Department of Radiology, University of Pennsylvania, 3400 Spruce Street, 1 Founders Building, Philadelphia, PA 19104; Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
Acad Radiol. 2017 Nov;24(11):1332-1342. doi: 10.1016/j.acra.2017.05.014. Epub 2017 Jun 23.
Low intensity vibration (LIV) may represent a nondrug strategy to mitigate bone deficits in patients with end-stage renal disease.
Thirty end-stage renal patients on maintenance hemodialysis were randomized to stand for 20 minutes each day on either an active or placebo LIV device. Analysis at baseline and completion of 6-month intervention included magnetic resonance imaging (tibia and fibula stiffness; trabecular thickness, number, separation, bone volume fraction, plate-to-rod ratio; and cortical bone porosity), dual-energy X-ray absorptiometry (hip and spine bone mineral density [BMD]), and peripheral quantitative computed tomography (tibia trabecular and cortical BMD; calf muscle cross-sectional area).
Intention-to-treat analysis did not show any significant changes in outcomes associated with LIV. Subjects using the active device and with greater than the median adherence (70%) demonstrated an increase in distal tibia stiffness (5.3%), trabecular number (1.7%), BMD (2.3%), and plate-to-rod ratio (6.5%), and a decrease in trabecular separation (-1.8%). Changes in calf muscle cross-sectional area were associated with changes in distal tibia stiffness (R = 0.85), trabecular bone volume/total volume (R = 0.91), number (R = 0.92), and separation (R = -0.94) in the active group but not in the placebo group. Baseline parathyroid hormone levels were positively associated with increased cortical bone porosity over the 6-month study period in the placebo group (R = 0.55) but not in the active group (R = 0.01). No changes were observed in the nondistal tibia locations for either group except a decrease in hip BMD in the placebo group (-1.7%).
Outcomes and adherence thresholds identified from this pilot study could guide future longitudinal studies involving vibration therapy.
低强度振动（LIV）可能代表一种非药物策略，可以减轻终末期肾病患者的骨骼缺陷。
30 名接受维持性血液透析的终末期肾病患者被随机分配，每天站立在主动或安慰剂 LIV 设备上 20 分钟。在基线和 6 个月干预结束时进行分析，包括磁共振成像（胫骨和腓骨硬度；小梁厚度、数量、分离、骨体积分数、板-杆比；皮质骨孔隙率）、双能 X 射线吸收测定法（髋部和脊柱骨矿物质密度[BMD]）和外周定量计算机断层扫描（胫骨小梁和皮质 BMD；小腿肌肉横截面积）。
意向治疗分析未显示 LIV 相关结局的任何显著变化。使用主动设备且依从性大于中位数（70%）的受试者显示出远端胫骨硬度（5.3%）、小梁数量（1.7%）、BMD（2.3%）和板-杆比（6.5%）增加，以及小梁分离度（-1.8%）降低。小腿肌肉横截面积的变化与远端胫骨硬度（R=0.85）、小梁骨体积/总体积（R=0.91）、数量（R=0.92）和分离度（R=-0.94）的变化相关在主动组中，但在安慰剂组中没有。在安慰剂组中，甲状旁腺激素水平基线与 6 个月研究期间皮质骨孔隙率的增加呈正相关（R=0.55），但在主动组中无相关性（R=0.01）。两组的非远端胫骨部位均未观察到变化，除安慰剂组的髋部 BMD 下降（-1.7%）外。
本研究的初步结果确定的结局和依从性阈值可指导未来涉及振动治疗的纵向研究。
