About the Author.
Doctor of Medicine, Master of Clinical Epidemiology, Chief Physician, Doctoral Supervisor of Endocrinology, is currently the Director of the Department of Geriatrics at Zhongshan Hospital Affiliated to Fudan University. Member of the Geriatrics Branch of the Chinese Medical Association and leader of the Osteoporosis Group, Vice Chairman of the Geriatric Branch of the Chinese Society for Prevention, Member of the Standing Committee of the Geriatric Branch of the Chinese Women Physicians Association, Vice Chairman of the Endocrinology Expert Committee of the Osteoporosis Branch of the Chinese Gerontology and Geriatrics Society, Member of the Cardiovascular and Cerebrovascular Disease Professional Committee of the Chinese Gerontology Society, Member of the Gerontology Group of the Chinese Society of Enteral and Parenteral Nutrition, Vice Chairman of the Osteoporosis Branch of the Shanghai Medical Association, Member of the Geriatric Branch of the Shanghai Medical Association and Leader of the Endocrinology Group, aging He is a member of the editorial board of many journals such as Medicine, Chinese Journal of Geriatric Multi-organ Diseases, International Diabetes, Geriatrics and Health Care, executive editorial board member of "Practical Internal Medicine", and reviewer of many domestic and foreign journals.
1) Research progress on osteoporosis risk factors and clinical diagnosis.
1.The Expert Consensus on the Clinical Application of Bone Metabolism Biochemical Indicators (2023 Revised Edition) was released. In April 2023, in order to better guide clinical practice, improve the diagnosis, ** and prevention level of osteoporosis and other diseases, and serve clinical needs, the Expert Consensus on the Clinical Application of Bone Metabolism and Biochemical Indicators (2023 Revised Edition) was released. The consensus classifies the bone metabolism indexes, and introduces the common detection methods and advantages and disadvantages of various indicatorsThe mechanism of various indexes in the occurrence and development of osteoporosis and other bone diseases and the possible variation factors of various indicators in the detection process were describedThe consensus emphasizes the important role of bone metabolism biochemical indexes in the diagnosis and differential diagnosis of osteoporosis, fracture risk and anti-osteoporosis efficacy, and gives specific application suggestions.
2.A real-world retrospective study found that people with cirrhosis had an increased risk of osteoporosis and those with fractures had a high risk of death. The study conducted a retrospective study of outpatients** with compensated and decompensated cirrhosis identified in a single health system over a 6-year period, extracting patient demographics, liver and bone health comorbidities, DEXA scan results, and drug use. The study found that 5398 patients (444%) met the criteria, mostly whites and older adults, of whom 64Decompensated cirrhosis occurred in 6% of patients, and DEXA suggested 48Osteopenia occurs in 5% of patients, 30Osteoporosis occurs in 2% of patients, but only 226% of patients with osteoporosis receive**. Studies suggest that the majority of people with cirrhosis have osteopenia or osteoporosis, but less than a quarter of people with osteoporosis start receiving it**.
3.Studies have found associations between different types, disease durations, and microangiopathies in patients with diabetes mellitus and fracture risk. The study selected 502,221 participants in the UK Biobank database, of which type 1 diabetes accounted for 03, 0 for males4, while type 2 diabetes mellitus is 32 and 65％。The results showed that the risk of fracture was increased in patients with both types of diabetes, and there was no gender difference. The risk of fractures in type 2 diabetes is related to the course of the disease, with a significantly increased risk in patients with a 5-year history [IRR: 2.].75(1.10,6.87)] , but the risk is not increased in patients with disease lasting less than five years [0.].42(0.16,1.09)]。In addition, people with diabetic microangiopathy have a higher risk of fracture [irr 231(1.91,2.79)]。With the increase of the number of complications, the risk of fracture increased, suggesting that the fracture risk of diabetic patients was poorly correlated with fat content, bone mineral density and C-reactive protein, while the correlation with the course of diabetes mellitus and chronic complications was better.
2) Suggestions and research progress on the application of vitamin D and analogues of active vitamin D.
