近五年来中医体质类型与骨质疏松症相关性研究的现状

目的探析近五年来中医体质类型与骨质疏松症(OP)的相关性研究的现状,探讨OP患者的中医体质分布规律,更好地为中医药防治OP提供一定的基础数据。方法对2013年1月～2017年12月在国内外期刊发表的有关OP与中医体质相关性的调查文献,以"骨质疏松、中医体质"为检索词进行检索,并将最终纳入的文献根据类型分为病例对照研究和横断面研究,分别进行综合分析。结果共检索105篇全文文献,其中11篇文献符合要求,调查范围涉及全国9个省市自治区,单个调查样本量80～1 957例,研究类型中横断面研究为6篇(54.55%),病例对照研究为5篇(45.45%)。提取两种研究中OP患者在样本中所占人数,发现在横断面研究中气虚型体质OP患者占6项总样本量3 251人的9.07%,阳虚型体质为7.90%,阴虚型体质为9.25%,同时基于1 992人的大样本人群病例对照研究的Meta分析发现,OP患者为气虚型体质、阳虚型体质、阴虚型体质的发病风险的OR值分别为1.29(95%CI:1.00～1.65),1.90(95%CI:1.44～2.49)和1.95(95%CI:1.47～2.59)。并发现华北地区、华东地区OP患者多以气虚型体质与阴虚型体质为主,而中南地区、西北地区OP患者多以气虚型体质与阳虚体质为主。结论气虚型体质、阳虚型体质、阴虚型体质以及血瘀型体质是OP患者的主要体质类型,通过大样本量的分析,期望为未来中医药防治OP,提供一定的参考价值,但目前的文献仍然缺乏多种相关因素的研究,这可能会对判断OP患者的中医体质出现偏颇,有待进一步提高。     

中医传统运动与骨质疏松症相关性研究现状

目的探析近五年来中医传统运动与骨质疏松症(osteoporosis,OP)相关性研究的现状,探讨OP患者的中医传统运动状况,更好地为运用中医传统运动防治OP提供一定的基础数据。方法对2013年1月至2018年5月在国内外期刊发表的有关OP与中医传统运动相关性的调查文献,以"骨质疏松、太极拳、五禽戏、八段锦、易筋经、运动"为检索词进行检索,并进行综合分析。结果共检索129篇全文文献,其中17篇文献符合要求,调查范围涉及全国12个省、市、自治区,单个调查样本量为46～188例,研究类型中横断面研究为5篇(29. 41%),病例对照研究为12篇(70. 59%)。运用太极拳改善OP的人数达43. 46%,其余分别是八段锦(23. 23%)、五禽戏(21. 90%)、易筋经(11. 42%)。同时将12项病例对照研究中的OP患者与对照组进行对比,并从骨密度、OP患者腰背疼痛及血清骨钙素(BGP)三个方面评价中医传统运动对OP患者的改善情况,MD值分别为0. 11(95%CI:0. 09～0. 13),-1. 22(95%CI:-1. 35～-1. 09),0. 21(95%CI:0. 16～0. 27),P0. 00001。结论中医传统运动可明显改善OP患者的临床表现,并有效延缓OP的发生。     

中国各地区绝经后骨质疏松症患病率及骨密度测量检出率分析

目的了解近10年来中国不同地区女性绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)的患病现状,分析其危险因素和不同部位骨密度测量的差异,为临床工作及流行病学调查提供理论指导。方法使用中国知网及万方数据进行文献检索。检索词:"骨质疏松症"和"患病率"。检索时间:2009年1月至2019年1月。按照检索词总共检索到509篇文献,最终纳入文献20篇,统计了北京、青海、四川、山东、江苏、海南等14个省市自治区的骨质疏松症流行病学情况。结果国内绝经后骨质疏松症患病率大致呈北方低、南方高的分布趋势。腰椎正位骨密度测量对于骨质疏松症的检出率高于股骨近端或两者差异无统计学意义。结论我国50～59岁女性骨质疏松症的患病率约为20.38%,且呈北方低、南方高的分布趋势,这受到平均日照、当地居民体重、生活习惯、饮食结构等有关因素的影响,其诊断结果受到检测部位的影响,对于50～59岁的绝经后妇女,腰椎骨密度测量具有检出率高、操作方便的特点,可以作为疾病筛查的首选检测部位。     

