ObjectiveTo review the effects and mechanisms of various myokines secreted by skeletal muscle on various bone tissue cells.MethodsLiterature related to myokines and their regulation of bone tissue cells was reviewed and analyzed comprehensively in recent years.ResultsBone and skeletal muscle are important members of the motor system, and they are closely related in anatomy, genetics, and physiopathology. In recent years, it has been found that skeletal muscle can secrete a variety of myokines to regulate bone marrow mesenchymal stem cells, osteoblasts, osteoclasts, and bone cells; these factors mutual crosstalk between myoskeletal unit, contact each other and influence each other, forming a complex myoskeletal micro-environment, and to some extent, it has a positive impact on bone repair and reconstruction.ConclusionMyokines are potential targets for the dynamic balance of bone tissue cells. In-depth study of its mechanism is helpful to the prevention and treatment of myoskeletal diseases.
Objective To evaluate the effectiveness of hormone replacement therapy (HRT) for osteoporosis in postmenopausal women. Method Systematic reviews and meta-analyses were searched in Cochrane Library (Issue 4, 2008), MEDLINE (1978-2008) and Clinical Evidence database. Search terms included Postmenopausal (post-menopausal) osteoporosis, therapy, vertebral fracture, hormone replacement therapy, randomized controlled trial, meta analysis, female,human. Result A total of 4 protocols were found in Cochrane Library and a meta-analyse was found in MEDLINE. The result demonstrated that both cancellous and cortical bone mineral density increased after HRT. Statistically significant reductions in the risk of vertebral and non-vertebral fracture were also found. Conclusion HRT can reduce the risk of osteoporotic fracture by increasing bone density. However, other disease and adverse event were also associated with the BMD increase. Therefore, both advantage and disadvantage should be considered before applying HRT therapy to postmenopausal osteoporosis patients.
ObjectiveTo explore the therapeutic effects and clinical characteristics of repeated percutaneous vertebroplasty (PVP) on subsequent non-operative osteoporotic vertebral compressible fractures (OVCF) after initial PVP for OVCF. MethodsFrom January 2008 to May 2013, 277 patients (331 vertebral bodies) with OVCF who were regularly followed up had underwent PVP. Among the 277 patients, the second treatment group included 42 patients who developed subsequent OVCF, which were retreated by PVP. And they were divided into adjacent new OVCF group (group A, 19 patients) and non-adjacent new OVCF group (group B, 23 patients). Analgesic effects and functional improvements were compared between the initial and second treatment. The interval of new OVCF after initial surgery, complications, and other clinical characteristics including age, gender, history of trauma, the amount of injected polymethylmethacrylate (PMMA) and PMMA leakage were compared between group A and B. ResultsThe improvement rates of visual analogue scale scores were (64.6±12.6)% in the initial treatment group and (67.4±12.8)% in the second treatment group (P>0.05). The improvement rates of Oswestry Disability Index (ODI) were (60.6±13.3)% in the initial treatment group and (62.6±12.9)% in the second treatment group (P>0.05). The interval of incidence of subsequent new OVCF after the initial treatment were (62.4±45.5) days in group A and (203.7±77.6) days in group B, respectively (P<0.05). There were no significant differences in age, gender, history of trauma, the amount of injected PMMA and PMMA leakage between group A and group B (P>0.05). No surgery-related complications occurred after the second treatment except asymptomatic cement leakage in 5 patients, one of whom suffered from adjacent OVCF 3 months after the operation. ConclusionThe therapeutic effect of repeated PVP for new OVCF on alleviating the pain and improving the function is just as the effect of the initial operation. Adjacent new OVCF primarily occurs earlier after initial PVP.
【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.