1.Idecalciferol ** Postmenopausal osteoporosis Chinese expert recommendations released. In May 2023, the Chinese expert recommendation for idecalciferol** postmenopausal osteoporosis was released, which fully summarized and summarized the existing idecalciferol-related research and evidence-based evidence, and elaborated the mechanism of action, pharmacokinetic characteristics, clinical effectiveness, use regimen and other related contents of idecalciferolAnd give corresponding answers to the clinical problems that clinicians are widely concerned about when using idecalciferol in the form of questions and answers. Idecalciferol is a new type of active vitamin D, which introduces 3-hydroxypropoxy group at the 2nd position of 1,25(OH)2D3, which makes it more firmly bound to vitamin D-binding protein (DBP), increases the half-life of idecalciferol in the blood, the half-life of normal 1,25(OH)2D3 in the body is about 6 8 hours, and the action time of idecalciferol is significantly prolonged. Active vitamin D is recommended for some patients with senile osteoporosis, renal insufficiency, or -hydroxylase deficiency without the need for additional calcium supplementation.
2.The study found that idecalciferol inhibits bone marrow mesenchymal stem cell (BMSC) senescence by regulating SIRT1-NRF2 signaling, thereby preventing osteoporosis. In this study, an ovarian resection (OVX) rat model was established, 30 ng kg of idecalciferol was orally administered once a day, the body weight of the rats was recorded regularly, microcomputed tomography (CT) and histochemical staining were used to assess bone mass, histological parameters and aging-related factors, and rat bone mesenchymal stem cells were extracted and cultured in vitro, and senescent cells were labeled with senescence-related -gal staining. RT-PCR, Western blot, immunofluorescence staining and other methods were used to detect the levels of mRNA and protein of aging-related factors, as well as the signal of SIRT1-NRF2, and the level of reactive oxygen species (ROS) was detected by DCFH-da staining. Results: Idecalciferol prevented bone loss and inhibited weight gain in ovariectomized rats. Idecalciferol significantly ameliorates oophorectomy-induced senescence of bone mesenchymal stem cells. In addition, idecalciferol increased the expression of SIRT1 and NRF2 in ovariected rat bone mesenchymal stem cells, showing an inhibitory effect on the level of reactive oxygen species in bone mesenchymal stem cells. The results showed that idecalciferol could inhibit the cellular senescence of osteomesenchymal stem cells in ovariectomized rats by regulating SIRT1-NRF2 signaling, thereby preventing bone loss caused by osteoporosis.
3.Idecalciferol (ELD) prevents muscle wasting and osteoporosis caused by suspension tail mice. Six-week-old C57BL 6J male mice were randomly divided into four groups: control group, tail suspension group, and ELD low-dose group (35 ng times) and ELD high-dose group (5 ng times). Mice are intraperitoneally injected with ELD twice a week for three weeks. The results showed a decrease in gastrocnemius (GAS), tibialis anterior (TA), and soleus (SOL) muscle weight in suspension-tailed mice. 7% and 423%, the cross-sectional area of gas decreased by 186%, while the decrease in these indicators was not significant in the ELD intervention mice. In addition, ELD prevented the increase in myofibrillar protein levels caused by tail suspension and also prevented the increase in levels of atrogin-1 and MURF-1 (two markers of muscle atrophy) caused by tail suspension. In addition, ELD prevented the reduction in cortical and cancellous bone mineral density of the distal femur due to tail suspension, while bone tissue volume (TV) did not show any change between groups, while trabecular bone volume as a percentage of total bone tissue volume (BV TV) improved in the ELD group by 122 compared to the control group7%(p<0.05)。More often than not, the oxidative stress of mice in the ELD group was significantly improved compared with the control group (P<0.).05)。These results suggest that idecalciferol can prevent muscle wasting and bone loss caused by weight loss.
4.The Role of Vitamin D3, Omega-3 and Simple Home Exercise Programs—A Randomized Controlled Pilot Study (DO-HEALTH) of Older Adults in Europe. The study was a re-analysis of the DO-HEALTH study, a 3-year, multicenter, double-blind, randomized controlled study of 1486 older adults (aged 70 years) who were followed for 3 years in four study centers with vitamin D3 2000IU D, omega-3 1 g d, or a simple home exercise program (30 minutes each time, 3 times a week). To see if vitamin D3, omega-3, or a simple home exercise program, alone or in combination, improves bone mineral density in the lumbar spine, femoral neck, or total hip joints in older European adults. The results showed that there was a significant difference in the mean change of bone mineral density in the whole hip area in the vitamin D3 group compared with the group without vitamin D3. There was a significant difference in mean changes in bone mineral density in the whole hip area between the vitamin D3 + omega-3 and omega-3 groups compared to the no vitamin D3 and no omega-3 groups. Subgroup analysis showed a significant interaction between sex and vitamin D3 in lumbar area bone mineral density (p=0.).003)。Vitamin D3 significantly increased lumbar spine area bone mineral density in men over 3 years compared to no vitamin D3, but there was no difference in women. Studies have shown that daily vitamin D3 supplementation, or a combination of omega-3, in generally healthy and active older adults can slightly improve bone mineral density in the whole hip area.
