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1.
Jun Iwamoto Tsuyoshi Takeda Shoichi Ichimura Mitsuyoshi Uzawa 《Journal of orthopaedic science》2002,7(6):637-643
The purpose of this retrospective study was to compare the effects of long-term treatment (5 years) with elcatonin and alfacalcidol
on bone mineral density (BMD) and the incidence of vertebral fractures in postmenopausal women with osteoporosis. Fifty-six
osteoporotic women, more than 5 years after menopause and 58–79 years of age, were enrolled in the study and allocated to
an elcatonin treatment group (20 units IM, weekly; n = 30) or an alfacalcidol treatment group (1 μg/day, daily; n = 26). BMD of the lumbar spine (L2-L4) was measured by dual energy X-ray absorptiometry at baseline and every year for 5
years. There were no significant differences in age, body mass index, years since menopause, BMD, or number of prevalent vertebral
fractures at baseline between the two groups. One-way analysis of variance with repeated measurements showed no significant
longitudinal changes in BMD in either group, suggesting that both treatments sustained the BMD over 5 years. Two-way analysis
of variance with repeated measurements also showed no significant differences in longitudinal changes in BMD between the two
groups, suggesting that the effects of the two treatments on BMD were similar. However, the number of incident vertebral fractures
per patient was significantly lower in the alfacalcidol treatment group than in the elcatonin treatment group (0.80 ± 1.19
and 2.08 ± 2.73, respectively; P < 0.05). These findings indicate that both treatments appeared to sustain lumbar BMD similarly over a 5-year period in postmenopausal
women with osteoporosis, but alfacalcidol treatment may be superior to elcatonin treatment regarding the incidence of vertebral
fractures. Further study with prospective observations are needed to confirm the results of the present study.
Received: April 2, 2002 / Accepted: July 13, 2002
Offprint requests to: J. Iwamoto 相似文献
2.
Treatment of Glucocorticoid-Induced Osteoporosis with Alfacalcidol/Calcium Versus Vitamin D/Calcium 总被引:6,自引:0,他引:6
J. D. Ringe A. Cöster T. Meng E. Schacht R. Umbach 《Calcified tissue international》1999,65(4):337-340
Vitamin D/calcium substitution is generally regarded as an effective first step treatment for glucocorticoid-induced osteoporosis
(GIOP). The aim of our study was to evaluate the efficacy of the active vitamin D metabolite alfacalcidol (1α) compared with
the native vitamin D3 in patients with established GIOP with or without vertebral fractures. Patients on long-term corticoid therapy were given
either 1 μg alfacalcidol plus 500 mg calcium per day (group A, n = 43) or 1000 IU vitamin D3 plus 500 mg calcium (group B, n = 42). The two groups were alike in age range, sex ratio, percentages of underlying diseases,
average initial bone density values (lumbar spine: mean T-score −3.28 and −3.25, respectively), and rates of vertebral and
nonvertebral fractures. During the 3-year study we found a small but significant increase of lumbar spine density in group
1α (+2.0%, P < 0.0001) and no significant changes at the femoral neck. In the D3 group, there were no significant changes at both sites. At the end of the study, 12 new vertebral fractures had occurred
in 10 patients of the group 1α and 21 in 17 patients of the D3 group. In accordance with the observed fracture rates, the alfacalcidol group showed a significant decrease in back pain
(P < 0.0001) whereas no change was seen in the vitamin D group. We conclude that with the doses used in this trial, alfacalcidol
is superior to vitamin D in the treatment of established GIOP. 相似文献
3.
