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定量计算机断层扫描分析绝经后骨质疏松症患者停用地舒单抗后的三维骨矿物质密度和骨强度。

Analysis of three-dimensional bone mineral density and bone strength measured by quantitative computed tomography following denosumab discontinuation in a patient with postmenopausal osteoporosis.

机构信息

Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo 142-8666, Japan.

Department of Orthopaedic Surgery, Yamanashi Red Cross Hospital, Yamanashi, Japan.

出版信息

Clin Interv Aging. 2019 Aug 7;14:1445-1450. doi: 10.2147/CIA.S205971. eCollection 2019.

Abstract

Discontinuation of denosumab during osteoporosis treatment leads to rapid loss of bone mineral density and induces a bone turnover rebound effect. Previous studies have reported analysis based on dual-energy X-ray absorptiometry scanning (DXA). Here, we report the first case involving analysis of three-dimensional bone mineral density and bone strength, measured by quantitative computed tomography (QCT) after discontinuation of denosumab. An 82-year-old woman who discontinued denosumab because of patient's wish was administered the fifth dose after a gap of 14 months. Her bone mineral density evaluated by DXA and QCT, bone strength, and bone turnover marker levels showed significant rebound phenomenon. The levels of the cortical parameters of the hip were also decreased indicating an increased risk of femoral fractures after denosumab interruption. Our case highlights the increased risk of fractures after discontinuation of denosumab. Therefore, denosumab must be used judiciously without interruption in the dosage schedule.

摘要

骨质疏松症治疗中停用地舒单抗会导致骨密度迅速丢失,并引起骨转换反弹效应。先前的研究报告了基于双能 X 射线吸收法扫描(DXA)的分析结果。在这里,我们报告了首例在停用地舒单抗后通过定量计算机断层扫描(QCT)分析三维骨密度和骨强度的病例。一名 82 岁的女性因患者意愿而停用了地舒单抗,停药 14 个月后接受了第五次治疗。她的骨密度通过 DXA 和 QCT 评估、骨强度和骨转换标志物水平均显示出明显的反弹现象。髋部皮质参数水平也降低,表明在停用地舒单抗后发生股骨骨折的风险增加。我们的病例强调了在不中断剂量方案的情况下,地舒单抗停药后骨折风险增加。因此,必须谨慎使用地舒单抗,避免中断治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/be39/6689764/b67347b8d0f3/CIA-14-1445-g0001.jpg

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