BACKGROUND & AIMS: :The cause-effect relationship between iron deficiency anemia (IDA) and osteoporosis has not been established in the general population. Thus, the current longitudinal study determined the role of IDA as a risk factor for osteoporosis by analyzing a large nationwide population-based sample. In a sample of 1,000,000 randomly sampled individuals from the 1998-2012. Taiwan National Health Insurance Research Database, patients with IDA (case group (n = 35,751)) and individuals without IDA (control group (n = 178,755)) were compared. Patients who were <20 years of age and who had pre-existing osteoporosis prior to the diagnosis of IDA were excluded. Each patient with IDA was age- and gender-matched to five individuals without IDA. The diagnoses of IDA and osteoporosis (coded using ICD-9CM) were further confirmed with blood test results and X-ray bone densitometry to ensure the accuracy of the diagnoses. Osteoporosis occurred more often among patients with IDA compared to individuals without IDA (2.27% vs. 1.32%, p < 0.001). Cox proportional hazard analysis revealed that the risk for osteoporosis was significantly higher in the case than the control group (hazard ratio (HR) = 1.74; 95% CI = 1.61-1.88) and remained similar after adjustment for covariates (adjusted HR = 1.81; 95% CI = 1.67-1.97). Compared with individuals without IDA, the risk for osteoporosis was even higher for patients with IDA who received intravenous ferrum therapy (adjusted HR = 2.21; 95% CI = 1.85-2.63). In contrast, the risk for osteoporosis was reduced for patients with IDA who received a blood transfusion (adjusted HR = 1.47; 95% CI = 1.20-1.80). As a predictor, prior IDA is a significant and independent risk factor for development of osteoporosis.

背景与目标： : 在普通人群中，缺铁性贫血 (IDA) 与骨质疏松症之间的因果关系尚未建立。因此，当前的纵向研究通过分析大量全国基于人群的样本来确定IDA作为骨质疏松症危险因素的作用。在从1998-2012中随机抽取的1,000,000个样本中。对台湾全民健康保险研究数据库、IDA患者 (病例组 (n = 35,751)) 和无IDA患者 (对照组 (n = 178,755)) 进行比较。年龄 <20岁且在诊断IDA之前已有骨质疏松症的患者被排除。每位IDA患者的年龄和性别与五名没有IDA的患者相匹配。通过血液检查结果和x射线骨密度法进一步确认IDA和骨质疏松症 (使用ICD-9CM编码) 的诊断，以确保诊断的准确性。与没有IDA的个体相比，IDA患者中更经常发生骨质疏松症 (2.27% vs. 1.32%，p <0.001)。Cox比例风险分析显示，该病例的骨质疏松症风险显着高于对照组 (风险比 (HR) = 1.74; 95% CI = 1.61-1.88)，并且在校正协变量后保持相似 (调整后HR = 1.81; 95% CI = 1.67-1.97)。与没有IDA的个体相比，接受静脉铁治疗的IDA患者的骨质疏松症风险更高 (调整后的HR = 2.21; 95% CI = 1.85-2.63)。相比之下，接受输血的IDA患者的骨质疏松症风险降低 (调整后的HR = 1.47; 95% CI = 1.20-1.80)。作为预测因素，先前的IDA是骨质疏松症发生的重要且独立的危险因素。