W. F. Lems MD PhD W. G. Jacobs J. W. J. Bijlsma A. Croone H. C. M. Haanen H. H. M. L. Houben M. I. Gerrits H. J. M. van Rijn 《Osteoporosis international》1997,7(6):575-582
To investigate whether sodium fluoride (NaF) is able to prevent bone loss in patients treated with corticosteroids (Cs), we
performed a randomized, double-masked, placebo-controlled trial with 44 Cs-treated patients without established osteoporosis,
defined as the absence of previous peripheral fractures and vertebral deformities on radiographs. The effects of NaF (25 mg
twice daily) and placebo on the bone mineral density (BMD) of the lumbar spine and hips were compared at baseline and at 6,
12, 18 and 24 months. After 2 years, the BMD of the lumbar spine had decreased in the placebo group by 3.0% (95% CI: −4.9%
to −1.0%;p<0.01); in the NaF group there was a statistically insignificant increase in BMD of 2.2% (95% CI: −0.8% to +5.3%). The difference
in the changes in BMD between the two groups was +5.2% (95% CI: +1.8% to +8.6%;p<0.01). In the hips, BMD had decreased after 2 years in both groups: in the placebo group by −3.0% (95% CI: −5.0% to −1.0%;p<0.05) and in the NaF group by 3.8% (95% CI: −6.1% to −1.5%;p<0.01). The difference in the changes in BMD between the two groups was not significant: +0.8% (95% CI: −2.1% to +3.8%). Three
vertebral deformities were observed in the placebo group and one in the NaF group (insignificant difference), while no peripheral
fractures occurred during the study period. It is concluded that in Cs-treated patients without established osteoporosis NaF
prevents bone loss in the lumbar spine but does not have a positive effect on the BMD of the hips. 相似文献
4.
Takuo Fujita Yoshio Fujii Bunrei Goto Akimitsu Miyauchi Yasuyuki Takagi 《Journal of bone and mineral metabolism》1997,15(4):223-226
The effect of agents commonly used for osteoporosis treatment in Japan—calcium, alfacalcidol (1α-hydroxyvitamin D3), elcatonin (eel calcitonin derivative), and an alfacalcidol-elcatonin combination—on lumbar spine bone mineral density (BMD)
was assessed in 136 subjects aged 51–83 years with various degrees of osteopenia or osteoporosis, divided into five groups
approximately matched for age and BMD over a period of 3 years. Lumbar spine BMD decreased by about 3.5% without treatment
but was maintained at approximately baseline level on elcatonin. Oral administration of 900mg/day calcium as AAA Ca (active
absorbable algae calcium) or 1μg/day alfacalcidol increased lumbar BMD by 4.5% or 3.7%, respectively, after 3 years. Combined
use of alfacalcidol and elcatonin was most effective, increasing the BMD by 8.0% after 3 years. Extremely low calcium and
vitamin D intake in Japan with consequent low calcitonin secretion may be responsible for the favorable effects. Alfacalcidol,
an active form of vitamin D, and elcatonin acting through different mechanisms may act synergistically on bone to increase
BMD. 相似文献
5.
G. Leidig-Bruckner B. Limberg D. Felsenberg T. Bruckner S. Holder A. Kather J. Miksch C. Wüster R. Ziegler C. Scheidt-Nave 《Osteoporosis international》2000,11(2):102-119
Morphometric methods have been developed for standardized assessment of vertebral deformities in clinical and epidemiologic
studies of spinal osteoporosis. However, vertebral deformity may be caused by a variety of other conditions. To examine the
validity of morphometrically assessed vertebral deformities as an index of osteoporotic vertebral fractures, we developed
an algorithm for radiological differential classification (RDC) based on a combination of quantitative and qualitative assessment
of lateral spinal radiographs. Radiographs were obtained in a population of 50- to 80-year-old German women (n= 283) and men (n = 297) surveyed in the context of the European Vertebral Osteoporosis Study (EVOS). Morphometric methods (Eastell 3 SD and
4 SD criteria, McCloskey) were validated against RDC and against bone mineral density (BMD) at the femur and the lumbar spine.
According to RDC 36 persons (6.2%) had at least one osteoporotic vertebral fracture; among 516 (88.9%) nonosteoporotics 154
had severe spondylosis, 132 had other spinal disease and 219 had normal findings; 14 persons (2.4%) could not be unequivocally
classified. The prevalence of morphometrically assessed vertebral deformities ranged from 7.3% to 19.2% in women and from
3.5% to 16.6% in men, depending on the stringency of the morphometric criteria. The agreement between RDC and morphometric
methods was poor. In men, 62–86% of cases with vertebral deformities were classified as nonosteoporotic (severe spondylosis
or other spinal disease) by RDC, compared with 31–68% in women. Among these, most had wedge deformities of the thoracic spine.
