Research Institute and Practice for Involutional Diseases, Nagano, Japan.
J Bone Miner Metab. 2011 Jan;29(1):62-70. doi: 10.1007/s00774-010-0191-2. Epub 2010 May 11.
To clarify what kind of risk factors predict incident fractures in patients treated with bisphosphonates, the authors investigated the relationship between baseline characteristics and incident vertebral fracture in Japanese osteoporosis patients undergoing bisphosphonate treatment. This was a multi-center follow-up study conducted at three centers, in which a total of 251 Japanese patients with osteoporosis (mean age 70.5 years) from the three centers were followed for 3.2 ± 2.0 years. Baseline data, including pre-existing fractures, bone mineral density in the lumbar spine (LBMD), bone metabolic markers, urinary pentosidine, and plasma homocysteine, were evaluated. Changes in LBMD, bone turnover markers, and incident fractures after the treatment were followed. Sixty-one patients developed incident vertebral fractures; this group of patients was older and had lower LBMD, a higher prevalent vertebral fracture number, and higher homocysteine and pentosidine levels than patients who did not develop incident vertebral fractures. Changes in LBMD, urinary N-terminal telopeptides of type I collagen (NTX), and bone-derived alkaline phosphatase showed no significant association with the occurrence of vertebral fractures. Cox's proportional hazard model demonstrated that age, prevalent fracture, pentosidine, and homocysteine were independent predictors of the incident vertebral fracture rate under bisphosphonate treatment. Higher baseline levels of pentosidine and homocysteine in osteoporosis patients are potential risk factors for incident vertebral fractures when these patients are treated with bisphosphonates. Further clarification is needed to explain why such patients have higher fracture susceptibility.
为了明确哪些风险因素可预测接受双磷酸盐治疗的患者发生骨折事件，作者研究了日本骨质疏松症患者接受双磷酸盐治疗后，基线特征与椎体骨折事件之间的关系。这是一项在三个中心进行的多中心随访研究，共纳入了来自三个中心的 251 名骨质疏松症日本患者（平均年龄 70.5 岁），随访时间为 3.2±2.0 年。评估了基线数据，包括既往骨折、腰椎骨密度（LBMD）、骨代谢标志物、尿戊糖和血浆同型半胱氨酸。随访治疗后 LBMD、骨转换标志物和新发骨折的变化。61 例患者发生了椎体骨折事件；该组患者年龄较大，LBMD 较低，椎体骨折数较多，同型半胱氨酸和戊糖水平较高。LBMD、尿Ⅰ型胶原 N 末端肽（NTX）和骨源性碱性磷酸酶的变化与椎体骨折的发生无显著相关性。Cox 比例风险模型表明，年龄、既往骨折、戊糖和同型半胱氨酸是双磷酸盐治疗下椎体骨折发生率的独立预测因素。骨质疏松症患者基线水平较高的戊糖和同型半胱氨酸是这些患者接受双磷酸盐治疗后发生椎体骨折的潜在危险因素。需要进一步阐明为什么这些患者骨折易感性更高。
