Objective To explore the significance and the relationshi p between osteoporosis and the mRNA expressions of vascular endothel ial growth factor (VEGF) and bone morphogenetic protein 2 (BMP-2) in nontraumatic avascular necrosis of the femoral head (NONFH), so as to provide a theoretical basis for the pathogenesis and the cl inical treatment of NONFH. Methods Sixty-nine specimens of femoral head were collected from voluntary donators undergoing total hi p arthroplasty, including 37 cases of NONFH (NONFH group) and 32 cases of fresh femoral neck fracture (control group). In NONFH group, there were 26 males and 11 females with an average age of 57.3 years (range, 43-75 years), including 19 cases of steroid-induced avascular necrosis of the femoral head (ANFH), 16 cases of alcohol ic ANFH, and 2 cases of idiopathicANFH; according to Ficat staging system, there were 23 cases at stage III and 14 cases at stage IV. In control group, there were 23 males and 9 females with an average age of 58.6 years (range, 46-79 years). The NO level of serum, the Q value of femur, and the bone mineral density (BMD) of weight-bearing area were measured firstly. The bone tissues were harvested from weightbearing necrosis area and healthy area. The pathological change was observed by HE staining, the percentage of empty bone lacuna and the percentage of trabecular bone area were calculated. The mRNA expressions of VEGF and BMP-2 in femoral head were detected through in situ hybridization technique. Results There were significant differences (P lt; 0.05) in the NO level of serum, the Q value of femur, and the BMD between NONFH group and control group. In NONFH group, the femoral head showed irregular shape, the articular cartilage exfol iated and collapsed. In weight-bearing necrosis area, the bone trabeculae were sparse and non-intact with a great number of empty lacuna; necrotic bone trabeculae were decomposed and absorbed; no obvious bone regeneration and repair were observed. In weight-bearing healthy area, the fat cells in bone marrow showed prol iferation and hypertrophy. In control group, the femoral head had normal appearance, intact articular cartilage, and intact bone trabeculae with a regular arrange, and osteocytes were clearly seen. There were significant differences in the percentage of empty bone lacuna and the percentage of trabecular bone area between NONFH group and control group (P lt; 0.05). The mRNA expressions of VEGF and BMP-2 were positive in 2 groups. The positive area ratio, the absorbance value, and integral absorbancevalue of VEGF mRNA and BMP-2 mRNA in NONFH group were significantly lower than those in control group (P lt; 0.05);the grey scales of VEGF mRNA and BMP-2 mRNA in NONFH group were significantly higher than that in control group (P lt;0.05). Conclusion The pathological stage of osteoporosis may play an important role in the mechanism of the NONFH. The decrease of mRNA expressions of VEGF and BMP-2 in femoral head of NONFH is important reason that affect its bone mass, osteoporosis, rehabil itation, and reconstruction. It may be benefit to the reparative process of the necrosis femoral head to increase the mRNA expressions of VEGF and BMP-2 in the femoral head.
In order to meet the requirements of ultrasound bone density measurement, we proposed a software solution to improve the accuracy and speed of measurement of bone mineral density of the ultrasound bone densitometer. We used a high-speed USB interface chip FT232H, along with a high-speed AD converter chip to calculate speed of sound (SOS), broadband ultrasound attenuation (BUA ) and other bone density parameters in the PC software. This solution improved the accuracy of the measurement data, reduced the measurement time and increased the quality of the displayed image. It is well concluded that the new software can greatly improve the accuracy and transmission speed of bone density measurement data through a high-speed USB interface and a software data processing technology.
