Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Kenézy Gyula University Hospital, University of Debrecen, Bartók Béla 2-26, Debrecen, H-4031, Hungary.
Osteoporos Int. 2018 Dec;29(12):2677-2683. doi: 10.1007/s00198-018-4674-7. Epub 2018 Aug 30.
BMD changes in patients under tight control (monitored at 3-month intervals with adjustment of therapy guided by bone turnover markers) and routine management (controlled once a year) were compared. After 1 year, the femoral neck BMD increased significantly in the tight control compared to the routine management group.
We intended to ascertain whether tight control (i.e., follow-up visits and bone turnover markers/BTM/and parathyroid hormone/PTH/monitoring at 3-month intervals) strategy achieves a statistically greater increase in bone mineral density over the observation period than standard follow-up care (i.e., bone densitometry at 1-year intervals, without BTM monitoring).
We studied involutional osteoporotic patients newly enrolled into chronic care. One hundred and eleven patients underwent tight control, while another 113 received routine treatment (with follow-up visits scheduled at > 1-year intervals). We compared the changes in bone mineral density reflected by the results of bone mineral density (BMD) measurements of the lumbar spine and of the left femoral neck. Statistical analyses were performed with version 22 of the SPSS software package.
In the group of patients under tight control, baseline and follow-up median BMD values were 0.842/0.881 g/cm at the L vertebrae and 0.745/0.749 g/cm at the femoral neck. In the group under routine care, the corresponding values were 0.903/0.915 g/cm and 0.742/0.72 g/cm, respectively. The relative changes of the bone mineral density of the femoral neck was significantly (p = 0.041) higher in patients under tight control than in those receiving routine care; however, BMD changes in the lumbar spine were not statistically different.
Our findings suggest that adopting tight control as a new therapeutic strategy might be justified in the osteoporosis management. In fact, a greater improvement of BMD can be achieved by treatment according to these principles.
本研究旨在确定与标准随访护理（即每 1 年进行 1 次骨密度测量，不监测骨转换标志物）相比，强化控制（即每 3 个月进行 1 次随访和骨转换标志物/BTM/甲状旁腺激素/PTH 监测）策略是否能在观察期内使骨密度的增加具有统计学意义。
我们研究了新纳入慢性病管理的绝经后骨质疏松症患者。111 例患者接受强化控制，另 113 例患者接受常规治疗（随访间隔>1 年）。我们比较了腰椎和左侧股骨颈骨密度测量结果反映的骨密度变化。统计分析采用 SPSS 软件包 22 版进行。
在强化控制组中，基线和随访时腰椎的中位数 BMD 值分别为 0.842/0.881 g/cm，股骨颈为 0.745/0.749 g/cm；常规治疗组分别为 0.903/0.915 g/cm 和 0.742/0.72 g/cm。强化控制组股骨颈骨密度的相对变化显著高于常规治疗组（p=0.041），而腰椎骨密度的变化无统计学差异。
我们的研究结果表明，强化控制作为一种新的治疗策略可能是合理的骨质疏松症管理方法。事实上，根据这些原则进行治疗可以更好地改善骨密度。