BACKGROUND & AIMS: OBJECTIVE:To determine genome-wide methylation profiles of bone from patients with hip osteoarthritis (OA) and those with osteoporotic (OP) hip fractures. METHODS:Trabecular bone pieces were obtained from the central part of the femoral head of 27 patients with hip fractures and 26 patients with hip OA. DNA was isolated, and methylation was explored with Illumina methylation arrays. RNA was extracted, pooled, and deep-sequenced to obtain the whole transcriptome. Differentially methylated regions were identified, and connections between genes with differentially methylated regions were explored by pathway and text-mining analyses. RESULTS:After quality control, methylation of 23,367 CpG sites (13,463 genes) was analyzed. There was a genome-wide inverse relationship between methylation and gene expression in both patient groups. Comparison of OP and OA bones revealed 241 CpG sites, located in 228 genes, with significant differences in methylation (false discovery rate<0.05). Of them, 217 were less methylated in OP than in OA. The absolute methylation differences were >5% in 128 CpG sites and >10% in 45 CpG sites. The differentially methylated genes were enriched for association with bone traits in the genome-wide association study catalog. Pathway analysis and text-mining analysis with Gene Relationships Across Implicated Loci software revealed enrichment in genes participating in glycoprotein metabolism or cell differentiation, and particularly in the homeobox superfamily of transcription factors. CONCLUSION:Genome-wide methylation profiling of bone samples revealed differentially methylated regions in OP and OA. These regions were enriched in genes associated with cell differentiation and skeletal embryogenesis, such as those in the homeobox superfamily, suggesting the existence of a developmental component in the predisposition to these disorders.

背景与目标：

BACKGROUND & AIMS: :Osteoporosis maintains a special position in today's medicine, regarding both its growing incidence and its clinical and social consequences--fractures, leading to the loss of self-dependence, disabilities and higher mortality rates. It was thought for many years that osteoporosis affected mainly women after menopause. At present, it is known that the problem concerns men, as well. In the present review, similarities and differences between osteoporosis in either sex are discussed, concentrating on epidemiological and pathogenetic aspects, as well as on therapeutic differences.

背景与目标： : 骨质疏松症在当今医学中保持着特殊的地位，无论是其发病率的增长还是其临床和社会后果-骨折，导致丧失自我依赖性，残疾和更高的死亡率。多年来，人们一直认为骨质疏松症主要影响更年期后的妇女。目前，众所周知，这个问题也涉及男性。在本综述中，讨论了两种性别的骨质疏松症之间的异同，重点是流行病学和致病方面以及治疗上的差异。

BACKGROUND & AIMS: To assess the cost-effectiveness of interventions to prevent osteoporosis, it is necessary to estimate total health care expenditures for the treatment of osteoporotic fractures. Resources utilized for the treatment of many diseases can be estimated from secondary databases using relevant diagnosis codes, but such codes do not indicate which fractures are osteoporotic in nature. Therefore, a panel of experts was convened to make judgments about the probabilities that fractures of different types might be related to osteoporosis according to patient age, gender, and race. A three-round Delphi process was applied to estimate the proportion of fractures related to osteoporosis (i.e., the osteoporosis attribution probabilities) in 72 categories comprised of four specific fracture types (hip, spine, forearm, all other sites combined) stratified by three age groups (45-64 years, 65-84 years, 85 years and older), three racial groups (white, black, all others), and both genders (female, male). It was estimated that at least 90% of all hip and spine fractures among elderly white women should be attributed to osteoporosis. Much smaller proportions of the other fractures were attributed to osteoporosis. Regardless of fracture type, attribution probabilities were less for men than women and generally less for non-whites than whites. These probabilities will be used to estimate the total direct medical costs associated with osteoporosis-related fractures in the United States.

背景与目标： 为了评估预防骨质疏松症的干预措施的成本效益，有必要估算用于治疗骨质疏松性骨折的医疗保健总支出。可以使用相关的诊断代码从二级数据库中估算用于治疗许多疾病的资源，但是这些代码并未指出哪些骨折本质上是骨质疏松的。因此，召集了一个专家小组，根据患者的年龄，性别和种族来判断不同类型的骨折可能与骨质疏松症有关的可能性。采用三轮Delphi程序来估计与骨质疏松症相关的骨折的比例 (即骨质疏松症归因概率)，包括由三个年龄组 (45-64岁，65-84岁，85岁及以上)，三个种族群体 (白人，黑人，所有其他) 和两个性别 (女性，男性)。据估计，在老年白人妇女中，至少90% 的髋部和脊柱骨折应归因于骨质疏松症。其他骨折的比例要小得多，这归因于骨质疏松症。无论骨折类型如何，男性的归因概率低于女性，非白人的归因概率通常低于白人。这些概率将用于估算美国与骨质疏松症相关的骨折相关的总直接医疗费用。