应用金天格胶囊治疗骨质疏松症的Meta分析

目的系统评价金天格胶囊治疗骨质疏松症(osteoporosis,OP)的临床疗效。方法检索建库至2018年9月的Cochrane图书馆、Springer Link、EMBASE、PubM ed、中国生物医学文献数据库、万方数据库、中国知网数据库、维普中文期刊数据库,并手工检索相关期刊。收集金天格胶囊治疗OP的随机对照实验,筛选出合格的文章,采用Cochrane风险偏倚评估工具和Jadad量表评估纳入文献的研究质量。采用Cochrane协作网提供的RevM an 5. 3软件进行Meta分析。结果共检索出161篇文献,经筛选最终纳入15篇随机对照研究的文献,共涉及1 957例患者,所纳入文献质量偏低,采用随机数字表进行分组的仅3篇文献,采用计算机随机进行分组的文献有1篇,1篇文献说明了安全性评价结果,纳入的所有文献均未说明随机分配方案的隐藏方法、病例脱落情况、也未交代是否采用盲法、样本量估算方法及随访情况,Jadad评分≤2分。纳入的15篇文献均进行了干预组与对照组间的临床疗效有效率的比较,各研究结果之间具有同质性(I2=0%,P=0. 88)。治疗组的有效率高于对照组[Z=9. 64,P0. 01; OR=4. 61,95%CI(3. 38,6. 30)]。漏斗图表明试验研究散布在竖线的两边,分布比较均匀,未有发表偏倚。结论金天格胶囊单独使用或联合其他疗法均能有效缓解OP患者的临床症状。因为本次研究纳入的研究质量及病例数量的局限性,上述结论尚需要更多高质量的随机对照实验进一步验证。     

老年骨质疏松患者营养状况及影响因素分析

目的探讨老年骨质疏松(osteoporosis,OP)患者营养状况的影响因素,为指导老年骨质疏松患者的疾病康复提供依据。方法采用便利抽样的方法,使用微型营养评价量表(MNA)对2014年7月~2014年12月就诊于华北理工大学附属医院的老年骨质疏松患者412人进行问卷调查。结果在老年骨质疏松患者中,MNA≥24分者占总人数的39.6%,17≤MNA24分者占总人数的51%,MNA17分者占总人数的9.4%;性别、文化程度、婚姻、月收入、吸烟、饮酒、牛奶、运动、疼痛程度、OP类型、OP程度是老年人骨质疏松症患者营养状况的影响因素,差异具有统计学意义(P0.05),其中,性别、婚姻、吸烟、运动、疼痛程度和OP类型对老年人骨质疏松症患者营养总分的影响大于文化程度、月收入、饮酒、牛奶和OP程度;多因素分析中,性别、婚姻、月收入、牛奶、运动、疼痛程度、OP类型、OP程度是老年人骨质疏松症患者营养状况的影响因素,差异有统计学意义(P0.05),性别对骨质疏松患者营养状况的影响最大,其次是OP类型、婚姻、月收入、OP程度、疼痛程度、饮用牛奶和运动情况。结论多种因素对老年人骨质疏松症患者的营养状况有影响,具有各种降低营养状况因素的老年骨质疏松患者应通过改善生活方式、积极治疗骨质疏松等措施改善其营养状况。     

绝经后骨质疏松症影响因素的Meta分析

目的 系统评价绝经后骨质疏松症的危险因素及保护因素.方法 以电子检索结合手工检索及索引检索的方式检索所有绝经后骨质疏松症影响因素的病例对照研究、队列研究的中英文研究文献,对纳入的文献进行质量评价后提取数据信息,采用专用软件RevMan 5.0完成系统评价过程.结果 共纳入13篇临床研究.家族骨折史、个人骨折史、绝经年限(≥5年)、经常吸烟、文化程度低、体重指数(≥25)、激素替代疗法、补充钙剂、少量饮酒、经常运动等与绝经后骨质疏松症的发生有关.结论 初步得出家族骨折史、个人骨折史、绝经年限(≥5年)、经常吸烟、文化程度低能够促进绝经后骨质疏松症的发生,而体重指数(≥25)、激素替代疗法、补充钙剂、少量饮酒、经常运动等有助于预防绝经后骨质疏松症的发生.     

