应用FRAX®预测绝经后女性骨质疏松性椎体骨折的临床研究

目的比较骨折风险评估工具(fracture risk assessment tool,FRAX~?)通过不同部位骨密度(bone mineral density,BMD)预测绝经后女性骨质疏松性椎体骨折(osteoporotic vertebral fracture,OVF)风险的准确性。方法回顾性研究2016年12月至2018年3月我院收治符合选择标准的287例患者,根据有无OVF分为骨折组和对照组。根据股骨颈(femoral neck,FN)与腰椎(lumbar spine,LS) BMD是否相差一个标准差(standard deviation,SD),分为BMD差异组和对照组。比较FRAX~?使用不同部位BMD的骨折风险预测值。以就诊时发生OVF与否为参考标准,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,比较FNBMD、LSBMD、FRAX~?、FRAX~?-FNBMD、FRAX~?-LSBMD预测OVF发生风险的准确性。结果 OVF组共计86例患者,OVF组FNBMD、LSBMD均显著低于对照组(P0. 05),FRAX~?-LSBMD骨折风险评分显著高于FRAX~?-FNBMD(P0. 05)。BMD差异组共计39例患者,其中31例LSBMD低于FNBMD,24例OVF发生在低LSBMD组。FRAX~?-LSBMD骨折风险评分显著高于FRAX~?-FNBMD(P0. 05)。FNBMD、LSBMD、FRAX~?、FRAX~?-FNBMD、FRAX~?-LSBMD预测骨折风险的ROC曲线下面积分别为0. 601、0. 719、0. 746、0. 810、0. 833。结论部分OVF患者存在FN-LSBMD差异,FRAX~?较BMD更能综合的评估OVF风险,有效的识别高危人群。同时FRAX~?-LSBMD评估OVF骨折风险的准确性可能优于FRAX~?-FNBMD,尤其是FN-LSBMD存在明显差异的时候。     

DXA影像评估绝经后女性椎体骨折

目的：做骨密度检测时,应用椎体骨折评估软件发现椎体骨折,提高椎体骨折诊断率。方法连续对217例≥50岁绝经后女性做股骨近端骨密度检测时,行胸腰椎侧位扫描,应用椎体骨折评估软件发现椎体骨折。根据骨密度T值分为T＞－2．5组和T≤－2．5组,年龄分为50～59岁组、60～69岁组和≥70岁组,绝经年限分为0～9年组、10～19年组和≥20年组,分析骨密度、年龄和绝经年限对椎体骨折率的影响,为了了解VFA对椎体骨折的评估的一致性,由同一位研究人员间隔2个月后再次对影像进行评估,采用Kappp统计方法行重复性检验。结果骨密度T＞－2．5患者椎体骨折率为21．6％,T≤－2．5患者椎体骨折率34．8％;各年龄组椎体骨折率：50－59岁为12．5％,60－69岁为25．6％,≥70岁为44．8％;绝经年限长的女性椎体骨折率显著升高。重复性检验提示一致性强度极强。结论对绝经后女性做骨密度检测时,同时进行椎体骨折评估有利于提高椎体骨折和骨质疏松诊断率。     

绝经后妇女骨质疏松性椎体骨折与腰椎骨密度的关系

目的探讨绝经后妇女骨质疏松性椎体骨折与腰椎骨密度的关系。方法选择骨质疏松性椎体骨折的绝经后妇女23例为骨折组,无椎体骨折的25例绝经后骨质疏松妇女为对照组。两组的年龄、绝经年限、身高、体重、体重指数差异无显著性,均行胸腰椎正侧位X线摄片。用双能X线吸收仪（DXA）测量的腰椎（L2-4）前后位骨密度（BMD）、骨矿含量（BMC）和T值。结果骨折组BMD、BMC和T值均低于对照组（P〈0.01）。结论腰椎BMD降低与绝经后妇女的骨质疏松性椎体骨折相关。绝经后骨质疏松妇女应重视BMD变化,预防椎体骨折的发生。     

