Division of Endocrinology, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa, ON, Canada.
Osteoporos Int. 2012 Nov;23(11):2703-11. doi: 10.1007/s00198-012-1911-3.
The impact of intravenous bisphosphonate treatment to treat painful vertebral fractures in boys with DMD has not been documented. In this retrospective observational study of seven boys, 2 years of intravenous bisphosphonate therapy was associated with back pain improvement and stabilization or increases in the height ratios of fractured vertebrae.
Boys with Duchenne muscular dystrophy (DMD) are at risk for vertebral fractures. We studied the impact of intravenous bisphosphonate therapy for the treatment of painful vertebral fractures in DMD.
This was a retrospective observational study in seven boys with DMD (median 11.6 years, range 8.5 to 14.3) treated with intravenous pamidronate (9 mg/kg/year) or zoledronic acid (0.1 mg/kg/year) for painful vertebral fractures.
At baseline, 27 vertebral fractures were evident in the seven boys. After 2 years of bisphosphonate therapy, 17 of the fractures had an increase in the most severely affected vertebral height ratio, 10 vertebrae stabilized, and none showed a decrease in height ratio. Back pain resolved completely (N = 3) or improved (N = 4). The median change in lumbar spine volumetric bone mineral density Z-score was 0.5 standard deviations (interquartile range, -0.3 to 1.7). Two boys had three incident vertebral fractures in previously normal vertebral bodies that developed over the observation period. There was a decline in the trabecular bone formation rate on trans-iliac bone biopsy but no evidence of osteomalacia. First-dose side effects included fever and malaise (N = 4), hypocalcemia (N = 2), and vomiting (N = 1); there were no side effects with subsequent infusions.
Intravenous bisphosphonate therapy was associated with improvements in back pain and stabilization to improvement in vertebral height ratios of previously fractured vertebral bodies. At the same time, such therapy does not appear to completely prevent the development of new vertebral fractures in this context.
静脉用双膦酸盐治疗 DMD 男孩的疼痛性椎体骨折的影响尚未有文献记载。在这项对 7 名男孩的回顾性观察研究中，2 年的静脉用双膦酸盐治疗与背痛改善以及骨折椎体高度比值的稳定或增加相关。
患有杜氏肌营养不良症（DMD）的男孩有发生椎体骨折的风险。我们研究了静脉用双膦酸盐治疗 DMD 中疼痛性椎体骨折的效果。
这是一项对 7 名 DMD 男孩（中位数 11.6 岁，范围 8.5 至 14.3）的回顾性观察性研究，这些男孩接受了静脉用帕米膦酸（9 mg/kg/年）或唑来膦酸（0.1 mg/kg/年）治疗疼痛性椎体骨折。
在基线时，7 名男孩中有 27 处椎体骨折。在双膦酸盐治疗 2 年后，17 处骨折的最严重受累椎体高度比值增加，10 处椎体稳定，无一处高度比值下降。背痛完全缓解（N=3）或改善（N=4）。腰椎容积骨密度 Z 评分的中位数变化为 0.5 个标准差（四分位距，-0.3 至 1.7）。2 名男孩在观察期间，3 处先前正常的椎体发生了 3 处新的椎体骨折。髂骨活检的小梁骨形成率下降，但没有骨软化的证据。首次输注的副作用包括发热和不适（N=4）、低钙血症（N=2）和呕吐（N=1）；随后的输注没有副作用。
静脉用双膦酸盐治疗与背痛改善以及先前骨折椎体的高度比值稳定或增加相关。与此同时，在这种情况下，这种治疗似乎并不能完全预防新的椎体骨折的发生。