儋州农村地区老年人群骨质疏松症的患病率及其危险因素分析

目的了解儋州农村地区老年人群骨质疏松症(OP)的患病率,并分析其相关危险因素,为有效预防和干预提供依据。方法采用美国GE公司生产的Lunar Prodigy Advance PA+300164型双能X线骨密度仪测量儋州农村地区老年人群的右侧跟骨骨密度。通过对受试者进行调查问卷,记录其一般资料及骨质疏松症相关因素等。单因素Logistic分析,有统计学意义的因素(P0.05)进一步行二分类非条件Logistic回归分析,计算OR值及其95%置信区间(95%CI)。应用受试者工作特征(ROC)曲线评价Logistic回归模型的效果。结果在2186名调查对象中,OP总患病率为31.6%(691/2186),其中男性占21.4%(148/691),女性占78.6%(543/691)。随着年龄的增长,男、女性骨质疏松症患病率均明显增加,差异有统计学意义(P0.05)。在男性,单因素及二分类非条件Logistic回归分析显示,年龄、饮酒次数、OP家族史、骨折次数是OP发生的独立危险因素(P0.05),体质指数、饮用牛奶、每天锻炼时间、对骨质疏松症的认识程度可能是OP保护因素(P0.05)。在女性,单因素及二分类非条件Logistic回归分析显示,年龄、OP家族史、骨折次数、婚姻状况、绝经状态是OP发生的独立危险因素(P0.05),体质指数、饮用牛奶、每天锻炼时间、对骨质疏松症的认识程度可能是OP保护因素(P0.05)。ROC曲线评价Logistic回归模型预测效果的曲线下面积(AUC)及95%CI为0.895(0.842~0.974)。结论儋州农村地区老年人群骨质疏松症的患病率较高,影响骨质疏松症的危险因素较多,需积极采取预防措施,以减少或延缓骨质疏松症的发生。     

我国护生评判性思维能力研究的文献分析

目的分析国内关于护生评判性思维的研究内容、文献数量变化趋势和存在的问题,了解现阶段我国护生评判性思维的研究现状。方法以中文关键词"护生"、"护理专业学生"、"评判性思维",检索中国知网数据库,运用文献分析法对文献进行分析与评价。结果共检索到1998~2015年有关护生评判性思维的文献60篇,其中1998~2004年3篇,2005~2009年23篇,2010年至今34篇;文献涉及范围最主要为现况调查23篇,占文献总量的38.33%。结论我国对护生评判性思维的研究起步较晚,以横断面调查为主,存在研究不够深入,缺乏定性研究等问题,今后应进一步加深研究深度,定性和定量研究相结合。     

长骨医源性骨不连的临床流行病学调查

目的探讨长骨骨干医源性骨不连的流行病学特征及原因。方法对自2005年1月～2009年2月期间收治的185例肱骨、股骨、胫骨无菌性骨不连,进行了流行病学调查,其中134例与医源性有关。回顾调查此类骨不连的流行病学特征及分析引起医源性骨不连的各种相关因素。结果骨不连的发生部位:肱骨、股骨、胫骨分别占24%、31%、45%;骨不连的患者以青壮年为主;其中骨不连肥大型62例,萎缩型72例;原复位方式切开复位占72%,闭合复位的占15%,有限切开复位占13%;内固定术不能为骨折愈合提供充分的力学稳定51例,手术操作问题11例,内固定技术理念的偏差84例,不恰当的康复指导24例。结论熟悉骨不连的流行病学特点,对于治疗和预防骨不连发生具有重要的意义。     