绝经后女性躯干肌指数与骨质疏松性椎体骨折的相关性

目的 探索绝经后女性躯干肌指数与骨质疏松性椎体骨折（osteoporotic vertebral fracture,OVF）的相关性,为骨质疏松性骨折的防治提供新的思路。方法 共纳入424名绝经后女性,其中OVF 212例,骨质疏松症（无OVF）212例,评估其临床因素,测量骨密度、四肢及躯干肌量。采用多元Logistic回归分析躯干肌指数与OVF之间的相关性。结果 与无OVF相比,OVF女性的躯干肌量及躯干肌指数较低（15.99±2.04 vs. 16.72±2.22;6.76±0.72 vs. 7.09±0.85）。调整骨质疏松症的传统危险因素后,躯干肌指数与腰椎骨密度呈正相关（r=0.186,P＜0.001）,躯干肌指数是OVF的保护因素（P=0.037,OR=0.684,95% CI：0.478～0.978）,基于躯干肌指数,OVF的患病率在4个四分位中呈显著下降趋势。结论 在昆山地区绝经后妇女中,躯干肌指数与腰椎骨密度及OVF密切相关。保持较高的躯干肌指数可能有利于减少OVF的发生。躯干肌指数与腰椎骨密度及OVF的相关性暗示了肌肉与骨骼的内在关联。     

绝经后女性骨质疏松性椎体骨折与腰椎体骨密度的相关性

随着我国步入老龄化社会,骨质疏松症的患病率明显升高。骨质疏松症最严重的危害来自骨质疏松性骨折,绝经后女性尤其多见。由于脊柱独特的解剖学和生物力学特点,骨质疏松患者更易发生椎体骨折。骨密度测量是诊断骨质疏松的金标准。本文通过回顾近年来相关文献,探讨腰椎体骨密度检测对绝经后女性骨质疏松性椎体骨折的意义,发现:绝经后骨质疏松性椎体骨折患者的BMD水平比绝经后骨质疏松症但无脊椎骨折者明显减少;绝经后骨质疏松症患者的BMD水平越低,其发生椎体骨折的风险越高;有椎体骨折史的绝经后骨质疏松症患者的BMD水平与发生再次椎体骨折的风险呈负相关。药物干预通常可明显提高绝经后骨质疏松症患者的BMD水平,同时还可减少椎体骨折的发生。尚存在一些不足:腰椎骨密度可能出现假性增高;需进一步探讨预测骨质疏松性椎体骨折的骨密度阈值;药物干预的研究中BMD水平与椎体骨折发生的相关性并没有得到深入研究;缺少大规模的绝经后骨质疏松性椎体骨折的流行病学,现有研究也大都存在病例收集方法不规范、样本量小、年龄分布存在差异等不足。对绝经后骨质疏松性椎体骨折的深入研究需要多学科共同协作。     

绝经后妇女前白蛋白水平与骨质疏松性椎体骨折的关系

目的　营养在骨质疏松性椎体骨折(ｏｓｔｅｏｐｏｒｏｔｉｃ ｖｅｒｔｅｂｒａｌ ｆｒａｃｔｕｒｅ?ＯＶＦ)的预防和治疗中起着重要作用? 前白蛋白是营养状况评估中常用的临床参数? 本研究目的是探讨绝经后妇女中前白蛋白水平和ＯＶＦ 的相关性? 方法　在这项基于医院的横断面研究中?纳入１ １０３ 名绝经后妇女?平均年龄(６７?? ９±８?? ８)岁? 评估临床因素?测量前白蛋白水平和骨密度(ＢＭＤ)? 采用多元Ｌｏｇｉｓｔｉｃ 回归分析评估前白蛋白与ＯＶＦ 之间的相关性? 结果　与无ＯＶＦ 妇女(ｎ ＝ ４８１)相比?ＯＶＦ 妇女(ｎ ＝ ６２２)的前白蛋白水平较低[(１９２?? ７３±４９?? ２１) ｍｇ/ Ｌ ｖｓ. (２１６?? ７１±４４?? ５７) ｍｇ/ Ｌ]? 调整骨质疏松症的传统危险因素后?前白蛋白水平最高的四分位患者发生ＯＶＦ 的可能性是前白蛋白水平最低的四分位患者的０?? ３６９ 倍(Ｐ<０?? ００１)? 基于前白蛋白?ＯＶＦ 的患病率在４ 个四分位中呈显著下降趋势? 同时?前白蛋白水平与ＢＭＤ 显著相关(Ｐ<０?? ００１)? 结论　低前白蛋白水平是中国绝经后妇女ＯＶＦ 的潜在独立危险因素? 前白蛋白和骨密度之间的正相关暗示了营养和骨骼健康之间的内在联系?     