3) Research progress on osteoporosis**.
1.2023 Asia-Pacific Consensus—Prevention of osteoporotic fractures in postmenopausal women with low bone mass or osteoporosis but no fragility fractures. At the beginning of 2023, the American College of Physicians released the consensus on "Prevention of Osteoporotic Fractures in Postmenopausal Women with Low Bone Mass or Osteoporosis but No Fragility Fractures". The consensus is aimed at postmenopausal women with low bone mineral density or osteoporosis but no fragility fractures in the Asia-Pacific region, and a total of ten consensus statements have been issued to prevent fractures, including:1Postmenopausal women with no history of fragility fractures, if they are at high risk of fractures, may be able to use medications** to prevent fractures. 2.For the prevention of fragility fractures in postmenopausal women, raloxifene, alendronate, and risedronate are accepted options. 3.For postmenopausal women with low bone mass or osteoporosis, zoledronic acid is effective in preventing fragility fractures. 4.Denosumab and romosumab may be considered in postmenopausal women who are at high risk of fracture but have not previously had a fragility fracture. 5.Menopausal hormones** (MHT) have substantial data to support the prevention of fragility fractures, but should be used with caution in clinical practice. 6.There is limited evidence for the prevention of fragility fractures in postmenopausal women with osteoporosis but no fragility fractures, such as ibandrozone, teboxone, bazexifene, lasoxifene, teriparatide, and abaparatide. 7.Evaluation of the efficacy of prevention of fragility fractures can be determined by changes in bone turnover markers, bone mineral density, imaging, and clinical fractures. 8.Individuals at high risk of fracture should be given medications to prevent osteoporotic fractures**. 9.For long-term** regimens, further research is needed in terms of safety, efficacy, economic burden, racial disparities, and drug selection for the prevention of osteoporotic fractures. 10.Non-pharmacological management strategies are necessary and should be used in combination with medications**.
2.The American College of Rheumatology has published guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis. In early 2023, the American College of Rheumatology released the Guidelines for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis, which updated the use of daily glucocorticoids for patients with rheumatic or non-rheumatic diseases25mg 3 months to induce osteoporosis (GIOP) is recommended. Guidelines recommend that these patients be assessed for fracture risk and clinical fracture risk as soon as possible, and strongly recommend medications for intermediate, high, or very high fracture risk**. Including oral or intravenous bisphosphonates, denosumab, or parathyroid hormone analogues, osteogenesis drugs are conditionally recommended as an initial ** for those with a high and very high risk of fracture. The guidelines cover special populations, including children, organ transplant recipients, people who may become pregnant, and people receiving very high doses of glucocorticoids**.
3.A 10-year follow-up survey of a cohort within the private healthcare system. The study found that the use of bisphosphonates after hip fracture can help prevent second fractures and reduce morbidity and mortality after fractures. The study, which evaluated the long-term effects of bisphosphonates after hip fracture on mortality and morbidity, included a total of 965 patients, 39% of whom were treated with bisphosphonates for secondary prevention within one year of hip fracture. The results showed that the first-year mortality rate was 149%, 73 years later2% with a median survival of 56 years. The median survival of hip fracture patients receiving bisphosphonate** was 8At 33 years, the median survival of patients who did not receive ** was 4Year 06 (p<00001), there was still a significant difference after propensity score matching (PSM) (p=0.).022)。In addition, the median readmission-free survival was 2In 93, the number of patients using bisphosphonates** increased to 4In 02, 2 were patients who did not use bisphosphonates**09 (p<00001), there is still a difference after PSM (p = 0.).045)。The study showed that the use of bisphosphonates for secondary prevention remains an independent factor in survival and readmission-free survival, and that bisphosphonates have a positive effect on survival and readmission rates.
