[Bone histology in postmenopausal osteoporosis--variations in cellular activity].
[Bone histology in postmenopausal osteoporosis--variations in cellular activity].
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发表时间：
2004
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通讯作者：
P. Lozo;D. Krpan;A. Krvavica;Tanja Vukelić Baturić;I. Fistonić;V. Kušec
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作者：
P. Lozo;D. Krpan;A. Krvavica;Tanja Vukelić Baturić;I. Fistonić;V. Kušec
目的绝经后骨质疏松症的现代病因学认识是基于雌激素缺乏导致骨吸收和骨形成失衡，其表现形式可能是两种或一种细胞活性降低和/或增加。绝经后骨质疏松症的研究已经指出，在重塑不平衡的异质性的存在。对一组绝经后骨质疏松症妇女进行骨组织学分析是诊断程序的一部分。根据已发表的绝经后骨质疏松症的组织形态学分类，对数据进行比较和分组。方法43例绝经后妇女，年龄44-71岁，经腰椎和髋部骨密度测定确诊为骨质疏松症。骨质疏松症的次要原因被排除。在用土霉素（Geomycin，Pliva）双标记方案后获得全层经髂骨活检标本。活检标本进行处理，不脱钙包埋在树脂和切片染色的Goldner三色和甲苯胺蓝，或用于荧光显微镜。使用连接到显微镜目镜的网格进行组织形态测定。根据美国骨与矿物质研究协会的建议评估以下参数：骨体积（BV/TV，%）、类骨质表面（OS/BS，%）、成骨细胞表面（Ob. S/BS，%）、类骨质体积（OV/BV，%）、类骨质厚度（O. Th，m）、破骨细胞表面（Oc. S/BS，%），矿物沉积率（MAR，m/天）。将由此获得的数据与正常健康人群的已发表参考数据进行比较，并表示为z评分（数值与正常年龄和性别匹配对照组平均值的标准差数量）。该研究得到了医院伦理委员会的批准。所有患者均签署了参加临床研究的知情同意书。讨论骨活检的组织形态学分析表明，平均骨吸收，即破骨细胞表面，显着增加和类骨质体积适度增加。与已发表的参考数据相比，研究的其余组织形态计量学参数在年龄和性别方面基本正常。65%的患者破骨细胞表面增加表明，在这些绝经后妇女中，骨丢失是一个活跃和普遍的过程，这比正常年龄匹配的人群更为明显。根据已发表的绝经后骨质疏松症分类，对组织形态计量学分析结果进行分类。每组患者的百分比与文献数据不同，最可能是由于样本量和选择。没有一个患者具有成骨细胞和骨细胞活性降低的组织形态计量学特征，但在37%的绝经后妇女中，骨细胞活性增加，而成骨细胞活性正常，这一特征在绝经后骨质疏松症的原始组织形态计量学分类中没有描述。结论：绝经后骨质疏松症妇女骨活检的组织形态计量学分析显示骨吸收是主要的发现。根据骨细胞活性的多样性识别不同的组。研究组中的频率差异，以及观察到一个不包括在绝经后骨质疏松症的组织形态学分类中的独特组可能是由于样本量和非特异性人群特征。绝经后骨质疏松症的骨组织形态计量学分析对更好地了解这一最常见的骨疾病有重要贡献。
AIM Modern understanding of the etiology of postmenopausal osteoporosis is based on the imbalance between bone resorption and formation due to estrogen deficiency, which may take several forms and combinations of decreased and/or increased activity of both or one cell type. Studies of postmenopausal osteoporosis have pointed to the existence of heterogeneity in the remodeling imbalance. Bone histology analyzed in a group of women with established postmenopausal osteoporosis undergoing bone biopsy is part of the diagnostic procedure. Data were compared and grouped according to the published histomorphometric classification of postmenopausal osteoporosis. METHODS The study included 43 postmenopausal women aged 44-71 years with osteoporosis established by densitometry of the lumbar spine and hip. Secondary causes of osteoporosis were ruled out. Full thickness transiliacai bone biopsy specimens were obtained after double labeling regime with oxytetracycline (Geomycin, Pliva). Biopsy specimens were processed for undecalcified embedding in resin and sections stained by Goldner trichrome and toluidine blue, or used for fluorescence microscopy. A grid attached to the microscope eyepiece was used for histomorphometry. The following parameters were assessed according to the recommendations of the American Society for Bone and Mineral Research: bone volume (BV/TV, %), osteoid surface (OS/BS, %), osteoblast surface (Ob. S/BS, %), osteoid volume (OV/BV, %), osteoid thickness (O. Th, m), osteoclast surface (Oc. S/BS, %), mineral apposition rate (MAR, m/day). Thus obtained data were compared to published reference data for normal healthy population and also expressed as z-scores (the number of standard deviations by which the value differs from the mean of the normal age and sex matched controls). The study was approved by the hospital ethics committee. All patients signed an informed consent to take part in the clinical study. DISCUSSION Histomorphometric analysis of bone biopsy demonstrated that on an average bone resorption, i.e. osteoclast surface, was considerably increased and osteoid volume moderately increased. The remaining histomorphometric parameters studied were generally normal for age and sex as compared to the published reference data. Increased osteoclast surface in 65% of patients indicated that bone loss was an active and prevailing process in these postmenopausal women, which was considerably more pronounced than in the normal age-matched population. Results of the histomorphometric analysis were categorized according to the published classification of postmenopausal osteoporosis. The percentage of patients in each group differed from literature data, most probably due to the sample size and choice. None of the patients had histomorphometric features of reduced osteoblastic and osteoclastic activity, but in 37% of postmenopausal women osteoclastic activity was increased while osteoblastic activity was normal, a feature not described in the original histomorphometric classification of postmenopausal osteoporosis. CONCLUSIONS Histomorphometric analysis of bone biopsy in women with postmenopausal osteoporosis revealed bone resorption as a predominant finding. Different groups were recognized based on the diversity of bone cell activity. The difference in the frequencies in study groups, and observation of a distinct group not included in the histomorphometric classification of postmenopausal osteoporosis probably resulted from sample size and nonspecific population traits. Histomorphometric analysis of bone in postmenopausal osteoporosis is an important contribution to better understanding of this most common bone disorder.