绝经后医务人员骨密度与椎体骨折的横向研究

目的通过横向研究探讨绝经后医务人员骨密度与椎体骨折的相互关系。方法从单中心医务人员中,随机抽取216名绝经后女性,通过双能X线吸光测定仪检测其骨密度,运用Genant半定量法评估椎体骨折,分析骨密度与骨质疏松性骨折、椎体骨折的畸形程度以及EQ-5D评分的关系。结果绝经后医务人员椎体骨密度的正常组、骨量减少组及骨质疏松组分别占27%、35%、38%;随着骨密度T值的降低,正常组(T≥-1. 0)、骨量减少组(-2. 5T-1. 0)和骨质疏松组(T≤-2. 5)的椎体骨质疏松性骨折患病率明显升高(P0. 05),分别为28%、42%和53%;椎体骨折组(无论有/无临床症状)的骨密度明显低于无骨折组(P0. 01);椎体骨折畸形程度越重,其骨密度越低(P0. 01),躯体伸展程度、日常活动、疼痛或舒适度的EQ-5D评分亦越低(P0. 05)。结论绝经后医务人员随着骨密度的降低,骨质疏松和椎体骨折的患病率增加,生活质量亦降低。     

DXA椎体骨折评价在骨质疏松诊断中的意义

目的比较双能X线骨密度仪的椎体骨折评价(vertebral fracture assessment,VFA)中Genant半定量法和6点定量法对椎体压缩诊断的差异,探讨联合应用VFA在骨质疏松诊断中的意义。方法对85名主诉有腰背痛或身高变矮的患者行骨密度检查(男12例,女73例),平均年龄68.1±10.4岁;女性绝经年龄49.4±3.4岁。同时应用VFA软件分析椎体是否存在压缩,分别采用Genant半定量法和6点定量法进行分析。结果骨密度采用世界卫生组织(WHO)诊断标准,诊断骨质疏松66人,低骨量14人,5人骨量正常,骨质疏松诊断率为77.65%。采用Genant半定量法判断椎体Ⅰ~Ⅲ度压缩76人,6点定量法判断椎体压缩64人,两种方法的椎体压缩诊断率有差异(P0.01),两种方法的Ⅱ、Ⅲ度椎体压缩的诊断率无差异(P0.05)。6例通过骨密度T值诊断的非骨质疏松患者用VFA分析诊断有椎体骨折(压缩Ⅱ~Ⅲ度),应用T值联合VFA椎体压缩Ⅱ~Ⅲ度诊断的骨质疏松率为84.71%,与单独使用T值相比诊断率有差异(P0.05)。结论使用双能X线骨密度仪进行椎体骨折评价时,Genant半定量法和6点定量法对椎体压缩程度为Ⅱ、Ⅲ度的诊断率无差异、一致性好。骨密度检查时联合行VFA可增加骨质疏松的诊断率。     

骨质疏松性压缩骨折椎体成形术后再发椎体骨折

目的研究椎体骨质疏松性压缩骨折行椎体成形术后再发骨折的规律及相关危险因素。方法 2005年12月至2009年8月,收治外伤所致胸腰椎骨质疏松性压缩骨折行PVP治疗并资料完整的病例218例,其中男44例,女174例;年龄48～82岁,平均72.1岁。收集术前、术后1d、末次随访（至少18个月）时影像资料,对新发骨折情况进行统计分析。结果 218例（286个椎体）患者中,有22例患者进行2次以上PVP治疗,60.7%的新发椎体骨折为相邻椎体骨折;相邻椎体新发骨折较非相邻椎体新发骨折发生更快（P〈0.001）;在椎体骨折2次以上的病例,高龄、低骨密度的病例再发椎体骨折比例较大（P〈0.005）;将单次及多次骨折（2次以上）两组病例比较,性别和骨水泥注入量无明显差异（P〉0.05）。结论椎体成形术后数年内易新发椎体骨折,其中相邻椎体骨折所占比例更大,且发生更快;高龄、低骨密度的患者再发骨折可能性更大。椎间盘骨水泥渗漏亦对相邻椎体骨折的发生起重要影响。     

