Cairoli E, Eller-Vainicher C, Ulivieri F M, Zhukouskaya V V, Palmieri S, Morelli V, Beck-Peccoz P, Chiodini I
Unit of Endocrinology and Metabolic Diseases, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Padiglione Granelli, Via F. Sforza 35, 20122, Milan, Italy,
Osteoporos Int. 2014 Apr;25(4):1401-10. doi: 10.1007/s00198-014-2619-3. Epub 2014 Feb 8.
Among 97 postmenopausal women with primary osteoporosis, adequate calcium and vitamin D supplementation, and good compliance to a 36-month bisphosphonate treatment, the 25.8% of patients are inadequate responders. Current smoking and a bone turnover in the upper part of the normal range increase the risk of treatment failure.
To evaluate the prevalence of the bisphosphonate treatment failure and its possible associated factors in women with primary osteoporosis (PO).
We studied 97 previously untreated postmenopausal women with PO and fragility fractures and/or a FRAX® 10-year probability of a major osteoporotic fracture ≥ 7.5%, before and after a 36-month treatment with alendronate or risedronate and adequate vitamin D supplementation with good compliance. At baseline and after 36 months, lumbar spine (LS) and femoral bone mineral density (BMD) were assessed by Dual X-ray absorptiometry and vertebral fractures by spinal radiographs. Spinal deformity index (SDI) was calculated. Treatment failure was defined by the presence of ≥ 2 incident fragility fractures and/or a BMD decrease greater than the least significant change.
Bisphosphonate treatment failure was observed in 25.8% of patients. Age, body mass index, years since menopause, familiar history of hip fracture, number of falls, type of bisphosphonate used, 25-hydroxyvitamin D levels (25OHVitD), BMD, SDI, and FRAX® score at baseline were not different between responders and inadequate responders. Treatment failure was associated with current smoking (OR 3.22, 95% CI 1.10-9.50, P = 0.034) and baseline alkaline phosphatase total activity levels ≥ 66.5 U/L (OR 4.22, 95% CI 1.48-12.01, P = 0.007), regardless of age, number of falls, LS BMD, and baseline SDI.
The 25.8 % of PO postmenopausal women inadequately responds to bisphosphonates, despite a good compliance to therapy and normal 25OHVitD levels. The current smoking and bone turnover in the upper part of the normal range are associated with the inadequate response to bisphosphonates.
在97名患有原发性骨质疏松症的绝经后女性中，给予充足的钙和维生素D补充，并对36个月的双膦酸盐治疗有良好的依从性，但仍有25.8%的患者治疗反应不佳。当前吸烟以及骨转换处于正常范围的上限会增加治疗失败的风险。
评估原发性骨质疏松症（PO）女性中双膦酸盐治疗失败的患病率及其可能的相关因素。
我们研究了97名先前未接受治疗的绝经后PO女性，她们有脆性骨折和/或FRAX® 10年主要骨质疏松性骨折概率≥7.5%，在接受阿仑膦酸钠或利塞膦酸钠36个月治疗并补充充足的维生素D且依从性良好之前和之后进行研究。在基线和36个月后，通过双能X线吸收法评估腰椎（LS）和股骨骨密度（BMD），通过脊柱X线片评估椎体骨折情况。计算脊柱畸形指数（SDI）。治疗失败定义为出现≥2次新发脆性骨折和/或BMD下降大于最小有意义变化。
25.8%的患者出现双膦酸盐治疗失败。年龄、体重指数、绝经年限、髋部骨折家族史、跌倒次数、所用双膦酸盐类型、25-羟维生素D水平（25OHVitD）、基线BMD、SDI和FRAX®评分在反应良好者和反应不佳者之间无差异。治疗失败与当前吸烟（比值比3.22，95%可信区间1.10 - 9.50，P = 0.034）以及基线碱性磷酸酶总活性水平≥66.5 U/L（比值比4.22，95%可信区间1.48 - 12.01，P = 0.007）相关，与年龄、跌倒次数、LS BMD和基线SDI无关。
25.8%的绝经后PO女性对双膦酸盐治疗反应不佳，尽管对治疗依从性良好且25OHVitD水平正常。当前吸烟以及骨转换处于正常范围的上限与对双膦酸盐治疗反应不佳有关。