【摘要】 目的 观察重组人甲状旁腺激素（1-34）[rhPTH（1-34）]治疗骨质疏松症患者骨密度的疗效和安全性。 方法 采用自身前后对照临床研究，纳入2008年3-5月就诊的原发性骨质疏松症患者共39例，予rhPTH（1-34） 20 μg 1次/d皮下注射，疗程18个月。治疗期间均同时口服钙制剂600 mg/d及维生素D3 125 U/d作为基础治疗。患者治疗前采用双能X线检测腰2~4椎体（L2~4）和股骨颈骨密度（BMD）、肝肾功能、血钙、血磷，治疗后6、12、18个月复查BMD和上述生化指标改变，记录患者不良事件，对患者治疗前后L2~4、股骨颈BMD变化进行对比分析。 结果 35例患者完成全疗程治疗，其中男2例，女33例；平均年龄65岁，平均病程6.5年；治疗6、12、18个月时L2~4 BMD均较治疗前明显提高（Plt;0.01），而股骨颈BMD在治疗6、12个月时改善不明显（Pgt;0.05），18个月时表现出较治疗前明显增加（Plt;0.01）；腰椎平均BMD增长率为12.27%，股骨颈BMD增长率为4.11%；治疗期间不良反应少，均不需特殊处理而自行好转。 结论 rhPTH（1-34）治疗原发性骨质疏松症安全有效，对改善椎体BMD疗效迅速明显，对改善股骨颈BMD起效慢；适用于绝经后骨质疏松和老年性骨质疏松症患者。【Abstract】 Objective To observe the therapeutic effect of recombinant human parathyroid hormone (1-34) [rhPTH(1-34)] on the improvement of bone mineral density (BMD) in patients with primary osteoporosis. Methods A before and after self control study was performed on 39 patients with primary osteoporosis from March to May 2008. The patients underwent the subcutaneous injection with rhPTH (1-34) 20 μg/d for 18 months. All patients were given oral calcium (Ca 600 mg+Vit D3 125 U per day) as primary drug treatment. BMD of lumbar spine (L2-L4) and femur neck, serum calcium, and serum phosphate were measured before and 6, 12, and 18 months after the treatment. All of the adverse reactions were recorded. Results A total of 35 patients finished the trial,including two males and 33 females with the average age of 65 years and the course of disease of (6.54±4.30) years. BMD of lumbar spine (L2-L4) significantly increased 6, 12, and 18 months after treatment (Plt;0.01). There was no significant difference of femur neck BMD 6 and 12 months after treatment (Pgt;0.05), whereas by the end of the treatment, it improved significantly (Plt;0.01). The average increase rate was 12.27% in lumbar spine (L2-L4) and was 4.11% in femur neck BMD. There were a few adverse reactions during the therapeutic process, most of which were tolerable and self-restored. Conclusion rhPTH(1-34) is an effective and safe drug in treating primary osteoporosis. It can increase lumbar spine BMD rapidly and raise femur neck BMD gradually. It is applicable for postmenopausal osteoporosis and senile osteoporosis.
Objective To determine whether statins has some effects on the treatment of cardio-cerebral vascular diseases or hyperlipdemia increases bone mineral density （BMD）. Methods One hundred and sixty-two patients aged over 60 were identified in the outpatient-department of Geriatrics of West China Hospital from Jan. 1998 to Aug. 2003. Seventy cases were exposed to statins with follow-up for 5 years. BMD of the spine, femoral neck, femoral wards triangle and femoral trochanter was measured by dual-energy X-ray absorptiometry. The multiple regression analysis was used to exclude potential confounders, e.g. age, BMI, comorbidity,etc. Results Those elderly patients with a history of taking statins had higher BMD, such as femoral neck with t =-2. 466 （P =0. 015）, femoral wards triangle with t =-2. 483 （P = 0. 014 ）and femoral trochanter with t =-2. 743 （P =0. 007 ）than the control elderly at the end of follow-up. Conclusions It has been found that HMG-CoA reductase inhibitors （statins ） may prevent bone loss in elderly patients by increasing BMD. Further prospective studies of statins are needed to confirm these observatioris.
Objective To analyze the correlation between the polymorphism on interleukin 6 (IL-6) gene promoter region-174 locus and adolescent idiopathic scoliosis (AIS), including the susceptibility, the bracing effectiveness, and the possible mechanism. Methods The 182 AIS patients and 210 healthy controls who met the inclusion criteria between January 2013 and January 2016 were collected as research objects. The genotype of IL-6 gene promoter region-174 locus, the serum IL-6, the bone mineral density (BMD) of femoral neck and vertebrae (L1–4), and the bone metabolism parameters, including bone alkaline phosphatase (BALP), bone gla protein (BGP), tartrate resistant acid phosphatase 5b (TRACP-5b), urine Ca, and urine Ca/Cr, were detected. All research objects were divided into the AIS group and the control group according to whether they had AIS, the GG, CG, CC groups according to their genotype, and progression-free group and progression group according to the therapeutic effectiveness of 1-year bracing treatment. Statistical analysis for the indexes were conducted respectively. Results There were significant differences in AIS history, BMD of femoral neck and lumbar vertebrae between the AIS group and control group (P<0.05). According to the therapeutic effecitveness of 1-year bracing treatment, 182 AIS patients were divided into progression-free group in 110 cases and progression group in 72 cases. The results of single factor analysis showed that there were significant differences in the genotype and allele distribution of IL-6 gene promoter region-174 locus, BMD of femoral neck and lumbar vertebrae, IL-6, TRACP-5b, urine Ca, and urine Ca/Cr between the progression-free group and progression group (P<0.05). The results of multivariable analysis showed that the BMD of lumbar vertebrae, TRACP-5b, and urine Ca were the influencing factors of bracing efficacy (P<0.05). According to the results of genotype detection, all research objects were divided into GG group in 264 cases, CG group in 104 cases, and CC group in 24 cases. The IL-6, TRACP-5b, urine Ca, and urine Ca/Cr of GG type carriers were higher and BMD of femoral neck and lumbar vertebrae were lower when compared with the CG and CC type carriers (P<0.05). The BMD of lumbar vertebrae of CG type carriers was lower than that of CC type carriers (P<0.05). Conclusion The polymorphism of IL-6 genepromoter region-174 locus wasn’t correlated with the AIS susceptibility, but it was correlated (not independently correlated) with the scoliosis progression under bracing treatment, and the risk for G-carried patients was higher. The mechanism may be that the polymorphism affected the IL-6 expression level and eventually affected the BMD of AIS patients through the bone metabolism.