5mg唑来膦酸治疗绝经后骨质疏松及其骨折

目的 探讨5mg唑来膦酸每年1次在干预绝经后妇女不同原因所致骨质疏松及其骨折的作用. 方法 2009年10月至2009年12月收治且符合纳入标准的绝经后妇女骨质疏松患者89例,根据病情分为两组:A组(原发性骨质疏松)47例,年龄47～83岁,平均63.7岁;其中骨折患者27例,6个月内均未服用影响骨代谢的药物.B组(继发性骨质疏松)44例,年龄45 ～78岁,平均62.5岁;其中骨折患者28例;同时伴有类风湿关节炎(6例)、乳腺癌术后(9例)、子宫内膜癌术后(3例)、消化系统溃疡(7例)、溃疡性结肠炎(3例).所有患者均接受5 mg唑来膦酸,30 min静脉注射治疗,每年1次,骨化三醇0.25 μg和钙剂600 mg及维生素D125 IU,1次/d.分别比较两组患者治疗前和治疗后12个月时腰椎和髋部骨密度及跌倒风险指数(FI),观察患者治疗依从性和药物不良反应. 结果 所有新鲜骨折患者在治疗3个月后随访,骨折愈合良好,未出现骨折延迟愈合或不愈合.治疗12个月后,A、B组分别有43例、42例患者获得随访.A组骨密度增加:腰椎5.8％、股骨颈2.9％、Words区5 2％、大转子5.3％和髋部总量3.9％,FI降低26.1％;B组骨密度增加:腰椎3.4％、股骨颈2.1％、Words区3.2％、大转子3.0％和髋部总量2.5％,FI降低21.8％.与治疗前自身比较差异均有统计学意义(P＜0 05).A、B组各有1例发生骨折,均行保守治疗.两组患者血钙、血磷测定均在正常范围内,部分患者有不良反应.结论 每年1次5 mg唑来膦酸治疗绝经后骨质疏松可显著提高腰椎、髋部及股骨颈的骨密度,降低跌倒风险,是一种方便高效的临床骨质疏松治疗手段.     

Systematic vertebral fracture assessment in asymptomatic postmenopausal women

IntroductionRecognition of vertebral fractures (VFs) changes the patient's diagnostic classification, estimation of fracture risk, and threshold for pharmacological intervention. Vertebral fracture assessment (VFA) enables the detection of VFs in the same session as bone mineral density (BMD) testing.ObjectiveTo study prevalence and risk factors of VFs using VFA in asymptomatic women and measure its effect on treatment recommendations.MethodsWe enrolled 908 postmenopausal women (mean age, weight and BMI of 60.9 ± 7.7 (50–91) years, 73.2 ± 13.2 (35–150) kg and 29.8 ± 5.3 (14.5–50.8) kg/m², respectively. Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genant semiquantitative (SQ) approach and morphometry.ResultsVFs were identified in 382 patients (42.0%): 203 (22.3%) had grade 1 and 179 (19.7%) had grade 2 or 3. The prevalence of VFA-detected fractures globally increased significantly with age and as BMI and BMD declined. A fracture was identified on VFA in 63 (28.3%) women with normal BMD (8.5% had grade 2/3 VFs) and in 145 (38.5%) with osteopenia (15.7% had grade 2/3 VFs). Stepwise regression analysis showed that presence of VFs was independently related to age, BMI, number of parity, history of peripheral fracture and lumbar spine BMD.ConclusionA high proportion of women with asymptomatic VFs would not receive treatment if screening were based only on BMD evaluation. Our results support the recommendation to enlarge the indications of VFA in the presence of risk factors such as age over 60, multiparity, history of peripheral traumatic fractures and low BMI.     

Effects of long-term strontium ranelate treatment on vertebral fracture risk in postmenopausal women with osteoporosis

Summary

Vertebral fractures are a major adverse consequence of osteoporosis. In a large placebo-controlled trial in postmenopausal women with osteoporosis, strontium ranelate reduced vertebral fracture risk by 33% over 4 years, confirming the role of strontium ranelate as an effective long-term treatment in osteoporosis.

Introduction

Osteoporotic vertebral fractures are associated with increased mortality, morbidity, and loss of quality-of-life (QoL). Strontium ranelate (2 g/day) was shown to prevent bone loss, increase bone strength, and reduce vertebral and peripheral fractures. The preplanned aim of this study was to evaluate long-term efficacy and safety of strontium ranelate.

