Effect of Exercise Therapy on Bone Turnover and Inflammatory Factors in Postmenopausal Osteoporosis
1.Anhui University of Traditional Chinese Medicine
2.Department of Orthopaedics I，Taihe Traditional Chinese Medicine Hospital Affiliated to Anhui University of Traditional Chinese Medicine
3.Department of Orthopaedics V，Taihe Traditional Chinese Medicine Hospital Affiliated to Anhui University of Traditional Chinese Medicine
摘要目的 观察运动疗法在常规抗骨质疏松药物治疗基础上对绝经后骨质疏松症(postmenopausal osteoporosis，PMOP)骨转换、炎性因子水平的影响及相关性分析。方法 筛选符合纳入标准的绝经后骨质疏松症患者72例，随机分为观察组和对照组。观察组36例，年龄52～59岁，平均(56.03±2.86)岁；对照组36例，年龄50～58岁，平均(55.36±2.88)岁。对照组予以常规抗骨质疏松药物(钙剂、膦酸盐类)治疗，观察组在对照组的基础上予以有氧运动和递增式抗阻训练的组合式运动疗法。分别于治疗前和治疗3个月后检测患者L1～4骨密度(bone mineral density，BMD)、左侧股骨颈BMD、血清Ⅰ型原胶原N端前肽(serum N terminal peptide of type Ⅰ collagen，S-PINP)、血清Ⅰ型胶原C末端肽交联(serum C-terminal telopeptide of type Ⅰ collagen，S-CTX)、白细胞介素(interleukin，IL)-6、肿瘤坏死因子(tumour necrosis factor，TNF)-α水平并进行统计分析。结果 两组患者的L1～4 BMD、左侧股骨颈BMD均较治疗前增高，且观察组显著高于对照组(P＜0.05)；两组患者骨转换生化指标(bone turnover marker，BTM)中的S-PINP 、S-CTX均较治疗前降低，且观察组显著低于对照组(P＜0.05)；两组患者炎性指标IL-6、 TNF-α水平均较治疗前降低，且观察组显著低于对照组(P＜0.05)。结论 运动疗法联合治疗可以有效增加PMOP患者骨密度，降低骨转换水平，抑制炎性因子，进而促进骨重塑的正性平衡，有利于PMOP的防治。
Objective To observe the effect of exercise therapy on bone turnover and inflammatory factor level in postmenopausal osteoporosis (PMOP) on the basis of conventional anti osteoporosis drug therapy and analyze the correlation.Methods 72 postmenopausal osteoporosis patients who met the inclusion criteria were selected and randomly divided into an observation group and a control group.The observation group consisted of 36 cases，ranging in age from 52 to 59 years old，with an average age of (56.03±2.86) years.The control group consisted of 36 cases，ranging in age from 50 to 58 years old，with an average age of (55.36±2.88) years.The control group was treated with conventional anti osteoporosis drugs (calcium and phosphonates)，while the observation group received a combination of aerobic exercise and incremental resistance training on the basis of the control group.Bone mineral density (BMD) of L1~4，left neck of femur BMD，serum N-terminal peptide of type I collagen (S-PINP)，serum C-terminal peptide of type I collagen (S-CTX)，interleukin (IL)-6，tumor necrosis factor (TNF)-α Level were measured before treatment and 3 months after treatment respectively.Results The L1~4 BMD and left neck of femur BMD of the two groups were higher than those before treatment，and the BMD of the observation group was significantly higher than that of the control group (P＜0.05).The biochemical indicators of bone turnover marker (BTM) S-PINP and S-CTX in both groups of patients decreased compared with those before treatment，and the observation group was significantly lower than the control group (P＜0.05).Inflammatory markers IL-6 and TNF-α in two groups of patients decreased compared to those before treatment，and the observation group was significantly lower than the control group (P＜0.05).Conclusion Combined exercise therapy can effectively increase BMD of PMOP patients，reduce bone turnover，inhibit inflammatory factors，and then promote the positive balance of bone remodeling，which is conducive to the prevention and treatment of PMOP.
卢爱民，尹君，李春峰，龙大伟. 运动疗法对绝经后骨质疏松症骨转换及炎性因子的影响[J]. 实用骨科杂志, 2023, 29(5): 422-.
Lu Aimin，Yin Jun，Li Chunfeng，Long Dawei. Effect of Exercise Therapy on Bone Turnover and Inflammatory Factors in Postmenopausal Osteoporosis. sygkzz, 2023, 29(5): 422-.
［1］夏维波，章振林，林华，等.原发性骨质疏松症诊疗指南(2017)［J］.中国骨质疏松杂志，2019，25(3)：281-309.
［2］中华医学会骨质疏松和骨矿盐疾病分会.中国骨质疏松症流行病学调查及“健康骨骼”专项行动结果发布［J］.中华骨质疏松和骨矿盐疾病杂志，2019，12(4)：317-318.