Objective To ananlyze the relationship between bone mineral density and sex hormone in male patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods The study recruited 88 male patients with OSAHS aged 45-60 years in our hospital from October 2014 to October 2016 as an OSAHS group, and 30 healthy subjects without OSAHS as a control group. The general information and PSG parameters were recorded, the bone metabolic markers and bone mineral density of lumbar spine 1-4 (L1-4) and femoral neck (Neck) were measured, and the expressions of serum sex hormone (E2, P, T, FSH, LH and PRL) were determined by chemical luminescence immunity analyzer. The differences in above indexes between two groups and their correlation with bone mineral density were analyzed. Results Smoking rate, drinking rate, neck circumference and body mass index (BMI) of the OSAHS group were significantly higher than those of the control group. Compared with the control group, beta crosslaps (β-CTX, a bone metabolic marker) was significantly higher [(0.53±0.14) ng/ml vs. (0.47±0.15) ng/ml], the bone mineral density of L1-4 and Neck was significantly lower [(0.92±0.12) g/cm2 vs. (1.08±0.08) g/cm2, (0.91±0.11) g/cm2 vs. (1.06±0.13) g/cm2], and the serum testosterone was significantly lower in the OSAHS group [(267.32±89.56) ng/dlvs. (315.68±78.49) ng/dl] (all P<0.05). The result of Pearson correlation analysis showed that apnea hypopnea index (AHI) was negatively correlated with bone mineral density of L1-4 and Neck (bothP<0.001), lowest oxygen saturation (LSaO2) and testosterone were positively correlated with bone mineral density of L1-4 and Neck (all P<0.01). Conclusions The risk of suffering from osteoporosis is higher in male OSAHS patients and it is closely related to the degree of hypoxia. The decrease of testosterone may be one of the mechanisms.
ObjectiveTo analyze the relationship between the bone mineral density (BMD) and lumbar intervertebral disc degeneration in rhesus macaques by using T1ρ-MRI. MethodsTwenty female rhesus macaques at the age of 10.9 years on average (rang, 4-20 years) were selected. The lumbar intervertebral discs were classified by Pfirrmann grading system and the T1ρ relaxation time (T1ρ value) was examined by using MRI (Philips 1.5 Tesla), and then BMD values of the L4,5 vertebrae and femoral ward's triangle were detected by using Osteocore dual energy X-ray absorptiometry. Finally, the relationship of T1ρ value of the lumbar intervertebral discs and Pfirrmann grading with age, weight, BMD of lumbar vertebrae and femoral ward's triangle was analyzed. ResultsThe BMD values of lumbar vertebrae and femoral ward's triangle were (0.64±0.17) g/cm2 and (0.67±0.19) g/cm2 respectively, showing no significant difference (t=2.893, P=0.128). According to Pfirrmann grading system, there were 7 cases of grade I, 8 cases of grade Ⅱ, and 5 cases of grade Ⅲ at L4,5 intervertebral discs. The T1ρ value of the lumbar intervertebral disc was (104.08±18.65) ms; the T1ρ values of grades I, Ⅱ, and Ⅲ were (121.31±13.44), (104.73±15.01), and (77.41±11.87) ms, respectively. There was a negative correlation between T1ρ value and the age and the BMD of lumbar vertebrae and femoral ward's triangle. There was a positive correlation between Pfirrmann grading and the variables as listed above. Significant negative linear correlation was also observed between T1ρ value and Pfirrmann grading. ConclusionThe T1ρ value is a reliable index when quantifying lumbar intervertebral disc degeneration, and there is a significant positive correlation between BMD and lumbar intervertebral disc degeneration in rhesus macaques.