On the other hand, up to 80% of osteoporotic vertebral fractures in men and up to 48% in women were missed by morphometry,
in particular endplate fractures at the lumbar spine. In the group with osteoporotic vertebral fractures by RDC the proportion
of persons with osteoporosis according to the WHO criteria (T-score <−2.5 SD) was 90.0% in women and 86.6% in men, compared with 67.9–85.0% in women and 20.8–50.0% in men with vertebral
deformities by various methods. Although vertebral deformities by most definitions were significantly and inversely related
to BMD as a continuous variable in both sexes [OR; 95% CI ranged between (1.70; 1.07–2.70) and (3.69; 1.33–10.25)], a much
stronger association existed between BMD and osteoporotic fractures defined by RDC [OR; 95% CI between (4.85; 2.30–10.24)
and (15.40; 4.65–51.02)]. In the nonosteoporotic group individuals with severe spondylosis had significantly higher BMD values
at the femoral neck (p <0.01) and lumbar spine (p <0.0004) compared with the normal group. On the basis of internal (RDC) and external (BMD) validation, we conclude that assessment
of vertebral osteoporotic fracture by quantitative methods alone will result in considerable misclassification, especially
in men. Criteria for differential diagnosis as used within RDC can be helpful for a standardized subclassification of vertebral
deformities in studies of spinal osteoporosis.
Received: 5 February 1999 / Accepted: 24 June 1999 相似文献
6.
Quantitative ultrasound (QUS) is emerging as a simple, inexpensive and noninvasive method for assessing bone quality and
assessing fracture risk. We assessed the usefulness of a contact calcaneal ultrasonometer by studying normal premenopausal
women (group I, n= 53), normal postmenopausal women (group II, n= 198), and osteoporotic women without (group III, n= 141) and with vertebral fractures (group IV, n= 53). The osteoporotic subjects had a T-score of the spine or hip neck bone mineral density (BMD) <−2.5 based on the local Chinese peak young mean values. When compared
with postmenopausal controls, mean broadband ultrasound attenuation (BUA), speed of sound (SOS), and quantitative ultrasound
index (QUI) were 26%, 2.1% and 25% lower in women with vertebral fractures (p all <0.005). The correlation coefficients between QUS parameters and BMD of the spine and hip ranged between 0.4 and 0.5.
The ability of the QUS to discriminate between patients groups was determined based on the mean value of normal premenopausal
women in group I. The mean T-score for women with fractures was −2.87 ± 1.02 for BUA, −2.54 ± 0.79 for SOS, −3.17 ± 0.70 for QUI, −2.65 ± 0.86 for L2–4
BMD and −2.53 ± 0.66 for hip neck BMD. After adjustment for age and body mass index, the odds ratio of vertebral fracture
was 1.71 (95% CI 1.2–2.6) for each 1 SD reduction in BUA, 2.72 (1.3–5.3) for SOS, 2.58 (1.4–4.6) for QUI, 2.33 (1.6–3.3) for
L2–4 BMD, 2.09 (1.37–3.20) for femoral neck BMD and 1.88 (1.34–2.92) for total hip BMD. The association between the QUS parameters
and vertebral fracture risk persisted even adjustment for BMD. The area under the receiver operating characteristic curve
for BUA for vertebral fracture was 0.92, for SOS, QUI, L2–4 BMD and femoral neck BMD was 0.95, and for total hip was 0.91.
Received: 7 January 1999 / Accepted: 18 May 1999 相似文献
7.