BACKGROUND & AIMS: :Combining the measurement of bone mineral density (BMD) and the classification of the trabecular structure in cancellous bone improves the estimation of the degree of osteoporosis. A fractal method for the automatic quantitative classification of the trabecular structure in midvertebral slices of lumbar vertebrae is introduced. This method is based on the computation of the fractal dimension (box counting method) for varying binarization thresholds. Radiographic images from 30 lumbar vertebrae and CT images from an additional 16 lumbar vertebrae were analysed by calculating the dimension D in dependency of the threshold value T. The function D(T) was normalized by the average image grey value, eliminating the bone mineral density from the computations. The results show that the images of the lumbar vertebrae have fractal properties, and the function D(T) has a typical behaviour that allows the discrimination of the degree of osteoporosis. With two parameters extracted from the function D(T) the correlation coefficients with BMD were both -79% for the radiographic images, and -93% and -91% for the CT data, respectively.

背景与目标： : 结合骨密度 (BMD) 的测量和松质骨中小梁结构的分类，可以改善对骨质疏松症程度的估计。介绍了一种用于腰椎中段椎板小梁结构自动定量分类的分形方法。此方法基于分形维数 (盒计数法) 的计算来改变二值化阈值。通过根据阈值T计算尺寸D来分析来自30个腰椎的放射线图像和来自另外16个腰椎的CT图像。函数D(T) 通过平均图像灰度值进行归一化，从而从计算中消除了骨矿物质密度。结果表明，腰椎图像具有分形特性，函数D(T) 具有典型的行为，可以区分骨质疏松症的程度。利用从函数D(T) 中提取的两个参数，射线照相图像与BMD的相关系数分别为-79%，CT数据与-93% 和-91%。

BACKGROUND & AIMS: :The transcription factors Runx2 and estrogen receptor-alpha (ERalpha) are involved in numerous normal and disease processes, including postmenopausal osteoporosis and breast cancer. Using indirect immunofluorescence microscopy and pull-down techniques, we found them to colocalize and form complexes in a ligand-dependent manner. Estradiol-bound ERalpha strongly interacted with Runx2 directly through its DNA-binding domain and only indirectly through its N-terminal and ligand-binding domains. Runx2's amino acids 417-514, encompassing activation domain 3 and the nuclear matrix targeting sequence, were sufficient for interaction with ERalpha's DNA-binding domain. As a consequence of the interaction, Runx2's transcriptional activation activity was strongly repressed, as shown by reporter assays in COS7 cells, breast cancer cells, and late-stage MC3T3-E1 osteoblast cultures. Metaanalysis of gene expression in 779 breast cancer biopsies indicated negative correlation between the expression of ERalpha and Runx2 target genes. Selective ER modulators (SERM) induced ERalpha-Runx2 interactions but led to various functional outcomes. The regulation of Runx2 by ERalpha may play key roles in osteoblast and breast epithelial cell growth and differentiation; hence, modulation of Runx2 by native and synthetic ERalpha ligands offers new avenues in selective ER modulator evaluation and development.

