心理学与骨质疏松症的相关性研究概况

骨质疏松症是一种全身骨量减少、骨的微观结构退化的骨骼疾病。随着生物-心理-社会医学模式的推动,发现骨质疏松症与心理之间存在着一定的联系。心理对人体的骨密度、骨转换指标的含量、骨细胞因子的浓度及骨质疏松症患者的骨折率都有一定的影响,同时骨质疏松症患者由于疾病可引起生活质量的改变影响到自身心理状态。     

围绝经期骨量减少与骨质疏松的临床观察

目的 探讨围绝经期妇女中骨量减少与骨质疏松患者的临床特点及防治措施.方法 对一组40-50岁伴有腰背疼痛的围绝经期女性进行双能X线骨密度仪(DXA)检测,以确定骨量减少与骨质疏松症患者.同时,以问卷调查的方式,询问与骨质疏松相关的生活饮食习惯,有无骨折史及相关慢性疾病史.结果 被调查229名门诊受检者中,T值＜-1者共计137例,占总人数的59.83％;其中,骨量减少(-1 ＞T＞ -2.5)者68例,占总人数的29.69％,骨质疏松症(T≤-2.5)者69例,占总人数的30.13％.在本组围绝经期存在骨质疏松改变的人群中,普遍缺乏预防骨质疏松相关健康保健常识,但所有患者否认有脆性骨折史.结论 在重庆地区,处于围绝经期伴有腰背疼痛不适的女性患者,经DXA骨密度检测骨量减少与骨质疏松症患者检出率较高(超过50％),处于发生骨质疏松性骨折的低风险阶段.早期确诊围绝经期骨量减少与骨质疏松症患者,可早期预防绝经后可能发生的骨质疏松症与骨质疏松性骨折的健康威胁.     

肠道菌群在骨质疏松症发病机制中的研究

骨质疏松症是一种慢性全身性代谢性骨病，由于骨吸收与骨形成的失衡造成骨量减少及骨密度的降低，与此同时骨组织微结构的破坏导致骨折风险升高，影响患者的生活质量甚至威胁生命安全。对于骨质疏松症的发病机制，目前认为与激素、内分泌、免疫、肠道菌群等因素有关。近年来微生物-肠-骨轴成为了骨代谢领域的研究热点。本文将从肠道粘膜屏障、骨免疫学、肠道菌群代谢产物等方面对肠道菌群在骨质疏松症中的发病机制进行综述。     

骨代谢标志物在宁波地区绝经后女性骨质疏松症患者中的临床应用

目的 研究骨代谢标志物在宁波地区绝经后中老年女性骨质疏松症患者诊疗中的作用。方法 随机选择绝经后的中老年女性受试者264例,年龄均大于50岁,根据骨密度结果将264例检测对象根据骨密度大小分为骨量正常组82例,骨量减少组90例,骨质疏松组92例,同时采用电化学发光免疫分析方法测定受检对象血清中β-CTX、PINP、25-OHD3水平,并进行对比分析。结果 骨质疏松组：β-CTX水平与正常对照组、骨量减少组比较差异有统计学意义（P <0.05) ;PINP、25-OHD3水平在3组间差异无统计学意义（P>0.05)。结论骨质疏松症患者血清骨代谢标志物水平与骨质疏松存在密切的相关性;β- CTX是骨质疏松症诊断和疗效评估的理想指标;PINP、25-OHD3是骨质疏松症诊断和治疗的参考指标。     

2型糖尿病患者合并骨量减少及骨质疏松症相关影响因素分析

目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者合并骨量减少及骨质疏松症(osteoporsis,OP)相关影响因素。方法采用双能X线骨密度仪(DXA)测定617例住院T2DM患者股骨颈(N)及腰椎1~4(L1-4)的骨密度(bone mineral density,BMD),按BMD分为骨量正常、骨量减少及骨质疏松组,采用SPSS软件比较各组之间年龄、性别、病程及生化指标之间的差异性,分析T2DM骨密度相关影响因素。结果 OP组及骨量减少组女性比例、年龄均高于骨量正常组(P0.05),BMI低于骨量正常组(P0.05)。OP组T2DM病程大于骨量减少组及骨量正常组(P0.05),FPG、2h PG、糖化血红蛋白低于骨量正常组(P0.05),空腹C肽水平低于骨量正常组(P0.05)。血钙低于骨量减少组及骨量正常组(P0.05),骨量减少组空腹胰岛素水平低于骨量正常组(P0.05)。将上述结果进行Logistic回归分析结果显示:高龄、低FC-P水平、低Hb A1C、低BMI与T2DM合并骨量减少及OP有相关关系(P0.05)。结论老龄、低空腹C肽水平、低BMI的2型糖尿病患者易出现骨量减少及骨质疏松症。     