2010 -2016年中国老年人骨质疏松症患病率Meta分析

目的对2010-2016年发表的有关中国人骨质疏松症流行病学研究数据进行汇总,运用Meta分析方法汇总分析中国老年人骨质疏松症患病率情况。方法检索Pub Med、EMbase、Web of Science、Ovid、万方数据、中国知网及VIP中的英文和中文文献,提取纳入研究的特征信息。数据分析采用R3.3.0软件,检验异质性,根据异质性结果选择相应的效应模型对提取数据进行加权定量合并。结果共纳入33项研究,样本总量30526例。33项研究存在异质性,按照随机效应模型计算中国60岁以上人群骨质疏松症总体患病率为36%,其中男性为23%,女性为49%,差异有统计学意义。结论骨质疏松症是中国老年人高发疾病,开展骨质疏松宣传防治工作意义重大。     

骨质疏松症诊断标准的探讨

本文目的是再次讨论骨质疏松的诊断标准问题。骨质疏松症的诊断以骨密度DXA检测为金标准。1994年世界卫生组织(WHO)推荐的骨质疏松诊断标准为:患者骨密度低于同性别人群峰值骨量均值2.5个标准差以上,或减少30%以上。这个标准的T值是根据年轻白人妇女计算的,但是对于不同地区是不能固守这一标准的。有研究调查我国部分地区骨质疏松症总患病率为32.3%(2.0SD)和14.9%(2.5SD),2种骨密度诊断标准计算骨质疏松症患病率差异有显著性,若以2.5SD为标准很可能造成漏诊。该研究者还发现骨质疏松症的患病率在老年远高于年轻人。而WHO采用的是白人年轻女性的数据库,它是否适用就更值得推敲。另有研究者以骨密度低于-2.0SD标准,推算杭州市妇女骨质疏松的发病率为29.5%。认为以-2.0SD为标准可以相对早期发现骨质疏松。还有研究对于高原的藏族人群进行检测,也得出同样结论。有研究者推算我国各个DXA仪器之间的换算公式,发现上述换算公式基本上与日本推出的相同,但是与美国推出的换算公式有差异。这都证明WHO骨密度诊断标准是否适用于黄种人是有疑问的。国内有研究者以BMD-2.0SD为诊断标准,结合以骨代谢生化指标,认为能全面合理评价骨转换。还有研究者对目前国内使用骨密度检测方法进行统计分析,发现60岁骨量丢失率有18%左右,70岁阶段达到22%左右。这个患病百分率比较符合中国人的实际情况。按照世界上基本通用的换算方法,1.0SD约等于10%～12%的骨量丢失百分率,因此建议男性骨质疏松诊断标准为骨量丢失率达到25%或2.0SD,实际诊断年龄在70岁以上。如果采用2.5SD,中国人患病诊断时间会推迟到70岁以后,尤其是男性要推迟到90岁以后。骨质疏松症的研究关键是正确合理的诊断,不同种族、不同国家或地区有不同的诊断标准。1994年以前全世界都执行WHO1985年提出的峰值骨量丢失2.0个标准差诊断为骨质疏松症。1994年WHO提出了白人妇女小于-2.5SD为骨质疏松,但也明确指出该标准仅适用于欧美白人妇女。以Orimo为首的日本骨代谢学会制定了日本人群的骨质疏松诊断标准:骨密度在同性别青年人平均值30%以下为骨质疏松,丢失20%～30%为骨量减少。1999年中国老年学学会骨质疏松委员会诊断学组建议骨质疏松的诊断标准为骨量丢失百分率达到25%,或者说2.0SD。对于国外也有学者倾向于采用-2.0SD的标准来评价骨质疏松症。有研究发现不同国家间,和每国内部不同人群和人种的骨密度是明显不同的。非洲和拉丁美洲人种的骨密度高于白种人,而白种人的骨密度则高于黄种人。总结:1、国内外人群间骨密度的差异是公认的,我国人群骨密度是低于制定国际标准的白种人的,有倾向以T值低于-2.0SD为骨密度诊断标准。但是大规模的流行病学调查比较研究还很少,有必要进一步提供更确切的骨质疏松诊断更改的流行病学依据。2、以2.0SD为标准可以减少骨质疏松的漏诊,对于流行病学人群调查筛选病例,进行危险因素分析和对骨质疏松高危人群进行干预实验尤为有必要。3、如果加强国内和国际间多单位的联合研究,可以提高标准制定的科学性和权威性。     

Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review

Fragility fractures are a strong indicator of underlying osteoporosis (OP). With the risk of future fracture being increased 1.5- to 9.5-fold following a fragility fracture, the diagnosis and treatment of OP in men and women with fragility fractures provides the opportunity to prevent future fragility fractures. This review describes the current status of practice in investigation and diagnosis of OP in men and women with fragility fractures, the rates and types of postfracture treatment in patients with fragility fractures and OP, interventions undertaken in this population, and the barriers to OP identification and treatment. A literature search performed in Medline, Healthstar, CINAHL, EMBASE, PreMedline, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews identified 37 studies on OP diagnosis, treatment, and interventions. The studies varied in design methodology, study facilities, types of fractures, and pharmacological treatments. Some studies revealed that no patients with fragility fractures received investigation or treatment for underlying OP. Investigation of OP by bone mineral density was low: 14 of 16 studies reported investigation of less than 32% of patients. Investigation by bone mineral density resulted in high rates of OP diagnosis (35–100%), but only moderate use of calcium and vitamin D (8–62%, median 18%) and bisphosphoates (0.5–38%) in patients investigated postfracture. Studies on barriers to OP identification and treatment focused on various groups of health practitioners. Barriers included the cost of therapies, time and cost of resources for diagnosis, concerns about medications, and the lack of clarity regarding the responsibility to undertake this care.     

Femoral neck bone mineral density and 10-year absolute fracture risk in a national representative sample of Bulgarian women aged 50?years and older

Summary

This study explored the epidemiology of osteoporosis in Bulgarian women (>50?years). Of the women included in the study, 16.8% had osteoporosis and 46.5% had osteopenia at the femoral neck. The mean 10-year absolute fracture risk was 13.4?±?9.2% (major fractures) and 2.8?±?5.2% (hip fractures). This study is the largest Bulgarian epidemiological osteoporosis trial.

Purpose

The aim of this study was to determine the prevalence of the major risk factors for osteoporosis and the 10-year absolute fracture risk in a national representative sample of Bulgarian women aged 50 and older.

Methods

This work is a part of the Bulgarian Osteoporosis Epidemiology Study. The National Statistical Institute selected a national representative epidemiological sample. A questionnaire was used allowing fracture risk calculation according to FRAX. Ten osteoporosis centers throughout the country participated. Bone mineral density (BMD) was measured at the femoral neck by dual X-ray absorptiometry. The statistical analysis was performed on a SPSS 13.0 for windows platform.

Results

A total of 1,331 women were included (mean age 63.8?±?8.3?years), divided into decades. Of them, 16.8% had osteoporosis and 46.5% had low femoral neck BMD. Their mean 10-year absolute fracture risk for major fractures was 13.4?±?9.2%, and for hip fractures 2.8?±?5.2%, respectively. The prevalence of some major risk factors for osteoporosis was as follows: height loss?>?3?cm??33.1% of all women; family history of hip fractures??4.1%; previous hip fractures??1.9%; previous vertebral fractures??2.3%; all fractures??23.3%; smoking??11.9%.

Conclusions

This study is the largest epidemiological osteoporosis trial in Bulgaria to date and allows assumptions about the prevalence of osteoporosis and fractures among women aged 50 and older in our country.     

中国原发性骨质疏松症危险因素的Meta分析

目的 通过Meta分析探讨中国原发性骨质疏松症的危险因素,为预防及延缓骨质疏松症提供理论依据。方法 通过计算机与手工检索结合的方法,检索中国知网（CNKI）、万方（Wang Fang Data）、维普（VIP）、PubMed、Web of Science、The Cochrane Library数据库自建库以来有关骨质疏松症及其危险因素相关的病例对照研究,根据纳入、排除标准对纳入的文献进行数据提取并应用RevMan 5.4分析软件进行Meta分析。结果 最终纳入14篇临床研究,共提取13个相关影响因素,Meta分析结果显示除体质量指数（body mass index, BMI）、饮茶两种危险因素的结果不具有统计学意义之外（P>0.05）,年龄、运动、服用钙剂、摄入乳制品、孕产次、哺乳时长等11种影响因素均具有统计学意义（P<0.05）。结论 运动、服用钙剂、摄入乳制品是原发性骨质疏松症的保护因素,而年龄、吸烟、摄入谷氨酸钠、绝经年限、 哺乳时长、孕产次、收缩压、空腹血糖则是危险因素,BMI和饮茶对原发性骨质疏松症的影响尚需进一步研究。     