Saetung S Ongphiphadhanakul B Rajatanavin R 《Journal of bone and mineral metabolism》2008,26(1):47-52
An Asian-specific screening tool for osteoporosis, the so-called OSTA index, was devised and is likely to be helpful in determining
which postmenopausal women need bone mineral density (BMD) measurement. Besides BMD, prevalent vertebral fracture is a strong
risk factor for future fractures. However, the relationship of the OSTA index to prevalent vertebral fractures is currently
unknown. In this study, we evaluated the performance of the OSTA index in elderly Thai women and assessed the relationship
of the index to prevalent vertebral deformities. Subjects consisted of 741 healthy Thai elderly women. BMD was measured by
DEXA and T-score ≤2.5 SD is defined as osteoporosis. Prevalent vertebral deformities were determined by morphometric X-ray
absorptiometry. OSTA index >−1 is classified as having low risk of osteoporosis, −1 to −4 as intermediate risk and, <−4 as
high risk. Data were expressed as mean ± SD. The mean age and body weight of subjects were 67 ± 4.8 years and 57.8 ± 8.7 kg,
respectively. The area under the ROC curve for OSTA index to identify osteoporosis at femoral neck and lumbar spine was 0.80
and 0.72, respectively. Femoral neck osteoporosis was found in 40.4%, 6.3%, and 2.4% of subjects with high-risk, intermediate-risk,
and low-risk OSTA indexes, respectively. With regard to vertebral deformities, the area under the ROC curve relating OSTA
index to vertebral deformities was 0.70 (P < 0.001). The prevalence of vertebral deformities in according to the OSTA index was 19.2% in the high-risk, 7.9% in the
intermediate-risk, and 2.8% in the low-risk group. We concluded that the OSTA index can be of assistance in the selection
of postmenopausal women for BMD measurement. In addition, this index may be helpful in the identification of postmenopausal
women with vertebral deformity and those who need antifracture treatments. 相似文献
8.
The Effects of Alendronate Treatment in Osteoporotic Patients Affected by Monoclonal Gammopathy of Undetermined Significance 总被引:1,自引:0,他引:1
Pepe J Petrucci MT Mascia ML Piemonte S Fassino V Romagnoli E Minisola S 《Calcified tissue international》2008,82(6):418-426
In patients with monoclonal gammopathy of undetermined significance (MGUS) the increase of bone turnover rate can increase
the risk of fracture. Thus, a treatment normalizing this negative balance could be of benefit in these patients. We studied
100 patients affected by MGUS, grouped according to the presence (group A, 50 patients) or absence (group B) of vertebral
fractures and/or osteoporosis. Group A was treated with alendronate (70 mg/weekly) plus calcium and cholecalciferol for 18 months,
and group B was treated with calcium and cholecalciferol. After 18 months, the mean bone mineral density (BMD) of the lumbar
spine and total femur had increased by 6.1% and 1.5%, respectively, in group A. In the nine patients of this group not taking
alendronate, BMD values of the lumbar spine and total femur decreased by 1.6% (P ≤ 0.001 ) and 1.3% (P ≤ 0.01), respectively. In patients of group B, BMD increased by 1.2% at the lumbar spine and decreased by 1.2% at the total
femur. Corresponding figures of those patients in the same group not taking calcium and vitamin D supplementation were −0.1%
and −1.2%, respectively. At 18 months we observed significant decreases of serum bone markers: the difference between the
groups was −23.2 (P ≤ 0.0l) for bone alkaline phosphatase, −23.6 for osteocalcin (P ≤ 0.0l), −35.1 for C-terminal telopeptides of collagen type I (P ≤ 0.00l), and −0.47 for bone sialoprotein (P = nonsignificant). Treatment with alendronate could lead to a significant reduction in fracture risk in MGUS patients with
skeletal fragility. 相似文献
9.
Vertebral Deformities and Low Bone Mineral Density in Adults with Cystic Fibrosis: A Cross-sectional Study 总被引:5,自引:0,他引:5
S. L. Elkin A. Fairney S. Burnett M. Kemp P. Kyd J. Burgess J. E. Compston M. E. Hodson 《Osteoporosis international》2001,12(5):366-372
Patients with cystic fibrosis (CF) have low bone mineral density (BMD). The clinical relevance of this is not clearly established.