背景与目标： : 转录因子Runx2和雌激素受体 α (ERalpha) 参与许多正常和疾病过程，包括绝经后骨质疏松症和乳腺癌。使用间接免疫荧光显微镜和下拉技术，我们发现它们以配体依赖性方式共定位并形成复合物。雌二醇结合的ERalpha直接通过其DNA结合结构域与Runx2强烈相互作用，仅通过其N端和配体结合结构域间接相互作用。Runx2的氨基酸417-514，包括活化结构域3和核基质靶向序列，足以与ERalpha的DNA结合结构域相互作用。作为相互作用的结果，Runx2的转录激活活性被强烈抑制，如COS7细胞，乳腺癌细胞和晚期MC3T3-E1成骨细胞培养物中的报告分析所示。对779乳腺癌活检组织中基因表达的荟萃分析表明，ERalpha和Runx2靶基因的表达呈负相关。选择性ER调节剂 (SERM) 诱导ERalpha-Runx2相互作用，但导致各种功能结果。ERalpha对Runx2的调节可能在成骨细胞和乳腺上皮细胞的生长和分化中起关键作用; 因此，天然和合成的ERalpha配体对Runx2的调节为选择性ER调节剂的评估和开发提供了新的途径。

BACKGROUND & AIMS: :Background Warfarin, a vitamin K antagonist, has been shown to affect bone mineral density and cause osteoporosis. However, studies investigating the relationship between non-vitamin K antagonist oral anticoagulants (NOACs) and osteoporosis are limited. We thus compared the risk of osteoporosis in patients with atrial fibrillation treated with either NOACs or warfarin. Methods and Results This nationwide, retrospective cohort study used Taiwan's National Health Insurance Research Database. All adult patients in Taiwan who were newly diagnosed with atrial fibrillation and treated with NOACs or warfarin between January 2012 and December 2015 were included and classified into their respective cohorts. Patients who received NOACs were subcategorized into the rivaroxaban, dabigatran, and apixaban subgroups. Propensity score matching was performed for each head-to-head comparison. Adjusted hazard ratios (aHRs) for the risk of osteoporosis were calculated using Cox proportional hazards regression models, with adjustment for confounders. Overall, 17 008 patients were included, with 8504 in each cohort. NOACs were associated with a lower osteoporosis risk than warfarin (aHR=0.82; 95% CI=0.68-0.97). A subgroup effect of treatment duration was identified (namely, the lower osteoporosis risk with NOAC compared with warfarin became stronger in those with longer treatment duration [P for interaction <0.001]). Furthermore, significantly lower risks of osteoporosis were observed in the rivaroxaban (aHR=0.68; 95% CI=0.55-0.83) and apixaban (aHR=0.38; 95% CI=0.22-0.66) subgroups, but not in the dabigatran subgroup (aHR=1.04; 95% CI=0.85-1.27). Conclusions Compared with warfarin, rivaroxaban and apixaban were associated with a significantly lower risk of osteoporosis in patients with atrial fibrillation.

背景与目标： 背景: 华法林是一种维生素k拮抗剂，已被证明会影响骨矿物质密度并引起骨质疏松症。然而，研究非维生素k拮抗剂口服抗凝剂 (NOACs) 与骨质疏松症之间关系的研究有限。因此，我们比较了使用NOACs或华法林治疗的房颤患者的骨质疏松症风险。方法和结果这项全国性的回顾性队列研究使用了台湾的国民健康保险研究数据库。纳入了台湾所有新诊断为房颤并在2012年1月和2015年12月之间接受NOACs或华法林治疗的成年患者，并将其分类为各自的队列。接受NOACs的患者分为利伐沙班，达比加群和阿哌沙班亚组。对每次头对头比较进行倾向评分匹配。使用Cox比例风险回归模型计算骨质疏松症风险的校正风险比 (aHRs)，并对混杂因素进行校正。总体而言，包括17 008名患者，每个队列中有8504名。与华法林相比，NOACs与更低的骨质疏松症风险相关 (aHR = 0.82; 95% CI = 0.68-0.97)。确定了治疗持续时间的亚组效应 (即，在治疗持续时间较长的患者中，与华法林相比，NOAC降低的骨质疏松症风险变得更强 [相互作用P <0.001])。此外，在利伐沙班 (aHR = 0.68; 95% CI = 0.55-0.83) 和阿哌沙班 (aHR = 0.38; 95% CI = 0.22-0.66) 亚组中观察到明显更低的骨质疏松症风险，但在达比加群亚组中没有观察到 (aHR = 1.04; 95% CI = 0.85-1.27)。结论与华法林相比，利伐沙班和阿哌沙班与房颤患者发生骨质疏松的风险显著降低相关。