Methods

A total of 1,649 postmenopausal osteoporotic women were randomized to strontium ranelate or placebo for 4 years, followed by a 1-year treatment-switch period for half of the patients. Primary efficacy criterion was incidence of patients with new vertebral fractures over 4 years. Lumbar bone mineral density (BMD) and QoL were also evaluated.

Results

Over 4 years, risk of vertebral fracture was reduced by 33% with strontium ranelate (risk reduction?=?0.67, p?<?0.001). Among patients with two or more prevalent vertebral fractures, risk reduction was 36% (p?<?0.001). QoL, assessed by the QUALIOST®, was significantly better (p?=?0.025), and patients without back pain were greater (p?=?0.005) with strontium ranelate than placebo over 4 years. Lumbar BMD increased over 5 years in patients who continued with strontium ranelate, while it decreased in patients who switched to placebo. Emergent adverse events were similar between groups.

Conclusion

In this 4- and 5-year study, strontium ranelate is an effective and safe treatment for long-term treatment of osteoporosis in postmenopausal women.     

A simple method for determining the probability a new vertebral fracture is present in postmenopausal women with osteoporosis

The vertebral fracture status of women with osteoporosis has strong prognostic implications that may influence clinical decisions. We developed a simple method for estimating the probability that a new vertebral fracture has occurred in postmenopausal women with osteoporosis. Data was from the placebo groups of the Fracture Prevention Trial (median observation =21 months) and the MORE Trial at 2 years. A logistic regression analysis identified prior vertebral fracture (yes/no), new or worsening back pain (yes/no), and height loss (≥2 cm, yes/no) as significant predictors for the presence of a new vertebral fracture. The actual probability of a new vertebral fracture in patients without these predictors, over the median observation period of 23 months, was 2.1%. Presence of back pain increased this probability fourfold; prior vertebral fracture increased this probability threefold, and height loss ≥2 cm increased this probability threefold. The predicted probabilities of a new vertebral fracture being present for each subgroup representing each of the eight possible combinations of back pain, prior vertebral fracture, and height loss were highly correlated with both the multivariate logistic regression-derived probabilities (r=0.98, p <0.001) and with the actual probabilities (r=0.99, p <0.001). The validity of this simple method was confirmed in patients from the MORE trial at both 2 years and 3 years, and in the Fracture Prevention Trial alone. This simple method provides clinicians with an estimate of the probability that a new vertebral fracture has occurred in postmenopausal women with osteoporosis.     

Increase in vertebral body size in postmenopausal women with osteoporosis

Bone geometry plays a prominent role in bone strength. Cross-sectional studies have shown that advancing age is associated with increasing diameter of long bones, related to both periostal apposition and endosteal resorption. However, there are few data provided by prospective studies, especially concerning the changes in vertebral body dimensions. The objective of this prospective study was to measure the changes occurring in the vertebral body size of women with postmenopausal osteoporosis.Three-year data from placebo groups of the SOTI and TROPOS trials, performed in women with postmenopausal osteoporosis, were used for this study. In these trials, patients underwent lateral radiographs of the thoracic and lumbar spine at baseline and annually over 3 years, according to standardized procedures. Six-point digitization method was used: the four corner points of the vertebral body from T4 to L4 are marked, as well as an additional point in the middle of the upper and lower endplates. From these 6 points, the vertebral body perimeter, area and depth were measured at baseline and at 3 years. The analysis excluded all vertebrae with prevalent or incident fracture.A total of 2017 postmenopausal women (mean age 73.4 ± 6.1 years) with a mean lumbar spine T score of – 3.1 ± 1.5, and a mean femoral neck T score of – 3.0 ± 0.7 are included in the analysis. Vertebral body dimensions increased over 3 years, by 2.1 ± 5.5% (mean depth ± SD), by 1.7 ± 8.3% (mean area ± SD) and by 1.5 ± 4.9% (mean perimeter ± SD) at the thoracic level (T4 to T12). At the lumbar level (L1 to L4), these dimensions increased as well: 1.4 ± 3.6% (mean depth ± SD), 1.4 ± 5.7% (mean area ± SD), 0.7 ± 2.9% (mean perimeter ± SD). A significant increase in vertebral body size was observed for each vertebral level from T5 to L4 for each of these parameters (p < 0.01).These prospective results demonstrate that vertebral body dimensions increase over 3 years in women with postmenopausal osteoporosis.     

