生物医学工程学杂志

生物医学工程学杂志

低强度全身振动与绝经后骨质疏松症

查看全文

绝经后骨质疏松症是体内雌激素降低而导致的一类高骨转换型骨质疏松症,是以骨量减少、骨折风险性增加为特征的一种全身性骨骼疾病。近年来,低强度全身振动,即加速度小于 1 gg = 9.81 m/s2)的全身振动,作为一种非药理性防治骨质疏松症的方式,因其副作用小、操作简单且相对安全而受到广泛关注。研究表明,低强度全身振动可以改善骨强度,增加骨体积和骨密度。但大量的研究结果发现,针对动物模型或人类患者,由于年龄和激素水平不同,低强度全身振动的治疗效果也不尽相同。迄今尚未有明确的低强度全身振动治疗方案适用于不同的治疗对象。整体和细胞水平的研究亦表明,低强度全身振动刺激很可能与改变机体激素水平和干细胞的定向分化有关。本文分析了近年来相关文献,从振动参数、振动效果以及作用机制三方面进行综述,以期为低强度全身振动用于绝经后骨质疏松症的治疗提供科学依据和临床指导。

Postmenopausal osteoporosis is a type of osteoporosis with high bone transformation rate, caused by a decrease of estrogen in the body, which is a systemic bone disease characterized by decreased bone mass and increased risk of fracture. In recent years, as a kind of non-pharmacologic treatment of osteoporosis, defined by whole-body vibration less than 1 g (g = 9.81 m/s2), low magnitude whole-body vibration is widely concerned, mainly because of its small side effects, simple operation and relative safety. Studies have shown that low magnitude whole-body vibration can improve bone strength, bone volume and bone density. But a lot of research found that, the therapeutic effects of low magnitude whole-body vibration are different depending on ages and hormone levels of subjects for animal models or human patients. There has been no definite vibration therapy can be applied to each subject so far. Studies of whole-body and cellular level suggest that low magnitude whole-body vibration stimulation is likely to be associated with changes of hormone levels and directed differentiation of stem cells. Based on the analysis of related literature in recent years, this paper made a review from vibration parameters, vibration effects and the mechanisms, to provide scientific basis and clinical guidance for the treatment of postmenopausal osteoporosis with low magnitude whole-body vibration.

关键词: 低强度全身振动; 绝经后骨质疏松症; 非药理性; 骨髓间充质干细胞

Key words: low magnitude whole-body vibration; postmenopausal osteoporosis; non-pharmacologic; bone marrow-derived mesenchymal stem cells

