Department of Chemical Pathology and Metabolic Medicine, St Thomas' Hospital, 5Th Floor, North Wing, Lambeth Palace Road, London, UK.
Osteoporosis Unit, Guy's Hospital, London, SE1 7EH, UK.
J Endocrinol Invest. 2024 Jul;47(7):1667-1677. doi: 10.1007/s40618-023-02280-4. Epub 2024 Jan 9.
PURPOSE: The aim of this study was to evaluate changes in hip geometry parameters following treatment with teriparatide (TPD), denosumab (Dmab) and zoledronate (ZOL) in real-life setting. METHODS: We studied 249 patients with osteoporosis (OP) with mean [SD] age of 71.5 [11.1] years divided into 3 treatment groups; Group A received TPD; n = 55, Group B (Dmab); n = 116 and Group C (ZOL); n = 78 attending a routine metabolic bone clinic. Bone mineral density (BMD) was measured by DXA at the lumbar spine (LS), total hip (TH) and femoral neck (FN) prior to treatment and after 2 years (Group A), after a mean treatment duration of 3.3 [1.3] years (Group B) and after 1, 2 and 3 doses of ZOL (Group C) to assess treatment response. Hip structural analysis (HSA) was carried out retrospectively from DXA-acquired femur images at the narrow neck (NN), the intertrochanter (IT) and femoral shaft (FS). RESULTS: Changes in parameters of hip geometry and mechanical strength were seen in the following treatment. Percentage change in cross-sectional area (CSA): 3.56[1.6] % p = 0.01 and cross-sectional moment of inertia (CSMI): 4.1[1.8] % p = 0.029 increased at the NN only in Group A. Improvement in HSA parameters at the IT were seen in group B: CSA: 3.3[0.67]% p < 0.001, cortical thickness (Co Th): 2.8[0.78]% p = 0.001, CSMI: 5.9[1.3]% p < 0.001, section modulus (Z):6.2[1.1]% p < 0.001 and buckling ratio (BR): - 3.0[0.86]% p = 0.001 with small changes at the FS: CSA: 1.2[0.4]% p = 0.005, Z:1.6 [0.76]%, p = 0.04. Changes at the IT were also seen in Group C (after 2 doses): CSA: 2.5[0.77]% p = 0.017, Co Th: 2.4[0.84]% p = 0.012, CSMI: 3.9[1.3]% p = 0.017, Z:5.2[1.16]% p < 0.001 and BR: - 3.1[0.88]% p = 0.001 and at the NN (following 3 doses): outer diameter (OD): 4.0[1.4]% p = 0.0005, endocortical diameter(ED): 4.3[1.67% p = 0.009, CSA:5.2[1.8]% p = 0.003, CSMI: 9.3[3.8]% p = 0.019. CONCLUSIONS: Analysis of the effect of OP therapies on hip geometry is useful in understanding the mechanisms of their anti-fracture effect and may provide additional information on their efficacy.
目的：本研究旨在评估特立帕肽（TPD）、地舒单抗（Dmab）和唑来膦酸（ZOL）治疗对真实世界中髋部几何参数的影响。
方法：我们研究了 249 名骨质疏松症（OP）患者，平均年龄为 71.5 [11.1]岁，分为 3 个治疗组；A 组接受 TPD；n=55，B 组（Dmab）；n=116 和 C 组（ZOL）；n=78 名患者参加常规代谢骨门诊。在治疗前和治疗 2 年后（A 组）、平均治疗 3.3 [1.3]年后（B 组）和接受 ZOL 1、2 和 3 剂后（C 组），使用 DXA 测量腰椎（LS）、全髋（TH）和股骨颈（FN）的骨矿物质密度（BMD），以评估治疗反应。从 DXA 获得的股骨图像中进行髋部结构分析（HSA），在窄颈（NN）、转子间（IT）和股骨干（FS）处进行。
结果：以下治疗后观察到髋部几何和机械强度参数的变化。横截面面积（CSA）的百分比变化：3.56[1.6]% p=0.01 和横截面惯性矩（CSMI）：4.1[1.8]% p=0.029 仅在 A 组的 NN 处增加。B 组在 IT 处观察到 HSA 参数的改善：CSA：3.3[0.67]% p<0.001，皮质厚度（Co Th）：2.8[0.78]% p=0.001，CSMI：5.9[1.3]% p<0.001，节段模量（Z）：6.2[1.1]% p<0.001 和屈曲比（BR）：-3.0[0.86]% p=0.001，FS 处的变化较小：CSA：1.2[0.4]% p=0.005，Z：1.6 [0.76]%，p=0.04。C 组（接受 2 剂后）也在 IT 处观察到变化：CSA：2.5[0.77]% p=0.017，Co Th：2.4[0.84]% p=0.012，CSMI：3.9[1.3]% p=0.017，Z：5.2[1.16]% p<0.001 和 BR：-3.1[0.88]% p=0.001，NN 处（接受 3 剂后）：外径（OD）：4.0[1.4]% p=0.0005，内皮质直径（ED）：4.3[1.67% p=0.009，CSA：5.2[1.8]% p=0.003，CSMI：9.3[3.8]% p=0.019。
结论：分析 OP 治疗对髋部几何结构的影响有助于了解其抗骨折作用的机制，并可能提供其疗效的额外信息。
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