The aim of this study was to determine the prevalence of low BMD and vertebral deformities in CF adults with varied disease
severity. One hundred and seven patients (58 men) aged 18–60 years underwent dual-energy X-ray absorptiometry scanning of
the lumbar spine and hip, radiology of the spine and biochemical studies. Thirty-eight percent had a Z-score of <−1, with 13% having Z-scores <−2. Seventeen percent had evidence of vertebral deformity on radiography, mostly in the thoracic spine. Thirty-five
percent reported past fractures, of which 9% were rib fractures. Percent predicted forced expiratory volume in 1 second (FEV1)
and the amount of daily physical activity were positively related to BMD. The number of intravenous antibiotic courses in
the previous 5 years was negatively related to BMD. Patients with a history of rib fracture and CF-related diabetes had significantly
lower femoral neck BMD (p<0.02). The median serum 25-hydroxyvitamin D was 28 nmol/l, with 36% of patients having levels below 25 nmol/l despite vitamin
D supplementation. Forty-four percent had raised levels of urinary pyridinium crosslinks (NTx). In conclusion, fragility fractures
and hypovitaminosis D occur commonly in adult patients with CF. Low BMD occurs in patients with more severe disease and significantly
relates to FEV1, infective exacerbations and daily energy expended in physical activity.
Received: 27 June 2000 / Accepted: 1 December 2000 相似文献
10.
Y. Rhee M. Kang Y. Min D. Byun Y. Chung C. Ahn K. Baek J. Mok D. Kim D. Kim H. Kim Y. Kim S. Myoung D. Kim S.-K. Lim 《Osteoporosis international》2006,17(12):1801-1807
Introduction A randomized, double-blind, prospective, 24-week clinical trial was performed to evaluate the effects of a combinative agent, Maxmarvil, of calcitriol (0.5 μg) and alendronate (5 mg) on bone metabolism in postmenopausal women.Methods A total of 217 postmenopausal women with osteoporosis were enrolled; 199 patients were randomly assigned to one of two treatment groups (Maxmarvil group or alfacalcidol group). None of the patients were vitamin-D-deficient, as assessed by serum 25-hydroxyvitamin D (25(OH)D), nor had they received any drugs affecting bone metabolism before enrollment. Bone mineral densities (BMD) of L1–L4 and the femur were measured by dual-energy X-ray absorptiometry (DXA) at the initial assessment and after 6 months of treatment. Serum biochemical assays, including serum calcium, 24-h urinary calcium excretion, and bone turnover markers (both bone-specific alkaline phosphatase [bsALP] and urine N-telopeptide [NTx]), were performed at the baseline and after 3 and 6 months of treatment.Results In the Maxmarvil group, the BMD of the lumbar spine increased up to 2.42±0.5% from the baseline after 6 months (p<0.05). On the other hand, the change in BMD in the alfacalcidol group was 0.28±0.5% after 6 months. There was no significant difference in femoral BMD between the two groups. The levels of bsALP and NTx were significantly lower in the Maxmarvil group than in the alfacalcidol group (−22.04±3.9% vs. −11.42±2.8% [p<0.05] and −25.46±5.2% vs. 1.24±6.2% [p<0.001], respectively). Interestingly, there was a significantly smaller amount of 24-h urinary calcium in the Maxmarvil group (p<0.05).Conclusions Our study demonstrates that a combination of calcitriol and alendronate is quite effective in preventing bone loss, with the advantage of lesser hypercalciuric effect of calcitriol in the postmenopausal osteoporotic women. 相似文献
11.
Bone Mineral Density and Vertebral Fractures in Men 总被引:1,自引:0,他引:1
E. Legrand D. Chappard C. Pascaretti M. Duquenne C. Rondeau Y. Simon V. Rohmer M.-F. Basle M. Audran 《Osteoporosis international》1999,10(4):265-270
In women, many studies indicate that the risk of vertebral fragility fractures increases as bone mineral density (BMD) declines.
