Objective To explore the relationship between periodontitis and postmenopausal osteoporosis.Methods Databases were electronically searched from PubMed (1966 to December, 2010), EMbase (1974 to December, 2010), CBM (1978 to December, 2010), VIP (1989 to December, 2010), CNKI (1979 to December, 2010) and WanFang Data (January, 2007 to December, 2010), and the references listed in all papers were also retrieved. The literature was screened according to the inclusion and exclusion criteria by two reviewers independently; the methodology quality was evaluated after data abstraction; and then the RevMan 5.0 software was used for meta-analyses. Results Four trials were included. Among the total 678 patients involved, 263 were postmenopausal osteoporosis patients, while the other 415 were non-osteoporosis patients. The results of meta-analyses showed that: a) Clinical attachment loss (CAL) of the postmenopausal osteoporosis patients was significantly higher than that of the non-osteoporosis patients (WMD=0.60, 95%CI 0.23 to 0.96); b) The level of gingival recession of the postmenopausal osteoporosis patients was significantly higher than that of the non-osteoporosis patients (WMD=0.78, 95%CI 0.41 to 1.14); c) There were no significant differences in plaque index (PI), gingival index (GI) and periodontal probing depth (PPD) between the two groups (WMD=0.17, 95%CI 0.00 to 0.35; WMD=0.05, 95%CI –0.09 to 0.19; and WMD=–0.08, 95%CI –0.24 to 0.09); d) The results of one study indicated that the rate of periodontitis in the postmenopausal osteoporosis patients was higher than that of the non-osteoporosis patients (OR=2.45, 95%CI 1.38 to 4.34, Plt;0.01); the severe alveolar crest height loss was related to osteoporosis (OR=4.20, 95%CI 1.57 to 11.22, Plt;0.01). Conclusion Postmenopausal osteoporosis patients are more prone to suffer from periodontitis or turn to the worse stage of periodontitis. In consideration of the factors such as small scales and incomplete measure indexes of the included studies, which have influences on the intensity and comprehensiveness of this conclusion, more high-quality studies are required.
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。
Objective To establish a rapid, simple, and economic method to prepare osteoporosis (OP) in vitro model. Methods Eighty pairs of fresh goat femur were collected from 18-month-old female goats and were randomly divided into 4 groups (20 pairs in each group). The femur was immersed decalcifying solution (18% EDTA) for 1-5 days (group B), 6-10 days (group C), and 11-15 days (group D), while group A had no treatment as control. Four pairs of femur were taken out every day. Quantitative computed tomography was used to scan the medial and lateral femoral condyles, and the bone mineral density (BMD) was calculated. Electronic universal testing machine was used to do three-point bending test and compress and tensile ultimate strenght test, and the mechanical parameters for femur were calculated. Results With demineralized time passing, BMD of the medial and lateral femoral condyles were downtrend in groups A, B, C, and D, showing significant differences among 4 groups (P lt; 0.05); BMD of the lateral femoral condyle was significantly higher than that of the medial femoral condyle in each group (P lt; 0.05). The three-point bending test showed that broken load, ultimate strength, and elastic modulus of groups A and B were significantly higher than those of groups C and D (P lt; 0.05); but no significant difference was found between groups A and B, and between groups C and D (P gt; 0.05). Compress and tensile ultimate strength test showed that the compress and tensile ultimate strengths were significantly higher in group A than in groups C and D (P lt; 0.05), and in group B than in group D (P lt; 0.05), but no significant difference was found between groups A and B, between groups B and C, and between groups C and D (P gt; 0.05). Conclusion The 18% EDTA immersing for 6-15 days is a fast, simple, economical method to prepare an OP in vitro model of goat femur.
