Boehm Elena, Sauer Christina, Baur-Melnyk Andrea, Biebl Johanna Theresia, Harada Saori, Wegener Bernd, Kraft Eduard, Stahl Robert, Feist-Pagenstert Isa
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
J Bone Miner Metab. 2024 Nov;42(6):741-753. doi: 10.1007/s00774-024-01553-z. Epub 2024 Sep 17.
Monitoring of bone mineral density (BMD) is used to assess pharmacological osteoporosis therapy. This study examined the real-life effects of antiresorptive and osteoanabolic treatments on volumetric BMD (vBMD) of the spine by quantitative computed tomography (QCT).
Patients aged ≥ 50 years with a vBMD < 120 mg/ml had ≥ 2 QCT. For analysis of therapy effects, the pharmacological treatment and the duration of each therapy were considered. Identical vertebrae were evaluated in all vBMD measurements for each patient. A linear mixed model with random intercepts was used to estimate the effects of pharmacological treatments on vBMD.
A total of 1145 vBMD measurements from 402 patients were analyzed. Considering potential confounders such as sex, age, and prior treatment, a reduction in trabecular vBMD was estimated for oral bisphosphonates (- 1.01 mg/ml per year; p < 0.001), intravenous bisphosphonates (- 0.93 mg/ml per year; p = 0.015) and drug holiday (- 1.58 mg/ml per year; p < 0.001). Teriparatide was estimated to increase trabecular vBMD by 4.27 mg/ml per year (p = 0.018). Patients receiving denosumab showed a statistically non-significant decrease in trabecular vBMD (- 0.44 mg/ml per year; p = 0.099). Compared to non-treated patients, pharmacological therapy had positive effects on trabecular vBMD (1.35 mg/ml; p = 0.001, 1.43 mg/ml; p = 0.004, 1.91 mg/ml; p < 0.001, and 6.63 mg/ml; p < 0.001 per year for oral bisphosphonates, intravenous bisphosphonates, denosumab, and teriparatide, respectively).
An increase in trabecular vBMD by QCT was not detected with antiresorptive agents. Patients treated with teriparatide showed increasing trabecular vBMD. Non-treatment led to a larger decrease in trabecular vBMD than pharmacological therapy.
骨密度（BMD）监测用于评估骨质疏松症的药物治疗效果。本研究通过定量计算机断层扫描（QCT）检查了抗吸收和骨合成代谢治疗对脊柱体积骨密度（vBMD）的实际影响。
年龄≥50岁且vBMD<120mg/ml的患者进行了≥2次QCT检查。为分析治疗效果，考虑了药物治疗及每种治疗的持续时间。对每位患者的所有vBMD测量均评估相同的椎体。采用具有随机截距的线性混合模型来估计药物治疗对vBMD的影响。
共分析了402例患者的1145次vBMD测量结果。考虑到性别、年龄和既往治疗等潜在混杂因素，估计口服双膦酸盐类药物使小梁骨vBMD每年降低1.01mg/ml（p<0.001），静脉注射双膦酸盐类药物使小梁骨vBMD每年降低0.93mg/ml（p=0.015），药物假期使小梁骨vBMD每年降低1.58mg/ml（p<0.001）。估计特立帕肽使小梁骨vBMD每年增加4.27mg/ml（p=0.018）。接受地诺单抗治疗的患者小梁骨vBMD每年下降0.44mg/ml，差异无统计学意义（p=0.099）。与未治疗患者相比，药物治疗对小梁骨vBMD有积极影响（口服双膦酸盐类药物、静脉注射双膦酸盐类药物、地诺单抗和特立帕肽分别为每年1.35mg/ml，p=0.001；每年1.43mg/ml，p=0.004；每年1.91mg/ml，p<0.001；每年6.63mg/ml，p<0.001）。
未发现抗吸收药物通过QCT检测到小梁骨vBMD增加。接受特立帕肽治疗的患者小梁骨vBMD增加。与药物治疗相比，未治疗导致小梁骨vBMD下降幅度更大。
