanical detection and the bone mineral density of the healthy side was detected. After 4 and 8 weeks, the femurs of the surgical side were taken for in vitro Micro-CT scanning and angiography detection. After 1, 2, 4 and 8 weeks, the femurs of the surgical side were taken for bone histopathologic detection. Results:During the entire experiment, no rats in the control group died while the mortality rate of the rats in the plateau group was as high as 26.7% (8/30). In the plateau group, some organs were pathologically damaged in the rats, fracture union was delayed, and the callus differentiated and matured slowly with the chondrocytes still dominant at the 8th week. The bone mineral density and the maximum load of the femur in the plateau group were significantly lower than those in the control group ( P< 0.05). Angiography showed that the rats in the plateau group had microvascular proliferation which did not penetrate the fracture end at the 8th week. The bone formation indexes like osteocalcin, procollagen type Ⅰ N-terminal propeptide (PⅠNP), and osteoprotegerin of the rats in the plateau group were significantly lower than those in the control group at the 4th week ( P<0.05). The bone resorption indexes like tartrate resistant acid phosphatase 5b (TRACP-5b) and receptor activator for nuclear factor-κB ligand (RANKL) in the plateau group were significantly higher than those in the control group ( P<0.05). Conclusion:A simulated plateau environment at an altitude of 5,000 m may lead to delayed fracture healing in rats.
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Objective:To investigate the association between serum bone turnover marker osteocalcin and the distal symmetric poly neuropathy(DSPN) in male diabetic patients.Methods:Clinical data from 370 male diabetic patients who admitted to Zhongshan Hospital, Fudan University from January 2020 to November 2021 were collected. These patients were grouped into tertiles by serum osteocalcin level: T1 group(osteocalcin<9.2 ng/mL, n=123), T2 group(osteocalcin 9.2-13 ng/mL, n=122), and T3 group(osteocalcin≥13 ng/mL, n=125). The percentage ratios of DSPN were compared among these groups. Using logistic regression model, the adjusted odds ratio ( OR) for DSPN was calculated. Results:There were 50(40.7%), 29(23.8%), 49(39.2%) patients with DSPN in T1, T2, and T3 group respectively. The ratio of patients with DSPN in osteocalcin T2 group were lower than that in the T1 and T3 groups. Further logistic regression showed a 133.9%( OR=2.339, 95% CI 1.097-4.988, P=0.028) and a 134.2%( OR= 2.342, 95% CI 1.040-5.275, P=0.039) increased risk for DSPN in the T1 and T3 group respectively compared with the T2 group, even after adjusted for age, diabetic duration, HbA 1C, diabetic complications, β cross-linked C-telopeptide of type Ⅰ collagen(CTXβ), 25-hydoxy vitamin D(25-OHD), bone mineral density, and treatment. Conclusions:The serum levels of bone turnover marker osteocalcin were associated with the occurrence of DSPN in male diabetic patients, a moderate level of bone turnover(the serum osteocalcin level of between 9.2 and 13 ng/mL for instance) might be protective for male diabetic patients from DSPN.
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Objective:To investigate the effect of alendronate treatment and assess the value of bone turnover markers (BTMs) in predicting the changes of bone mineral densities (BMDs) in postmenopausal women with osteoporosis.Methods:In this retrospective study, 409 postmenopausal women with osteoporosis aged (64.86±7.21) years in the Department of Osteoporosis and Bone Disease, Shanghai Sixth People′s Hospital were enrolled from 2012 to 2020. BMDs at lumbar spine 1-4, femoral neck, and total hip, serum β cross-linked C-telopeptide of type 1 collagen (β-CTX), and osteocalcin (OC) were measured before and after treatment.Results:After alendronate treatment for 1 year, BMDs at lumbar spine 1-4, femoral neck and total hip increased 4.84%, 2.13%, and 2.89%, respectively ( P<0.05). At 6 months and 1 year on treatment, β-CTX and OC levels decreased by 77.7%, 42.3% and 78.2%, 49.5%, respectively ( P<0.05). Linear regression analysis showed that for every 10% decrease in the change of β-CTX at 6 months after alendronate treatment, the rate changes in BMDs at the lumbar spine 1-4, femoral neck, and total hip decreased by 0.417%, 0.127%, and 0.213% at 1 year after alendronate treatment; for every 10% decrease in OC, the change rates in BMDs at the lumbar spine 1-4, femoral neck, and total hip decreased by 0.582%, 0.258%, and 0.375%. Conclusions:Alendronate significantly increases BMDs and decreases BTMs levels in elderly women with osteoporosis. BTMs have a predictive value for the changes of BMDs, allowing early monitoring for the effect of alendronate treatment.
