Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
Osteoporos Int. 2022 Jan;33(1):293-298. doi: 10.1007/s00198-021-06063-6. Epub 2021 Aug 2.
Fracture prevention in cognitively impaired individuals is lacking. This work highlights the benefits of zoledronic acid on bone health in cognitively impaired older adults. Demonstrating benefits of therapy may increase treatment uptake and reduce fracture risk in this group.
Osteoporosis has detrimental consequences for frail older adults. The effects on those with both osteoporosis and cognitive impairment are compounded due to increased risk of falls and changes in mobility, both of which can lead to fracture. However, there are limited data on treatment benefits for osteoporotic individuals with cognitive impairment.
This post hoc, secondary analysis of data from a randomized, double-blind, placebo-controlled clinical trial of single-dose zoledronic acid included 179 women age ≥ 65 years residing in assisted living facilities or nursing homes, 43 of whom had mild to severe cognitive impairment. We assessed bone mineral density (BMD) of the total hip, femoral neck, and lumbar spine by dual-energy x-ray absorptiometry and serum bone turnover markers (C-terminal telopeptide of type I collagen and procollagen type I N propeptide) at 6 and 12 months.
In participants with cognitive impairment, those who received zoledronic acid had 4.3% greater BMD at the total hip (p=.005) and 5.3% greater BMD at the femoral neck (p<.001) after 12 months compared to those in the placebo group. Bone turnover markers demonstrated significant decreases at 6 months in those with cognitive impairment who received active treatment compared to the placebo group. Improvements in bone health measures with zoledronic acid were similar to those seen in participants without cognitive impairment.
Zoledronic acid improves bone health in frail older women with cognitive impairment similar to those without impairment. Further studies are warranted to assess the benefit for fracture reduction in this undertreated population.
认知障碍个体的骨折预防措施不足。这项工作强调了唑来膦酸对认知障碍老年患者骨骼健康的益处。证明治疗的益处可能会增加该人群的治疗率并降低骨折风险。
骨质疏松症对体弱的老年人有不利影响。对于既有骨质疏松症又有认知障碍的患者，由于跌倒风险增加和活动能力改变，情况更为复杂，这两者都可能导致骨折。然而，针对患有认知障碍的骨质疏松症患者的治疗效果数据有限。
对单剂量唑来膦酸随机、双盲、安慰剂对照临床试验数据进行了一项事后、二次分析，该研究纳入了 179 名年龄≥65 岁、居住在辅助生活设施或疗养院的女性，其中 43 名患有轻度至重度认知障碍。我们通过双能 X 射线吸收法评估了全髋、股骨颈和腰椎的骨密度（BMD），并在 6 个月和 12 个月时检测了血清骨转换标志物（I 型胶原 C 端肽和 I 型前胶原 N 端肽）。
在认知障碍患者中，与安慰剂组相比，接受唑来膦酸治疗的患者在 12 个月时全髋骨密度增加了 4.3%（p=0.005），股骨颈骨密度增加了 5.3%（p<0.001）。与安慰剂组相比，接受活性治疗的认知障碍患者在 6 个月时骨转换标志物显著下降。唑来膦酸治疗对骨健康指标的改善与无认知障碍患者相似。
唑来膦酸可改善认知障碍体弱老年女性的骨骼健康，效果与无认知障碍患者相似。需要进一步研究评估该治疗方法对这一治疗不足人群骨折减少的益处。
