• 제목/요약/키워드: Osteoporotic

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골다공증의 진단과 치료 (The Diagnosis and Treatment of Osteoporosis)

  • 문준성;원규장
    • Journal of Yeungnam Medical Science
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    • 제25권1호
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    • pp.19-30
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    • 2008
  • 골다공증은 골밀도와 골의 질로 구성되는 골의 강도가 손상됨으로 골절의 위험이 높아지는 골격질환이며, 최근 유병율이 점차 증가하고 있는 추세이다. 임상적으로 무증상인 경우가 많으며 방사선학적 검사인 단순 방사선 검사, 골 스캔, CT, MRI 등이 골밀도 및 골절의 진단에 유용하다. 골밀도의 정량적 검사로는 이중에너지 방사선 흡수법, 정량적 전산화 단층촬영이 사용되고 있다. 골다공증의 진단은 WHO 기준에 따라 T-score가 -2.5 이하일 경우 진단할 수 있다. 그 외에 생화학적 골표지자들도 진단에 도움이 된다. 골다공증 치료제는 골흡수억제제와 골형성자극제(formation stimulator)로 나눌 수 있는데 골흡수억제제로는 칼슘, 에스트로겐, 칼시토닌, 비스포스포네이트(bisphosphonate), 비타민 D 등이 있으며 골량을 증가시키는 골형성자극제로는 현재 부갑상선 호르몬이 유일하며 최근 strontium ranelate가 추가되었다. 일일 1200 mg의 칼슘과 800 IU 의 비타민 D 섭취가 권장되고 있으며, 폐경기 여성에서 에스트로겐이 효과가 입증되었고 골다공증으로 인한 통증에는 칼시토닌이 효과가 있다. 비스포스포네이트는 폐경 후 골다공증의 치료, 예방 및 스테로이드에 의한 골다공증 치료에 대해 FDA의 승인을 받았다. 폐경 후 골다공증의 치료, 예방에 사용되는 SERM은 골의 질을 향상시킴으로써 골절을 예방한다고 알려져 있다. 골형성자극제인 부갑상선 호르몬이 골절의 위험을 감소시킨다고 보고된 바 있으며, strontium은 최근에 개발된 약제로 3상 연구에서 골절 위험율 감소효과를 보였으나 더 많은 연구가 필요할 것으로 생각된다.

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The Role of Bone Cement Augmentation in the Treatment of Chronic Symptomatic Osteoporotic Compression Fracture

  • Kim, Hyeun-Sung;Kim, Sung-Hoon;Ju, Chang-Il;Kim, Seok-Won;Lee, Sung-Myung;Shin, Ho
    • Journal of Korean Neurosurgical Society
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    • 제48권6호
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    • pp.490-495
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    • 2010
  • Objective : Bone cement augmentation procedures such as percutaneous vertebroplasty and balloon kyphoplasty have been shown to be effective treatment for acute or subacute osteoporotic vertebral compression fractures. The purpose of this study was to determine the efficacy of bone cement augmentation procedures for long standing osteoporotic vertebral compression fracture with late vertebral collapse and persistent back pain. Methods : Among 278 single level osteoporotic vertebral compression fractures that were treated by vertebral augmentation procedures at our institute, 18 consecutive patients were included in this study. Study inclusion was limited to initially, minimal compression fractures, but showing a poor prognosis due to late vertebral collapse, intravertebral vacuum clefts and continuous back pain despite conservative treatment for more than one year. The subjects included three men and 15 women. The mean age was 70.7 with a range from 64 to 85 years of age. After postural reduction for two days, bone cement augmentation procedures following intraoperative pressure reduction were performed. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed. Results : The mean follow-up period after bone cement augmentation procedures was 14.3 months (range 12-27 months). The mean injected cement volume was 4.1 mL (range 2.4-5.9 mL). The unipedicular approach was possible in 15 patients. The mean pain score (visual analogue scale) prior to surgery was 7.1, which decreased to 3.1 at 7 days after the procedure. The pain relief was maintained at the final follow up. The kyphotic angle improved significantly from $21.2{\pm}4.9^{\circ}$ before surgery to $10.4{\pm}3.8^{\circ}$ after surgery. The fraction of vertebral height increased from 30% to 60% after bone cement augmentation, and the restored vertebral height was maintained at the final follow up. There were no serious complications related to cement leakage. Conclusion : In the management of even long-standing osteoporotic vertebral compression fracture for over one year, bone cement augmentation procedures following postural reduction were considered safe and effective treatment in cases of non-healing evidence.