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ObjectiveTo study the effect on quality of life and the bone turnover markers of Buzhong Yiqitang in the treatment of senile osteoporotic vertebral compression fracture （OVCF， syndrome of Qi deficiency in spleen and stomach） after operation based on ''spleen governing muscle''. MethodA total of 135 senile patients with OVCF treated by percutaneous kyphoplasty in Rizhao Hospital of Traditional Chinese Medicine from January 2020 to January 2021 were enrolled in this study. They were randomly assigned to two groups on the basis of block randomization at a ratio of 2∶1 （90 cases in the observation group and 45 cases in the control group）. Both groups were administrated with calcitriol capsules （0.5 μg·d-1） and caltrate D （1 200 mg·d-1） for basic treatment of osteoporosis. The observation group was additionally treated with Buzhong Yiqitang. Bone mineral density （BMD）， procollagen type Ⅰ N-terminal propeptide （PINP）， osteocalcin （OST）， β cross-linked C-telopeptide of type 1 collagen （β-CTx）， appendicular skeletal muscle mass index （ASMI）， and quadriceps muscle strength were compared between the two groups before and 6， 12 months after treatment. Additionally， traditional Chinese medicine （TCM） symptom score and visual analogue score （VAS） before and 3， 6 months after treatment， as well as quality of life questionnaire of the European Foundation for osteoporosis （QUALEFFO） score before and 3， 6， 12 months after treatment， were compared between the two groups. ResultA total of 85 patients in the observation group and 41 patients in the control group were followed up. The general curative effect of the observation group was better than that of the control group （χ2=10.503， P<0.05）. Specifically， the observation group had higher PINP， BMD， ASMI， and quadriceps muscle strength but lower β-CTx， TCM symptom score， VAS， and QUALEFFO score than the control group （P<0.05， P<0.01）. No adverse reactions related to Buzhong Yiqitang were observed. ConclusionBuzhong Yiqitang can regulate bone metabolism indexes， promote osteogenesis， increase bone density， enhance skeleton appendiculare and quadriceps muscle strength， relieve clinical symptoms， and improve quality of life in patients with senile OVCF （syndrome of Qi deficiency in spleen and stomach）， being worthy of promotion in clinical application.
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Objective:To explore the value of hemagglutination index in the diagnosis of osteoporosis in patients with spinal degenerative diseases.Methods:In this retrospective study, 313 patients with spinal degenerative diseases who were admitted to the Department of Spine Surgery of Beijing Jishuitan Hospital from November 2018 to April 2020 were selected and divided into osteoporosis group (119 cases), osteopenia group (101 cases) and normal group (93 cases) according to quantitative computed tomography (QCT) detection results. Fasting venous blood samples were taken to test coagulation indicators and bone turnover markers. One-way ANOVA or Kruskal-Wallis H tests were used to analyze the differences among three groups. The independent risk factors associated with Osteoporosis(OP)in patients with spinal degenerative diseases were screened from the blood indices. Furthermore, the osteopenia group and the normal group were combined into the non-osteoporosis group. Binary Logistic regression analysis was performed between the non-osteoporosis group and the osteoporosis group. Receiver operating curve (ROC) was used to evaluate the diagnostic value of relevant indicators in patients with spinal degenerative diseases.Results:Gender (χ 2=13.555, P=0.001), age ( F=17.53, P<0.001), Body Mass Index (BMI) ( F=4.068, P=0.018), β-C-terminal telopeptide of type I collagen (β-CTx) (χ 2=8.684, P=0.013), 25-hydroxyvitamin D [25(OH)D] (χ 2=6.155, P=0.046), D-dimer (χ 2=8.111, P=0.017) and platelet (PLT) ( F=6.809, P=0.001) were different significantly among three groups. The age ( P=0.006), D-dimer ( P=0.020) and PLT ( P=0.002) in normal group were remarkably lower than those in osteoporosis group. Age ( P<0.001) and PLT ( P=0.006) in osteopenia group were considerably lower than those in osteoporosis group, while β-CTX ( P=0.015) and BMI ( P=0.014) were significantly higher than those in osteoporosis group. The differences between non-osteoporosis group and osteoporosis group in gender, age, BMI, β-CTx, D-dimer and PLT were statistically significant (ALL P<0.05). Logistic regression showed that age [ OR=1.164, 95% CI (1.097-1.236)], gender [ OR=0.495, 95% CI (0.274-0.896)], BMI [ OR=0.890, 95% CI (0.816-0.971)] and PLT [ OR=1.008, 95% CI (1.003-1.103)] were independent risk factors for the osteoporosis group ( P<0.05). The AUCs (area under the curve) were detected separately by age AUC=0.715[95% CI (0.647-0.783)], gender AUC=0.612[95% CI (0.539-0.684)], BMI AUC=0.694[95%C I (0.622-0.766)], PLT AUC=0.610[95% CI (0.539-0.682)], and the combination of the former four indicators AUC=0.768[95% CI (0.706-0.829)] ( P<0.05). Conclusions:Based on the QCT results, the PLT count has considerable value in the diagnosis of osteoporosis in patients with spinal degenerative diseases. PLT combined with age, gender and BMI can greatly improve the diagnostic efficiency of osteoporosis.
