| BackgroundOsteoporosis is defined as a disease characterized by low bone mass, low bone mineral density and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures. It is known to be a systemic disease that often happens in elderly people especially postmenopausal women. Of osteoporosis is fracture, which caused by fell or slight power, to lead to confined activity and the majority patients have a heart cerebrovascular disease, so it affects mostly women and elderly people in their late-life years. There are over one-quarter osteoporotic fractures annually in postmenopausal women in the US. Recently, the diagnostic and monitor treatment of osteoporosis depends on BMD, it is an effective and noninvasive method with objectivity and sensibility for extensive use, but owing to lacking reflect the change of sclerotin in early stage, low rate of diagnosis, it also used for limitations, so the compliance of the patient is not very good, it cann't effectively prevent osteoporosis and its complication.The bone remodeling processes: bone formation and bone resorption tightly coupled to be in the same reconstruction unit. The amount of bone mass depends on balance between bone resorption and formation, when the balance is upset-bone resorption more than formation, bone mineral and bone matrix reduce the same proportion, it is the outcome of bone metabolism. Changes in bone metabolism will inevitably bring about change in bone biochemcial in cell level. Recent researchers more and more widely used biochemical markers of bone metabolism in bone disease track treatment and differential diagnosis.Although bone metabolic markers such as serum BGP, PINP, BAP, TRACP-5b, urinary DPD, urinary CTX with high specificity and sensitivity play an important value in early diagnosis of osteoporosis, treatment, monitoring, evaluation and guidance of drug efficacy, their application in clinical practice is still relatively few small mostly for economic, education and other reasons. Currently low diagnosis rate and poor compliance with treatment at osteoporosis patients,higher rates of recurrent fractures after once osteoporotic fracture, especially in female patients. What is the difference in changes of bone metabolism markers between the patients with osteoporotic fracture and the young patient with fracture caused by high-energy injury such as a car accident? Why the higher incidence of fractures in elderly women than men? These issues deserve our further exploration. Moreover, In addition to early diagnosis, the treatment timing also plays an important role on prevention of postmenopausal osteoporosis and its complications. If not timely received the osteoporosis treatments, Whether there are therapeutic effect differences between the patients who not timely receive antiresorption treatment and the patients who accept early intervention when serious bone loss such as fractures occur?Objective1. To discuss the characters of bone metabolic markers of middle-aged and older people, to analysis the diagnosis estimated value in clinical application and variation difference between male and female osteoporosis with bone metabolic markers. Compare to the difference of bone metabolism in patients with kinds of fractures,to know the role of biochemical markers of bone turnover in osteoporotic fractures.2. To establish postmenopausal osteoporosis animal model, investigate changes of bone mass and bone metabolism in early antiresorptive treatment of postmenopausal osteoporosis, provide a basis of early detection and treatment of postmenopausal osteoporosis. Methods1.The study included 240 hospital patients in orthopaedics, The Second Affiliated Hospital of GuangZhou Medical, from June 2009 to June 2010.Bone mineral density (BMD) of anterior-posterior lumbar spines and fasting serum bone alkaline phosphatase (BAP) and tart rate-resistant acid phosphates isoform-5b were tested in 240 patients. Then statistic biochemical criterion value was used in each age stage(>40),different BMD groups(osteoporosis group, osteopenia group, normal group)and fracture factors(the young fracture group, osteoporotic fracture group) with man and woman respectively.2.we took the ovariectomized rats as experimental subjects and took Zoledronic as forming drug,44 female SD rats were 6 months old, they were randomly divided into A,B,C,D four groups ,such as sham group, OVX control group, OVX with early prevent group, OVX with late treat group. In addition to the sham group, the other groups underwent bilateral ovariectomy. The sham and OVX control groups were treated by placebo, the other two groups were received single intravenous dose of zoledronic acid 500μg/kg at 3 days,1 month after ovariectomy, we measured the femur bone mineral density and observed the change of procollagenⅠN-terminal propeptide and tart rate-resistant acid phosphates 5b in serum at the trials start, after 1 month and after 3 months animals were sacrificed respectively, we also observed pathological changes with light microscope and bone histomorphometry TBV, Tb.Th and Tb.Sp changes though image analysis system of rat femur after the experiment.Results1. Middle-aged and senile men's BAP lowered down and serum TRACP-5b rised with growth of age, but they are less than women (p<0.05). Middle-aged and senile women's BAP and TRACP-5b significantly rised from 50 years old to 69 years old and higher than other age groups (p<0.05), they showed the lowering trend after 70 years old. BAP of middle- aged and senile men osteoporosis group and osteopenia group was lower than that of normal group while the TRACP-5b was higher than that of normal group(p<0.05).BAP,TRACP-5b of middle-aged and senile women osteoporosis group and osteopenia group was higher than that of normal group (p<0.05).BAP, of female higher than that of men at the osteoporotic fracture groups(t=2.672 p<0.05).TRACP-5b of elderly osteoporotic fracture caused by low energy was higher that of the young fracture caused by high energy while the BAP was lower than that of the young fracture group, there was significant differences.2.There was significant difference between the OVX control group and the control group in BMD, serum PINP and TRACP5b,TBV,Tb.Th and Tb.Sp after 1 month of ovariectomy(p<0.01);There was no significant difference between the early prevent groups that 3days after ovariectomy and the control group in them(p>0.05). Only partially restored bone mineral density in the groups after one month of ovariectomy; There was significant difference between the late treatment groups and the early prevent groups in serum PINP and TRACP5b,TBV,Tb.Th and Tb.Sp and the trabecular connectivity has obvious degeneration(p<0.01).Conclusion1. The serum BAP and TRACP-5b are specific and sensitive markers for giving expression to bone formation and bone resorption. Therefore, to test serum BAP and TRACP-5b contributes to the early diagnosis and prevention from primary osteoporosis.2. we suggest that they should regularly test the biochemical markers of bone in postmenopausal women, Once the abnormal bone turnover markers, should be considered anti-osteoporosis therapy. The elderly bone resorption is rised after fracture, the ability of bone formation is not as well as young men, it is not conducive to the healing of fractures and the elevated risk of re-fracture. Long-term monitoring the bone metabolic markers of middle-aged and senile people or fracture patients even the women can not only raise the diagnosis of primary osteoporosis, but also greatly improve the treatment compliance.3. The OP postmenopausal animal model created by the excision of ovary on the rats is successful.4. The postmenopausal OP animal model created by the excision of ovary on the rats is successful; Bone metabolic markers can be used for early monitoring of therapeutic effect of anti-bone resorption; Early prevent treatment for the ovariectomized rats can inhibit bone loss and slow down the degeneration of trabecular bone, recovery bone mineral density. |
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