Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea.
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
Bone. 2017 Dec;105:148-153. doi: 10.1016/j.bone.2017.08.020. Epub 2017 Aug 24.
Bisphosphonates are effective in preventing osteoporotic fractures. However, their limited efficacy of bisphosphonates has been suggested as a result of these drugs, which prevent the resorption of bone without improving bone connectivity. The trabecular microarchitecture in patients with osteoporotic hip fractures was evaluated according to their history of bisphosphonate treatment (BT).
One hundred thirty-three patients with hip fractures admitted and treated between November 2014 and September 2016. The patients were divided into two groups based on whether they had received treatment with bisphosphonates for >3years or not [non-bisphosphonate-treated patients (NT)]. One-to-one propensity score matching generated 15 matched pairs of patients. Microstructural parameters of femoral head were measured by using micro-computed tomography (μCT). Mechanical compression test (Young's modulus, yield strength, and maximum compressive force) was performed following μCT.
Trabecular bone pattern factor (1.15±0.7mm versus 1.61±0.5mm, p=0.037) and specific bone surface (14.1±0.8mm versus 15.4±1.9mm, p=0.050) were significantly lower in the BT group than in the NT group. Furthermore, Young's modulus was significantly higher in the BT group than in the NT group (72.14±30.75MPa versus 47.89±29.89MPa, p=0.037). In both groups, trabecular bone pattern was the most closely correlated microstructural parameter to bone strength. Microstructural analysis demonstrated that bone connectivity was better preserved in the BT group than in the NT group.
Bisphosphonate treatment preserves bone mass and bone quality. The factors influencing osteoporotic hip fractures in patients treated with bisphosphonates warrant further research.
双磷酸盐在预防骨质疏松性骨折方面是有效的。然而,由于这些药物在预防骨吸收的同时没有改善骨连接,因此它们的疗效有限。根据双磷酸盐治疗(BT)史评估骨质疏松性髋部骨折患者的小梁微结构。
纳入 2014 年 11 月至 2016 年 9 月期间收治的 133 例髋部骨折患者。根据是否接受过>3 年的双磷酸盐治疗,将患者分为两组[未接受双磷酸盐治疗的患者(NT)]。采用 1:1 倾向评分匹配生成 15 对匹配的患者。采用微计算机断层扫描(μCT)测量股骨头的微观结构参数。在 μCT 之后进行机械压缩测试(杨氏模量、屈服强度和最大压缩力)。
BT 组的骨小梁模式因子(1.15±0.7mm 对 1.61±0.5mm,p=0.037)和特定骨表面(14.1±0.8mm 对 15.4±1.9mm,p=0.050)明显低于 NT 组。此外,BT 组的杨氏模量明显高于 NT 组(72.14±30.75MPa 对 47.89±29.89MPa,p=0.037)。在两组中,骨小梁模式是与骨强度最密切相关的微观结构参数。微观结构分析表明,BT 组的骨连接保存较好。
双磷酸盐治疗可以维持骨量和骨质量。双磷酸盐治疗患者影响骨质疏松性髋部骨折的因素值得进一步研究。