Study On TCM Syndrome Distribution Of Primary Osteoporosis And Pathogenesis Characteristics Of Brittle Fracture

Objective: In view of the high incidence and prevalence of primary osteoporosis(POP),the distribution of traditional Chinese medicine(TCM)syndromes and the characteristics of brittle fracture were explored from the perspective of TCM,which would provide new ideas for the early prevention and treatment of osteoporosis,as well as keeping away from osteoporotic fracture,and play a unique advantage in better guiding TCM syndrome differentiation and TCM prevention and treatment of osteoporosis.Methods: According to the strict admission and exclusion criteria,subjects were included in Jinan municipal hospital,Yikang community,Wendong community,Yanshan community,Shunyu community and our osteoporosis clinic.The general situation,physical examination,information of TCM syndrome,history of brittle fracture and its fracture characteristics were collected.The bone mineral density of the forearms(all)and lumbar vertebrae L1–L4 and the whole hip were measured by a dual-energy X-ray absorptiometry.In addition,patients with primary osteoporosis were differentiated according to the strict diagnostic criteria of TCM syndrome differentiation and spss22.0 was used for statistical analysis of the general situation of included subjects,the distribution of TCM syndrome differentiation and the characteristics of brittle fracture.Results:1.A total of 303 subjects were finally included in the study,including226 patients with primary osteoporosis(osteoporosis group)and 77 participants with normal bone mass(normal bone mass group).The proportion of women was higher than that of men.The data analysis and comparison between the two groups showed that the age of the osteoporosis group was significantly higher than that of the normal bone mass group,and the height,weight,body mass index(BMI)and bone mineral density(BMD)levels were significantly lower than those of the normal bone mass group(P<0.01).The brittle fracture rate in the osteoporosis group was much higher than that in the normal bone mass group,and the difference was statistically significant(P<0.01).2.In the osteoporosis group,the TCM syndrome types were distributed as follows: 78 cases with spleen and kidney yang deficiency,58 cases with liver and kidney yin deficiency,57 cases with kidney deficiency and blood stasis,and 33 cases with spleen and stomach weakness,with the constituent ratios of 34.5%,25.7%,25.2%,and 14.6%,respectively.There was no significant difference in gender,age,height,weight,and BMI among the four syndrome groups(P>0.05).As for the comparison of BMD data,the BMD of the kidney deficiency and blood stasis syndrome type group was lower than that of other groups,and the BMD of the forearms(all)and lumbar vertebrae L1-L4 was significant and the difference was statistically significant(P<0.05).3.Among 226 cases of primary osteoporosis,there were 103 cases(45.6%)with brittle fracture(brittle fracture group)and 123 cases(54.4%)without brittle fracture(non-brittle fracture group).The sites of brittle fracture from high to low were: vertebral body(47.5%),limb(31.6%),rib(12.2%),hip(5.8%)and pelvis(2.9%).There was no significant difference in sex,age,height,weight,BMI between the brittle fracture group and the non-brittle fracture group(P > 0.05).There was no significant difference in forearm(all)BMD and hip overall BMD between the two groups(P>0.05).Compared with lumbar L1–L4 BMD,the bone mineral density of the brittle fracture group was significantly lower than that of the nonbrittle fracture group(P<0.01).4.The incidence rates of fragile fractures among the four syndrome groups were different,from high to low,in descending order: kidney deficiency and blood stasis syndrome,spleen and kidney deficiency syndrome,liver and kidney yin deficiency syndrome,and spleen and stomach deficiency syndrome,and the differences were statistically significant(P<0.01).In the fragile fracture group,there were 24 cases with liver and kidney yin deficiency,34 cases with spleen and kidney yang deficiency,38 cases with kidney deficiency and blood stasis,and 7 cases with spleen and stomach deficiency.Among the subjects who suffered from vertebral body brittle fracture,there were 8 cases with liver and kidney yin deficiency syndrome,16 cases with spleen and kidney yang deficiency syndrome,29 cases with kidney deficiency and blood stasis syndrome,and 1 case with spleen and stomach deficiency syndrome,accounting for 33.3%,47.1%,76.3%,and 14.3%of all the syndromes in the brittle fracture group,respectively.The incidence of vertebral body brittle fracture in patients with different TCM syndromes was statistically significant(P<0.01).Further pairwise comparison,the incidence of vertebral body brittle fracture in patients with kidney deficiency and blood stasis syndrome was statistically significant compared with that of liver and kidney yin deficiency syndrome and spleen and stomach deficiency syndrome(P<0.008),and the differences among the other groups were not statistically significant(P>0.008).The incidences of brittle fracture of remaining limbs,brittle fracture of ribs,and brittle fracture of hip and pelvis were not statistically significant between the syndrome groups(P> 0.05).Conclusion:1.Compared with those with normal bone mass,the patients with osteoporosis had higher age,lower height,weight,BMI and bone density,and higher incidence of brittle fracture2.The TCM syndrome type distribution of primary osteoporosis patients was kidney-yang deficiency of spleen and kidney,with the highest frequency,followed by liver and kidney yin deficiency,kidney deficiency and blood stasis syndrome,and spleen and stomach deficiency syndrome with the lowest frequency.Among the four syndrome types,the patients with kidney deficiency and blood stasis syndrome had the lowest bone mineral density,and it was speculated that the patients with kidney deficiency and blood stasis syndrome had a higher risk of bone mineral density reduction,which should be paid attention to in clinical practice.3.The vertebral body is the most common site of brittle fracture in patients with primary osteoporosis.Osteoporotic patients with brittle fractures have lower bone mineral density,especially in the lumbar spine.4.Among the four TCM syndrome types,the kidney deficiency and blood stasis syndrome is the one with the highest incidence of fragile fracture;the incidence of fragile fracture of vertebral body in the kidney deficiency and blood stasis syndrome is higher than that in the other three syndrome types;the kidney deficiency and blood stasis syndrome is the main syndrome for fragile fracture of vertebral body;therefore,prevention and timely intervention are required in clinical practice.