强骨胶囊治疗原发性骨质疏松症、骨量减少的疗效及安全性评价

目的探讨强骨胶囊治疗原发性骨质疏松症、骨量减少的有效性及临床应用的安全性。方法采用多中心、开放的临床试验,对原发性骨质疏松症、骨量减少患者给予强骨胶囊治疗共12周,治疗前、后用中医证候进行分级评分,检测血压、心率、血常规、尿常规、心电图及肝肾功能。部分患者治疗后复查骨密度。结果共入组2062例,年龄范围45～75岁。治疗后患者腰背疼痛、下肢无力、畏寒肢冷、抽筋、夜尿频多等证候明显改善,临床症状缓解率93.8%。治疗12周后,未发现腰椎2-4及股骨颈的骨密度有明显变化。全部不良事件发生率7.6%(157/2061),无严重不良事件及罕见不良反应发生。药物相关不良事件有:口干5.19%(107/2061)、便秘2.33%(48/2061)、胃部不适0.24%(5/2061),没有因与药物有关的不良事件而退出试验的病例。结论强骨胶囊能明显改善原发性骨质疏松症、骨量减少患者的腰背疼痛、下肢无力、畏寒肢冷、抽筋、夜尿频多等临床症状,同时具有良好的安全性。     

骨质疏松性骨折机理研究进展

骨质疏松是以骨量减少、骨组织显微结构退化（松质骨骨小梁变细、断裂、数量减少;皮质骨多孔、变薄）为特征,以致骨的脆性增高及骨折危险性增加的一种全身性骨病.骨质疏松症的最大危害在于骨折,20%的骨质疏松症患者有发生骨质疏松性骨折的可能.     

补肾法治疗骨质疏松症临床疗效观察

补肾法治疗骨质疏松症临床疗效观察申洪波白云静＊⒇王宗辉刘德胜骨质疏松症是以单位体积骨量减少，骨组织纤维结构异常，以腰背痛，易发骨折为主要临床表现的一种多病因疾病。随着人口老龄化骨质疏松症患者也迅速增加，老年骨质疏松引起的骨痛、骨折及其并发症给医学和社...     

骨健康基本补充剂联合运动、生活方式干预对围绝经期骨量减少的临床观察

目的研究对于围绝经期女性骨量减少的干预效果,探讨女性骨质疏松症的早期预防措施。方法对围绝经期骨量减少女性给予生活方式改变、饮食结构调整、运动训练指导及骨健康基本补充剂治疗的综合干预,比较干预前后骨密度、骨转化标志物、四肢肌肉含量的变化。结果观察组在干预后腰椎骨密度、全身肌肉含量、25-OHD3水平均有改善。结论对围绝经期骨量减少女性进行多方位的早期干预可以延缓绝经后骨质疏松症的发生发展。     

2200例指骨骨密度测定分析

目的评价采用X线放射吸收法测定指骨骨密度（BMD）的结果及在适用人群普查的可行性.方法自2001年1月至2004年12月随机对2200例各年龄段男、女性进行BMD测定.结果人体40岁以后骨中BMD（患者3根手指相对BMD的平均值）逐渐减少;男性50岁以后有20.40%的人为骨量减少,22.25%的人为骨质疏松;女性50岁以后有28.99%为骨量减少,29.97%的人为骨质疏松.结论采用指骨BMD所获的测定结果符合骨质疏松症流行病学的发病率,可以对45岁以上的人群进行普查,针对骨量减少和骨质疏松症患者给予治疗.     