Präventive Knochendichtemessung bei postmenopausalen Frauen

Background

Osteopenia (OP) or osteoporosis (OST) was diagnosed by bone densitometry (DXA) in postmenopausal women free of known skeletal disorders and without acute fracture. DVO guidelines were applied to define therapeutic indication.

Methods

The study included 94 women aged 59–81 years. Fracture or operation ≤12 months, malignant tumor, ovariectomy, and drugs such as cortisone, strontium, fluorides, bisphosphonates, SERMs, estrogens, and steroids were exclusion criteria. The lowest T-score at the spine, femoral neck, or total hip was decisive. The indication for therapy was determined by evaluating age, BMD, and other risk factors.

Results

Using the WHO criteria 22.3% (n=21) had normal BMD, 52.1% (n=49) had OP, and 25.6% (n=24) had OST. According to “Dachverband Osteologie” (DVO) guidelines, 28 women (29.8%) of the whole group needed therapy. Of the 28 women receiving therapy, 9 had OP and 19 had OST. Therapy was indicated in 18.4% for OP and 79.2% for OST.

Conclusion

A preventive measurement of BMD with DXA provides a benefit for postmenopausal women. Combinatory assessment and consideration of other risk factors allows identification of women who might benefit from early treatment.     

Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients

This study aims to determine osteoporosis (OP) investigation and treatment within post-fracture initiatives conducted in fracture clinics and other orthopedic environments. A systematic review was conducted. Eligibility criteria were: hip fracture patients plus all other fracture patients presenting with a fragility fracture, orthopedic setting where orthopedic physicians/staff were involved, intervention to improve OP management, primary data on ≥20 patients from randomized controlled trials (RCTs) and other study designs. We calculated outcome data within 6 months of screening from an intention-to-treat principle to derive an equated proportion (EP) across interventions. Outcomes were: (1) proportion of patients investigated with bone densitometry, (2) proportion of patients initiating OP medication, and (3) proportion of patients taking OP medication. We identified 2,259 citations, of which 57 articles that included 64 intervention groups were eligible. The median EP for patients investigated was 43% and the 75th percentile was 71%. The median EP for medication initiation was 22% and the 75th percentile was 34%. The median EP for medication taking was 27.5% and the 75th percentile was 43%. The EPs for all outcomes were higher for interventions with dedicated personnel to implement the intervention and those within which bone mineral density testing and/or treatment were included. In studies with an EP, up to 71% of patients were investigated for OP, but <35% initiated medication, and <45% were taking medication within 6 months of screening. Calculating an EP allowed us to compare outcomes across the studies, therefore capturing both RCTs and other study designs typical of real-world settings.     

Maternal History of Osteoporosis and Femur Geometry

Most studies that have examined the role of skeletal factors in the relationship between an individual's family history of fracture or osteoporosis and their fracture risk have focused on bone density. In this study, we expanded the scope of skeletal factors to include geometric properties (subperiosteal width, section modulus, cortical thickness, and buckling ratio) in addition to areal bone mineral density (BMD). We compared these skeletal factors at the femur neck and shaft by self-reported maternal history of osteoporosis (OP HX) from 5334 non-Hispanic whites, ages > or =20 years in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-94). A total of 213 men and 315 women reported a positive OP HX (e.g., their biological mother had sustained a hip fracture after age 50 years or had a physician's diagnosis of osteoporosis). Differences in bone density and geometry by OP HX were examined after adjusting for potential confounding variables. Several bone parameters differed significantly by OP HX in both sexes at the femur neck, but none differed at the femur shaft. At the neck, those with a positive OP HX had values that differed by approximately 3% to 4% (lower for BMD, bone mineral content (BMC), cross-sectional area, and cortical thickness; higher for buckling ratios) from those with a negative OP HX (P < 0.05). The magnitude of these relationships was similar in both sexes, but differences were greater in younger versus older adults. In conclusion, both men and women with a positive maternal history of osteoporosis may be at greater risk of femur neck fracture owing to thinner cortices and lower BMC, which in turn results in potentially greater cortical instability (buckling ratio) at this skeletal site.     