Objective To investigate the association between the genetic polymorphisms of osteoprotegerin gene and bone mineral density ( BMD) in elderly patients with chronic obstructive pulmonary disease ( COPD) .Methods 178 elderly COPD patients admitted in respiratory department between January 2008 and December 2009 were recruited as a COPD group. 195 elderly healthy subjects without COPD were recruited as a control group. The subjects were all chosen from the Han population in Lanzhou city, Gansu province. Pulmonary function ( FEV1 /FVC, FEV1% pred) , body mass index ( BMI) , serum calcium ( Ca) , serum phosphate ( P) , and alkaline phosphatase ( ALP) were determined in all subjects. The OPG gene polymorphisms were analyzed by polymerase chain reaction and restriction fragment length polymorphism ( PCR-RFLP) . BMD was examined by dual-energy X-ray absorptiometry. Results In the COPD group, the distribution frequency of AAGG, GATA, and GGTT in OPG HTT gene-linked polymorphic region G209A and T245G were 2.5%, 27.2% , and 72.3% , respectively, which in the control group were 2.2% , 26.9% , and 70.9%, respectively. The genotype distribution difference of two groups had no statistical significance ( P gt; 0.05) . There were also no statistical differences in BMI, serum Ca, serum P, serum ALP or BMD between different genotype subgroups in two groups ( P gt;0.05) . In the COPD group, the genotype distribution had no statistical significance between different BMD subgroups( P gt; 0.05) . Conclusion In the elderly patients with COPD from Han population at Lanzhou city, OPG HTT gene-linked polymorphic region and T245G gene polymorphism have no significant correlation with reduced lung function, reduced BMD and bone metabolism which are not likely to be susceptibility loci for osteoporosis in COPD patients.
ObjectiveTo investigate the femoral bone remodeling and long-term effectiveness of total hip arthroplasty (THA) with anatomic medullary locking (AML) prosthesis.MethodsThe clinical data of 24 cases (26 hips) who were treated with THA with AML prosthesis between November 1997 and January 2003 were retrospectively analyzed. There were 12 males and 12 females with an age of 32-69 years (mean, 53.7 years). There were 5 cases (5 hips) of avascular necrosis of the femoral head, 6 cases (7 hips) of secondary osteoarthritis of the hip dysplasia, 6 cases (6 hips) of femoral neck fracture, 2 cases (2 hips) of primary osteoarthritis, 3 cases (3 hips) of revision surgery, 1 case (2 hips) of ankylosing spondylitis, 1 case (1 hip) of femoral head fracture. The patients were followed up at immediate, 6 weeks, 3 months, 6 months, 1 year, and then every year after operation for imaging evaluation (X-ray film was taken immediately after operation to evaluate the femoral isthmus compression, Engh standard was used to evaluate the biological fixation of the femoral shaft prosthesis, and Brooker method was used to evaluate the occurrence of heterotopic ossification); bone reconstruction evaluation [reconstruction of prosthesis and bone interface (type of bone reaction, Gruen zone, incidence, and occurrence time were recorded), reconstruction of bone around prosthesis (proximal femur stress shielding bone absorption was evaluated according to Engh and Bobyn methods, and bone mineral density change rate was measured)]; clinical efficacy evaluation [Harris score for efficacy, visual analogue scale (VAS) score for thigh pain].ResultsAll patients were followed up 15 years and 2 months to 20 years and 4 months, with a median of 16 years and 6 months. At immediate after operation, 24 hips (92.3%) had good femoral isthums compression, 24 hips (92.3%) had good bone ingrowth. Heterotopic ossification occurred in 2 patients with degree 1, 2 patients with degree 2, and 1 patient with degree 3 at 3-6 months after operation. Hyperplastic bone reactions were more common in Gruen 2, 3, 4, 5, 6, 10, 11, and 12 zones, mainly occurring at 6-20 months after operation, with the incidence of 3.8%-69.2%, with the highest incidence of spot welding. All absorptive bone reactions were osteolysis, which was common in Gruen 1 and 7 zones, and mainly occurred at 8 years after operation, with an incidence of 42.3%. No clear line (area) or enlarged sign of medullary cavity was observed. Twenty-one hips (80.8%) had 1 degree stress shieding, and 5 hips (19.2%) had 2 degree stress shieding. It mainly occurred at 10-24 months after operation in Gruen 1 and 7 zones. Dual energy X-ray absorptiometry showed that bone mineral density mainly decreased in Gruen 1, 2, 6, and 7 zones, mainly increased in Gruen 3, 4, and 5 zones. Bone mineral density loss progressed slowly after 2 years of operation, and it was stable in 5-8 years, but decreased rapidly in 8-9 years, and stabilized after 10 years. The Harris score increased from 51.1±6.2 before operation to 88.3±5.1 at last follow-up (t=–21.774, P=0.000). Mild thigh pain occurred in only 2 cases (7.7%) with the VAS score of 2. No aseptic loosening or revision of femoral prosthesis occurred during the follow-up.ConclusionThe application of AML prosthesis in THA has a good bone remodeling and a good long-term effectiveness.