BACKGROUND & AIMS: :Strontium (Sr)-doped calcium sulfate hemihydrate (SrCSH) bioactive materials have been demonstrated to promote osteoporotic bone repair, being associated with the stimulation of bone formation and a reduction in bone resorption. However, the rapid degradation and absorption of SrCSH affects its clinical value. In order to delay the degradation time of SrCSH and improve the utilization of Sr2+, chitosan (CS)-coated SrCSH microspheres (CS-SrCSH) are prepared by electrostatic interaction between CS and SrCSH. X-ray diffraction analysis verifies that SrCSH coated by CS does not alter the phase composition of the SrCSH. It was observed that CS-SrCSH microspheres have uniform particle size. More importantly, the in vivo and in vitro degradation time of CS-SrCSH microspheres is significantly longer than that of SrCSH, and the release rate of Sr2+ is stable, achieving a sustained release effect. Furthermore, CS-SrCSH-based cement is used to repair critical-sized OVX rat tibial defects. The in vivo results reveal that CS-SrCSH exhibits a long-term capability for osteogenesis, angiogenesis and bone metabolism inhibition. In conclusion, the controllable degradation of CS-SrCSH-based cements described here could be beneficial for the repair of bone defects, especially in the osteoporotic bone.

背景与目标： : 掺锶 (Sr) 的半水硫酸钙 (SrCSH) 生物活性材料已被证明可促进骨质疏松的骨修复，与刺激骨形成和减少骨吸收有关。然而，SrCSH的快速降解和吸收影响了其临床价值。为了延缓SrCSH的降解时间并提高Sr2的利用率，通过CS和SrCSH之间的静电相互作用制备了壳聚糖 (CS) 包覆的SrCSH微球 (CS-SrCSH)。X射线衍射分析验证了用CS涂覆的SrCSH不会改变SrCSH的相组成。观察到CS-SrCSH微球具有均匀的粒径。更重要的是，cs-srcsh微球的体内外降解时间明显长于SrCSH，且Sr2 + 的释放速率稳定，达到了缓释效果。此外，基于cs-srcsh的水泥用于修复临界尺寸的OVX大鼠胫骨缺损。体内结果表明，cs-srcsh具有长期的成骨，血管生成和骨代谢抑制能力。总之，本文所述的基于cs-srcsh的水泥的可控降解可能有利于骨缺损的修复，尤其是在骨质疏松的骨中。

BACKGROUND & AIMS: :Osteoporosis is an important skeletal disease characterized by bone weakness and high risk of fracture in postmenopausal women. Tea consumption is known to play an important role in the prevention or alleviation of osteoporosis. However, the therapeutic effects of aqueous extracts of white tea (WT) have not been evaluated in osteoporosis rat models. The aim of this study was to investigate the potential anti-osteoporotic role of WT in ovariectomized (OVX) rats. WT was given orally at 0.5% w/v doses for 12 weeks in OVX rats. Biochemical parameters in blood samples, bone tartrate-resistant acid phosphatase (TRAP), C-terminal telopeptide of type 1 collagen (CTX) and estradiol levels were evaluated. Bone mineral density and bone mineral content values were measured in the left femur. In addition to histopathological examination, osteolcalcin, osteopontin and TUNEL levels were determined. OVX group data demonstrated that bone loss occurred by thinning of the metaphyseal growth plates of the femur. Similarly, the levels of TRAP and CTX, markers of osteoclastic activity, were found to be high concurrently with a decrease in femoral bone mineral density. In addition, increased osteolcalcin and osteopontin levels were present in the metaphyseal growth zones. On the other hand, while TRAP and CTX levels were suppressed in the OVX-WT group, bone mineral content increased. In ad-dition, TUNEL, osteocalcin and osteopontin positivity decreased in the right femoral metaphysis growth zones, proliferating zone and resting zone cells. These results showed that chronic WT consumption has a protective effect by reducing bone resorption in OVX-induced osteoporotic rats.

