唑来膦酸在骨质疏松症患者非骨水泥全髋关节置换术后抑制加速性假体周围骨丢失的效率：一项前瞻性队列研究。

Efficiency of Zoledronic Acid in Inhibiting Accelerated Periprosthetic Bone Loss After Cementless Total Hip Arthroplasty in Osteoporotic Patients: A Prospective, Cohort Study.

机构信息

Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.

Division of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China.

出版信息

Orthop Surg. 2019 Aug;11(4):653-663. doi: 10.1111/os.12513.

OBJECTIVE

To investigate the influence of preoperative osteopenia/osteoporosis on periprosthetic bone loss after total hip arthroplasty (THA) and the efficiency of zoledronate (ZOL) treatment in periprosthetic bone preservation.

METHODS

This multicenter, prospective cohort study was conducted in four centers between April 2015 and October 2017. Patients were assigned to Normal BMD, Osteopenia, and Osteoporosis+ZOL groups. Patients with osteopenia received daily oral calcium (600 mg/d) and vitamin D (0.5 μg/d), while patients in the Osteoporosis+ZOL group received additional ZOL annually (5 mg/year). Periprosthetic bone mineral density (BMD) in seven Gruen zones, radiographic parameters, Harris hip score, EuroQol 5-Dimensions (EQ-5D) score, and BMD in hip and spine were measured within 7 days, 3 months, 12 months postoperation and annually thereafter.

RESULTS

A total of 266 patients were enrolled, while 81 patients that completed the first year follow-up were involved in the statistical analysis. The mean follow-up time was 1.3 years. There were significant decreases of mean BMD in total Gruen zones (-4.55%, P < 0.05) and Gruen zone 1 (-10.22%, P < 0.01) in patients with osteopenia during the first postoperative year. Patients in the Osteoporosis+ZOL group experienced a marked increase in BMD in Gruen zone 1 (+16%) at the first postoperative year, which had a significant difference when compared with the Normal BMD group (P < 0.05) and the Osteopenia Group (P < 0.001). Low preoperative BMD in hip and spine was predictive of bone loss in Gruen zone 1 at 12 months after THA in patients with normal BMD (R = 0.40, P < 0.05).

CONCLUSIONS

Patients with osteopenia are prone to higher bone loss in the proximal femur after cementless total hip arthroplasty (THA). ZOL, not solely calcium and vitamin D, could prevent the accelerated periprosthetic bone loss after THA in patients with osteopenia and osteoporosis.

目的

研究术前骨质疏松/骨量减少对全髋关节置换术后假体周围骨丢失的影响，以及唑来膦酸（ZOL）在假体周围骨保存中的治疗效果。

方法

本多中心前瞻性队列研究于 2015 年 4 月至 2017 年 10 月在四个中心进行。患者被分为正常骨密度、骨质疏松症和骨质疏松症+ZOL 组。骨质疏松症患者接受每日口服钙（600mg/d）和维生素 D（0.5μg/d），而骨质疏松症+ZOL 组患者每年额外接受 ZOL 治疗（5mg/年）。术后 7 天、3 个月、12 个月及此后每年测量假体周围骨矿物质密度（BMD）、影像学参数、Harris 髋关节评分、欧洲五维健康量表（EQ-5D）评分和髋部及脊柱 BMD。

结果

共纳入 266 例患者，其中 81 例完成了 1 年随访，纳入统计分析。平均随访时间为 1.3 年。骨质疏松症患者术后第一年总 Gruen 区（-4.55%，P<0.05）和 Gruen 区 1（-10.22%，P<0.01）的平均 BMD 均显著下降。骨质疏松症+ZOL 组患者术后第一年 Gruen 区 1 的 BMD 显著增加（16%），与正常 BMD 组（P<0.05）和骨质疏松症组（P<0.001）相比有显著差异。正常 BMD 患者术后 12 个月，髋关节和脊柱的低术前 BMD 可预测 Gruen 区 1 的骨丢失（R=0.40，P<0.05）。