IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.
PLoS One. 2020 Mar 11;15(3):e0229820. doi: 10.1371/journal.pone.0229820. eCollection 2020.
Teriparatide is a bone-forming therapy for osteoporosis that increases bone quantity and texture, with uncertain action on bone geometry. No data are available regarding its influence on bone strain. To investigate teriparatide action on parameters of bone quantity and quality and on Bone Strain Index (BSI), also derived from DXA lumbar scan, based on the mathematical model finite element method. Forty osteoporotic patients with fractures were studied before and after two years of daily subcutaneous 20 mcg of teriparatide with dual X-ray photon absorptiometry to assess bone mineral density (BMD), hip structural analysis (HSA), trabecular bone score (TBS), BSI. Spine deformity index (SDI) was calculated from spine X-ray. Shapiro-Wilks, Wilcoxon and Student's t test were used for classical statistical analysis. Auto Contractive Map was used for Artificial Neural Network Analysis (ANNs). In the entire population, the ameliorations after therapy regarded BSI (-13.9%), TBS (5.08%), BMD (8.36%). HSA parameters of femoral shaft showed a worsening. Dividing patients into responders (BMD increase >10%) and non-responders, the first presented TBS and BSI ameliorations (11.87% and -25.46%, respectively). Non-responders presented an amelioration of BSI only, but less than in the other subgroup (-6.57%). ANNs maps reflect the mentioned bone quality improvements. Teriparatide appears to ameliorate not only BMD and TBS, but also BSI, suggesting an increase of bone strength that may explain the known reduction in fracture risk, not simply justified by BMD increase. BSI appears to be a sensitive index of TPD effect. ANNs appears to be a valid tool to investigate complex clinical systems.
特立帕肽是一种用于骨质疏松症的成骨治疗药物，可增加骨量和质地，但对骨几何形状的作用不确定。目前尚无关于其对骨应变影响的数据。本研究旨在基于数学模型有限元方法，研究特立帕肽对腰椎双能 X 线吸收法（DXA）扫描衍生的骨量和骨质量参数以及骨应变指数（BSI）的影响。40 例骨质疏松性骨折患者接受了为期 2 年的每日皮下 20 mcg 特立帕肽治疗，用双能 X 线吸收法评估骨密度（BMD）、髋部结构分析（HSA）、骨小梁评分（TBS）、BSI。脊柱畸形指数（SDI）由脊柱 X 线计算。采用 Shapiro-Wilks、Wilcoxon 和 Student t 检验进行经典统计学分析。采用自收缩映射图进行人工神经网络分析（ANNs）。在整个人群中，治疗后的改善情况如下：BSI（-13.9%）、TBS（5.08%）、BMD（8.36%）。股骨干 HSA 参数恶化。将患者分为反应者（BMD 增加>10%）和非反应者，前者 TBS 和 BSI 改善（分别为 11.87%和-25.46%）。非反应者仅 BSI 改善，但不及其他亚组（-6.57%）。ANNs 图反映了上述骨质量的改善。特立帕肽似乎不仅能改善 BMD 和 TBS，还能改善 BSI，这表明骨强度增加，这可能解释了已知的骨折风险降低，而不仅仅是 BMD 增加的原因。BSI 似乎是 TPD 疗效的敏感指标。ANNs 似乎是研究复杂临床系统的有效工具。