背景与目标： : 骨质疏松症是一种重要的骨骼疾病，其特征是绝经后妇女的骨骼无力和高骨折风险。众所周知，饮茶在预防或减轻骨质疏松症中起着重要作用。然而，尚未在骨质疏松症大鼠模型中评估白茶 (WT) 水提取物的治疗作用。这项研究的目的是研究WT在去卵巢 (OVX) 大鼠中的潜在抗骨质疏松作用。在OVX大鼠中以0.5% w/v剂量口服WT 12周。评估血液样本中的生化参数，抗骨酒石酸酸性磷酸酶 (TRAP)，1型胶原蛋白的C末端肽 (CTX) 和雌二醇水平。测量左股骨的骨矿物质密度和骨矿物质含量值。除组织病理学检查外，还确定了骨钙素，骨桥蛋白和TUNEL水平。OVX组数据表明，股骨干phy端生长板变薄会导致骨质流失。同样，发现破骨细胞活性标志物TRAP和CTX的水平很高，同时股骨骨矿物质密度降低。此外，在干phy端生长区域中存在骨钙素和骨桥蛋白水平升高。另一方面，尽管OVX-WT组的TRAP和CTX水平受到抑制，但骨矿物质含量增加。另外，TUNEL，骨钙素和骨桥蛋白阳性在右股骨干端生长区，增殖区和静息区细胞中降低。这些结果表明，长期消耗WT通过减少OVX诱导的骨质疏松大鼠的骨吸收而具有保护作用。

BACKGROUND & AIMS: :Bisphosphonates have been shown to increase bone mineral density in patients with established osteoporosis as well as those with osteopenia. The evidence conclusively shows a reduction in fracture rates in patients on the more potent nitrogen containing bisphosphonates. Indeed, significant vertebral fracture rate reduction has been demonstrated after only 1 year of therapy. Alendronate, a second-generation bisphosphonate, and risedronate, a third-generation bisphosphonate, are first line medications for the treatment of osteoporosis given their efficacy in preventing both vertebral and non-vertebral fractures. There is evidence that vertebral fractures may be prevented by intermittent cyclic therapy with etidronate. All three have been shown to increase bone mineral density in the spine, with alendronate and risedronate producing significant increases in hip bone density. Calcitonin has demonstrated the ability to reduce vertebral fracture rates with minimal changes in bone density. Calcitonin is also beneficial in reducing the bone pain associated with fractures.

背景与目标： : 已证明双膦酸盐可增加已确定的骨质疏松症患者以及骨质减少的患者的骨矿物质密度。证据最终表明，使用更有效的含氮二膦酸盐的患者骨折率降低。实际上，仅经过1年的治疗，就已证明椎体骨折率显着降低。第二代双膦酸盐阿仑膦酸盐和第三代双膦酸盐利塞膦酸盐是治疗骨质疏松症的一线药物，因为它们在预防椎骨和非椎骨骨折方面均具有功效。有证据表明，间歇性的周期性治疗可以预防椎体骨折。已显示所有这三个都增加了脊柱的骨矿物质密度，阿仑膦酸盐和利塞膦酸盐显着增加了髋部骨密度。降钙素已证明能够以最小的骨密度变化降低椎体骨折率。降钙素在减轻与骨折相关的骨痛方面也是有益的。

