Clinical Observation Of Bone Metabolism Of Compound Vibration Machine On The Treatment Of Osteoporosis

BackgroundsOsteoporosis is a common disease in middle- aged and old people,characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture.It was estimated that the people with osteoporosis had been more than 200 millions in the world,and there had been more than 84 millions patients in China.Its incidence rate has leapt to the 7th of common diseases.The most important risk of osteoporosis is from osteoporotic fracture,and hip fracture,spinal fractures and distal radius fractures are common,and the largest risk of which is hip fracture,because of its high morbidity and high mortality.With the world's elderly population continues to increase, osteoporosis has become a world-wide,increasingly serious impact on important health problem.Drug treatment is used regularly on OP at clinical by inhibiting bone resorption or promote bone formation,but most of which have drug side effects, therefore,in recent years,the majority of scholars began to look on with a new treatment with non-invasive,no side effects,such as physical characteristics factor therapy.The mechanical vibration signal which is lower than leading to injury the bone tissue has a strong osteogenic effect,not only prevents bone loss,but also can improve the bone structure and mechanical properties of biology,which is a new mode of treatment of osteoporosis.Our research is supported by Natural Science Found of Guangdong Province.We have the intellectual property rights of compound vibration and compound vibration machine.The compound vibration is compound by special balance interruption and vertical whole-body-vibration(WBV).We hoped it could enhance the muscle function and balance control based on the bone formation situation of WBV,and gain the improvement of both bone quality and balance control.The group has been on many basic research in cells and animals with the self-developed compound vibration machine,to be a better osteogenic effect.Early studies of our group draw the preliminary findings have:1).In the loading process of vibration stresss,the suffered stress of osteoblasts is the form of fluid shear stress;2). Different frequencies of vibration stresss on the osteoblasts's cycle,proliferation and alkaline phosphatase activity have an impact,while the appropriate frequency of promoting osteoblasts's proliferation and differentiation of the vibration stresss is 15～45Hz;3) The L-type voltage-dependent calcium Road activated by vibration stresss is one of the reasons of osteoblasts's membrane potential depolarization and the increasing concentrations of intracellular Ca~2,and the increasing in the intracellular Ca~2 concentration and nitric oxide(NO) activity lead to enhanced cell function,so Ca~2 and NO participate in the early osteoblasts's mechanical signal transduction.4) Composite vibration at a lower intensity may increase bone mineral density of ovariectomized rats at different stages,improving bone micro-institutions,improve bone strength;5) What's more,composite vibration can improve the quality of bone at a certain extent,be on the prevention or improvement of muscular atrophy, maintain or enhance muscle strength,and reduce or improve peripheral degeneration of peripheral nerve function,which may help to improve or enhance the balance. Although the composite vibration have been very good osteogenic effect at cell and animal studies,but not yet in clinical applications,whether in clinical practice can be a better role in osteogenesis and the affects of the bone metabolism in the human body, which need to be further study.The degradation of the fragment of bone matrix components and secreted products from osteoclast's activity,as well as the metabolites of osteoblasts with the formation of new bone,which constitutes a reflection of resorption activity indicators of osteoclast and reflect the activity of bone formation of osteoblasts Indicators.Both of the indicators are collectively referred to as biochemical markers of bone turnover or biochemical markers of bone metabolism.Common biochemical markers of bone formation have alkaline phosphatase(ALP),bone isoenzyme alkaline phosphatase(BALP),osteocalcin(OC),aminoterminal propeptide of typeⅠprocollagen(PINP),carboxyterminal propeptide of typeⅠprocollagen(PICP) et al. Common biochemical markers of bone resorption have tartrate-resistance acid phosphatase(TRAP),pyridinoline(PYD),deoxypyridinoline(DPD),hydroxyproline (HOP),hydroxylysine glycoside(HOLG),typeⅠcollagen cross- linked N-telopeptide(NTX),typeⅠcollagen cross-linked C-telopeptide(CTX) et al.With the rapid development of science and technology,the new biochemical markers of bone turnover have been found,and the recent discovery of new biochemical markers of bone metabolism include osteoprotegerin(OPG),leptin,and insulin-like growth factors-1(IGF-1) et al.Serum alkaline phosphatase is composed by the isozyme of the bone,liver, intestine placental and kidney.Under normal physiological conditions,the ratio of the bone-derived ALP(BALP) and liver-derived ALP is around 1:1.ALP with bone metabolism-related bone is mainly secreted by osteoblasts,accounting for 50%of the total ALP,and its half-life is 1～2 days.ALP is the least heat-resistant,which can be leaded to inactivation under 25 minutes at 56℃.Serum total ALP and BALP are first discovered and used to evaluate bone formation and bone