老年女性骨质疏松骨折患者骨质量变化规律前瞻性研究

The refracture rate in patients with osteoporotic fractures is high, which influence on the prognosis and quality of life. The change of bone quality plays key role in its development. There is no research report on the change of bone quality following the osteoporotic fracture till now. In order to improve the early prevention and treatment of refracture the prospectively research on the bone quality change patterns in the older female patients with osteoporotic fractures is designed based on completing the former Natural Science Foundation about osteoporotic fracture. Based on effective previous research and hypothesis proposed by the applicant, who has been investigating osteoporotic fracture for 10 years, this project will prospectively explore potential mechanism of microstructural, function of bone marrow stromal cells and bone remodeling after osteoporotic fracture in older woman by means of international advanced application of interdiscipline, such as QCT/ Finite Element Analysis, mechanical load measurement, molecular markers of bone marrow stromal cells, bone mineral density and biochemical index determination. This can improve Translational Medicine in the field of prevention and treatment of osteoporotic fracture and have great clinical application prospect. At the same time an advanced research platform consisting of some new technology can be established for the related research of the associate organization. This will benefit for the development of the research of osteoporosis in our country.

骨质疏松骨折后再骨折发生率高，对患者生存质量及预后影响很大，骨质量的改变在其发展中起重要作用。目前尚未见骨质疏松骨折后骨质量变化规律研究的报道。申请者在完成骨质疏松患者骨折研究的国家自然科学基金基础上，对老年女性骨质疏松患者骨折后骨质量变化规律进行前瞻性研究，探讨再骨折的早期防治。在申请者围绕骨质疏松骨折长期科研所提出的理论假说指导下，利用近10年前期研究所获得的良好研究基础，综合QCT/有限元分析、力学载荷测定、骨髓基质干细胞分子标志物检测以及骨密度和生化指标测定等临床可应用的国际最新学科交叉方法，从骨微结构及功能、骨髓基质干细胞功能以及骨重建水平等方面综合探讨老年女性骨质疏松骨折后骨质量的变化规律。本项目丰富骨质疏松骨折防治领域转化医学研究的内容，具备临床应用前景，同时发展研究平台，为兄弟单位相关研究提供高水平技术服务，共同提高我国骨质疏松研究水平，促进学科进步。

骨质疏松骨折后再次骨折研究逐渐成为国际骨质疏松研究关注的趋势，本项目研究了老年女性严重骨质疏松患者有骨折与没有骨折组骨密度与骨重建水平改变以及骨髓干细胞功能。发现：骨折患者较无骨折患者腰椎松质骨骨量丢失明显，发生再骨折风险较高，QCT在预测再骨折风险上较DXA占优势。外周血MSCs表达CD34+CD14+的细胞可能有分化为破骨细胞的潜能，表达CD34+CD14-CD105+的细胞可能有分化为成骨细胞的潜能。骨质疏松骨折后骨吸收、骨形成指标高于正常参考值呈高转换状态，与严重骨质疏松无骨折患者相比差异无统计学意义。体重、体重指数为BMD的保护性因素；绝经年限与BMD呈明显负相关。通过本项目研究，探讨了老年女性严重骨质疏松患者有无骨折组骨密度及骨重建水平变化的规律，建了新技术，培养了人才，与临床实际相关性强，对临床有着直接促进作用。