Osteoporosis (OP) is a systemic bone disease characterized by decreased bone mass, damaged bone tissue microstructure, increased bone fragility, and susceptibility to fractures. In China, the population with OP is large. With the increase of age, not only the bone health but also the muscle strength gradually declines. Currently, there are few studies on the dynamic balance between muscle-bone-fat and the pathogenesis of OP.

The purpose of this study is to explore the distribution pattern of TCM syndrome types in OP patients and their relationship with muscle-bone-fat, and to explore the clinical characteristics of OP patients from the perspective of TCM syndrome differentiation, so as to better prevent the occurrence of OP and further exert the advantages of TCM in the diagnosis and treatment of OP.

From July 19, 2019 to January 31, 2022, 108 OP patients were recruited at the Third Affiliated Hospital of Guangzhou University of Chinese Medicine. Among them, 97 were female and 11 were male, with an age range of 49 to 88 years and an average age of (62.9±7.2) years. The general clinical data of the patients were recorded. According to different TCM syndrome types, the patients were divided into 39 cases in the liver-kidney yin deficiency group, 53 cases in the spleen-kidney yang deficiency group, and 16 cases in the qi stagnation and blood stasis group. The bone mineral density of the anterior-posterior lumbar vertebrae (L1-L4) of the patients was detected by DXA, and 25-hydroxyvitamin D [25(OH)D], 1, 25-dihydroxyvitamin D [1, 25-(OH)₂D], fibroblast growth factor 23 (FGF-23), semaphorin 4D (SEMA4D), and serum soluble receptor activator of nuclear factor κB ligand (sRANKL) were detected by ELISA.

The results showed that there were statistically significant differences in bone mineral content and fat mass among different TCM syndrome type groups (P<0.05). The bone mineral content of the spleen-kidney yang deficiency group and the qi stagnation and blood stasis group was higher than that of the liver-kidney yin deficiency group, the fat mass of the spleen-kidney yang deficiency group was lower than that of the liver-kidney yin deficiency group, and the fat mass of the qi stagnation and blood stasis group was higher than that of the spleen-kidney yang deficiency group, with statistically significant differences (P<0.05). There were statistically significant differences in the severe OP rate among different syndrome types. The OP rate of the liver-kidney yin deficiency group was higher than that of the qi stagnation and blood stasis group. There were statistically significant differences in severe OP sRANKL among different syndrome types (P<0.05). The sRANKL of the spleen-kidney yang deficiency group was lower than that of the liver-kidney yin deficiency group (P<0.05). Bone mineral content was positively correlated with fat mass and muscle mass; fat mass was positively correlated with muscle mass, 1, 25-(OH)₂D, FGF-23, SEMA4D, and sRANKL; 25(OH)D was positively correlated with 1, 25-(OH)₂D, FGF-23, SEMA4D, and sRANKL; 1, 25-(OH)₂D was positively correlated with FGF-23, SEMA4D, and sRANKL; FGF-23 was positively correlated with SEMA4D and sRANKL; SEMA4D was positively correlated with sRANKL (P<0.05).

With the increase of age, spleen-kidney deficiency, muscle weakness, and bone insufficiency occur, leading to bone atrophy. Further, water retention occurs internally, generating phlegm and fat, which disrupts the dynamic balance between muscle-bone-fat in the body. In patients with different TCM syndrome types of OP, there are certain differences in muscle, bone, and fat mass, and fat mass is correlated with bone metabolism biochemical indicators.

骨质疏松症（OP）是一种以骨量降低、骨组织微结构损坏导致骨脆性增加、易骨折为特征的全身性骨病。我国OP患病人口基数大，随着年龄的增长，不仅骨骼健康受到影响，肌力也逐步下降，目前针对肌-骨-脂之间的动态平衡与OP发病的研究较少。

探讨OP患者中医证型分布规律与肌-骨-脂的关系，从中医辨证角度探讨OP人群的临床特征，以更好地预防OP发生，从而进一步发挥中医药辨证防治OP的优势。

2019-07-19—2022-01-31前瞻性在广州中医药大学第三附属医院招募原发性OP患者，选取符合研究标准的OP患者108例，其中女97例、男11例；年龄49~88岁，平均年龄（62.9±7.2）岁。记录患者一般临床资料，按照不同中医证型，将患者分为肝肾阴虚组患者39例、脾肾阳虚组患者53例、气滞血瘀组患者16例。采用双能X线骨密度仪（DXA）检测患者前后位腰椎（L1~L4）的骨密度，酶联免疫吸附法检测25羟维生素D[25（OH）D]、1，25二羟维生素D[1，25-（OH）₂D]、成纤维细胞生长因子23（FGF-23）、信号素4D（SEMA4D）、血清可溶性核因子κB受体活化因子配基（sRANKL）等。

不同中医证型组骨矿含量、脂肪质量比较，差异有统计学意义（P<0.05），其中脾肾阳虚组和气滞血瘀组的骨矿含量高于肝肾阴虚组，脾肾阳虚组的脂肪质量低于肝肾阴虚组，气滞血瘀组脂肪质量高于脾肾阳虚组（P<0.05）。肝肾阴虚组严重OP发病率为48.72%（19/39），脾肾阳虚组严重OP发病率为37.74%（20/53），气滞血瘀组严重OP发病率为12.50%（2/16）。3组严重OP发病率比较，差异有统计学意义（χ²=6.32，P=0.04），其中肝肾阴虚组OP率高于气滞血瘀组（P=0.01）。不同证型严重OP sRANKL比较，差异有统计学意义（P<0.05），其中脾肾阳虚组sRANKL低于肝肾阴虚组（P<0.05）。骨矿物含量与脂肪质量、肌肉质量呈正相关，脂肪质量与肌肉质量、1，25-（OH）₂D、FGF-23、SEMA4D、sRANKL呈正相关；25（OH）D与1，25-（OH）₂D、FGF-23、SEMA4D、sRANKL呈正相关，1，25-（OH）₂D与FGF-23、SEMA4D、sRANKL呈正相关，FGF-23与SEMA4D、sRANKL呈正相关，SEMA4D与sRANKL呈正相关（P<0.05）。

随着人体年龄增长，脾肾亏虚、肌肉痿弱、骨骼不实、发为骨痿，进一步水饮内停，生为痰脂，导致体内肌-骨-脂之间的动态平衡被打破，在不同证型的OP患者中，肌肉、骨骼、肌肉质量存在一定差异，其中脂肪质量与骨代谢生化指标具有相关性。