transformation.OC,also known asγ-carboxyglutamic acid protein,is the non-collagenous protein that is secreted by mature osteoblasts synthesis,and its physiological function is related with bone turnover.The half-life of osteocalcin is 15 to 70 minutes,and is cleared by the kidneys.The level of OC is a circadian rhythm,which is dropped from morning to afternoon,and then gradually increased,and the peak emerge after midnight.The values between peak and valley is 10%～30%.TRAP is one of the six kinds of isoenzymes(0～5) of acid phosphatase.Serum TRAP comes mainly from the osteoclasts.The secretion of TRAP increased when osteoclast activity enhance.We can know the osteoclast activity and bone resorption by detecting the level of TRAP.Growth and renewal of bone are closely related to the of metabolism calcium and phosphate.The status between calcium and phosphorus in the plasma are fairly constant,and the product of both([Ca]×[p]) in adults is 30～40 mg~2/dl~2.When([Ca]×[P])＞40 mg~2/dl~2,the calcium and the phosphorus will be in the form of bone salt deposition in bone tissue;if([Ca]×[P])＜35 mg~2/dl~2,which impede bone calcification,even lead to the dissolution of bone salt and affect osteogenesis.Objectives:1.To observe the effect of bone metabolism of compound vibration machine on the treatment of osteoporosis.2.To study preliminarily the mechanism of compound vibration machine on the treatment of osteoporosis.Methods1.To collect qualified volunteers of osteoporosis at nursing homes.1.1 Inclusion criteria:with reference to WHO diagnostic criteria,to select volunteers whose BMD is below 2.5 standard deviation of the peak of the young adult's BMD,simultaneously with or without osteoporosis clinical symptoms, mental status and flexibility of action,and can finish the entire experiment.1.2 Exclusion criteria:1.2.1 With drug control,blood pressure is greater than 160/110 mmHg or systolic blood pressure is less than 90 mmHg;1.2.2 With cerebrovascular disease,epilepsy or kidney stones;1.2.3 With thrombosis or there is thrombosis in the past six month;1.2.4 With implants or cardiac stent in the body.1.2.5 With Lumbar disc herniation or spondylolisthesis,lumbar spinal stenosis or nerve compression1.2.6 All kinds of surgery have not yet recovered.1.2.7 Joint trauma,fractures,muscle strain has not yet recovered;1.2.8 With weak and sickly,serious obstacles to balance or dizziness; 1.2.9 Suffering from gout,rheumatoid,diabetes,poor glycemic control,or other serious diseases that affect bone metabolism;1.2.10 Who had taken drug of the treatment of osteoporosis or other drugs affect bone metabolism in the past a month;1.2.11 The cessation of testing will be if the volunteers do not apply when they are in the composite vibration training2.Seventy volunteers of osteoporosis were selected from a gerocomium and were randomly assigned to a whole body compound vibration training group(WBCV, n-35) or a control group(CON,n-35).Height,weight,body mass index and bone mineral density between WBCV and CON were no significant difference(P＞0.05).3.The WBCV group intervention consisted of an 6-month whole body compound vibration(30 min/day,1 time/qd).During the 30-minute vibration program,the platform oscillated in an ascending order from 45 to 55 Hz,corresponding to estimated maximum compound accelerations from 0.5 g to 0.8 g.The CON did not participate in any training,just keeping the normal life as before.4.Alkaline phosphatase(ALP),osteocalcin(OC),tartrate-resistance acid phosphatase(TRAP),calcium and phosphorus were measured at baseline,after the 1-month intervention,after the 3-month intervention and after the 6-month intervention.5.Statistical treatment is used SPSS13.0 statistical packages.To express data by mean±standard deviation((?)±s).The basic situation between WBCV and CON and the bone metabolism between WBCV and CON at different time points are both analysised by Independent-Sanples T Test,while bone metabolism between WBCV and CON and of each group are analysised by Repeated Measures,P= 0.05.Results1.There was a volunteer who gave up due to internal diseases hospital treatment in the treatment of 30 days in the WBCV group.2.The p of ALP in the 3th,6th months is respectively 0.003 and 0.686.ALP increased early,to a peak in the 3th month,then was into the downward trend,3.The p of OC in the 3th,6th months is respectively 0.768 and 0.618.OC had no significant change in trend.4.Thep of TRAP in the 3th,6th months is respectively 0.817 and 0.855.TRAP had no significant change in trend5.The p of[Ca]×[p]in the 3th,6th months is respectively 0.077 and 0.001. [Ca]×[P]is in the ever-increasing trend.Conclusions1.Volunteers of the trials does not appear obvious adverse reactions,suggesting the used vibration parameters is safe.2.Composite vibration may promote bone tissue calcification early.3.Composite vibration may promote calcium and phosphorus deposition in bone tissue in the form of bone salt.4.The effect of compound vibration on the tretment of osteoporosis may reduce if doing continuously,and to take short-term,intermittent load may be more conducive to the promotion of osteogenic effect of composite vibration.5.The increase in BMD caused by vibration may be not because the vibration intervention inhibite the bone resorption,but the vibration intervention maybe reverse the negative calcium balance to a positive balance,at the same time,the positive role of vibration for BMD may be partially the result.