BACKGROUND & AIMS: OBJECTIVE:To investigate the effects of age, body mass index (BMI), bone mineral density (BMD), and levels of serum 25-hydroxyvitamin D (25OHD) on hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis. METHODS:A total of 252 postmenopausal women patients, whose bone density had reached the threshold of osteoporosis and age ≥50 years (50-98 years), collected from the Second Affiliated Hospital of Fujian Medical University from January 2015 to December 2018, were performed by retrospective analysis. According to whether or not they had a hip fracture, including femoral neck fracture or intertrochanteric fracture, the patients were divided into two groups, including 117 cases (50-84 years old) in the non-hip fracture group and 135 cases (57-98 years old) in the hip fracture group. BMD was measured by Hologic Discovery A DXA bone mineral densitometer. Levels of serum 25OHD were detected by ROCHE detection instrument. Comparisons of age, BMI, bone density of femoral neck, and levels of serum 25OHD between the two groups were performed by using the Student's t-test. Furthermore, the statistically significant factors were analyzed by multiple regression analysis to investigate the independent risk factors of hip fracture. RESULTS:The group without hip fracture: 117 cases; average age: 67.4 ± 8.5 years; BMI: 22.3 ± 3.2 kg/m2 ; bone density of femoral neck: (0.504 ± 0.067) g/cm2 ; T-value of femoral neck: -3.1 ± 0.6; levels of serum 25OHD: (24.9 ± 8.5) ng/mL. The group with brittle hip fracture: 135 cases; average age: 80.7 ± 7.6 years; BMI: 20.3 ± 3.5 kg/m2 ; bone density of femoral neck: (0.426 ± 0.077) g/cm2 ; T-value of femoral neck: -3.8 ± 0.7; levels of serum 25OHD: (15.9 ± 8.9) ng/mL. Age, BMI, bone density of femoral neck, and 25OHD level of the group without hip fracture were markedly lower than hip fracture group (P < 0.05). The results of logistic regression analysis suggested that age, bone density of femoral neck, and levels of serum 25OHD were independent risk factors for fragile hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis. CONCLUSION:Higher age, lower levels of bone density and 25OHD are the main risk factors of hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis.

背景与目标：

BACKGROUND & AIMS: UNLABELLED:We examined osteoporosis diagnosis/treatment in 2,187 community dwelling men age 50+. After five years in the study, 90% of men with fragility fractures remained undiagnosed and untreated for osteoporosis. The need to treat fragility fractures is well established in guidelines, and these numbers represent an important care gap. INTRODUCTION:Whether physicians in the community are recognizing and appropriately treating osteoporosis and fragility fractures in men remains unknown. We examined the rate of diagnosis and treatment in community dwelling men participating in the Canadian Multicentre Osteoporosis Study (CaMos). METHODS:Between February 1996 and September 2002, 2,187 participants were recruited from nine sites across Canada and prospectively followed. Information on osteoporosis diagnosis, fractures, medications were collected annually by a detailed questionnaire. DXA examination of lumbar spine (L1-4) and hip were conducted at baseline and year five. RESULTS:Diagnosis and treatment in men with clinical fragility fractures was low: at baseline and year five only 2.3% and 10.3% of men with a clinical fracture reported an osteoporosis diagnosis, respectively. At year five, 90% of men with a clinical fragility fracture were untreated. Hip fractures were the most commonly treated (37.5% by year five). A diagnosis of osteoporosis resulted in greater treatment: 67% of participants with diagnosed osteoporosis were treated with a bisphosphonate and 87% were taking calcium and/or vitamin D (year five). CONCLUSIONS:In this population-based study, both a diagnostic and therapeutic gap existed between knowledge and practice related to fragility fractures and osteoporosis in men aged >or=50 years.

