Park Jun Young, Lim Jun-Young, Kim Tae Kang, Cho Byung Woo, Kwon Hyuck Min, Park Kwan Kyu, Lee Woo-Suk
Department of Orthopaedic surgery, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Seoul, Yongin-si, 16995, Gyeonggi-do, Republic of Korea.
Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Orthop Surg Res. 2025 Jul 16;20(1):662. doi: 10.1186/s13018-025-06084-5.
Therapy using anabolic and antiresorptive agents in sequence is reportedly effective for severe osteoporosis management. However, evidence for this approach in osteoporotic hip fracture patients remains limited. This study aimed to evaluate the effectiveness of sequential therapy using short-term anabolic agents followed by antiresorptive treatment on bone mineral density (BMD) and bone turnover markers (BTMs) in patients with osteoporotic hip fractures.
We retrospectively reviewed 330 patients with osteoporotic hip fractures between February 2022 and December 2023 and selected 113 patients. The patients were categorized into a sequential group (n = 68), who received an anabolic agent (teriparatide or romosozumab) for three to six months, followed by two doses of denosumab administered at six-month intervals, and a non-sequential group (n = 45), who received anabolic agent monotherapy. The primary outcome was mean change in BMD at the lumbar spine (LS), femoral neck (FN), and total hip (TH) at one-year postoperatively. Secondary outcomes were the osteoporosis medication profile and mean change of 25-hydroxyvitamin D₃ (25(OH)D₃) and BTMs including C-terminal telopeptide (CTX) and procollagen type 1 N-terminal propeptide (P1NP).
The sequential group showed significant increases in LS-, FN-, and TH-BMD at one-year follow-up (3.6 ± 3.7%, 4.4 ± 7.9%, and 1.9 ± 4.1%, respectively; p < 0.001 for all). In contrast, the non-sequential group showed non-significant changes in BMD at all sites. In the sequential group, CTX levels decreased significantly (0.57 ± 0.39 to 0.32 ± 0.30 ng/ml, p < 0.001), whereas the non-sequential group showed a non-significant increase in CTX levels (0.73 ± 0.47 to 0.90 ± 0.56 ng/ml, p = 0.44). P1NP levels decreased significantly in the sequential group (88.2 ± 65.7 to 66.2 ± 62.8 µg/L, p < 0.001). The 25(OH)D₃ levels improved in both groups but were higher in the sequential group (20.7 ± 11.1 to 37.2 ± 13.6 ng/mL).
Sequential therapy with short-term anabolic agents followed by antiresorptive therapy significantly improved BMD and normalized BTMs in patients with osteoporotic hip fractures. This treatment approach may be an effective strategy to enhance bone health and potentially reduce subsequent fracture risk in this high-risk population.
据报道，序贯使用合成代谢药物和抗吸收药物治疗对重度骨质疏松症的管理有效。然而，这种方法在骨质疏松性髋部骨折患者中的证据仍然有限。本研究旨在评估短期使用合成代谢药物后进行抗吸收治疗的序贯疗法对骨质疏松性髋部骨折患者骨密度（BMD）和骨转换标志物（BTMs）的有效性。
我们回顾性分析了2022年2月至2023年12月期间330例骨质疏松性髋部骨折患者，并选取了113例患者。这些患者被分为序贯组（n = 68），接受三至六个月的合成代谢药物（特立帕肽或罗莫佐单抗）治疗，随后每隔六个月注射两剂地诺单抗；以及非序贯组（n = 45），接受合成代谢药物单一疗法。主要结局是术后一年腰椎（LS）、股骨颈（FN）和全髋（TH）的BMD平均变化。次要结局是骨质疏松症用药情况以及25-羟基维生素D₃（25(OH)D₃）和包括C端肽（CTX）和I型前胶原N端前肽（P1NP）在内的BTMs的平均变化。
序贯组在一年随访时LS、FN和TH的BMD显著增加（分别为3.6±3.7%、4.4±7.9%和1.9±4.1%；所有p < 0.001）。相比之下，非序贯组所有部位的BMD变化不显著。在序贯组中，CTX水平显著降低（从0.57±0.39降至0.32±0.30 ng/ml，p < 0.001），而非序贯组的CTX水平无显著升高（从0.73±0.47升至0.90±0.56 ng/ml，p = 0.44）。序贯组的P1NP水平显著降低（从88.2±65.7降至66.2±62.8 μg/L，p < 0.001）。两组的25(OH)D₃水平均有所改善，但序贯组更高（从20.7±11.1升至37.2±13.6 ng/mL）。
短期使用合成代谢药物后进行抗吸收治疗的序贯疗法显著改善了骨质疏松性髋部骨折患者的BMD，并使BTMs恢复正常。这种治疗方法可能是增强该高危人群骨骼健康并潜在降低后续骨折风险的有效策略。