绝经后妇女桡骨远端骨质疏松性骨折相关因素的研究

目的 探讨绝经后妇女桡骨远端骨质疏松性骨折的危险因素,雌激素受体-α（ER-α）基因多态性与骨密度的关系.方法 以哈尔滨地区自然绝经后妇女108名为研究对象,采用问卷调查的方式,测量腰椎（L2-4）、股骨近端和桡骨远端的骨密度,分为桡骨远端骨质疏松性骨折组、骨质疏松症组和正常对照组.利用PCR-限制性片段长度多态技术检测ER-α基因的PvuⅡ和Xba Ⅰ的酶切多态性,分析基因多态性与骨密度之间的关系.结果 骨折组各部位骨密度均低于正常对照组各部位骨密度,差异有显著统计学意义（P＜0.01）,骨折组与骨质疏松症组各部位骨密度差异无统计学意义（P＞0.05）.Ca、P、AKP在不同组间无统计学意义（P＞0.05）.文化程度高、身高较高、月经初潮较早、钙制剂、牛奶饮用量、VD、体重指数大是桡骨远端骨质疏松性骨折的保护性因素,有统计学意义（P＜0.05）,绝经年龄早、绝经年限长、妊娠次数多、多产次、身高缩短为桡骨远端骨质疏松性骨折的危险因素,有统计学意义（P＜0.05）.ER-α基因PvuⅡ多态性与股骨颈、大转子及桡骨远端骨密度有统计学意义（P＜0.05）,PP基因型较Pp及pp型具有更低的骨密度值,差异有统计学意义（P＜0.05）,Xba Ⅰ多态性与骨密度无相关性（P＞0.05）.结论 文化程度高、身高较高、月经初潮较早、钙制剂、牛奶饮用量、VD、体重指数大是桡骨远端骨质疏松性骨折的保护性因素,绝经年龄早、绝经年限长、妊娠次数多、多产次、身高缩短为桡骨远端骨质疏松性骨折的危险因素.ER-α基因PvuⅡ多态性与股骨颈、大转子及桡骨远端骨密度具有相关性.     

新疆绝经后2型糖尿病女性SOST蛋白表达在骨质疏松中诊断价值的研究

目的探讨SOST蛋白表达水平与骨代谢的关系及其在骨质疏松(osteoporosis,OP)中的诊断价值,为预防绝经后2型糖尿病(type 2 diabetes mellitus,T2DM)女性合并OP的发生提供依据。方法纳入对象为135例新疆绝经后女性,记录其年龄等一般基线资料;全自动生化分析仪测定空腹血糖(FPG)、碱性磷酸酶(ALP)等生化指标;双能X线吸收检测法(dual energy X-ray absorptiometry,DXA)测定股骨颈及腰椎(L1~4)骨密度(BMD);酶联免疫吸附法(ELISA)测定SOST蛋白的表达水平。结果(1)与A组(277.261±251.144)相比,B组(785.507±366.941)和D组(884.056±631.041)的SOST蛋白表达水平高于A组,差异具有统计学意义(P<0.01)。(2)通过绘制ROC曲线显示,SOST蛋白表达水平诊断OP的最佳临界点为0.479,其对应的SOST蛋白水平为851.31 pg/mL,敏感度为61.4%,特异性为86.5%,曲线下面积(AUC)为0.741(95%可信区间:0.656~0.827);(3)Pearson相关性分析显示,新疆绝经后T2DM女性SOST蛋白表达水平与BMD(L1~4)呈负相关(r=-0.239,P=0.005)。结论(1)新疆绝经后T2DM女性SOST蛋白表达水平与骨代谢有关,且SOST蛋白高表达是腰椎BMD(L1~4)降低的危险因素。(2)以SOST蛋白表达水平≥851.31 pg/mL为0P的诊断标准,有较大的AUC和更高的敏感性。     

Change in lumbar spine BMD and vertebral fracture risk reduction in teriparatide-treated postmenopausal women with osteoporosis.

