随着糖尿病发病率不断攀升,人们逐渐聚焦于糖尿病合并骨质疏松。围绕此疾病,国内外学者开展了广泛而深入的研究,临床实践聚焦于两点：糖尿病的精准治疗和骨质疏松的有效干预。在确保血糖稳定的基础上,致力于抑制骨吸收、促进骨形成。在此治疗理念指导下,临床医生应当更加全面了解血糖管理与抗骨质疏松药物的作用机制并合理应用,更大程度改善患者的临床症状及预后。然而,药物作用机制复杂,联合应用存在潜在药物相互作用问题。未来研究方向包括探索更安全有效的联合治疗方案,更加精确化地治疗以提高临床疗效。文章分析了降糖药物及抗骨质疏松药物对疾病的疗效,并展望未来的研究方向,旨在为临床实践提供更为深刻与全面的指导。
As the incidence of diabetes mellitus continues to rise,people are also gradually focusing on diabetes mellitus combined with osteoporosis,which puts patients at a higher risk of fragility fracture．Scholars at home and abroad have conducted extensive and in-depth research around this condition,and clinical practice has focused on two points：first,the precise treatment of diabetes,and second,the effective intervention of osteoporosis．On the basis of ensuring blood glucose stabilization,we are committed to inhibiting bone resorption and promoting bone formation．Under the guidance of this therapeutic concept,we should have a more comprehensive understanding of the mechanism of action of blood glucose management and anti-osteoporosis drugs and apply them rationally,aiming to improve the clinical symptoms and prognosis of patients to a greater extent through dual intervention． However,the mechanism of action of different drugs is complex,and there are potential drug-drug interactions and safety issues associated with their combined use．Future research directions should include exploring safer and more effective combination therapies,developing novel drugs,and more precise and individualized treatments to improve clinical efficacy．This article analyzes the efficacy of glucose-lowering drugs and anti-osteoporosis drugs on the disease and looks forward to future research directions,aiming to provide more profound and comprehensive guidance for clinical practice．
目的 丹酚酸B是传统中药丹参的重要生物活性组分,临床应用广泛。新近发现,丹酚酸B具有防治骨质疏松的作用。本研究拟在前期工作基础上,系统地研究丹酚酸B对去卵巢骨质疏松小鼠的作用,探讨其对小鼠间充质干细胞（MSCs）成骨分化的影响。方法 将18只8周龄SPF级别的C57雌性小鼠分为假手术组、骨质疏松组、丹酚酸B治疗组。骨质疏松组和丹酚酸B治疗组行双侧卵巢摘除术。而假手术组则保持正常的卵巢结构,同时去除局部的脂肪。3组均于术后3日内给予抗生素进行抗感染治疗。4周内,丹酚酸B治疗组给予丹酚酸B 2.5 mg/kg腹腔注射,连续12周,2天1次,其余2组在相同的时间内给予等量生理盐水。16周后,在麻醉状态下将所有小鼠处死。应用MicroCT测量了小鼠右后股骨的骨密度。采用qRT-PCR技术,分析小鼠左后股骨骨髓MSCs中Runx2和Osterix的表达。将小鼠右后股骨进行液氮研磨处理,提取蛋白质,用WB法测定OPG和RANKL的含量。结果 骨质疏松组小鼠股骨骨密度比假手术组低（P<0.05）,丹酚酸B治疗组小鼠股骨骨密度比骨质疏松组高,但差异无显著性意义（P<0.05）。骨质疏松组小鼠Runx2和Osterix水平低于假手术组（P<0.05）,丹酚酸B治疗组小鼠Runx2和Osterix水平比骨质疏松组高（P<0.05）。骨质疏松组小鼠OPG和RANKL蛋白水平低于假手术组（P<0.05）,丹酚酸B组小鼠OPG和RANKL蛋白水平比骨质疏松组高（P<0.05）。结论 绝经后骨质疏松症早期对小鼠的骨质疏松具有一定的影响,但还需要更多的实验来验证本研究的结论。
Objective Salvianolic acid B is an important bioactive component of traditional Chinese medicine Salvia miltiorrhiza and is widely used in clinic．Recently,salvianolic acid B has been found to have the effect of preventing osteoporosis．On the basis of previous work,this study intends to systematically explore the effect of salvianolic acid B on ovariectomized mice with osteoporosis,and its effect on the osteogenic differentiation of mouse mesenchymal stem cells（MSCs）．Methods Eighteen eight-week-old SPF C57 female mice were divided into sham operation group,osteoporosis group and salvianolic acid B treatment group（6 mice in each group）．The osteoporosis group and salvianolic acid B group underwent bilateral ovariectomy．The sham group maintained normal ovarian structure while removing local fat tissue．All three groups were given antibiotics for anti-infection treatment within 3 days after operation．Within 4 weeks,salvianolic acid B treatment group was given salvianolic acid B 2.5 mg/kg intraperitoneal injection for 12 weeks,once every 2 days,and the other 2 groups were given the same amount of saline at the same time．