골다공증성 척추체 압박골절에 대한 경피적 척추성형술시 자기공명영상과 골 주사 검사의 의의 (The Value of Preoperative MRI and Bone Scan in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures)

  • 김세혁;이완수;서의교;신용삼;장호열;전평
    • Journal of Korean Neurosurgical Society
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    • 제30권7호
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    • pp.907-915
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    • 2001
  • Objective : Percutaneous vertebroplasty is often complicated by the presence of multiple fractures or non-localizing pain in the patients with osteoporotic vertebral fractures. The purpose of this study is to estimate the value of preoperative radiologic studies in the localization of symptomatic vertebrae and to determine the factors which can influence on the clinical results. Materials and Methods : We retrospectively reviewed the clinical and radiologic data of 57 vertebrae in 30 patients underwent percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Inclusion criteria was severe pain(McGill-Melzack score 3, 4 or 5) associated with the acute vertebral fractures and absence of spinal nerve root or cord compression sign. Acute symptomatic vertebral fracture was determined by the presence of signal change on MR images or increased uptake on whole body bone scan. Results : Pain improvement was obtained immediately in all patients and favorable result was sustained in 26 patients(86.7%) during the mean follow-up duration of 4.7 months(5 complete pain relief, 21 marked pain relief). Those who underwent vertebroplasty for all acute symptomatic vertebrae had significantly better clinical result than those who did not. Further vertebral collapse and eventual bursting fracture occurred in 1 vertebra which showed intradiskal leakage of bone cement and disruption of cortical endplate on postoperative CT scan. Conclusion : Preoperative MR imaging and whole body bone scan are very useful in determining the symptomatic vertebrae, especially in the patients with multiple osteoporotic vertebral fractures. To obtain favorable clinical result, the careful radiologic evaluation as well as clinical assessment is required. Control of PMMA volume seems to be the most critical point for avoiding complications.

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향부자(香附子) 약침(藥鍼)이 골다공증에 미치는 실험적 연구 (A Study of Herbal-acupuncture with Cyperi Rhizoma Infusion Solution on Osteoporotic Rats Induced by Ovariectomy)

  • 김정호;이현
    • Journal of Acupuncture Research
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    • 제25권2호
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    • pp.243-257
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    • 2008
  • Objective & Methods : The purpose of this study is to observe the effects of Cyperi Rhizoma Herbal-acupuncture infusion solution at Umgok($KI_{10}$) on Osteoporotic Rats Induced by Ovariectomy. The author performed several experimental items to analyze cytotoxic, osteoporosis evaluation, change of ALP, osteocalcin, Ca and histological change of tibia. Result : 1. BMD were increased non-meaningly in CR-HA than control group. 2. ALP was not inhibited by CR-HA, osteocalcin was decreased meaningly in CR-HA than control group. 3. Osteoclast like cell in tibia was increased meaningly in control group, decreased meaningly in CR-HA. 4. In the histological study in tibia, TBV was significantly increased, GPL was significantly decreased in the CR-HA than control group. Conclusions : From the result above, the results suggest that CR-HA at $KI_{10}$ has significant effect on osteoporosis, and to be put to practical use in the future osteoporosis clinic.

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복분자 음곡 약침이 난소적출 흰쥐의 골다공증에 미치는 영향 (Effects of Phamacopuncture with RUBI FRUCTUS Infusion Solution at $KI_{10}$ on Osteoporotic Rats Induced by Ovariectomy)

  • 신희웅;이현
    • Journal of Acupuncture Research
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    • 제27권4호
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    • pp.99-114
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    • 2010
  • Objectives : The purpose of this study is to observe the effects of RUBI FRUCTUS phamacopuncture infusion solution at $KI_{10}$ on osteoporotic Rats Induced by ovariectomy. Methods : The author performed several experimental items to analyze cytotoxic, osteoporosis evaluation, change of ALP, creatinine, Ca, P, osteocalcin, Ca/P ratio and histological change of serum and tibia. Results : 1. Creatinine and phosphorus in serum was decreased significantly in RF-HA than control group. 2. Calcium and phosphorus in tibia was increased significantly in RF-HA than control group. 3. Osteoclast like cell in tibia was increased significantly in control group, decreased significantly in RF-HA. 4. In the histological study in tibia, TBT was significantly increased, GPL was significantly decreased in the RF-HA than control group. Conclusions : This study suggested that RF-HA at KI10 has significant effect on osteoporosis.