In contrast, few studies are available for BMD and vertebral fractures in men. It is uncertain that the strength of the relationship
between BMD and fractures is similar in magnitude in middle-aged men and in postmenopausal women. In the present study, 200
men (mean age 54.7 years) with lumbar osteopenia (T-score <−1.5) were recruited to examine the relationships between spine BMD and hip BMD and the associations of BMD with vertebral
fractures. Lumbar BMD was assessed from L2 to L4, in the anteroposterior view, using dual-energy X-ray densitometry. At the
upper left femur, hip BMD was measured at five regions of interest: femoral neck, trochanter, intertrochanter, Ward’s triangle
and total hip. Spinal radiographs were analyzed independently by two trained investigators and vertebral fracture was defined
as a reduction of at least 20% in the anterior, middle or posterior vertebral height. Spinal radiographs evidenced at least
one vertebral crush fracture in 119 patients (59.5%). The results of logistic regression showed that age, femoral and spine
BMDs were significant predictors of the presence of a vertebral fracture. Odds ratios for a decrease of 1 standard deviation
ranged from 1.8 (1.3–2.8) for spine BMD to 2.3 (1.5–3.6) for total hip BMD. For multiple fractures odds ratios ranged from
1.7 (1.1–2.5) for spine BMD to 2.6 (1.7–4.3) for total hip BMD. In all models, odds ratios were higher for hip BMD than for
spine BMD, particularly in younger men, under 50 years. A T-score <−2.5 in the femur (total femoral site) was associated with a 2.7-fold increase in the risk of vertebral fracture while
a T-score <−2.5 in the spine was associated with only a 2-fold increase in risk. This study confirms the strong association of
age and BMD with vertebral fractures in middle-aged men, shows that the femoral area is the best site of BMD measurement and
suggests that a low femoral BMD could be considered as an index of severity in young men with lumbar osteopenia.
Received: 27 October 1998 / Accepted: 22 February 1999 相似文献
12.
Ralston SH Binkley N Boonen S Kiel DP Reginster JY Roux C Chen L Rosenberg E Santora A;FOCUS-D 《Calcified tissue international》2011,88(6):485-494
Vitamin D insufficiency is common in patients with osteoporosis. We conducted a randomized trial comparing alendronate 70 mg
combined with vitamin D3 5,600 IU in a single tablet (ALN/D5600, n = 257) with standard care chosen by the patients’ personal physicians (n = 258) in patients with postmenopausal osteoporosis (BMD T score ≤2.5 or ≤1.5 and a prior fragility fracture) who had vitamin
D insufficiency (serum 25[OH]D values 8–20 ng/ml) and who were at risk of falls. Virtually all patients randomized to standard
care received bisphosphonate therapy, and in approximately 70% of cases this was combined with vitamin D supplements. However,
only 24% took ≥800 IU/day of supplemental vitamin D. At 6 months the proportion of patients with vitamin D insufficiency was
8.6% in the ALN/D5600 group compared with 31.0% in the standard care group (P < 0.001). Those in the ALN/D5600 group also had a greater reduction in urinary NTX/creatinine ratio (−57% vs. −46%, P < 0.001) and bone-specific alkaline phosphatase (−47% vs. −40%, P < 0.001). In the ALN/5600 group, by 12 months the increase in BMD was greater at the lumbar spine (4.9% vs. 3.9%, P = 0.047) and the total hip (2.2% vs. 1.4%, P = 0.035), significantly fewer patients were vitamin D—insufficient (11.3% vs. 36.9%, P < 0.001), and bone turnover marker (BTM) results were similar to those at 6 months. There was no difference between groups
in those who experienced falls or fractures, and adverse events were similar. Based on the finding that ALN/D5600 was more
effective than standard care at correcting vitamin D insufficiency, increasing BMD, and reducing BTMs in this patient group,
greater attention needs to be directed toward optimizing the treatment of osteoporosis and correcting vitamin D deficiency
in postmenopausal women. 相似文献
13.