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BACKGROUND: The pathological changes of alcohol-induced osteonecrosis of the femoral head (ONFH) are the result of a combination of various factors, and its specific pathogenesis is inconclusive. Related studies have shown abnormal bone metabolism in patients with avascular necrosis of the femoral head. OBJECTIVE: To explore the bone turnover markers in patients with alcohol-induced ONFH and to explore the relationship between different stages of ONFH and bone metabolism. METHODS: This study retrospectively selected 193 male patients with alcohol-induced ONFH (necrosis group), including 35 cases of ARCO stage II, 131 cases of ARCO stage III and 27 cases of ARCO stage IV. Among them, there were 65 cases of a little drinking of alcohol 52 cases of moderate drinking, and 76 cases of heavy drinking. Another 182 healthy males undergoing physical examination with no history of drinking were taken as control group. The bone turnover markers [procollagen type 1 N-terminal propeptide (P1NP), C-terminal cross-linked telopeptides of type 1 collagen (β-CTX), molecular fragment of N-terminal osteocalcin (N-MID) and 25 hydroxyvitamin D (25OHD)] and biochemical indexes were tested and compared between two groups, followed by logistic regression analysis and correlation analysis. The study protocol was performed in line with the relevant ethic requirements of the First Affiliated Hospital of Guangzhou University of Chinese Medicine. All participants in the trial had been fully informed of the trial process. RESULTS AND CONCLUSION: In the necrosis group, P1NP, β-CTX, N-MID, 25OHD, serum calcium, uric acid, alkaline phosphatase, serum phosphorus levels were significantly higher than that of the control group (P < 0.05), and apolipoprotein A1 and high-density lipoprotein levels in the necrosis group were significantly lower than those in the control group (P < 0.05). Compared with patients with low level of alcohol, β-CTX and N-MID levels were significantly reduced in the patients with heavy drinking (P < 0.05). The P1NP level of patients with ARCO stage IV was significantly higher than that of patients with ARCO stage II and III (P < 0.05), and the β-CTX level of patients with ARCO stage IV was significantly higher than that of patients with ARCO stage III (P < 0.05). The correlation analysis results showed that alcohol intake levels were negatively correlated with β-CTX, alkaline phosphatase level was positively correlated with P1NP and β-CTX, and 25OHD was negatively correlated with low-density lipoprotein. Logistic regression analysis results showed that: P1NP (odds ratio=0.984, P=0.004), β-CTX (odds ratio=0.325, P=0.043), and high-density lipoprotein (odds ratio=2.622, P=0.014). To conclude, male patients with alcohol-induced ONFH have active bone formation and bone resorption, and obvious abnormalities in lipid metabolism. The progression of alcohol-induced ONFH can be predicted by these bone turnover markers.
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BACKGROUND@#The Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) study was launched to investigate risk factors for osteoporotic fractures, interactions of osteoporosis with other non-communicable chronic diseases, and effects of fracture on QOL and mortality.@*METHODS@#FORMEN baseline study participants (in 2007 and 2008) included 2012 community-dwelling men (aged 65-93 years) in Nara prefecture, Japan. Clinical follow-up surveys were conducted 5 and 10 years after the baseline survey, and 1539 and 906 men completed them, respectively. Supplemental mail, telephone, and visit surveys were conducted with non-participants to obtain outcome information. Survival and fracture outcomes were determined for 2006 men, with 566 deaths identified and 1233 men remaining in the cohort at 10-year follow-up.@*COMMENTS@#The baseline survey covered a wide range of bone health-related indices including bone mineral density, trabecular microarchitecture assessment, vertebral imaging for detecting vertebral fractures, and biochemical markers of bone turnover, as well as comprehensive geriatric assessment items. Follow-up surveys were conducted to obtain outcomes including osteoporotic fracture, cardiovascular diseases, initiation of long-term care, and mortality. A complete list of publications relating to the FORMEN study can be found at https://www.med.kindai.ac.jp/pubheal/FORMEN/Publications.html .