After 16 weeks,all mice were sacrificed under anesthesia．The bone density of the mouse right posterior femur was measured by MicroCT．The expressions of Runx2 and Osterix in the bone marrow of mouse left posterior femur were analyzed by qRT-PCR．The right posterior femur of mice was ground with liquid nitrogen to extract protein,and the contents of OPG and RANKL were determined by WB．Results The bone mineral density of the femur in the osteoporosis group was lower than that in the sham operation group（P<0.05）,and the bone mineral density of the femur in the salvianolic acid B treatment group was higher than that in the osteoporosis group,but the difference was not significant（P<0.05）．The levels of Runx2 and Osterix in the osteoporosis group were significantly lower than those in the sham operation group（P<0.05）,and the levels of Runx2 and Osterix in the salvianolic acid B treatment group were higher than those in the osteoporosis group（P<0.05）．The levels of OPG and RANKL protein in the osteoporosis group were significantly lower than those in the sham operation group（P<0.05）,while the levels of OPG and RANKL protein in the salvianolic acid B group were higher than those in the osteoporosis group（P<0.05）．Conclusions The early stage of postmenopausal osteoporosis has certain effects on osteoporosis in mice,but more experiments are needed to verify the conclusions of this study．
目的 探索2型糖尿病(T2DM)男性患者血尿酸水平与骨密度(BMD)、临床骨折患病率的相关性。方法 选取广州市第一人民医院住院的T2DM男性患者192例,采用双能X线骨密度仪测定各部位BMD,记录年龄、糖尿病病程、BMI,检测血尿酸、空腹血糖、糖化血红蛋白、血脂、碱性磷酸酶等,并分析BMD与其余指标的相关性。结果 骨质疏松组血尿酸、各部位BMD均低于骨量正常组及低骨量组(P＜0.05)。血尿酸与各部位BMD正相关(P＜0.01)。右股骨颈BMD与年龄负相关,与空腹血糖正相关(P＜0.05)。多元Logistic回归分析显示,血尿酸与临床骨折呈负相关。调整年龄、空腹血糖、ALP等混杂因素后,血尿酸水平与临床骨折仍有关联。当进一步调整各部位BMD时,结果无统计学意义。结论 维持正常稍高的血尿酸水平可能有利于减少T2DM男性患者骨质疏松及脆性骨折的发生。
Objective To explore the correlation in serum uric acid level and bone mineral density (BMD) and fracture rate in male patients with type 2 diabetes mellitus (T2DM). Methods 192 cases of male patients with T2DM in Guangzhou First People's Hospital were selected in this study.BMD was measured by bone density machine. The patient's age, diabetes course and BMI were recorded. Fasting blood glucose, glycated hemoglobin (HbA1c), liver and kidney function, blood uric acid, blood lipid, alkaline phosphatase, 25 hydroxyvitamin D3 levels were measured, and the correlation between BMD and other indicators was analyzed. Results The serum uric acid level,lumbar and right femoral neck BMD in the osteoporosis group were lower than those in the normal and low bone mass groups (P<0.05). Serum uric acid was positively correlated with BMD values of lumbar spine and right femoral neck in male patients with type 2 diabetes (P<0.01). BMD value of right femoral neck was negatively correlated with age and positively correlated with fasting blood glucose (P<0.05). Multivariate logistic regression analysis showed a significant negative correlation between serum uric acid and clinical fractures in male patients with type 2 diabetes (model 1). When the model was adjusted for age, fasting blood glucose, ALP and other factors, serum uric acid levels were still associated with clinical fractures (model 2). When the BMD values of the lumbar spine and the right femoral neck were further included (model 3), the results were not statistically significant. Conclusion Slightly higher blood uric acid levels may help to reduce the incidence of OP and fracture rate in male patients with T2DM.