［3］柴波，冯皓宇，常强，等.中国各地区绝经后骨质疏松症患病率及骨密度测量检出率分析［J］.实用骨科杂志，2020，26(9)：792-796.
［4］李美玲，黎叶飞，卢雪云.运动疗法治疗围绝经期骨质疏松症的效果研究［J］.中国现代药物应用，2022，16(11)：158-160.
［5］周隆，任兆舟，张展，等.运动疗法对防治绝经后妇女骨质疏松症的疗效分析及对骨密度的影响［J］.中国妇幼保健，2020，35(7)：1270-1273.
［6］陈少慧，陈苑红，周树根.运动疗法治疗围绝经期骨质疏松症对骨密度、脂肪含量的影响研究［J］.黑龙江医药，2019，32(6)：1481-1482.
［7］Kistler-Fischbacher M，Yong JS，Weeks BK，et al.A Comparison of bone-targeted exercise with and without antiresorptive bone medication to reduce indices of fracture risk in postmenopausal women with low bone mass：The MEDEX-OP randomized controlled trial［J］.J Bone Miner Res，2021，36(9)：1680-1693.
［8］Li L，Chen X，Lv S，et al.Influence of exercise on bone remodeling-related hormones and cytokines in ovariectomized rats：A model of postmenopausal osteoporosis［J］.PLoS One，2014，9(11)：e112845.
［9］Riebe D，Franklin BA，Thompson PD，et al.Updating ACSM's recommendations for exercise preparticipation health screening［J］.Med Sci Sports Exerc，2015，47(11)：2473-2479.
［10］段亚威，柴昊，安一方，等.原发性骨质疏松症的疗效评价［J］.中华骨质疏松和骨矿盐疾病杂志，2021，14(2)：199-206.
［11］吴连国，刘康.绝经后骨质疏松症(骨痿)中医药诊疗指南(2019年版)［J］.中医正骨，2020，32(2)：6.
［12］佟喆，张振南，于潼.运动疗法防治骨质疏松症机制的研究进展［J］.中国骨质疏松杂志，2022，28(10)：1556-1560.
［13］赵军，孔令俊，王兴盛，等.物理疗法调控骨髓间充质干细胞成骨分化治疗骨质疏松症的研究进展［J］.中医正骨，2022，34(7)：54-58.
［14］胡少云，曹晓宁，胡少君.运动疗法对绝经后骨质疏松症骨代谢影响的临床研究［J］.临床医药实践，2021，30(6)：403-405.
［15］Watson SL，Weeks BK，Weis LJ，et al.High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis：The LIFTMOR randomized controlled trial［J］.J Bone Miner Res，2018，33(2)：211-220.
［16］Hettchen M，von Stengel S，Kohl M，et al.Changes in menopausal risk factors in early postmenopausal osteopenic women after 13 months of high-intensity exercise：The randomized controlled ACTLIFE-RCT［J］.Clin Interv Aging，2021(16)：83-96.
［17］Bergmann P，Body JJ，Boonen S，et al.Evidencebased guidelines for the use of biochemical markers of bone turnover in the selection and monitoring of bisphosphonate treatment in osteoporosis：A consensus document of the Belgian bone club［J］.Int J Clin Pract，2009，63(1)：1926.〖1〗
［18］Vasikaran S，Eastell R，Bruyère O，et al.Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment：A need for international reference standards［J］.Osteoporos Int，2011，22(2)：391-420.
［19］李蕊，杨震，韩伟，等.联合性运动疗法对绝经后骨质疏松症患者骨代谢的影响［J］.国际骨科学杂志，2019，40(1)：52-56；62.
［20］Szulc P.Bone turnover：Biology and assessment tools［J］.Best Pract Res Clin Endocrinol Metab，2018，32(5)：725-738.
［21］Zhao R.Immune regulation of bone loss by Th17 cells in oestrogendeficient osteoporosis［J］.Eur J Clin Invest，2013，43(11)：1195-1202.
［22］Tso GH，Law HK，Tu W，et al.Phagocytosis of apoptotic cells modulates mesenchymal stem cells osteogenic differentiation to enhance IL-17 and RANKL expression on CD4+ T cells［J］.Stem Cells，2010，28(5)：939-954.
［23］Wu Q，Zhou X，Huang D，et al.IL-6 enhances osteocyte-mediated osteoclastogenesis by promoting JAK2 and RANKL activity in vitro［J］.Cell Physiol Biochem，2017，41(4)：1360-1369.
［24］Huynh NC，Everts V，Pavasant P，et al.Interleukin-1β induces human cementoblasts to support osteoclastogenesis［J］.Int J Oral Sci，2017，9(12)：e5.
［25］Mezil YA，Allison D，Kish K，et al.Response of bone turnover markers and cytokines to high-intensity low-impact exercise［J］.Med Sci Sports Exerc，2015，47(7)：1495-502.
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