脾肾阳虚证狼疮性肾炎继发骨质疏松的临床特征及影响因素

目的探讨脾肾阳虚证狼疮性肾炎继发骨质疏松的临床特征及相关影响因素。方法收集本院门诊及病房就诊的脾肾阳虚证狼疮性肾炎的患者。依据骨质疏松诊断标准,将入组患者分为骨质疏松组(OP组)与非骨质疏松组(非OP组)。记录、观察患者一般疾病特征、骨密度值、受累脏器、临床表现、实验室指标、SLEDAI评分,建立数据库。通过数据统计分析、比较,获得两组间的临床特征差异,通过回归分析得出继发骨质疏松的危险因素。结果本研究共纳入60例脾肾阳虚的狼疮性肾炎患者,OP组、非OP组各30例,OP组平均年龄42.1岁,平均病程113.8个月;非OP组平均年龄34.5岁,平均病程68.2个月。两组比较,OP组的年龄更大、病程更长,肝脏受累较多,畏寒、骨痛、心包积液相对常见,尿蛋白定量明显增多,尿素氮、胱抑素C、血沉、CRP升高更明显,肾小球滤过率、25羟基维生素D更低,差异均有统计学意义。回归分析发现,狼疮性肾炎继发骨质疏松的影响因素包括年龄大、病程长、尿素氮升高。结论脾肾阳虚证的狼疮性肾炎继发骨质疏松患者年龄更大、病程更长,多伴有肝脏、血液系统受累,临床上还可出现大量蛋白尿、肾功能显著下降。     

Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japanese men and women: the research on osteoarthritis/osteoporosis against disability study

Musculoskeletal diseases, especially osteoarthritis (OA) and osteoporosis (OP), impair activities of daily life (ADL) and quality of life (QOL) in the elderly. Although preventive strategies for these diseases are urgently required in an aging society, epidemiological data on these diseases are scant. To clarify the prevalence of knee osteoarthritis (KOA), lumbar spondylosis (LS), and osteoporosis (OP) in Japan, and estimate the number of people with these diseases, we started a large-scale population-based cohort study entitled research on osteoarthritis/osteoporosis against disability (ROAD) in 2005. This study involved the collection of clinical information from three cohorts composed of participants located in urban, mountainous, and coastal areas. KOA and LS were radiographically defined as a grade of ≥2 by the Kellgren–Lawrence scale; OP was defined by the criteria of the Japanese Society for Bone and Mineral Research. The 3,040 participants in total were divided into six groups based on their age: ≤39, 40–49, 50–59, 60–69, 70–79, and ≥80 years. The prevalence of KOA in the age groups ≤39, 40–49, 50–59, 60–69, 70–79, and ≥80 years 0, 9.1, 24.3, 35.2, 48.2, and 51.6%, respectively, in men, and the prevalence in women of the same age groups was 3.2, 11.4, 30.3, 57.1, 71.9, and 80.7%, respectively. With respect to the age groups, the prevalence of LS was 14.3, 45.5, 72.9, 74.6, 85.3, and 90.1% in men, and 9.7, 28.6, 41.7, 55.4, 75.1, and 78.2% in women, respectively. Data of the prevalence of OP at the lumbar spine and femoral neck were also obtained. The estimated number of patients with KOA, LS, and L2–L4 and femoral neck OP in Japan was approximately 25, 38, 6.4, and 11 million, respectively. In summary, we estimated the prevalence of OA and OP, and the number of people affected with these diseases in Japan. The ROAD study will elucidate epidemiological evidence concerning determinants of bone and joint disease.