目的 探讨血碱性磷酸酶水平对维持性透析患者血管钙化与骨质疏松的评估价值。方法 纳入我院186例维持性透析患者,记录相关临床资料并完善实验室检查,以X线片评价血管钙化情况,双能X线吸收法检查骨密度。对上述资料进行双变量相关分析、ROC曲线分析等统计学处理。结果 血碱性磷酸酶水平与股骨颈骨密度负相关,与腹主动脉钙化评分正相关。腹主动脉钙化评分与骨密度负相关。ALP对骨质疏松及严重腹主动脉钙化诊断的ROC曲线下面积分别为0.777及0.701。结论 碱性磷酸酶是评估透析患者血管钙化骨质疏松的良好指标。
Objective To explore evaluation value of alkaline phosphatase in vascular calcification and osteoporosis in maintenance dialysis patients. Methods 186 patients in maintenance dialysis were enrolled in this study. The related clinical data was recorded. The examination of X-ray (lateral abdomens) was done to estimate vascular calcification in patients. Bone mineral density was measured by dual energy X-ray absorptiometry. The results above were analyzed by bivariate correlation analysis and receiver operator characteristic curve. Results By bivariate correlation analysis,serum alkaline phosphatase level was negatively associated with femoral neck bone mineral density, and was positively associated with abdominal aortas calcification scores. Abdominal aortas calcification scores were negatively associated with femoral neck bone mineral density. ROC curve revealed AUCs were respectively 0.777 and 0.701 for serum alkaline phosphatase level in diagnosis of osteoporosis and severe abdominal aortas calcification. Conclusion Alkaline phosphatase may be a good index to evaluate calcification and osteoporosis in maintenance dialysis patients.
目的 分析25羟维生素D[25(OH)D]在新疆汉族及维吾尔族老年男性2型糖尿病(T2DM)合并骨质疏松(OP)患者中的水平及与骨密度(BMD)的相关性。方法 收集住院的汉族、维吾尔族老年男性T2DM患者281例,根据民族及骨密度值将其分为汉族非骨质疏松(NOP)组127人(A组)、汉族骨质疏松(OP)组21人(B组)、维族NOP组103人(C组)、维族OP组30人(D组),记录四组患者的25(OH)D水平并进行比较,分析25(OH)D与BMD的相关性。结果 同一民族中,B组的25(OH)D低于A组(P<0.05),D组的25(OH)D低于C组(P<0.05); T2DM合并OP患者中,D组的25(OH)D低于B组(P<0.05); 相关性分析显示,25(OH)D与BMD呈正相关。结论 维吾尔族老年男性T2DM合并OP患者较汉族患者的25(OH)D水平低,25(OH)D水平低的T2DM患者更易合并OP,25(OH)D检测有助于识别T2DM患者合并OP的风险。
Objective To analysis the level of 25 hydroxy vitamin D[25(OH)D] in Xinjiang Han and Uyghur elderly male patients with T2DM and osteoporosis, and the correlation between 25(OH)D levels and bone mineral density(BMD). Methods We collected 281 cases of T2DM patients from Hans and Uyghurs, divided them into four groups according to the nationality and BMD: Han non-osteoporosis(NOP) group including 127 cases(group A), Han osteoporosis(OP) group 21 cases(group B), Uyghur NOP group 103 cases(group C), Uyghur OP group 30 cases(group D). Recorded and compared their 25(OH)D levels, and analyzed the correlation between 25(OH)D levels and BMD. Results In the same nationality,the level of 25(OH)D in group B were lower than those in group A(P<0.05), and group D were lower than those in group C(P<0.05); In T2DM patients combined with OP, the levels of 25(OH)D in group D were lower than those in group B(P<0.05); Correlation analysis showed that 25(OH)D was positively correlated with BMD. Conclusion The level of 25(OH)D in elderly male patients with T2DM combined with osteoporosis, those of Uyghurs are lower than those of Hans. T2DM patients with lower 25(OH)D level are more likely to combine OP. The 25(OH)D level test may help to identify the risk of combining OP in T2DM patients.