Rico H Paez E Aznar L Hernández ER Seco C Villa LF Gervas JJ 《Journal of bone and mineral metabolism》2001,19(2):97-101
We observed the effects of sodium bicarbonate supplement on bone mass in rats on strenuous treadmill training. Sixty female
Wistar rats (93-days-old; mean initial weight 261 ± 16 g) were studied. One group of 15 rats was killed at the beginning of
the experiments (basal control group), while another group of 15 rats was not manipulated (Exer−NaB−). Another group of 15
rats was exercised but did not receive sodium bicarbonate (Exer+NaB−), while the final group of 15 rats exercised and received
sodium bicarbonate (Exer+NaB+) at a dose of 0.05 mg/kg/day, administered by esophageal catheter on exercise days. These rats
were killed at the end of 11 weeks. Femoral and vertebral length, weight, and bone mineral content (BMC) and density (BMD)
were measured. According to anova with the Tukey–Kramer test, femur length and weight, vertebral weight, femur BMC and BMD, vertebral BMC and BMD and the ratio
between femur and vertebral BMC and final body weight, and plasma bicarbonate were lower in the basal control and Exer+NaB−
groups than in the two other groups (P < 0.005–0.0001). Overall, there was a positive correlation between femur and vertebral BMC and femur BMC and length (P < 0.0001 for all). Only in the Exer+NaB− group was there a positive association between plasma bicarbonate levels and femur
length (r = 0.78; P < 0.0005). Our study demonstrates the adverse effects of strenuous exercise on bone, and the usefulness of sodium bicarbonate
supplements in preventing and minimized these effects.
Received: May 1, 2000 / Accepted: August 11, 2000 相似文献
14.
Introduction The purpose of this study was to evaluate the effects of alendronate (ALN) on bone mineral density (BMD) and bone turnover
markers in patients with orthotopic liver transplantation (OLT).
Methods In the prospective, controlled, open study with 24 months of follow-up, 98 patients with OLT were randomised to receive ALN
70 mg weekly or no ALN; calcium (Ca) 1,000 mg daily and 0.5 mcg calcitriol daily were provided to all patients. Lumbar spine
(LS) and hip BMDs were measured at 6-month intervals by dual-energy X-ray absorptiometry (DEXA). Spinal radiographs were obtained
to assess vertebral fractures. Additionally, bone turnover markers, serum parathyroid hormone (PTH) and biochemical parameters
were determined every 3 months.
Results Compared with the control group, the ALN group showed significant increases in BMD of the LS (5.1±3.9% vs 0.4±4.2%, p<0.05 at 12 months, 8.9±5.7% vs 1.4±4.9%, p<0.05 at 24 months), femoral neck (4.3±3.8% vs −1.1±3.1%, p<0.05 at 12 months, 8.7±4.8% vs 0.6±4.5%, p<0.05 at 24 months) and total femur (3.6±3.8% vs −0.6±4.0%, p<0.05 at 12 months, 6.2±3.8% vs 0.3±4.6%, p<0.05 at 24 months). In the ALN group, osteocalcin and urinary deoxypyridinoline (DPD) decreased significantly at the sixth
month, with no further change, by −35.6% and −63.0%, on average, respectively (p<0.05). In the control group, a significant increase in biochemical markers of bone turnover was observed in comparison to
baseline values (p<0.05). PTH increased within reference levels without a difference between groups. Two nonvertebral fractures (4.2%) and nine
vertebral fractures (18.8%) in the control group and three vertebral fractures (6.8%) in the ALN group occurred during the
follow-up. The weekly ALN was well tolerated, and no severe side effects occurred.
Conclusion This is the first randomised study including a control group to demonstrate that weekly ALN was able to significantly increase
BMD in patients with OLT when compared with Ca and calcitriol alone. However, ALN did not appear to offer protection against
fractures.
This study was awarded the “Novartis Young Investigator Award” at the Second Joint Meeting of the European Calcified Tissue
Society and the International Bone and Mineral Society, Geneva, 25–29 June 2005. 相似文献
15.