Depression risk in female patients with osteoporosis in primary care practices in Germany

Summary

Thirty-five thousand four hundred eighty-three female osteoporosis patients were compared with 35,483 patients without osteoporosis regarding the incidence of depression. The risk of depression is significantly increased for patients with osteoporosis compared with patients without osteoporosis in primary care practices within Germany.

Introduction

The objectives of the present study were to analyze the incidence of depression in German female patients with osteoporosis and to evaluate the risk factors for depression diagnosis within this patient population.

Methods

This study was a retrospective database analysis conducted in Germany utilizing the Disease Analyzer® Database (IMS Health, Germany). The study population included 70,966 patients between 40 and 80 years of age from 1072 primary care practices. The observation period was between 2004 and 2013. Follow-up duration was 5 years and was completed in April 2015. A total of 35,483 osteoporosis patients were selected after applying exclusion criteria, and 35,483 controls were chosen and then matched (1:1) to osteoporosis patients based on age, sex, health insurance coverage, depression diagnosis in the past, and follow-up duration after index date. The analyses of depression-free survival were carried out using Kaplan-Meier curves and log-rank tests. Cox proportional hazards models (dependent variable: depression) were used to adjust for confounders.

Results

Depression diagnoses were presented in 33.0 % of the osteoporosis group and 22.7 % of the control group after the 5-year follow-up (p?<?0.001). Dementia, cancer, heart failure, coronary heart disease, and diabetes were associated with a higher risk of developing depression (p?<?0.001). Private health insurance was associated with a lower risk of depression. There was no significant effect of fractures on depression risk.

Conclusion

The risk of depression is significantly increased for patients with osteoporosis in primary care practices within Germany.

     

绝经后患者焦虑、抑郁状态对骨质疏松和生活质量的影响

目的了解骨质疏松症与焦虑、抑郁状态的相关性。方法选取来我院门诊就诊和住院的绝经后骨质疏松患者74例和非骨质疏松患者76例,采用综合性医院焦虑抑郁量表和健康状况调查问卷对其焦虑、抑郁状态及生活质量进行评估,同时采用RIA方法测定雌二醇、睾酮、孕酮、促卵泡素和促黄体生成素水平。结果骨质疏松组患者血清E2水平较对照组降低,差异有显著性(P=0.020),而骨质疏松组FSH较对照组有所升高,差异有显著性(P=0.024),骨质疏松患者的焦虑分、抑郁分均显著高于对照组,差异均有显著性(P<0.01)。骨质疏松患者的生活质量显著低于对照组,8个纬度分值均显著高于对照组,差异均有显著性(P<0.01)。结论焦虑、抑郁状态也是绝经后骨质疏松的危险因素,对这部分患者进行有针对性的心理咨询和干预治疗也是非常必要的。     

老年男性抑郁情绪对原发性骨质疏松症的影响

目的研究老年男性抑郁情绪对原发性骨质疏松症的影响及其机制。方法选取于我院老年科住院的老年男性原发性骨质疏松患者68例(骨质疏松组)和非骨质疏松患者66例(对照组),老年抑郁量表(GDS)评估抑郁值,双能X线测定骨密度,放射免疫法测定血浆皮质醇(Cor)、促肾上腺皮质激素(ACTH)、睾酮(T)的水平,酶联免疫吸附法测定白介素-6(IL-6)、去甲肾上腺素(NA)、5-羟色胺(5-HT)水平,比较两组抑郁评分,分析骨密度值与抑郁评分的相关性,计算血浆IL-6、Cor、ACTH、T、NA、5-HT的水平,探讨抑郁对骨质疏松影响的潜在机制。结果骨质疏松组抑郁评分明显高于对照组(P0.01),而年龄和体重指数均无差别。骨密度值与抑郁评分呈负相关(r=-0.468,P=0.02);骨质疏松组血浆IL-6、Cor、ACTH、NA水平均高于对照组,而血浆睾酮(P)和5-HT低于对照组。结论老年男性抑郁情绪为原发性骨质疏松的重要危险因素。     

