Department of Mechanical Engineering, 6175 Etcheverry Hall MC 1740, University of California, Berkeley, CA 94720-1740, USA.
Bone. 2012 Jan;50(1):165-70. doi: 10.1016/j.bone.2011.10.002. Epub 2011 Oct 17.
To gain insight into the clinical effect of teriparatide and alendronate on the hip, we performed non-linear finite element analysis of quantitative computed tomography (QCT) scans from 48 women who had participated in a randomized, double-blind clinical trial comparing the effects of 18-month treatment of teriparatide 20 μg/d or alendronate 10mg/d. The QCT scans, obtained at baseline, 6, and 18 months, were analyzed for volumetric bone mineral density (BMD) of trabecular bone, the peripheral bone (defined as all the cortical bone plus any endosteal trabecular bone within 3 mm of the periosteal surface), and the integral bone (both trabecular and peripheral), and for overall femoral strength in response to a simulated sideways fall. At 18 months, we found in the women treated with teriparatide that trabecular volumetric BMD increased versus baseline (+4.6%, p<0.001), peripheral volumetric BMD decreased (-1.1%, p<0.05), integral volumetric BMD (+1.0%, p=0.38) and femoral strength (+5.4%, p=0.06) did not change significantly, but the ratio of strength to integral volumetric BMD ratio increased (+4.0%, p=0.04). An increase in the ratio of strength to integral volumetric BMD indicates that overall femoral strength, compared to baseline, increased more than did integral density. For the women treated with alendronate, there were small (<1.0%) but non-significant changes compared to baseline in all these parameters. The only significant between-treatment difference was in the change in trabecular volumetric BMD (p<0.005); related, we also found that, for a given change in peripheral volumetric BMD, femoral strength increased more for teriparatide than for alendronate (p=0.02). We conclude that, despite different compartmental volumetric BMD responses for these two treatments, we could not detect any overall difference in change in femoral strength between the two treatments, although femoral strength increased more than integral volumetric BMD after treatment with teriparatide.
为了深入了解特立帕肽和阿仑膦酸钠对髋部的临床疗效，我们对 48 名参加过一项随机、双盲临床试验的女性进行了定量 CT（QCT）扫描的非线性有限元分析，该试验比较了特立帕肽 20 μg/d 或阿仑膦酸钠 10mg/d 治疗 18 个月的效果。基线、6 个月和 18 个月时获得 QCT 扫描，用于分析骨小梁骨、外周骨（定义为所有皮质骨加骨皮质表面 3mm 内的任何骨内膜小梁骨）和整体骨（骨小梁和外周骨）的体积骨密度（BMD），以及模拟侧方跌倒时的整体股骨强度。18 个月时，我们发现特立帕肽治疗的女性骨小梁体积 BMD 与基线相比增加（+4.6%，p<0.001），外周体积 BMD 减少（-1.1%，p<0.05），整体体积 BMD（+1.0%，p=0.38）和股骨强度（+5.4%，p=0.06）无明显变化，但强度与整体体积 BMD 比值增加（+4.0%，p=0.04）。强度与整体体积 BMD 比值增加表明，与基线相比，整体股骨强度增加幅度超过整体密度。阿仑膦酸钠治疗的女性与基线相比，所有这些参数的变化均较小（<1.0%）但无统计学意义。唯一有显著差异的治疗间差异是骨小梁体积 BMD 的变化（p<0.005）；相关的，我们还发现，在外周体积 BMD 相同的变化下，特立帕肽治疗后股骨强度的增加幅度大于阿仑膦酸钠（p=0.02）。我们得出结论，尽管这两种治疗方法的不同容积 BMD 反应不同，但我们无法检测到两种治疗方法之间股骨强度变化的任何总体差异，尽管特立帕肽治疗后股骨强度的增加幅度大于整体容积 BMD。
