It is well known that one fragility fracture begets another. Fracture Liaison Services have been shown to narrow the care gap that exists in the care of patients with fragility fractures. A secondary fracture prevention programme "OPTIMAL" (Osteoporosis Patient Targeted and Integrated Management for Active Living) has been in existence in the public restructured hospitals and polyclinics of Singapore since 2008 and this is beginning to show significant beneficial results in terms of identification and management of fragility fractures. However, significant obstacles in the path of appropriate management of the patient with a fragility fracture still exist. A concerted, multipronged and interdisciplinary approach is needed to overcome these barriers.
Disease Management ; Hospitals, Public ; Humans ; Osteoporosis ; Secondary Prevention ; Singapore

OBJECTIVE: In traditional Chinese medicine, the herbal pair, Radix Achyranthis Bidentatae (RAB) and Eucommiae Cortex (EC), is widely used to treat osteoporosis. Herein, we determined whether this herbal pair can be used to ameliorate glucocorticoid (GC)-induced osteoporosis (GIOP) and find its optimal dosage in zebrafish. METHODS: The characteristics of the aqueous extract of RAB and EC were separately characterized using high-performance liquid chromatography. Osteoporosis was induced in 5-day post-fertilization zebrafish larvae by exposing them to 10 μmol/L dexamethasone (Dex) for 96 h. Seven combinations of different ratios of RAB and EC were co-administered. Treatment efficacy was determined by calculating zebrafish vertebral area and sum brightness, via alizarin red staining, and by detecting alkaline phosphatase (ALP) activity. Multiple regression analysis was conducted to test the optimal dosage ratio. RESULTS: According to the Chinese Pharmacopoeia (2015), β-ecdysone (β-Ecd) is a major bioactive marker in RAB extract, while pinoresinol diglucoside (PDG) is the major marker in EC extract. Both of β-Ecd and PDG content values aligned with the Chinese Pharmacopoeia standards. Treatment with 10 μmol/L Dex reduced zebrafish vertebral area, sum brightness, and ALP activity, but RAB and EC attenuated these effects. Combining 50 µg/mL RAB and 50 µg/mL EC was optimal for preventing GIOP in zebrafish. Reverse transcription-quantitative polymerase chain reaction was used to evaluate the mRNA expression of osteogenesis-related genes. A treatment of 10 μmol/L Dex decreased runt-related transcription factor 2 (Runx2), osteogenic protein-1 (OP-1), bone γ-carboxyglutamic acid-containing protein (BGLAP), and β-catenin levels. This effect was counteracted by RAB and EC co-treatment (P < 0.05). Additionally, the effect of using the two herbal extracts together was better than single-herb treatments separately. These results demonstrated that RAB and EC preserve osteoblast function in the presence of GC. The best mass ratio was 1:1. CONCLUSION RAB and EC herbal pair could ameliorate GC-induced effects in zebrafish, with 1:1 as the optimal dosage ratio.
Animals ; Glucocorticoids ; Medicine, Chinese Traditional ; Osteogenesis ; Osteoporosis/prevention & control* ; Zebrafish

No abstract available.
Aging ; Health Knowledge, Attitudes, Practice ; Hip Fractures/*prevention & control/therapy ; Humans ; Osteoporosis/*drug therapy ; Osteoporotic Fractures/*prevention & control/therapy

Weightlessness environment can lead to the muscle atrophy and body fluid distribution upward,which can cause the bone calcium metabolism disorder and always accompanied by the loss of bone microstructure and increased rate of bone fracture. Under microgravity,the astronauts are much easier to decrease the Ca2+ ion in bone, which can cause serious osteoporosis. However the bone lost is not equilibrium, it is especially serious in the mechanism loading bone and the recovery process is more difficult. These are very different from the osteoporosis in older people and postmenopausal osteoporosis. It is necessary to find an optimal method to due with it. In traditional Chinese medicine theory,the kidney stores "Jing" and dominates the bone, thus a lot of bone related diseases can be treated through the kidney. A lot of clinical practices have also proved that the Chinese herbs used under the guidance of basic Chinese medicine theory are always good at the treatment of common osteoporosis. In simulated weightlessness experiment, people found that the kidney nourishment drugs do can prevent the decrease of BMD. So in this article we want to review the causes of weightlessness and the potentials applications of tradition Chinese medicine in the treatment of weightlessness osteoporosis.
Humans ; Mechanical Phenomena ; Medicine, Chinese Traditional ; methods ; Osteoporosis ; etiology ; prevention & control ; therapy ; Weightlessness ; adverse effects

OBJECTIVETo investigate the role of perindopril for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) in rabbits.

METHODSA total of 45 male New Zealand white rabbits (10 months old, weight 3.0 to 3.5 kg) were randomly divided into 3 groups involving normal control group (muscle injection of saline solution, n = 15, group NC), model group (muscle injection of dexamethasone, n = 15, group GIOP), and treatment group (muscle injection of dexamethasone combined with oral perindopril, n = 15, group GIOP+ACEI). All rabbits put to death after 12 weeks' treatment. The changes of bone mass and strength were observed and analyzed by bone histomorphology, biomechanics, metabolic bone related serological indexes and mRNA expression.