中老年抑郁症病人骨密度测定的临床价值

目的了解中老年抑郁症病人的骨密度 (BMD)和骨质疏松 (OP)的发生率。方法采用双能X线骨密度仪对 4 4例中老年抑郁症病人 (抑郁组 )和 4 0例中老年健康对照者 (对照组 )进行BMD测定。结果抑郁组和对照组骨量减少及OP的发生率分别为 86 .4 0 %和 17.5 0 % ,两组比较 ,差异有显著性意义 (P <0 .0 5 ) ;抑郁组病人BMD明显低于对照组 (P <0 .0 5 )。结论中老年抑郁症存在骨质疏松性骨折的潜在危险 ,加强中老年抑郁症病人骨折的预防和护理具有重要意义。     

Critical impact of patient knowledge and bone density testing on starting osteoporosis treatment after fragility fracture: secondary analyses from two controlled trials

Summary

Most patients are not treated for osteoporosis after their fragility fracture “teachable moment.” Among almost 400 consecutive wrist fracture patients, we determined that better-than-average osteoporosis knowledge (adjusted odds?=?2.6) and BMD testing (adjusted odds?=?6.5) were significant modifiable facilitators of bisphosphonate treatment while male sex, working outside the home, and depression were major barriers.

Introduction

In the year following fragility fracture, fewer than one quarter of patients are treated for osteoporosis. Although much is known regarding health system and provider barriers and facilitators to osteoporosis treatment, much less is understood about modifiable patient-related factors.

Methods

Older patients with wrist fracture not treated for osteoporosis were enrolled in trials that compared a multifaceted intervention with usual care controls. Baseline data included a test of patient osteoporosis knowledge. We then determined baseline factors that independently predicted starting bisphosphonate treatment within 1 year.

Results

Three hundred seventy-four patients were enrolled; mean age 64 years, 78 % women, 90 % white, and 54 % with prior fracture. Within 1 year, 86 of 374 (23 %) patients were treated with bisphosphonates. Patients who were treated had better osteoporosis knowledge at baseline (70 % correct vs 57 % for untreated, p?Conclusions The most important modifiable facilitators of osteoporosis treatment in patients with fracture were knowledge and BMD testing. Specifically targeting these two patient-level factors should improve post-fracture treatment rates.     

抑郁症与老年性骨质疏松之间的相关性

抑郁症与骨质疏松症是严重影响老年群体身心健康的常见疾病,随着人口老龄化趋势的加剧,二者的发病率逐年增长。老年人各组织器官开始衰老、功能逐渐退化,机体内环境发生改变,各种不良因素的交互叠加,导致骨代谢紊乱,骨吸收大于骨形成,造成骨量丢失。抑郁症属于精神心理系统疾患,近年来随着研究的不断深入,发现与骨质疏松症的发生密切相关。本文通过总结分析近几年国内外在这方面取得的最新研究进展,就抑郁症与老年性骨质疏松症之间的相关性展开综述,从而有针对性地对这两种疾病进行早期干预,对降低不良事件的发生,改善老年患者临床症状,提高晚年生活质量具有积极意义。     

Osteoporosis and depression: A historical perspective

In the early 1980s, researchers studying osteoporosis noted that depression was one of the major negative consequences of bone loss and fractures. These researchers believed that osteoporosis and fractures occurred first, causing a reactive depression. Meanwhile, a similar but distinct psychiatry literature noted that osteoporosis or bone loss appeared to be an undesirable consequence of major depression. Here, depression was seen as the causal factor, and osteoporosis was the outcome. The psychiatric perspective is more biological, based on the presence of hypercorticoidism in depressed individuals. Those who believe that osteoporosis leads to depression point out that depression is a consequence of many chronic illnesses. Regardless of the correct causal order, the strong positive relationship between osteoporosis and depression merits further clinical and research attention in the future.     

Morphologic study of iliac crest spongiosa in patients with osteoporosis treated according to the ADFR (activation, depression of resorption, formation, repeat the cycle) with parathyroid hormone and diphosphonates (Hannover PTH I study)

Treatment of osteoporosis with a complete reconstruction of the normal three dimensional architecture of trabecular bone is an unsolved problem. In addition to the well established fluoride therapy new concepts in the treatment of osteoporosis were developed. There is growing interest in the so called ADFR concept (activation, depression of resorption, formation, repeat the cycle) as a physiological stimulation of osteoblastic bone formation. The histological results following ADFR treatment in 8 patients are reported. After 12 months of treatment with parathyroid hormone [1-38)hPTH) (stimulation of the basic metabolic units) and the diphosphonate EHDP (depression of osteoclastic resorption) no change of remodelling processes at the trabecular bone surface could be observed. The results demonstrate many doubts in the importance of the ADFR concept for the treatment of osteoporosis.     

