Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
PM R. 2013 Aug;5(8):663-71. doi: 10.1016/j.pmrj.2013.03.032. Epub 2013 Apr 1.
To evaluate the response of bone to 2 anabolic stimuli, teriparatide and mechanical loading, in subjects with spinal cord injury.
A pilot study, 1 group, pretest-posttest.
A rehabilitation hospital.
A convenience sample of 12 nonambulatory chronic spinal cord injury subjects.
The subjects were administered open-label teriparatide 20 μg/d while undergoing robotic-assisted stepping 3 times a week for 6 months, followed by 6 months of teriparatide alone.
Bone status was evaluated at 3, 6, and 12 months by using dual-energy x-ray absorptiometry to calculate bone mineral density (BMD) at the spine and hip, magnetic resonance imaging to assess bone microarchitecture of the distal tibia, and serum bone markers.
Mean (SD) baseline BMD measurements at the spine and the left and right total hip were 1.05 ± 0.162 g/cm(2), 0.638 ± 0.090 g/cm(2) and 0.626 ± 0.088 g/cm(2), respectively. After 6 months of treatment, BMD changed 2.19% ± 3.61%, 0.02% ± 2.21%, and 0.74% ± 2.80% at the spine, and left and right total hip, respectively. These changes were not statistically significant (P > .05 for all). Magnetic resonance imaging supported an anabolic effect after 3 months of treatment with significant (P < .05) changes in trabecular thickness, 4.4% ± 4.06%; surface-to-curve ratio, 23.6% ± 22.3%; and erosion index, -17.04% ± 12.9%. Although the trend remained after 6 months, statistical significance was not retained. At 6 months, bone markers indicated an increase in mean levels of bone-specific alkaline phosphatase, 53.8% ± 62.9%; C-terminal telopeptides of type I collagen, 137.6% ± 194.6%; and intact amino-terminal propeptide of type I procollagen, 61.4% ± 99.3%.
In this limited pilot study, teriparatide and mechanical loading resulted in a numerical but not statistically significant increase in lumbar spine BMD and no significant BMD changes at the hip. Magnetic resonance imaging at the distal tibia suggested an anabolic effect, but the high sensitivity offered by this technique was challenged by the limited ability to obtain analyzable data from all the subjects. Further studies that involve longer treatment periods and greater mechanical loading are warranted.
评估 2 种合成代谢刺激物（特立帕肽和机械加载）对脊髓损伤患者骨骼的反应。
单组预-后测试的初步研究。
一家康复医院。
12 名非运动性慢性脊髓损伤患者作为方便样本。
受试者接受为期 6 个月的每周 3 次机器人辅助步行治疗，同时接受开放性标签特立帕肽 20 μg/d 治疗，随后单独使用特立帕肽治疗 6 个月。
采用双能 X 射线吸收法测量脊柱和髋关节的骨矿物质密度（BMD），磁共振成像评估胫骨远端的骨微结构，血清骨标志物，在 3、6 和 12 个月时评估骨骼状态。
基线时脊柱、左侧和右侧全髋关节的平均（SD）BMD 测量值分别为 1.05±0.162 g/cm²、0.638±0.090 g/cm²和 0.626±0.088 g/cm²。治疗 6 个月后，脊柱、左侧和右侧全髋关节的 BMD 分别增加了 2.19%±3.61%、0.02%±2.21%和 0.74%±2.80%，但这些变化均无统计学意义（所有 P 值均>0.05）。磁共振成像支持治疗 3 个月后出现合成代谢效应，骨小梁厚度、表面-曲线比和侵蚀指数分别显著增加 4.4%±4.06%、23.6%±22.3%和-17.04%±12.9%（所有 P 值均<0.05），但 6 个月时这种趋势仍存在，无统计学意义。6 个月时，骨标志物显示骨特异性碱性磷酸酶、Ⅰ型胶原 C 端肽和Ⅰ型前胶原氨基端原肽的平均水平分别增加了 53.8%±62.9%、137.6%±194.6%和 61.4%±99.3%。
在这项有限的初步研究中，特立帕肽和机械加载导致腰椎 BMD 出现数值上而非统计学上的增加，髋关节的 BMD 无显著变化。胫骨远端磁共振成像提示出现合成代谢效应，但该技术的高敏感性受到从所有受试者获得可分析数据的能力限制的挑战。需要进行涉及更长治疗期和更大机械加载的进一步研究。
