Frost Michelle L, Cook Gary J R, Blake Glen M, Marsden Paul K, Fogelman Ignac
Osteoporosis Screening & Research Unit, King's College London School of Medicine, Guy's Hospital, London.
J Clin Densitom. 2007 Jan-Mar;10(1):46-54. doi: 10.1016/j.jocd.2006.10.006. Epub 2006 Dec 27.
Bone turnover is an important determinant of fracture risk. (18)F-fluoride positron emission tomography ((18)F-PET) allows the direct assessment of bone turnover at the clinically important skeletal sites such as the lumbar spine. The aim of this study was to determine if the relationship between regional bone turnover measured using (18)F-PET and changes in bone mineral density (BMD) is equivalent to that seen for global skeletal measurements of biochemical markers of bone turnover. Forty-three women who had previously had an (18)F-PET scan at the lumbar spine, assessment of biochemical markers of bone turnover, and a dual-energy X-ray absorptiometry scan of BMD at the lumbar spine and hip (baseline assessments) were split into 1 of 2 groups: (1) 22 women who commenced treatment for osteoporosis within 2mo of having the baseline assessments (Treatment group); (2) 21 women who had not taken any treatments for osteoporosis since having the baseline assessments (Untreated group). Sixteen of the women in the Treatment group started risedronate therapy as part of a prospective study they were participating in, whereas the decision to treat the remaining 6 women was made by the subject's treating physician. Subjects had between 2 and 5 BMD scans over a median follow-up time of 4.1yr to estimate the annual percentage change in BMD since baseline. The relationship between the tertiles of (18)F-PET skeletal kinetic parameter K(i), reflecting regional bone turnover, and annual changes in lumbar spine and hip BMD were compared to that seen for bone formation (bone-specific alkaline phosphatase, BSALP) and bone resorption (urinary deoxypyridinoline) markers. Treated women in the highest tertile of both regional ((18)F-PET) and global (biochemical markers) bone turnover showed the greatest annual percentage increases in lumbar spine BMD. The annual increase in lumbar spine BMD was 1.8%, 2.2%, and 3.2% for women in the lowest, middle, and highest tertile of BSALP, respectively, which was similar to that obtained for the regional measurement of K(i) of 1.7%, 2.2%, and 2.7% respectively. Untreated women in the highest tertile of regional and global bone turnover had larger decreases in lumbar spine BMD compared to those women in the lowest tertile, with a 1.4- to 4.8-fold difference in the annual decrease in BMD between the two. Less consistent patterns were observed when assessing the relationship between regional and global bone turnover with changes in hip BMD. This study has demonstrated that the relationship between regional bone turnover measured directly at the lumbar spine with changes in BMD is similar to that seen for global skeletal bone turnover using biochemical markers.
骨转换是骨折风险的一个重要决定因素。（18）F-氟化物正电子发射断层扫描（（18）F-PET）能够直接评估临床上重要的骨骼部位（如腰椎）的骨转换情况。本研究的目的是确定使用（18）F-PET测量的局部骨转换与骨矿物质密度（BMD）变化之间的关系是否等同于通过骨转换生化标志物进行的全身骨骼测量所观察到的关系。43名曾在腰椎进行过（18）F-PET扫描、评估骨转换生化标志物以及进行过腰椎和髋部双能X线吸收法BMD扫描（基线评估）的女性被分为两组中的一组：（1）22名在进行基线评估后2个月内开始接受骨质疏松症治疗的女性（治疗组）；（2）21名自基线评估后未接受任何骨质疏松症治疗的女性（未治疗组）。治疗组中的16名女性开始使用利塞膦酸盐治疗，这是她们参与的一项前瞻性研究的一部分，而其余6名女性的治疗决定由其主治医生做出。受试者在中位随访时间4.1年期间进行了2至5次BMD扫描，以估计自基线以来BMD的年变化百分比。将反映局部骨转换的（18）F-PET骨骼动力学参数K（i）的三分位数与腰椎和髋部BMD的年变化之间的关系，与骨形成（骨特异性碱性磷酸酶，BSALP）和骨吸收（尿脱氧吡啶啉）标志物所观察到的关系进行比较。在局部（（18）F-PET）和全身（生化标志物）骨转换最高三分位数的治疗女性中，腰椎BMD的年百分比增加最大。BSALP最低、中间和最高三分位数的女性腰椎BMD的年增加率分别为1.
