Lespessailles Eric, Hambli Ridha, Ferrari Serge
University Orleans, Orleans, France; Rheumatology Department, Orleans Hospital, Orleans, France.
Prisme, University Orleans , Orleans, France.
Bonekey Rep. 2016 Aug 31;5:836. doi: 10.1038/bonekey.2016.59. eCollection 2016.
With the development of new non-invasive analytical techniques and particularly the advent of high-resolution peripheral quantitative computed tomography (HRpQCT) it is possible to assess cortical and trabecular bone changes under the effects of ageing, diseases and treatments. In the present study, we reviewed the treatment-related effects on bone parameters assessed by HRpQCT imaging. We identified 12 full-length articles published in peer-reviewed journals describing treatment-induced changes assessed by HRpQCT. The design of these studies varied a lot in terms of duration and methodology: some of them were open-labelled, others were double-blind, placebo-controlled or double-blind, double-dummy, active controlled. In addition, the sample size in these studies ranged from 11 to 324 patients. Motion artifacts occurring during data acquisition were sometimes a real challenge particularly at the radius leading sometimes to exclude the analysis at the radius due to the uninterpretability of microstructural parameters. Responses to therapies were treatment-specific and divergent effects in cortical and trabecular bone with antiresorptive or anabolic agents were observed. Standardization of bone microarchitecture parameters (including porosity) and bone strength estimates by finite element analysis (FEA) are mandatory. The additional value of microarchitecture and FEA estimates changes with therapies in terms of improvement in fracture outcomes which have to be adequately assessed in clinical trials with fracture end point. Data from these reviewed studies advance our understanding of the microstructural consequences of osteoporosis and highlight potential differences in bone quality outcomes within therapies.
随着新型非侵入性分析技术的发展，尤其是高分辨率外周定量计算机断层扫描（HRpQCT）的出现，现在有可能评估衰老、疾病和治疗影响下皮质骨和小梁骨的变化。在本研究中，我们回顾了HRpQCT成像评估的与治疗相关的骨参数效应。我们在同行评审期刊上鉴定了12篇完整文章，这些文章描述了通过HRpQCT评估的治疗引起的变化。这些研究的设计在持续时间和方法上差异很大：其中一些是开放标签的，其他的是双盲、安慰剂对照或双盲、双模拟、活性对照。此外，这些研究中的样本量从11名到324名患者不等。数据采集期间出现的运动伪影有时是一个真正的挑战，尤其是在桡骨处，有时会因微观结构参数无法解读而导致排除桡骨分析。对治疗的反应具有治疗特异性，观察到抗吸收或促合成代谢药物对皮质骨和小梁骨有不同的影响。通过有限元分析（FEA）对骨微结构参数（包括孔隙率）和骨强度估计进行标准化是必不可少的。微结构和FEA估计的附加价值随治疗而变化，在骨折结局改善方面，这必须在以骨折为终点的临床试验中进行充分评估。这些综述研究的数据增进了我们对骨质疏松症微观结构后果的理解，并突出了不同治疗方法在骨质量结局方面的潜在差异。
