Rhumatology Center, hôpital Pierre Paul Riquet, CHU Toulouse, 1 place du Dr Baylac, 31059, Toulouse cedex 9, France.
Rheumatol Int. 2018 Mar;38(3):461-466. doi: 10.1007/s00296-018-3929-0. Epub 2018 Jan 23.
The objective of our prospective study is to specify the variability of densitometric response to Denosumab, given in the second line, and to try to understand the reasons. All menopausal patients with primary osteoporosis, treated by Denosumab in our centre from 2014 to 2015, were included in this open prospective work. At T0, the patient's age, type of fracture, and previous treatments were collated. At T0 and T1, after 1 year of treatment by Dmab, a DXA of the spine and the hip and a determination of CTX were performed. Sixty-three patients aged 68.8 ± 8.3 years were included. The median number of treatments prescribed for osteoporosis before switch to Denosumab was 2.4. The median duration of these treatments was 7.2 years. At T1, CTX was less than 33 pg/ml (minimum threshold for our assay kit) in all patients. The median BMD in the spine increased by + 5.44% compared to T0. 14 patients in the upper quartile had a median BMD gain in the spine of + 11.07%. Fourteen patients in the lower quartile had a median BMD gain in the spine of + 0.6%. Only the duration of previous treatments, which was greater in the non-responder group, differed between these two groups. In the total cohort, the spinal densitometric gain was negatively correlated with the age of the patient at baseline (p = 0.04), the duration of previous treatment (p = 0.02), and positively with the CTX level (p = 0.05). The Dmab densitometric response is highly variable, partly explained by the duration of previous treatments and the level of bone resorption at initiation of treatment.
我们的前瞻性研究目的是明确地舒单抗二线治疗时的骨密度反应变异性，并尝试理解其中的原因。纳入了 2014 年至 2015 年期间在本中心接受地舒单抗治疗的所有原发性骨质疏松绝经后患者。在这项开放前瞻性研究中，收集了患者的年龄、骨折类型和既往治疗情况。在 T0 和 T1 时，在接受地舒单抗治疗 1 年后进行了腰椎和髋部的 DXA 检查和 CTX 测定。纳入了 63 名年龄 68.8±8.3 岁的患者。在转为地舒单抗治疗之前，中位数处方了 2.4 次骨质疏松治疗，中位治疗时间为 7.2 年。在 T1 时，所有患者的 CTX 均低于 33pg/ml（本试剂盒的最低检测限）。与 T0 相比，腰椎骨密度中位数增加了+5.44%。14 名患者的腰椎骨密度增加处于中位数的上四分位（+11.07%）。14 名患者的腰椎骨密度增加处于中位数的下四分位（+0.6%）。仅在上四分位组中，治疗前的治疗持续时间较长，在两组间存在差异。在总队列中，脊柱骨密度的增加与患者的基线年龄（p=0.04）、既往治疗持续时间（p=0.02）呈负相关，与 CTX 水平（p=0.05）呈正相关。地舒单抗的骨密度反应高度可变，部分原因是与既往治疗的持续时间和治疗开始时的骨吸收水平有关。