【Abstract】 Objective To study the effectiveness of computer assisted pedicle screw insertion in osteoporotic spinalposterior fixation. Methods Between December 2009 and March 2011, 51 patients underwent pedicle screw fixation using the computer assisted navigation (navigation group), while 41 patients underwent the conventional technique (traditional group). All patients had osteoporosis under the dual-energy X-rays absorptiometry. There was no significant difference in age, gender, bone mineral density, involved segment, preoperative complications, and other general status between 2 groups (P gt; 0.05). The amount of blood loss, the operation time, the rate of the pedicle screw re-insertion, and the postoperative complication were observed. The state of the pedicle screw location was assessed by CT postoperatively with the Richter’s classification and the fusion state of the bone graft was observed using three-dimensional (3-D) CT scans during follow-up. Results A total of 250 screws were inserted in navigation group, and 239 were inserted successfully at first time while the other 11 screws (4.4%) were re-inserted. A total of 213 screws were inserted in traditional group, and 190 were successful at first time while 23 screws (10.8%) were re-inserted. There was significant difference in the rate of screws re-insertion between 2 groups (χ2=6.919, P=0.009). Both the amount of blood loss and the operation time in navigation group were significantly less than those in traditional group (P lt; 0.05). According to Richter’s classification for screw location, the results were excellent in 240 screws, good in 10 screws innavigation group; the results were excellent in 191 screws, good in 21 screws, and poor in 1 screw in traditional group. Significant difference was noticed in the screw position between 2 groups (χ2=7.566, P=0.023). The patients were followed up (7.8 ± 1.5) months in navigation group and (8.7 ± 1.5) months in traditional group. No loosening, extraction, and breakage of the pedicle screw occurred in navigation group, and all these patients had successful fusion within 6 months postoperatively. While in traditional group, successful fusion was shown in the other patients by 3-D CT, except the absorption of bone graft was found in only 1 patient at 6 months after operation. And then, after braking by adequate brace and enhancing the anti-osteoporotic therapy, the bone graft fused at 9 months postoperatively. Conclusion The computer assisted navigating pedicle screw insertion could effective reduce the deviation or re-insertion of the screws, insuring the maximum stabil ity of each screw, mean while it can reduce the exposure time and blood loss, avoiding complication. The computer assisted navigation would be a useful technique which made the pedicle screw fixation more safe and stable in patients with osteoporosis.
Objective To summary the functional roles and molecular mechanisms of microRNA (miRNA) in osteoblast differentiation so as to supply information for basic and cl inical researches. Methods Recent l iterature concerning miRNA in osteoblast differentiation was reviewed. The information was classified and summarized. Results miRNAs critically regulate bone morphogenetic protein, transforming growth factor β, and Wnt/β-catenin signal ing pathways during osteoblast differentiation. In pathological conditions, especially in some disorders of abnormal osteoblast differentiation, downregulated miRNA expression has been observed. Conclusion miRNA may represent a novel biomarker for diagnosis, and a candidate target therapies for the disorders with abnormal osteoblast differentiation.
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.
Objective To explore the differences between transient osteoporosis of the hi p (TOH) and bone marrow edema (BME) associated with osteonecrosis of the femoral head (ONFH) in terms of cl inical practice and imaging. Methods From January 2006 to February 2008, 5 hips of TOH in 5 cases (1 male and 4 females, aged 29-42 years) and 67 hips of BME associated with ONFH in 63 cases (53 males and 10 females, aged 18-70 years) were analyzed. According to ARCO classification, there were 23 hi ps of stage II, 43 hi ps of stage III, and 1 hi p of stage IV. The induced factors, the degree of pain, the duration of pain and commemorative symptoms were compared. The X-ray, MRI and ECT were also compared. Results There were no differences in induced factors, the degree of pain, joint effusion and ECT between TOH and BME associated with ONFH. TOH had no risk factors, antecedent symptoms and commemorative pain. There were 2 hips with TOH which showed osteopenia on X-ray films. The location of edema was in the superior part or the whole femoral head.A total of 65 hips with BME associated with ONFH had related causes of disease, 10 had antecedent pain and 59 had change of hardening on X-ray films. The X-ray films showed sclerotic area and the edema changes on MRI surrounded the necrotic lesion. The pain just amel iorated when BME disappeared. Conclusion There are differences between TOH and BME associated with ONFH on symptoms, X-ray films and MRI.
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.
Objective To assess the efficacy and safety of parathyroid hormone (PTH) on bone mineral density (BMD) and fractures in postmenopausal women with osteoporosis. Methods We searched MEDLINE (1966 to March 2008), EMBASE (1974 to March 2008), The Cochrane Library (Issue 1, 2008), Current Controlled Trials, The National Research Register, CBM (1983 to March 2008) and CNKI (1994 to March 2008). Some related journals were hand searched as well. The quality of included randomized controlled trials (RCTs) was evaluated and meta-analysis was conducted by The Cochrane Collaboration’s software RevMan 4.2.10. Results Twelve studies involving 5550 patients were included. PTH alone or in combination with antiresorptive drugs reduced the risk of vertebral fracture (RR=0.34, 95%CI 0.26 to 0.45, Plt;0.000 01), and increased spine BMD (SMD 0.41, 95%CI 0.17 to 0.65, P=0.0009) and femoral neck BMD (SMD 0.13, 95%CI 0.03 to 0.22, P=0.008). The rate of drop out and loss to follow-up because of adverse events was significantly higher in the PTH group (Peto-OR=1.69, 95%CI 1.39 to 2.05, Plt;0.000 01). Conclusion PTH is effective in the prevention and treatment of postmenopausal osteoporosis, especially in patients with preexisting osteoporotic fractures or with very low bone density. PTH alone or in combination with antiresorptive drugs can reduce the risk of vertebral fractures and increase spine and femoral neck BMD. PTH is more effective than alendronate, but these two should not be used as a combined treatment.