目的 评价综合营养干预措施与传统的单纯药物治疗对花都区老年原发性骨质疏松 (OP)患者生命质量的影响。方法 采用随机法将符合标准的OP患者随机分配到干预组(A组)和对照组(B组)接受相应的干预处理。干预组给予综合营养干预措施,而对照组只给予单纯的抗骨质疏松药物。结果 干预组人群干预前后生命质量的8个维度中的6个维度得分与干预前比较,差别有统计学意义(P<0.05)。 对照组人群生命质量的8个维度中只有2个维度与干预前比较,得分间差别有统计学意义(P<0.05)。结论 综合营养干预措施可以提高老年OP患者的生命质量。
目的 通过比较治疗组服药前、后骨密度及骨代谢指标的变化情况,并将治疗组、对照组分别作对比,观察壮骨颗粒治疗绝经后女性骨量减少及骨质疏松、改善其骨代谢的临床疗效。方法 将研究对象随机分为两组,治疗组服用壮骨颗粒＋迪巧,对照组只服用迪巧。结果 壮骨颗粒组治疗后血清中的PINP、β-Crosslaps及N-MID下降(P＜0.05);与治疗前相比,腰椎(L2-L4)BMD提高(P＜0.05);壮骨颗粒能改善绝经后女性骨代谢及提高骨密度的效果优于迪巧组。结论 壮骨颗粒是治疗绝经后女性骨量减少及骨质疏松、提高骨量、改善骨代谢情况的安全有效药物。
目的 探讨经皮微创技术应用股骨近端解剖锁定钢板治疗高龄骨质疏松粗隆间骨折的治疗。方法 我院自2009年12月—2013年6月共收治高龄骨质疏松粗隆间骨折56例,男35例,女21例;年龄76～94岁,平均81岁。所有患者应用股骨近端解剖锁定钢板通过经皮微创置入技术治疗。根据Harris髋关节功能评分对治疗效果进行评定。结果 56例手术时间30～90 min,平均45 min;术中失血量70～250 mL,平均110 mL。全部患者获随访,时间6～13.5个月,平均9.5个月。X线骨折愈合时间3～6个月,平均3.5个月。其中优41例,良12例。结论 对于高龄骨质疏松患者粗隆间骨折,采用经皮微创置入股骨近端解剖锁定钢板内固定治疗,具有手术创伤小、出血少、安全可靠等优点,有良好的临床应用价值。
Objective To study the application of proximal femur anatomic locking plate with minimally invasive percutaneous plate osteosynthesis (MIPPO) techniques in the treatment of senile osteoporosis curative effect of intertrochanteric fractures in elderly patients. Methods We have treated 56 elderly patients of senile osteoporosis intertrochanteric fractures in December 2009 to June 2013, including 35 male and 21 female cases, aged 76~94, the average of 81. All patients were applied in the proximal femur anatomic locking plate with minimally invasive percutaneous plate osteosynthesis technology according to Harris hip joint function scale curative effect. Results 56 cases of operation time 30~90 min, an average of 45 min. Intraoperative blood loss was 70~250 ml, an average of 110 ml. All patients received follow-up from 6 to 13.5 months, an average of 9.5 months. The X-ray fracture healing time was from 3~6 months, 3.5 months on average. According to the Harris hip joint function scale: 41 cases was excellent, 12 cases was good. Conclusion For the senile osteoporosis intertrochanteric fracture, using the proximal femur anatomic locking plate with minimally invasive percutaneous plate osteosynthesis technology can make minimal trauma, less bleeding reliable fixation,and has good clinical application value.
随着糖尿病发病率不断攀升，人们逐渐聚焦于糖尿病合并骨质疏松。围绕此疾病，国内外学者开展了广泛而深入的研究，临床实践聚焦于两点：糖尿病的精准治疗和骨质疏松的有效干预。在确保血糖稳定的基础上，致力于抑制骨吸收、促进骨形成。在此治疗理念指导下，临床医生应当更加全面了解血糖管理与抗骨质疏松药物的作用机制并合理应用，更大程度改善患者的临床症状及预后。然而，药物作用机制复杂，联合应用存在潜在药物相互作用问题。未来研究方向包括探索更安全有效的联合治疗方案，更加精确化地治疗以提高临床疗效。文章分析了降糖药物及抗骨质疏松药物对疾病的疗效，并展望未来的研究方向，旨在为临床实践提供更为深刻与全面的指导。
As the incidence of diabetes mellitus continues to rise，people are also gradually focusing on diabetes mellitus combined with osteoporosis，which puts patients at a higher risk of fragility fracture．Scholars at home and abroad have conducted extensive and in-depth research around this condition，and clinical practice has focused on two points：first，the precise treatment of diabetes，and second，the effective intervention of osteoporosis．On the basis of ensuring blood glucose stabilization，we are committed to inhibiting bone resorption and promoting bone formation．Under the guidance of this therapeutic concept，we should have a more comprehensive understanding of the mechanism of action of blood glucose management and anti-osteoporosis drugs and apply them rationally，aiming to improve the clinical symptoms and prognosis of patients to a greater extent through dual intervention．However，the mechanism of action of different drugs is complex，and there are potential drug-drug interactions and safety issues associated with their combined use．Future research directions should include exploring safer and more effective combination therapies，developing novel drugs，and more precise and individualized treatments to improve clinical efficacy．This article analyzes the efficacy of glucose-lowering drugs and anti-osteoporosis drugs on the disease and looks forward to future research directions，aiming to provide more profound and comprehensive guidance for clinical practice．