Increases in lumbar spine BMD account for 30-41% of the vertebral fracture risk reduction with teriparatide treatment. The remaining fracture risk reduction is caused by improvements in non-BMD determinants of bone strength. INTRODUCTION: Changes in BMD account for a small percentage of the fracture risk reduction seen in patients treated with antiresorptive drugs. The relationship between changes in lumbar spine BMD and vertebral fracture risk reduction with teriparatide treatment has not been assessed. MATERIALS AND METHODS: The relationship between spine BMD and the risk of new vertebral fractures after teriparatide treatment was assessed using data from the Fracture Prevention Trial. Postmenopausal women with osteoporosis (n = 1637) were randomized to placebo or teriparatide 20 or 40 microg/day for a median of 19 months. Spine BMD was assessed at baseline and 18 months. Vertebrae whose fracture status changed during the trial were removed from the calculation of BMD. Baseline and endpoint lateral spine radiographs were assessed using a visual semiquantitative technique. RESULTS: Both the baseline and change in spine BMD were contributors to vertebral fracture risk. The mean spine BMD increase in teriparatide-treated patients was 0.09 g/cm(2) across tertiles of baseline spine BMD. Compared with placebo, teriparatide significantly reduced the risk of new vertebral fracture for all endpoint BMD values. Teriparatide-mediated increases in spine BMD accounted for 30% (in the low baseline spine BMD tertile) to 41% (in the high baseline spine BMD tertile) of the reduction in vertebral fracture risk. CONCLUSIONS: Increases in BMD account for approximately one third of the vertebral fracture risk reduction seen with teriparatide. The majority of the risk reduction, however, results from improvements in non-BMD determinants of bone strength.     

FRAX在绝经后骨质疏松症中骨折风险评估的Meta分析

目的 系统评价未使用骨密度检测时,通过FRAX工具评估绝经后骨质疏松症(PMOP)中骨折发生概率的应用准确性。方法 系统检索CNKI、CBM、VIP、WanFang、PubMed、Embase、Cochrane 图书馆,开展方法学质量评估,同时借助软件Stata16.0和Metadisc实施Meta分析。所纳入文献合计12篇,涉及研究为14个。结果 Meta分析结果表明,FRAX敏感度为84.68%,特异性为63.18%。合并SROC曲线绘制,最终得到诊断的准确率为85%,P<0.05,准确率接近骨密度检测方法。其中,髋部骨折概率对于骨密度评估方法的敏感度为81.9%,特异性为65.02%。使用FRAX评估时,诊断的准确率为83%,P<0.05;主要部位骨折概率对于骨密度评估方法的敏感度为73.5%;特异性为72.71%,使用FRAX评估时得到诊断的准确率为81%,P<0.05。 结论 FRAX工具是一种可靠的应用于绝经后骨质疏松症中的骨折评估方法。     

Alendronate reduced vertebral fracture risk in postmenopausal Japanese women with osteoporosis: a 3-year follow-up study

The risk-reducing effect of alendronate on vertebral fractures has been consistently reported. In a 2-year, randomized, double-blind, active drug-controlled (1µg alfacalcidol) double-dummy study, we also reported that alendronate (5.0mg) had a fracture-reducing effect in Japanese patients with preexisting vertebral fractures. The present report describes the risk-reducing effect of alendronate (5.0mg) for 3 years in postmenopausal osteoporotic patients. The 3-year treatment period consisted of the original 2-year double-blind study followed by a 1-year extension. A total of 170 postmenopausal female patients were involved in the third year; 90 received alendronate and 80 received alfacalcidol. Both efficacy and safety were analyzed in these 170 patients. Vertebral fracture was determined by quantitative morphometry, and vertebral bone mineral density (BMD) was measured by the DXA method (dual-energy X-ray absorptiometry). The primary efficacy endpoint was the incidence of vertebral fracture, excluding fracture cases that occurred in the first 6 months after treatment initiation. The cumulative incidence of vertebral fracture at 3 years was 7.8% (7/90) in the alendronate group and 18.8% (15/80) in the alfacalcidol group, indicating a significantly reduced risk of fractures in the alendronate group (relative risk = 0.41, 95% CI = 0.18–0.97). Lumbar spine BMD increased by 9.2% in the alendronate group (n = 26) and by 1.4% in the alfacalcidol group (n = 22) at 3 years. The safety profile of alendronate during 3 years of treatment was similar to that of alfacalcidol. The present study thus demonstrated that treatment with alendronate 5.0mg for 3 years increased vertebral BMD and reduced the risk of vertebral fractures in Japanese, postmenopausal women with osteoporosis.An erratum to this article can be found at