College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA.
College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Osteoporos Int. 2024 May;35(5):877-891. doi: 10.1007/s00198-023-07008-x. Epub 2024 Feb 17.
Bone strength estimates are important for fracture prevention. This study compared bone strength changes in postmenopausal women with low bone mass who were assigned to 12 months of exercise, a bone medication, or control. Exercise and bone medications benefited structure at the hip. Structure should be considered in fracture prevention research.
Exercise and bisphosphonates reduce fracture risk, but their impact on estimates of bone strength remains uncertain. This study compared changes in tibial bone strength using peripheral quantitative computed tomography (pQCT) and hip structure analysis (HSA) outcomes from dual-energy X-ray absorptiometry (DXA) scans in postmenopausal women with low bone mass assigned to 12 months of exercise, risedronate, or control.
In this RCT, 276 postmenopausal women within 6 years of menopause were randomly assigned to three groups: exercise (92), risedronate (91), or control (93). Exercise included weighted jogging and progressive resistance exercises; risedronate treatment was 150 mg monthly; all groups received calcium and vitamin D. pQCT and DXA images were obtained at baseline and 6 and 12 months and compared between groups over time.
Participants had a mean (± SD) age of 54.5 (± 3.2) years with an average of 36.7 (± 40.7) months postmenopause. No significant differences were found between groups for the change in pQCT outcomes (volumetric bone mineral density, area, and strength estimates). At 12 months, mean percent differences (95% CI) in HSA measures between exercise and controls were as follows: intertrochanteric, cross-sectional area 2.25% (0.28, 4.12) (p = .03), cross-sectional moment of inertia (CSMI) 5.67% (1.47, 9.87) (p < .01), and section modulus (SM) 4.38% (1.02, 7.74) (p = .01), and narrow neck, average cortical thickness 2.37% (-0.08, 4.83) (p = .031). Mean percent differences (95% CI) in HSA measures between risedronate and control were as follows: intertrochanteric, CSMI 4.28% (-0.24, 8.81) (p = .03) and SM 3.35% (-0.21, 6.91) (p = .03), and shaft, subperiosteal width 0.82% (0.05, 1.58) (p = .047), CSMI 2.53% (0.88, 4.18) (p = .004), and SM 1.57% (0.34, 2.8) (p = .008). Exercise maintained neck-shaft angle compared to both control 1.27% (0.13, 2.41) (p = .04) and risedronate 1.31% (0.23, 2.39) (p = .03). All other differences for changes in HSA outcomes over time were not significantly different between the exercise and risedronate groups.
Exercise and bisphosphonates may influence structural and strength estimates at the hip, but not at peripheral sites (tibia). Neither exercise nor bisphosphonates were found to be superior in improving estimates of hip bone strength.
骨强度评估对于预防骨折很重要。本研究比较了骨量低的绝经后女性在接受 12 个月的运动、骨药物或对照组治疗后骨强度的变化。运动和双膦酸盐有益于髋部结构。在骨折预防研究中应考虑结构。
运动和双磷酸盐可降低骨折风险，但它们对骨强度评估的影响仍不确定。本研究比较了低骨量绝经后女性使用双能 X 射线吸收法（DXA）扫描的外周定量计算机断层扫描（pQCT）和髋结构分析（HSA）结果，这些女性在 12 个月内被随机分配到运动、利塞膦酸盐或对照组。
在这项 RCT 中，276 名绝经后 6 年内的女性被随机分为三组：运动（92 名）、利塞膦酸盐（91 名）或对照组（93 名）。运动包括负重慢跑和渐进式阻力运动；利塞膦酸盐治疗剂量为 150 毫克/月；所有组均接受钙和维生素 D 补充。基线和 6 个月和 12 个月时获得 pQCT 和 DXA 图像，并比较组间随时间的变化。
参与者的平均（± SD）年龄为 54.5（± 3.2）岁，平均绝经后 36.7（± 40.7）个月。在 pQCT 结果（体积骨密度、面积和强度估计）的变化方面，各组之间没有显著差异。在 12 个月时，运动与对照组之间 HSA 测量值的平均百分比差异（95%CI）如下：转子间区，横截面积 2.25%（0.28，4.12）（p=.03），横断面积惯性矩（CSMI）5.67%（1.47，9.87）（p<.01）和节段模量（SM）4.38%（1.02，7.74）（p=.01），以及狭窄颈部，平均皮质厚度 2.37%（-0.08，4.83）（p=.031）。利塞膦酸盐与对照组之间 HSA 测量值的平均百分比差异（95%CI）如下：转子间区，CSMI 4.28%（-0.24，8.81）（p=.03）和 SM 3.35%（-0.21，6.91）（p=.03），以及骨干，骨膜下宽度 0.82%（0.05，1.58）（p=.047），CSMI 2.53%（0.88，4.18）（p=.004）和 SM 1.57%（0.34，2.8）（p=.008）。与对照组相比，运动组维持颈干角的变化为 1.27%（0.13，2.41）（p=.04）和利塞膦酸盐组为 1.31%（0.23，2.39）（p=.03）。在 HSA 结果随时间的变化方面，运动和利塞膦酸盐组之间的其他差异均无统计学意义。
运动和双膦酸盐可能会影响髋部的结构和强度估计，但不会影响外周部位（胫骨）。运动和双磷酸盐都不能改善髋部骨强度的估计。