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Anciano , Humanos , Masculino , Persona de Mediana Edad , Densidad Ósea , Enfermedades Cardiovasculares/etiología , Estudios de Cohortes , Evaluación Geriátrica , Vida Independiente , Japón/epidemiología , Cuidados a Largo Plazo/estadística & datos numéricos , Osteoporosis/etiología , Fracturas Osteoporóticas/etiología , Factores de RiesgoRESUMEN
Objective:To evaluate the changes and significance of bone turnover makers in patients with SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome.Methods:Thirty-two patients with SAPHO syndrome who were treated in the department of rheumatology and immunology of Beijing Jishuitan Hospital were collected as the study group, and 28 healthy subjects were taken as the control group. The clinical data and bone turnover markers were compared between the two groups, and the correlation between the bone turnover markers and disease-related indicators were analyzed. Two independent samples were comp-ared by using t test (in line with normal distribution) and rank sum test (not in line with normal distribution). The results of more than two independent samples were compared by one-way analysis of variance, and the correlation between two variables was analyzed by Spearman. Results:Compared with the clinical data of the two groups, hemoglobin (Hb) of the study group [128(122, 140) g/L] was significantly lower than that of the control group [139(125, 154) g/L]( U=306.5, P<0.05), but alkaline phosphatase (ALP) [75.00(66.00, 85.75) mmol/L] was significantly higher than that of the control group [56.00(48.50, 63.25) mmol/L] ( U=153, P<0.01). The comparison of bone turnover markers showed that serum total procollagen type 1 amino-terminal propeptide (tP1NP)[52.51(41.72, 86.11) ng/ml], Beta C-terminal cross-linked telopeptides of type Ⅰ collagen (β-CTX) [0.57(0.39, 0.72) ng/ml] and OC [(20±8) ng/ml] levels in the study group were significantly higher than those in the control group [34.91(28.97, 42.80) ng/ml, 0.34(0.27, 0.49) ng/ml, (15±4) ng/ml] ( U=183, P<0.01; U=223, P<0.01; t=3.180, P<0.01). There was no significant difference in 25-(OH)VD 3 between the two groups [14.73(12.25, 19.23) ng/ml, 16.72(11.74, 20.92) ng/ml] ( P>0.05). The serum biochemical markers of bone turnover were not related to spine, bone and joints involvement. The grouping results of the number of joints involved showed that there were significant differences in serum osteocalcin (OC) levels of patients ( F=3.684, P<0.05), and the more the number of joints involved, the lower the OC value. Correlation analysis showed that serum tP1NP ( r=0.805), β-CTX ( r=0.460) and OC levels were positively correlated with each other(all P<0.01). Levels of tP1NP, β-CTX, OC, and 25-(OH)VD 3 in the study group were not related to age, course of disease, and neutrophil granulocyte (all P>0.05). However, β-CTX was positively correlated with C-reactive protein (CRP) ( r=0.392, P<0.05), and OC was positively correlated with erythrocyte sedimentation rate (ESR) ( r=0.475, P<0.05). Conclusion:The levels of tP1NP, β-CTX and OC in patients with SAPHO syndrome are significantly increased. Levels of β-CTX and OC can reflect the severity of patients' inflammation. The level of OC is related to the number of joint involvement of the patient.
