Disrupted Bone Metabolism in Long-Term Bedridden Patients.
Disrupted Bone Metabolism in Long-Term Bedridden Patients.
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DOI：
10.1371/journal.pone.0156991
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Watanabe K
中科院分区：
文献类型：
--
作者：
Eimori K;Endo N;Uchiyama S;Takahashi Y;Kawashima H;Watanabe K
卧床不起的患者有骨质疏松症和骨折的风险，尽管对这些患者的长期骨代谢过程知之甚少。因此，我们的目的是确定长期卧床如何影响骨代谢。本研究纳入了36例因严重不动而从出生起就卧床不起的患者。将所有研究患者的骨矿物质密度和骨代谢指标与卧床期间进行比较。研究了17名基线年龄<30岁的患者在12年随访期间骨代谢标志物的变化。骨密度降低（0.58±0.19 g/cm 3），骨钙素（13.9±12.4 ng/mL）和尿N-末端肽（NTX）水平（146.9±134.0 mM BCE/mM肌酐）均大于预测骨折的临界值。在骨代谢指标中，骨钙素和NTX与卧床不起呈负相关。在随访期间，骨钙素和甲状旁腺激素下降，25（OH）维生素D增加。基线NTX与12年后的骨密度呈负相关。在长期卧床的患者中发现了独特的骨代谢异常，这些代谢异常通过进一步的卧床限制而改变。根据独特的骨代谢变化进行适当的治疗对长期卧床患者可能是重要的。
Bedridden patients are at risk of osteoporosis and fractures, although the long-term bone metabolic processes in these patients are poorly understood. Therefore, we aimed to determine how long-term bed confinement affects bone metabolism. This study included 36 patients who had been bedridden from birth due to severe immobility. Bone mineral density and bone metabolism markers were compared to the bedridden period in all study patients. Changes in the bone metabolism markers during a follow-up of 12 years were studied in 17 patients aged <30 years at baseline. The bone mineral density was reduced (0.58±0.19 g/cm3), and the osteocalcin (13.9±12.4 ng/mL) and urine N-terminal telopeptide (NTX) levels (146.9±134.0 mM BCE/mM creatinine) were greater than the cutoff value for predicting fracture. Among the bone metabolism markers studied, osteocalcin and NTX were negatively associated with the bedridden period. During the follow-up, osteocalcin and parathyroid hormone were decreased, and the 25(OH) vitamin D was increased. NTX at baseline was negatively associated with bone mineral density after 12 years. Unique bone metabolic abnormalities were found in patients who had been bedridden for long periods, and these metabolic abnormalities were altered by further bed confinement. Appropriate treatment based on the unique bone metabolic changes may be important in long-term bedridden patients.