Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of Wiener Gebietskrankenkasse (WGKK), Allgemeine Unfallversicherungsanstalt (AUVA) Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria.
Eli Lilly and Company, Indianapolis, IN, USA.
J Bone Miner Res. 2018 Dec;33(12):2230-2235. doi: 10.1002/jbmr.3565. Epub 2018 Sep 14.
Teriparatide increases bone mass primarily through remodeling of older or damaged bone and abundant replacement with new mineralizing bone. This post hoc analysis investigated whether dual-energy X-ray absorptiometric (DXA) areal bone mineral density (aBMD) measurement adequately reflects changes of mineral and organic matrix content in cortical and trabecular bone. Paired biopsies and aBMD measurements were obtained before and at end of 2 years of teriparatide treatment from postmenopausal women with osteoporosis who were either alendronate pretreated (mean, 57.5 months) or osteoporosis-treatment naive. Biopsies were assessed by micro-computed tomography (μCT) to calculate mean cortical width (Ct.Wi), cortical area (Ct.Ar), and trabecular bone volume fraction (BV/TV). Fourier transformed infrared imaging (pixel size ∼6.3 × 6.3 μm ) was utilized to calculate mineral and organic matrix density (mean absorption/pixel), as well as total mineral and organic contents of cortical and cancellous compartments (sum of all pixels in the compartment). Effect of pretreatment over time was analyzed using mixed model repeated measures. μCT derived Ct.Wi and BV/TV increased, accompanied by similar increases in the overall mineral contents of their respective bone compartments. Mineral density did not change. Marked increases in the total content of both mineral and organic matrix associated with volumetric growth in both compartments consistently exceeded those of aBMD. Increases in organic matrix exceeded increases in mineral content in both cortical and trabecular compartments. For percent changes, only change in Ct.Wi correlated to change in femoral neck aBMD (r = .38, p = 0.043), whereas no other significant correlations of Ct.Wi or BV/TV with lumbar spine, total hip, or femoral neck aBMD were demonstrable. These data indicate that 2 years of teriparatide treatment leads to an increased bone organic matrix and mineral content in the iliac crest. The magnitude of these increases in the iliac crest were not detected with conventional aBMD measurements at other skeletal sites. © 2018 American Society for Bone and Mineral Research.
特立帕肽主要通过重塑旧骨或受损骨，并大量用新矿化骨替代来增加骨量。本事后分析旨在研究双能 X 射线吸收法（DXA）的骨密度（aBMD）测量是否能充分反映皮质骨和松质骨中矿物质和有机基质含量的变化。对接受特立帕肽治疗 2 年的绝经后骨质疏松症患者进行前瞻性研究，其中阿仑膦酸钠预处理（平均 57.5 个月）或未接受骨质疏松症治疗。在治疗前和 2 年治疗结束时，从这些患者的髂骨中采集配对活检标本和 DXA 测量值。采用微计算机断层扫描（μCT）评估活检标本，计算平均皮质宽度（Ct.Wi）、皮质面积（Ct.Ar）和松质骨体积分数（BV/TV）。利用傅里叶变换红外成像（像素大小约 6.3×6.3μm）计算矿物质和有机基质密度（平均吸收/像素），以及皮质和松质骨腔室的矿物质和有机基质总含量（腔室内所有像素的总和）。采用混合模型重复测量分析预处理随时间的影响。μCT 显示 Ct.Wi 和 BV/TV 增加，相应的皮质骨腔室和松质骨腔室的矿物质总含量也出现类似增加。矿物质密度没有变化。皮质和松质骨腔室的体积生长均伴有矿物质和有机基质总含量的显著增加，这一增加明显超过了 DXA 的变化。有机基质的增加超过了皮质和松质骨腔室中矿物质含量的增加。在百分比变化方面，只有 Ct.Wi 的变化与股骨颈 aBMD 的变化相关（r = .38，p = 0.043），而在其他骨骼部位，Ct.Wi 或 BV/TV 与腰椎、全髋或股骨颈 aBMD 之间没有显示出其他显著相关性。这些数据表明，特立帕肽治疗 2 年可增加髂嵴骨的有机基质和矿物质含量。这些增加的幅度不能通过其他骨骼部位的常规 aBMD 测量来检测。© 2018 美国骨骼与矿物质研究协会。