引用本文: 李汇明, 李良. 低强度全身振动与绝经后骨质疏松症. 生物医学工程学杂志, 2018, 35(2): 301-306. doi: 10.7507/1001-5515.201801071 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
1. Kanis J A, on behalf of the World Health Organization Scientific Group. Assessment of osteoporosis at the primary health-care level. University of Sheffield, UK: WHO Collaborating Centrefor Metabolic Bone Diseases, 2008.
2. Paineiras-Domingos L L, de Sa-Caputo D D C, Moreira-Marconi E, et al. Can whole body vibration exercises affect growth hormone concentration? A systematic review. Growth Factors, 2017, 35(4/5): 189-200.
3. Weber-Rajek M, Mieszkowski J, Niespodziński B, et al. Whole-body vibration exercise in postmenopausal osteoporosis. Prz Menopauzalny, 2015, 14(1): 41-47.
4. Jepsen D B, Thomsen K, Hansen S, et al. Effect of whole-body vibration exercise in preventing falls and fractures: a systematic review and meta-analysis. BMJ Open, 2017, 7(12): e018342.
5. Lam F M, Chan P F, Liao L R, et al. Effects of whole-body vibration on balance and mobility in institutionalized older adults: a randomized controlled trial. Clin Rehabil, 2017: 269215517733525. DOI: 10.1177/0269215517733525. [Epub ahead of print]
6. Fratini A, Bonci T, Bull A M. Whole body vibration treatments in postmenopausal women can improve bone mineral density: results of a stimulus focussed meta-analysis. PLoS One, 2016, 11(12): e0166774.
7. Lam F M H, Tang C Y, Kwok T C Y, et al. Transmissibility and waveform purity of whole-body vibrations in older adults. Clin Biomech (Bristol, Avon), 2018, 51: 82-90.
8. Rubin C, Pope M, Fritton J C, et al. Transmissibility of 15-hertz to 35-hertz vibrations to the human hip and lumbar spine: determining the physiologic feasibility of delivering low-level anabolic mechanical stimuli to skeletal regions at greatest risk of fracture because of osteoporosis. Spine (Phila Pa 1976), 2003, 28(23): 2621-2627.
9. Oxlund B S, Ørtoft G, Andreassen T T, et al. Low-intensity, high-frequency vibration appears to prevent the decrease in strength of the femur and tibia associated with ovariectomy of adult rats. Bone, 2003, 32(1): 69-77.
10. 陈履平, 韩祖斌, 杨秀珍, 等. 不同振动频率对实验性骨折愈合的影响. 中华外科杂志, 1994, 32(4): 217-219.
11. International Organization for Standardization. Mechanical vibration and shock-evaluation of human exposure to whole-body vibration. Part 1: general requirements. Geneva: International Organization for Standardization, 1997.
12. Tan Lei, Li Yanhui, Dong Xin, et al. Effect of 4-week whole body vibration on distal radius density. Chin Med Sci J, 2016, 31(2): 95-99.
13. Li Ming, Wu Wei, Tan Lei, et al. Low-magnitude mechanical vibration regulates expression of osteogenic proteins in ovariectomized rats. Biochem Biophys Res Commun, 2015, 465(3): 344-348.
14. Leung K S, Li C Y, Tse Y K, et al. Effects of 18-month low-magnitude high-frequency vibration on fall rate and fracture risks in 710 community elderly—a cluster-randomized controlled trial. Osteoporos Int, 2014, 25(6): 1785-1795.
15. Xie Pengfei, Tang Zhurong, Qing Fangzhu, et al. Bone mineral density, microarchitectural and mechanical alterations of osteoporotic rat bone under long-term whole-body vibration therapy. J Mech Behav Biomed Mater, 2016, 53: 341-349.
16. Bilgin H M, Çelik F, Gem M, et al. Effects of local vibration and pulsed electromagnetic field on bone fracture: A comparative study. Bioelectromagnetics, 2017, 38(5): 339-348.
17. Butezloff M M, Zamarioli A, Leoni G B, et al. Whole-body vibration improves fracture healing and bone quality in rats with ovariectomy-induced osteoporosis. Acta Cir Bras, 2015, 30(11): 727-735.
18. Qing Fangzhu, Xie Pengfei, Liem Y S, et al. Administration duration influences the effects of low-magnitude, high-frequency vibration on ovariectomized rat bone. J Orthop Res, 2016, 34(7): 1147-1157.
19. Brouwers J E, van Rietbergen B, Ito K, et al. Effects of vibration treatment on tibial bone of ovariectomized rats analyzed by in vivo micro-CT. J Orthop Res, 2010, 28(1): 62-69.
20. Chen G X, Zheng S, Qin S, et al. Effect of low-magnitude whole-body vibration combined with alendronate in ovariectomized rats: a random controlled osteoporosis prevention study. PLoS One, 2014, 9(5): e96181.