RESULTSAt 12 weeks, the analysis of bone histomorphology and biomechanics results showed that the bone mass and bone strength of group GIOP were significantly lower than that of group NC (P < 0.05); after perindopril treatment, the bone mass and bone strength of group GIOP+ACEI were higher obviously than that of group GIOP (P < 0.05). Mineralizing surface,mineral apposition rate and serum osteocalcin in group GIOP decreased than group NC; however, osteoclast number, osteoclast surface, eroded surface, and urinary deoxypyridinoline in group GIOP increased than group NC (P < 0.05); these changes were inhibited after perindopril treatment (P < 0.05). Quantitative RT-PCR revealed that after dexamethasone treatment, the ratio of SOST mRNS expression and RANKL/OPG mRNA expression obviously increased than that of group NC (P < 0.05); and Runx2 expression decreased significantly (P < 0.05); while the changes of mRNA expression were improved by perindopril treatment.

CONCLUSIONPerindopril can promote bone formation and inhibit bone resorption to deduce glucocorticoid-induced osteoporosis. This study provides a new method for prevention and treatment of GIOP.

Animals ; Biomechanical Phenomena ; Glucocorticoids ; adverse effects ; Male ; Osteoporosis ; chemically induced ; prevention & control ; Perindopril ; therapeutic use ; Rabbits

OBJECTIVES: To examine the effects of whole body vibration (WBV) on bone properties in growing rats, and to explore the optimal conditions for enhancing bone properties. METHODS: Thirty-six 4-week-old male rats were divided into 1 control and 5 experimental groups. Each experimental group underwent WBV at 15, 30, 45, 60, and 90 Hz (0.5 g, 15 min/d, 5 d/wk) for 8 weeks.We measured bone size, muscle weight and bone mechanical strength of the right tibia. Trabecular bone mass and trabecular bone microstructure (TBMS) of the left tibia were analyzed by micro-computed tomography. Serum levels of bone formation/resorption markers were also measured. RESULTS: WBV at 45 Hz and 60 Hz tended to enhance trabecular bone mass and TBMS parameters. However, there was no difference in maximum load of tibias among all groups. Serum levels of bone resorption marker were significantly higher in the 45-Hz WBV group than in the control group. CONCLUSIONS: WBV at 45–60 Hz may offer a potent modality for increasing bone mass during the period of rapid growth. Further studies are needed to explore the optimal WBV conditions for increasing peak bone mass and TBMS parameters. WBV modality may be a potent strategy for primary prevention against osteoporosis.
Animals ; Bone Resorption ; Humans ; Male ; Osteoporosis ; Primary Prevention ; Rats ; Tibia ; Vibration

The objective was to evaluate the preventive and therapeutic effects of the collagen hydrolysate extracted from Sika deer velvet (CSDV) on osteoporosis rats induced by retinoicacid. Histomorphometric indices and serum biochemical parameters were measured in osteoporosis rats treated with/without antler collagen and in sham-operated rats. Our results were as follows: compared with the osteoporosis group, significant elevation in the levels of bone mineral density (BMD), Ca, P and static histomorphometric indexes and biomechanical properties, but reduction in the level of serum alkaline phosphatase (ALP) were observed in antler collagen-treated groups. However, the above function with the collagenase solution velvet material varied with the different doses. In conclusion, the extracted collagen is found to play a role in the prevention and treatment of osteoporosis rats by retinoic acid.
Animals ; Bone Density ; drug effects ; Collagen ; metabolism ; therapeutic use ; Female ; Humans ; Male ; Osteoporosis ; prevention & control ; Osteoporosis, Postmenopausal ; Rats ; Rats, Wistar ; Tretinoin ; therapeutic use

The preventive effects of nitroglycerine (NG) on glucocorticoid-induced osteoporosis in growing rats were studied. Three-month-old female Wistar rats were randomly divided into control group (CON), dexamethasone group (DXM), DXM plus a low dose NG group (NG-L), DXM plus a middle dose NG group (NG-M) and DXM plus a high dose NG group (NG-H), 8 rats in each group. The rat model of osteoporosis was developed by intramuscular injection of dexamethasone twice a week. NG 0.2, 0.4 and 1.0 mg/kg was administered by oral gavages to the treatment groups every day for 12 weeks. Rats in CON group and DXM group were treated with normal saline of the same amount. After the treatment, the bone mineral density (BMD) and bone metabolism-associated biochemical markers were determined. Compared with CON group, BMD of lumbar spine and femur in DXM group was decreased significantly (P<0.05 and P<0.01 respectively), blood BGP levels and NO levels reduced (both P<0.01), and TRAP level increased (P<0.05). As compared with DXM group, BMD, serum BGP and NO were increased, and TRAP decreased in NG-L group and NG-M group, but had no significant difference in comparison to CON group. All the markers other than serum NO and TRAP levels had no significant difference between NG-H group and DXM group. It was concluded that low or middle doses of NG could prevent glucocorticoid-induced bone loss in growing rats, but high dose of NG could not. Supplement with NO donor could be considered as a preventive treatment for glucocorticoid-induced osteoporosis in a developing skeleton.
Bone Density/*drug effects ; Dexamethasone ; Nitric Oxide Donors/*therapeutic use ; Nitroglycerin/pharmacology ; Nitroglycerin/*therapeutic use ; Osteoporosis/chemically induced ; Osteoporosis/*prevention & control ; Random Allocation ; Rats, Wistar

OBJECTIVETo identify the optimal dosage of 17beta-estradiol gel + oral progestin for preventing bone loss in postmenopausal Chinese women.