We investigated the effects and optimal treatment frequency of pulsed electromagnetic fields (PEMFs) on postmenopausal osteoporosis (PMO). A comparison was performed with the cyclical alendronate and a course of PEMFs in the treatment for postmenopausal osteoporosis on bone mineral density (BMD), pain intensity and balance function. There was no significant difference between the two groups on mean percentage changes from baseline of BMD within 24 weeks after random treatments (P≥0.05). However, at the ends of 48 weeks and 72 weeks, the BMD of the PEMFs group were significantly lower than that of the alendronate group (P<0.05). No significant difference was detected between the two groups with regard to treatment effects on Visual Analogue Scale score, the Timed Up & Go Test and Berg Balance Scale score. Compared with cyclical alendronate, a course of PEMFs was as effective as alendronate in treating PMO for at least 24weeks. So its optimal treatment frequency for PMO may be one course per six months.
To evaluate the effects of XiangLingGuBao (XLGB) on femoral fracture heal ing in ovariectomized (OVX) rats. Methods Forty 12-week-old female SD rats weighing (258 ± 14) g were divided randomly into 4 groups (n=10 per group): group A, sham operation by opening the abdominal cavity; group B, bilateral ovariectomy; group C, bilateral ovariectomy, transverse midshaft fracture of the right femur with intramedullary nail fixation, and normal sal ine by gavage; group D, bilateral ovariectomy, transverse midshaft fracture of the right femur with intramedullary nail fixation, and 250 mg/(kg•d) XLGB by gavage. The weight of rabbits in groups A and B was measured 0, 1, 2, 3, 4 and 5 weeks after operation. The right femur of each rat was obtained 5 weeks after operation. Total femur bone mineral density (tBMD), distal femur bone mineral density (dBMD) and middle femur bone mineral density (mBMD) were measured by double energy X-ray absorptiometry CR filming, HE staining and immunohistochemistry staining of groups C and D were performed. Results The weight of rats in group B was obviously higher than that of group A at 3, 4 and 5 weeks after operation (P lt; 0.05), indicating the animal model of postmenopausal osteoporosis was establ ished successfully. CR films showed more callus and obscure fracture l ine in group D, while less callus and distinct fracture l ine in group C. The tBMD and the dBMD of group B were far less than that of group A, the mBMD of group D was significantly higher than that of group C(P lt; 0.05), the tBMD and the dBMD of group D were higher than that of group C, but no significant difference was evidentbetween two groups (P gt; 0.05). Histology observation showed, when compared with group C, most fracture ends in groupD reached bone union, and the introduction of capillaries was evident in the marrow cavity. Immunohistochemistry staining demonstrated that the BMP-2 integrated absorbance (IA) value in groups C and D was 2.236 6 ± 0.181 8 and 3.727 3 ± 0.874 2, respectively, the VEGF IA value in groups C and D was 2.835 5 ± 0.537 0 and 3.839 6 ± 0.223 0, respectively, indicating there were significant differences between two groups (P lt; 0.05). Conclusion XLGB can obviously promote the femoral fracture heal ing in OVX rats, and speed the transformation of woven bone into lamellar bone, which may rely on its role of enhancing expression of BMP-2 and VEGF.
目的 探讨独活寄生汤联合唑来膦酸治疗绝经后肝肾亏虚型骨质疏松症（PO）的疗效。 方法 选取2009年2月－2012年12月收治的210例绝经后肝肾亏虚型PO患者，且所有患者均愿意接受研究。采用随机对照试验法，将患者分为A、B、C 3组各70例。A组采用独活寄生汤联合唑来膦酸治疗；B组采用唑来膦酸治疗；C组采用独活寄生汤治疗。观察3组患者治疗前后骨密度、骨源性碱性磷酸酶（NBAP）、骨钙素（BGP）、雌二醇（E2）变化，疗效及不良反应。 结果 骨密度、NBAP、BGP、E2各项指标，治疗前3组患者比较差异无统计学意义（P＞0.05）；治疗后A组各项指标明显优于B组、C组（P＜0.05）；B组与C组对比，差异无统计学意义（P＞0.05）；治疗后A组总有效率为97.14%，与B组、C组对比，差异有统计学意义（P＜0.05）。3组均未见严重不良反应。 结论 独活寄生汤联合唑来膦酸治疗绝经后肝肾亏虚型PO疗效显著，可有效提高患者骨密度、BGP、E2含量，降低骨源性碱性磷酸酶含量，缓解骨质疏松，且无严重不良反应发生，值得临床推广。