Delmas Pierre D, Seeman Ego
Claude Bernard University of Lyon and INSERM Research Unit 403, Lyon, France.
Bone. 2004 Apr;34(4):599-604. doi: 10.1016/j.bone.2003.12.022.
The structural basis for the reduction in vertebral and nonvertebral fracture risk in patients using anti-resorptive therapy is not well understood. As reduced bone mineral density (BMD) increases the risk for fracture and anti-resorptive agents increase BMD, it was commonly held that the increase in BMD explained the fracture risk reduction until several meta-analyses either failed to detect a significant association between vertebral fracture risk reduction and the incremental increase in BMD or reported that only a small proportion of the vertebral fracture risk reduction was explained by changes in BMD. Recently, it was reported that the risk of nonvertebral fractures decreased when an increase in BMD accompanied anti-resorptive treatment [J. Clin. Endrocrinol. Metab. 87 (2002) 1586]. However, a reanalysis of the data, using the same statistical methods after correcting for discrepancies in the reported BMD and person-year data, suggested that the magnitude of reductions in nonvertebral fracture risk was not associated with the magnitude of increases in BMD at the end of the first year or at completion of the studies. We infer that only a small proportion of risk reduction in vertebral and nonvertebral fractures observed with anti-resorptive drug therapy is explained by the increase in BMD. Further studies are needed to define the structural basis of the fracture risk reduction.
使用抗吸收疗法的患者椎骨和非椎骨骨折风险降低的结构基础尚未完全明确。由于骨矿物质密度（BMD）降低会增加骨折风险，而抗吸收药物会增加BMD，因此人们普遍认为BMD的增加解释了骨折风险的降低，直到多项荟萃分析要么未能检测到椎骨骨折风险降低与BMD的增量增加之间存在显著关联，要么报告称BMD的变化仅解释了一小部分椎骨骨折风险的降低。最近，有报道称，当抗吸收治疗伴随BMD增加时，非椎骨骨折的风险会降低[《临床内分泌与代谢杂志》87 (2002) 1586]。然而，在对报告的BMD和人年数据中的差异进行校正后，使用相同的统计方法对数据进行重新分析表明，非椎骨骨折风险降低的幅度与第一年结束时或研究完成时BMD增加的幅度无关。我们推断，抗吸收药物治疗观察到的椎骨和非椎骨骨折风险降低中，只有一小部分是由BMD的增加所解释的。需要进一步的研究来确定骨折风险降低的结构基础。