METHODSA 3-year open label, randomized, prospective clinical trial was conducted. Sixty healthy women who had been postmenopausal for 1 to 5 years were recruited and divided into following 4 groups: group 1, percutaneous gel 17beta-estradiol (E(2)) 1.5 mg/d plus micronized progesterone (MP) 100 mg/d; group 2, percutaneous gel 17beta-estradiol (E(2)) 1.5 mg/d plus medroxyprogesterone acetate (MPA) 2 mg/d; group 3, percutaneous gel 17beta-estradiol (E(2)) 0.75 mg/d plus micronized progesterone (MP) 100 mg/d; and group 4, percutaneous gel 17beta-estradiol (E(2)) 0.75 mg/d plus medroxyprogesterone acetate (MPA) 2 mg/d. Estrogen and progestin were given continuously for 25 days per month. Bone mineral density (BMD) was measured using quantitative computed tomography (QCT) for trabecular bone of L2-5 and dual energy X-ray absorptiometry (DEXA) for L2-4 and hip 5 times during the trial at baseline and at the 6-, 12-, 18-, 24- and 36-month visits.

RESULTSFifty-nine patients (98.3%, 59/60) stayed in the study for 1 year, 56 patients (93.3%, 56/60) for 2 years, and 51 (85%, 51/50) for 3 years. On average, menopausal symptoms were relieved by 80% after 6 months of treatment. By the 24th month, the mean increase in BMD ranged from 4.3% to 7.5% in trabecular bone; and by the 36th month, it ranged from 4.2% to 6.2% in L2-4 and 1.61% to 3.77% in the neck. There were significant difference after treatment (P < 0.05). Among the four groups, no significant difference (P > 0.05) was found in improvement of symptoms, levels of bone markers or BMD.

CONCLUSIONA daily dose of estradiol gel, either 0.75 mg or 1.5 mg, is effective in preventing early postmenopausal bone loss and relieving menopausal symptoms. After 3-year treatment, spinal BMD could increase steadily, so does hip BMD, especially in the first 2 years.

Administration, Cutaneous ; Adult ; Bone Density ; Estradiol ; administration & dosage ; Estrogen Replacement Therapy ; Female ; Fractures, Bone ; prevention & control ; Humans ; Medroxyprogesterone Acetate ; administration & dosage ; Middle Aged ; Osteoporosis, Postmenopausal ; prevention & control

We have investigated the effects of different exercises on middle-aged and old women's bone mineral density (BMD), on the metabolic indexes of bone, on the levels of serum elements, and on the correlation between body components and the indexes. On the basis of informed consent, 90 cantonal women pursued three types of exercises (Taijiquan, Swimming and brisk walking) in Chengdu City. BMD indexes of calcaneus were tested by Osteospace quantitative ultrasound instruments; The serum levels of Mg, Ca, P elements and alkaline phosphatase (ALP) were determined by full-automatic biochemical analysis instrument; The serum level of osteocalcin (BGP) was determined by radioimmunoassay. There were no obvious differences of anthropometric indexes between Taijiquan, Swimming, Brisk walking and Control groups. In comparison with control, the serum levels of Mg element increased significantly in the three exercise groups, and the serum levels of Ca and P element increased significantly in Swimming group and Brisk walking group. The serum levels of BGP and ALP were lower than those of control group, but no statistically significant differences were observed. Speed of sound (SOS) and stiffness index (STI) of BMD indexes in Brisk walking group were significantly higher than in Taijiquan group, Swimming group and Control group, and the prevalences of osteopenia and osteoporosis were the lowest in the Brisk walking group, but no obvious decreases of osteopenia and osteoporosis were observed in Taijiquan group and Swimming group. Broadband ultrasound attenuation (BLIA), SOS, STI of BMD indexes were positively correlated to serum levels of Mg, Ca, P, and were negatively correlated to the serum levels of BGP and ALP, and were positively correlated to body weight, BMI, lean body mass and body fat percentage. In conclusion, brisk walking is a fitting type of exercise for middle-aged and old cantonal women; it maintaines normal levels of bone metabolism.
Aged ; Alkaline Phosphatase ; blood ; Bone Density ; Exercise ; physiology ; Female ; Humans ; Middle Aged ; Osteoporosis, Postmenopausal ; metabolism ; prevention & control ; Walking ; physiology