Low bone mineral density and high bone metabolism turnover in premenopausal women with unipolar depression

INTRODUCTION AND HYPOTHESIS: The majority of studies reporting decreased bone mineral density (BMD) in patients with unipolar depression neglected sex and age differences and menopause as the most important risk factor for osteoporosis. We presumed that physically healthy premenopausal women with unipolar depression have decreased BMD and altered bone cell metabolism. METHODS: BMD at lumbar spine and femoral neck by dual X-ray absorptiometry, bone alkaline phosphatase sera activity, 5b-tartarate resistant acid phosphatase sera activity and urine N-terminal telopeptide were measured in 73 premenopausal women with unipolar depression and compared with 47 healthy, age- and osteoporosis risk factors-matched premenopausal women. The duration and severity of depression, hormonal status (cortisol, prolactin, parathormone, oestradiol), antidepressive treatment, and physical activity through whole and modified QUALEFFO-41 questionnaire were evaluated. The results were statistically elaborated by the chi-square test, Student's t-test for independent samples, one-way analysis of variance - ANOVA, one-sample Kolmogorov-Smirnov test. Correlations were assessed by means of Pearson's coefficient. RESULTS: Patients with unipolar depression had significantly lower BMD, the decrease of which correlated only with the duration of depression. High bone metabolism turnover was found with a predomination of osteoresorption which, but not osteosynthesis, correlated with the severity of depression, estimated through Hamilton depression scores. Despite higher but not significant levels of cortisol in women with unipolar depression, the BMD decrease and high bone turnover seem not to be the consequence of hormonal changes or medical treatment. The significant correlations between physical activity and osteoresorption markers were found indicating possible underlying mechanism. CONCLUSIONS: Premenopausal women with unipolar depression have significantly lower BMD because of stimulated bone cell metabolism with predomination of osteoresorption process, mostly due to decreased physical activity in depression. These women should be investigated for osteoporosis and the multidisciplinary team approach is advocated.     

Colles’ fractures and osteoporosis—A new role for the Emergency Department

PurposeIn Denmark, guidelines from the Danish Orthopedic Society recommend that patients older than 65 years who sustain a Colles’ fracture should be referred to assessment of underlying osteoporosis. An assessment of referral rates at our hospital during the period October 2010–September 2013 showed that none were referred. Due to this, an automatic out-patient referral system for assessment of underlying osteoporosis was established. With this system, patients are referred directly from the Emergency Department (ED). The purpose of this study was to assess how effective this new referral system was at improving referral rates for assessment of osteoporosis and to evaluate how many more cases of osteoporosis that was identified with this practice during the period October 2013–September 2014.MethodThe automatic referral system for evaluation of osteoporosis in patients 65 years and above without known osteoporosis, living in the catchment area and sustaining a low energy distal forearm fracture was established in October 2013. With the new system, patients were referred directly from the ED for evaluation of osteoporosis at the osteoporosis out-patient department at the hospital. The system was evaluated for the period October 2013–September 2014. For comparison data was collected on the same patient group for the 3 years preceding the system.ResultsBefore the automatic system none were referred for evaluation of osteoporosis and thus none were diagnosed. After introduction of the system 100% were referred, 73.26% were examined and 65.08% of these were found to have osteoporosis. Anti-osteoporotic treatment was initiated in all but 4.88% of the patients.ConclusionThe results show that this type of automatic referral system can be an effective way of increasing the number of patients diagnosed with and treated for osteoporosis. It also shows that involvement of the ED in the screening for osteoporosis can be an effective way of increasing referral rates leading to higher rates of diagnosed osteoporosis. The early identification and initiating of treatment might result in a lower rate of secondary and potentially more severe osteoporotic fractures.