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Background: Individuals with diabetes mellitus are at increased risk of metabolic bone disease due to decrease in bone strength and quality. Several bone turnover markers like serum procollagen type I N propeptide (P1NP) and serum osteocalcin are powerful tools for studying osteoporosis and fracture risk across population to provide diagnostic and prognostic information of bone health. The aim of this study was to recognize possible correlation of levels of serum P1NP and osteocalcin in type-2 diabetic (T2DM) postmenopausal women as compared to healthy postmenopausal women.Methods: The study included 100 proven cases of type-2 diabetic postmenopausal women with age matched healthy postmenopausal women as controls. P1NP, osteocalcin, and other relevant parameters were measured. Differences between diabetics and controls were analyzed.Results: The body mass index was higher in diabetic group as compared to controls. The HbA1c% was (6.94±1.43) in diabetic group and (5.57±1.21) in non-diabetics. Low serum level of 25 (OH) D was observed both in diabetic and non-diabetic groups but significantly lower in T2DM. Procollagen type 1 N propeptide was lower in diabetic group (37.59±17.20 ng/mL) as compared to non-diabetic (52.14±24.82 ng/mL). Osteocalcin was lower (15.64±8.06 ng/ml) as compared to non-diabetic group (21.85±9.12 ng/ml). Lower osteocalcin and P1NP levels found in this study suggests slower bone metabolism with reduced bone formation in postmenopausal diabetics.Conclusions: Serum procollagen type 1 N propeptide and osteocalcin in postmenopausal diabetic women were lower as compared to non-diabetic group.
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@#Introduction: This study investigated the effect of combined plant-based protein supplementation and resistance training on muscular strength, blood markers of protein catabolism, immune function, and bone metabolism in sedentary adult males. Methods: In this randomised, double-blinded study, 28 healthy males aged 19 – 29 years old were equally assigned into four groups: a combined plant-based protein with resistance training (PBPEX), plant-based protein alone (PBP), resistance training alone (EX) and control (C). Mode of resistance training was flat barbell press, machine shoulder press, wide grip lateral pull-down, seated cable row, barbell back squat, leg press and leg extension. The 8-week resistance training involved three sets of 60-70% of one-repetition maximum (1-RM) at 4-6 repetition/set/mode per session, three sessions/week. Participants in PBPEX and PBP groups consumed a plant-based protein supplement consisted of 9.8 g soy and pea protein for seven days/week. Results: PBPEX showed significant increases (p<0.01) in the knee and shoulder flexion peak torque compared to EX groups, respectively. PBP showed a significantly higher level (p<0.05) of serum urea, and blood urea nitrogen (BUN) compared to other groups. There were no changes in immune function and bone metabolism markers between pre- and post-exercise in all groups. Conclusions: These findings implied that a combination of plant-based protein supplementation and resistance training elicited greater beneficial effects on muscular strength than resistance training alone and plant-based protein supplementation alone. Therefore, combined plant-based protein with resistance training may be recommended in planning exercise and nutritional programme for sedentary male adults.
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Objective: To investigate the correlation between bone turnover markers (BTMs) with bone mineral density (BMD) and the risk of fragility fracture in patients with lumbar degeneration. Methods: One hundred fifty-eight patients with lumbar degeneration were selected from May 2016 to May 2017 in the General Hospital of Western Theater Command. The lumbar BMD of all patients were measured by dual energy X-ray absorptiometry. The levels in fasting venous blood of procollagen type-1 N-terminal propeptide (PINP), Osteocalcin (OC), bone-specific alkaline phosphatase (BALP), C-terminal crosslinking telopeptides of type I collagen (β-CTX), 25-hydroxy Vitamin D (25-(OH)VitD) and tartrate resistant alkaline phosphatase (TRACP) were analyzed with Roche chemiluminescence. The past fragility fractures were analyzed by inquiring medical history and X-ray examination. The correlation between BTMs with BMD and fragility fracture risk were evaluated by multiple logistic regression and linear regression analysis. Results: The incidence of fragility fractures in 158 patients with lumbar degeneration was 20.3%. The BMD was significantly lower in patients with fragility fracture than in patients with no fragility fracture (P<0.05). The levels of PINP, BALP, OC and β-CTX were significantly higher in patients with fragility fracture than in those with no fragility fracture (P<0.05). PINP, BALP, OC, β-CTX and TRACP were negatively correlated with lumbar BMD (β=-0.431, -0.234, -0.167, -0.314 and -0.198, respectively; P=0.021, 0.009, 0.034, 0.033 and 0.049, respectively), and β-CTX and PINP were positively correlated with the fragility fracture risk (P<0.05). Conclusion: PINP, BALP, OC, β-CTX and TRACP were negatively correlated with BMD, and β-CTX and PINP were positively correlated with fragility fracture risk in patients with lumbar degeneration, implying that early monitoring BTMs and early anti-osteoporosis treatment may reduce the risk of long-term screw loosening and fragility fracture in patients with lumbar degeneration after surgery.