DW1350, a Newly Synthetic Anti-osteoporotic Agent: 1. DW-1350 Inhibited Bone Resorption and Promoted Bone Formation

  • Lee, Jin-Soo;Whang, Yun-Ha;Ahn, Seok-Hoon;PanSoo;Jin, Sang-Mi;Yi, Sun-Shin;Jung, Young-Ho;Suh, Hong-Suk;Ryu, Jei-Man
    • 대한약학회:학술대회논문집
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    • 대한약학회 2003년도 Proceedings of the Convention of the Pharmaceutical Society of Korea Vol.1
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    • pp.154.2-155
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    • 2003
  • Recently, we developed a new anti-osteoporotic agent, DW-1350, which not only inhibited osteoclast formation but also induced osteoblast differentiation through the in vitro randomized screening studies. We identified inhibitory activities of DW-1350 for each step of osteoclast differentiation, fusion and pit formation process in co-culture system with mouse bone marrow and primary osteoblasts. (omitted)

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난소절제로 유발된 골다공증 시 흰쥐 갑상샘에 대한 조직학적 및 면역조직화학적 연구 (Histological and Immunohistological Studies of the Thyroid Glands of the Osteoporotic Rats Induced by Ovariectomy)

  • 김대영;구세광;이재현;장인호;이형식
    • 한국임상수의학회지
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    • 제15권2호
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    • pp.235-241
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    • 1998
  • In order to investigate the histological and immunohistochemical changes of thyroid glands, and serum osteocalcini estradiol, pmgesterone, follicular-stimulating hormone (FSH), and calcium levels in the osteoporotic rats induced by ovariectomy, normal(sham-operated group) and experimental groups(ovariectomized group) were divided. The experimental groups were subdivide6 to 5, 10, 15, and 20 weeks after ovariectomized groups. The histological structure of the thyroid gland were observed in normal structure throughout all experimental periods but the calcitonin-immunoreartive cells in the experimental groups were significantly decreased compared with normal groups and degranulations of calcitonin-immunoreactive cells were observed. Theses numbers were decreased with time after ovariectomy. However, the serum osteocalcin and FSH levels of experimental groups were significantly increased compared with normal groups and these levels were increased along with time after ovariectomy, but serum estradiol, progestemn and calcium levels of experimental group were significantly decreased compared with normal groups and these levels were decreased with time after ovariectomy.

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Spontaneous Height Restoration of Vertebral Compression Fracture - A Case Report-

  • Joo, Young;Lee, Pyung-Bok;Nahm, Francis Sahngun
    • The Korean Journal of Pain
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    • 제24권4호
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    • pp.235-238
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    • 2011
  • Vertebral compression fractures result in vertebral height loss and alter sagittal spinal alignment, which in turn can lead to increased morbidity and mortality. Acute osteoporotic vertebral compression fractures are known to increase mobility and instability of the spine. There are limited published data correlating the degree of dynamic mobility and the efficacy of kyphoplasty on vertebral compression fractures. Here we report a 73-year-old female with a severe acute osteoporotic L2 compression fracture who obtained total vertebral height restoration following kyphoplasty, with resolution of back pain.

DW1350, a Newly Synthetic Anti-osteoporotic Agent: 2. Effect on Ovariectomized Osteoporosis Rat Model, a Histomorphometrical Aspect

  • Lee, Jin-Soo;Ku, Sae-Kwang;Jung, Da-Hee;Jin, Youn-Goo;Park, Jae-Hoon;Yang, Hee-Bok;Jung, Yong-Ho;Ryu, Jei-Man
    • 대한약학회:학술대회논문집
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    • 대한약학회 2003년도 Proceedings of the Convention of the Pharmaceutical Society of Korea Vol.1
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    • pp.155.1-155.1
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    • 2003
  • In the present study, the effect of DW-1350, a newly synthesized anti-osteoporotic agent, was evaluated in ovariectomized Rat. Female SD Rat mice underwent bilateral ovariectomy for prevention study that test article was administered from 2 days after ovariectomy for 6 weeks, for therapeutic study it was conducted from 6 weeks after ovariectomy for three months. (omitted)

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