21. Hatori K, Camargos G V, Chatterjee M, et al. Single and combined effect of high-frequency loading and bisphosphonate treatment on the bone micro-architecture of ovariectomized rats. Osteoporos Int, 2015, 26(1): 303-313.
22. Rubin C, Recker R, Cullen D, et al. Prevention of postmenopausal bone loss by a low-magnitude, high-frequency mechanical stimuli: A clinical trial assessing compliance, efficacy, and safety. J Bone Miner Res, 2004, 19(3): 343-351.
23. Verschueren S M, Roelants M, Delecluse C, et al. Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study. J Bone Miner Res, 2004, 19(3): 352-359.
24. Beck B R, Norling T L. The effect of 8 mos of twice-weekly low- or higher intensity whole body vibration on risk factors for postmenopausal hip fracture. Am J Phys Med Rehabil, 2010, 89(12): 997-1009.
25. Beck B R. Vibration therapy to prevent bone loss and falls: mechanisms and efficacy. Curr Osteoporos Rep, 2015, 13(6): 381-389.
26. Hawkey A, Griffiths K, Babraj J, et al. Whole-body vibration training and its application to age-related performance decrements: an exploratory analysis. J Strength Cond Res, 2016, 30(2): 555-560.
27. Stolzenberg N, Belavý D L, Rawer R, et al. Vibration or balance training on neuromuscular performance in osteopenic women. Int J Sports Med, 2013, 34(11): 956-962.
28. Klarner A, von Stengel S, Kemmler W, et al. Effects of two different types of whole body vibration on neuromuscular performance and body composition in postmenopausal women. Dtsch Med Wochenschr, 2011, 136(42): 2133-2139.
29. von Stengel S, Kemmler W, Engelke K, et al. Effects of whole body vibration on bone mineral density and falls: results of the randomized controlled ELVIS study with postmenopausal women. Osteoporos Int, 2011, 22(1): 317-325.
30. Yang F, King G A, Dillon L, et al. Controlled whole-body vibration training reduces risk of falls among community-dwelling older adults. J Biomech, 2015, 48(12): 3206-3212.
31. Edwards J H, Reilly G C. Vibration stimuli and the differentiation of musculoskeletal progenitor cells: Review of results in vitro and in vivo. World J Stem Cells, 2015, 7(3): 568-582.
32. Luu Y K, Capilla E, Rosen C J, et al. Mechanical stimulation of mesenchymal stem cell proliferation and differentiation promotes osteogenesis while preventing dietary-induced obesity. J Bone Miner Res, 2009, 24(1): 50-61.
33. Gao Heqi, Zhai Mingming, Wang Pan, et al. Low-level mechanical vibration enhances osteoblastogenesis via a canonical Wnt signaling-associated mechanism. Mol Med Rep, 2017, 16(1): 317-324.
34. Chen Bailing, Lin Tao, Yang Xiaoxi, et al. Low-magnitude, high-frequency vibration promotes the adhesion and the osteogenic differentiation of bone marrow-derived mesenchymal stem cells cultured on a hydroxyapatite-coated surface: The direct role of Wnt/β-catenin signaling pathway activation. Int J Mol Med, 2016, 38(5): 1531-1540.
35. Uzer G, Thompson W R, Sen B, et al. Cell mechanosensitivity to extremely low-magnitude signals is enabled by a LINCed nucleus. Stem Cells, 2015, 33(6): 2063-2076.
36. Pichler K, Loreto C, Leonardi R, et al. RANKL is downregulated in bone cells by physical activity (treadmill and vibration stimulation training) in rat with glucocorticoid-induced osteoporosis. Histol Histopathol, 2013, 28(9): 1185-1196.
37. Jordan M J, Norris S R, Smith D J, et al. Vibration training: An overview of the area, training consequences, and future considerations. J Strength Cond Res, 2005, 19(2): 459-466.
38. Judex S, Rubin C T. Is bone formation induced by high-frequency mechanical signals modulated by muscle activity?. J Musculoskelet Neuronal Interact, 2010, 10(1, SI): 3-11.
39. Calendo L R, Taeymans J, Rogan S. Does muscle activation during whole-body vibration induce bone density improvement in postmenopausal women? —A systematic review. Sportverletz Sportschaden, 2014, 28(3): 125-131.
40. Cardinale M, Soiza R L, Leiper J B, et al. Hormonal responses to a single session of whole-body vibration exercise in older individuals. Br J Sports Med, 2010, 44(4): 284-288.