4.A real-world assessment of the patterns and outcomes of osteoporosis after fragility fractures. Initiation and persistence after fragility fractures are critical to reducing the risk of subsequent fractures, and one study evaluated the management and outcomes of post-fracture osteoporosis, a retrospective cohort study that used real-world data from patients (older than 50 years) to assess the management of osteoporosis at least 12 months after the fracture of the first case, and to assess the incidence of secondary fractures and high-risk subgroups. Results suggest that among 755,312 eligible patients, a low proportion of bone mineral density tests were performed at 12 months after fracture [64,932 (8.)6%)] of which 753% of patients were older than 65 years, and most patients (88.)6%) were not received at any time after the fracture**. Of the patients who received **, the majority (649%) initially with bisphosphonates** (937%；Venous users accounted for 63%)。During the follow-up period, 13Secondary fractures occurred in 6% of patients, and fractures were more common in the subgroup considered to be at high risk of fracture than in the general population. This study demonstrates the need for better management of patients after fractures.
5.A comparison of the efficacy of romolimab in postmenopausal women in Japan followed by zoledronic acid or denosumab. The study compared the effects of switching from romosumab (RMAB) to denosumab (DMAB) or zoledronic acid (ZOL) in terms of changes in bone mineral density and bone metabolism. This study enrolled 100 patients who received RMAB** (49 patients received bisphosphonates (BP)**, 51 patients received active vitamin D3 analogues**, 42 patients switched to ZOL (20 patients received bisphosphonates beforehand), and 58 patients switched to DMAB (29 patients received bisphosphonates beforehand). Studies evaluated changes in bone metabolism markers (P1NP and TRACP-5B) and bone mineral density. Patients who received bisphosphonates (BP)** in advance switched to the ZOL group had an increase in TRACP-5B and a significantly lower mean bone mineral density in the lumbar spine at 24 months than in the other groups. In patients receiving ZOL**, changes in bone mineral density after 24 months correlated with TRACP-5B values at baseline and 12 months, while patients receiving DMAB** were associated with TRACP-5B values at baseline. The study confirms that TRACP-5B can be used as an important indicator of the efficacy of RMAB sequential and priorit.
References: 1Expert Consensus on the Clinical Application of Bone Metabolism Biochemical Indicators in Chinese Journal of Osteoporosis (2023 Revised Edition). Chin J Osteoporosis 2023,29(4):469-476
2.mary thomson, adam scott，et al. low screening rates and high prevalence of osteoporosis in cirrhosis: a real-world retrospective analysis[j].aliment pharmacol ther. 2023 dec 7. doi: 10.1111/apt.17823
3.Chinese Society of Osteoporosis and Bone Mineral Diseases Branch Idecalciferol**Postmenopausal osteoporosis Chinese expert recommendations. Chin J Osteoporosis and Bone Mineral Diseases 2023,16(3):189-196 doi:103969/j.issn.1674-2591.2023.03.001
4.yuying kou，xing rong et al.eldecalcitol prevented ovx-induced osteoporosis through inhibiting bmscs senescence by regulating the sirt1-nrf2 signal[j]. front pharmacol 2023,3(14): 1067-085. doi:10.3389/fphar. 2023. 1067085.
5.chun-feng huang, jung-fu chen ,et al. asia-pacific consensus on osteoporotic fracture prevention in ostmenopausal women with low bone mass or osteoporosis but no fragility fractures.journal of the formosan medical association. doi.org/10.1016/j.jfma.2023.01.013
6.mary beth humphrey,linda russell, et al. 2022 american college of rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis[j].arthritis & rheumatology 2023.doi 10.1002/art.42646
7.andrea j singer,setareh a williams，et al. an evaluation of treatment patterns for osteoporosis and outcomes after a fragility fracture in a real-world setting[j]. j orthop trauma 2023,37(4):e159-164.
8.tetsuro oue1，tomohiro shimizu et al.comparison of the efcacy of zoledronate acid or denosumab after switching from romosozumab in japanese postmenopausal patients[j].calcifed tissue international (2023) ，112:683–690.
This article was originally published on "Healthy Aging" on December 20, 2023, by Hu Yu, Department of Geriatrics, Zhongshan Hospital, Fudan University.