背景与目标：

BACKGROUND & AIMS: :Liver transplantation provides an important, often life-saving treatment for end-stage liver disease. Osteoporosis post-liver transplantation has been described in adults; however, this has not been described in the pediatric population to date. We present a case of a 13-year-old female patient who underwent an orthotopic liver transplant for cryptogenic liver cirrhosis. Her immunosuppressants were tacrolimus and prednisone. Four months posttransplant, she started complaining of bilateral lower limb pain and limping while walking, progressing to a point where she was almost immobile. Magnetic resonance imagining of the pelvis showed bilateral avascular necrosis involving the weight-bearing surfaces of both femoral heads, in addition to the extensive edema involving both hip joints. Bone mineral densitometry was below normal for her age at the hip and forearm. She was started on high-dose calcium and vitamin D supplement, as well as zoledronic acid with a remarkable symptomatic and functional improvement.

背景与目标： : 肝移植为终末期肝病提供了重要的，通常挽救生命的治疗方法。已在成年人中描述了肝移植后的骨质疏松症; 但是，迄今为止，尚未在儿科人群中描述。我们介绍了一例13岁的女性患者，该患者因隐源性肝硬化接受了原位肝移植。她的免疫抑制剂是他克莫司和泼尼松。移植后四个月，她开始抱怨双侧下肢疼痛和走路时跛行，进展到几乎不动的地步。骨盆的磁共振成像显示双侧缺血性坏死涉及两个股骨头的承重表面，此外还涉及两个髋关节的广泛水肿。在臀部和前臂的年龄，骨矿物质密度低于正常水平。她开始服用大剂量钙和维生素d补充剂，以及唑来膦酸，症状和功能明显改善。

BACKGROUND & AIMS: OBJECTIVE:To analyse the distribution of polymorphism of the collagen type Ialpha1 gene (COL1A1) and its relationship with bone metabolism and bone turnover in men with idiopathic osteoporosis. METHODS:A total of 35 male patients with idiopathic osteoporosis, aged 50.4 +/- 10.3 yr, and 60 healthy males (controls), aged 47 +/- 17 yr, were included in the study. Serum osteocalcin, 25-hydroxyvitamin D and parathyroid hormone were determined in all patients. The COL1A1 Sp1 genotypes (SS, SS:, ss) were assessed by restriction enzyme digestion (BAL:1) of DNA amplified by the polymerase chain reaction. RESULTS:Patients with idiopathic osteoporosis had a higher frequency of the s allele than men in the control group (29 vs 11%, P: = 0.003) and a higher frequency of the SS: genotype (patients, 48% SS, 46% SS:, 6% ss; controls, 80% SS, 18% SS:, 2% ss; P: = 0.003). No significant differences between genotypes were observed in serum concentrations of osteocalcin, vitamin D or parathyroid hormone among either the patients or the controls. CONCLUSION:This study suggests that, in men with idiopathic osteoporosis, there is a high prevalence of the s allele and the SS: genotype that is unrelated to other parameters of bone metabolism.

背景与目标：

BACKGROUND & AIMS: :Women who have significant bone loss or a new fracture on monotherapy are considered for combination therapy. Combination therapies increase bone density more than monotherapy by targeting different parts of the osteoclast pathway.In early postmenopausal women who are symptomatic, the use of combination antiresorptives should include hormone therapy with a bisphosphonate or with bazodoxifene. In women who initially receive a weaker antiresorptive such as the SERM raloxifene, a combination with bisphosphonates and calcium supplementation is necessary to prevent bone loss. In older women over 65 years of age who often have impaired calcium absorption, the combination of calcitriol with bisphosphonates has been shown to increase bone density more than monotherapy.

背景与目标： : 接受单药治疗有明显骨质流失或新骨折的女性被考虑联合治疗。联合疗法通过针对破骨细胞途径的不同部位，比单一疗法增加骨密度。对于有症状的绝经后早期妇女，联合抗吸收剂的使用应包括使用双膦酸盐或巴佐多昔芬的激素治疗。在最初接受较弱的抗吸收性 (例如SERM雷洛昔芬) 的女性中，必须与双膦酸盐和钙补充剂联合使用以防止骨质流失。在通常钙吸收受损的65岁以上的老年妇女中，骨化三醇与双膦酸盐的组合已被证明比单一疗法更能增加骨密度。