绝经后女性桡骨远端骨折后对侧桡骨远端骨质流失：一项为期两年的高分辨率外周定量CT随访研究。

Contra-lateral bone loss at the distal radius in postmenopausal women after a distal radius fracture: A two-year follow-up HRpQCT study.

作者信息

de Jong Joost J A, Arts Jacobus J C, Willems Paul C, Bours Sandrine P G, Bons Judith P A, Menheere Paul P C A, van Rietbergen Bert, Geusens Piet P, van den Bergh Joop P W

机构信息

NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, The Netherlands; Department of Rheumatology, Maastricht University Medical Center, The Netherlands.

CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, The Netherlands; Department of Orthopaedic Surgery, Maastricht University Medical Center, The Netherlands; Faculty of Biomedical Engineering, Section Orthopaedic Biomechanics, Eindhoven University of Technology, The Netherlands.

出版信息

Bone. 2017 Aug;101:245-251. doi: 10.1016/j.bone.2017.05.011. Epub 2017 May 11.

DOI:10.1016/j.bone.2017.05.011

PMID:28502885

Abstract

Opposite to the fracture side, bone mineral density (BMD) measured by DXA at the contra-lateral side does not change after a distal radius fracture. However, it is unknown if also bone micro-architecture and strength at the contralateral side are unaffected. Therefore, the aim of this study was to assess BMD, micro-architecture and bone mechanical properties at the contra-lateral side during two years follow-up after a distal radius fracture using high resolution peripheral quantitative computed tomography (HRpQCT). The contra-lateral distal radius of 15 postmenopausal women (mean age 64±8years) with a distal radius fracture treated by cast immobilization was scanned by HRpQCT at baseline, 3months and 2years post-fracture. BMD and cortical and trabecular micro-architecture were measured and biomechanical parameters were estimated using micro finite element analysis (μFEA). Additionally, markers of bone resorption and formation were measured at each visit. Bone parameters and turnover markers across the three visits were analysed using a linear mixed-effect model with Bonferroni correction. Two years post-fracture, a significant decrease from baseline was found in cortical BMD (-4.2%, p<0.001), failure load (-6.1%, p=0.001), stiffness in compression (-5.7%, p=0.003) and bending (-6.4%, p=0.008), and bone formation (-47.6%, p=0.010). No significant changes from baseline were observed in total and trabecular BMD, nor in cortical or trabecular micro-architecture and neither in bone resorption. Results were similar between patients with or without adequate anti-osteoporosis drug treatment. We found a significant decline in BMD in the cortical but not the trabecular region, and a reduction in bone strength and stiffness at the contra-lateral side two years after a distal radius fracture. These changes exceeded the changes that may be expected due to aging, even in the presence of adequate anti-osteoporosis treatment.

摘要

与骨折侧相反，通过双能X线吸收法（DXA）测量的桡骨远端骨折后对侧骨矿物质密度（BMD）没有变化。然而，对侧的骨微结构和强度是否也未受影响尚不清楚。因此，本研究的目的是使用高分辨率外周定量计算机断层扫描（HRpQCT）评估桡骨远端骨折后两年随访期间对侧的BMD、微结构和骨力学性能。对15名接受石膏固定治疗的绝经后桡骨远端骨折女性（平均年龄64±8岁），在骨折后基线、3个月和2年时通过HRpQCT扫描其对侧桡骨远端。测量BMD以及皮质和小梁微结构，并使用微观有限元分析（μFEA）估计生物力学参数。此外，每次就诊时测量骨吸收和形成标志物。使用带有Bonferroni校正的线性混合效应模型分析三次就诊时的骨参数和骨转换标志物。骨折后两年，皮质BMD（-4.2%，p<0.001）、破坏载荷（-6.1%，p=0.001）、压缩刚度（-5.7%，p=0.003）和弯曲刚度（-6.4%，p=0.008）以及骨形成（-47.6%，p=0.010）较基线显著下降。总BMD和小梁BMD、皮质或小梁微结构以及骨吸收与基线相比均未观察到显著变化。接受或未接受充分抗骨质疏松药物治疗的患者结果相似。我们发现桡骨远端骨折两年后，对侧皮质区域BMD显著下降，但小梁区域未下降，且骨强度和刚度降低。即使在接受充分抗骨质疏松治疗的情况下，这些变化也超过了因衰老可能预期的变化。