E. S. Siris J. A. Simon I. P. Barton M. R. McClung A. Grauer 《Osteoporosis international》2008,19(5):681-686
Summary This posthoc analysis of four trials studied the efficacy of risedronate to reduce fragility fractures in postmenopausal women
with osteopenia (i.e., T-scores between −1 and −2.5). Risedronate reduced the fracture risk by 73% (p = 0.023) in this population of women with low femoral neck bone mass and no prevalent vertebral fractures.
Introduction Low bone mass represents an increasing health risk and burden. Half of fragility fractures occur in osteopenic women underscoring
the need for treatments reducing fracture risk. This analysis reports the effect of risedronate to reduce fragility fracture
risk in osteopenic women without prevalent vertebral fractures.
Methods Postmenopausal women with osteopenia, defined as femoral neck T-score between −1 and −2.5 by DXA and no prevalent vertebral
fractures, were identified from four controlled randomized trials (BMD Multinational, BMD North America, VERT Multinational
and VERT North America). The risk reduction for fragility fractures in patients receiving 5 mg risedronate daily for 1.5 to
3 years compared to placebo was assessed. An additional sensitivity analysis excluded patients who were osteopenic at the
femoral neck but had a BMD lower than −2.5 SD at the lumbar spine.
Results Six hundred and twenty postmenopausal women with osteopenia were included, receiving either placebo (n = 309) or risedronate 5 mg (n = 311). Risedronate reduced the risk of fragility fractures by 73% over 3 years versus placebo (p = 0.023); cumulative fragility fracture incidence was 6.9% in placebo-treated versus 2.2% in risedronate-treated patients.
The magnitude of the effect was similar in the sensitivity analysis subset.
Conclusion Risedronate significantly reduced the risk of fragility fractures in postmenopausal women with osteopenia (femoral neck T-score
between −1 and −2.5 SD) and no prevalent vertebral fractures. 相似文献
16.
S. S. Papiha L. C. Allcroft R. M. Kanan R. M. Francis H. K. Datta 《Calcified tissue international》1999,65(4):262-266
Vitamin D binding protein (DBP) is a major carrier protein for the vitamin D metabolites, but may also play an important
role in osteoclast differentiation. Polymorphisms of the DBP gene have been reported, including (TAAA)n-Alu repeat polymorphisms downstream of intron 8. We have examined the relationship between polymorphisms of the DBP gene
and bone mineral density (BMD) and vertebral fractures in a group of 26 men with vertebral fractures but no underlying secondary
cause of osteoporosis (median age 64, ages 27–72 years) and 21 male control subjects (median age 65, ages 40–77 years). There
was no apparent effect of DBP phenotype on BMD, but there was a relationship between certain genotypes of (TAAA)n-Alu repeats and reduced BMD and vertebral fracture. Lumbar spine and femoral neck BMD were significantly lower in men with
10/8 genotype than 10/10 genotype (P < 0.05). Furthermore, the predominant genotype in men with vertebral fractures was 10/8, whereas the most common genotype
in control subjects was 10/10 (odds ratio 56; 95% confidence interval 7–445). Plasma DBP was higher in men with 10/8 genotype
than those with 10/10 genotype (P < 0.05), and patients with vertebral fractures were found to have higher levels than control subjects (P < 0.0005). Although our study is small because of the relative rarity of idiopathic osteoporosis in men, the results suggest
that (TAAA)n-Alu polymorphism may have an important effect on plasma levels of DBP, bone density and fracture risk in men.
Received: 5 May 1998 / Accepted: 10 April 1999 相似文献
17.
Stiffness in Discrimination of Patients with Vertebral Fractures 总被引:4,自引:0,他引:4
We measured the ultrasound parameters of the heels of 49 women with vertebral fractures and 87 age-matched controls using
an Achilles ultrasound device. Average broadband ultrasound attenuation (BUA), speed of sound (SOS) and Stiffness were significantly
lower in fracture patients (p<0.0001). We also estimated the ultrasound parameters of patients compared with age-matched non-fracture controls and found
the mean BUA to be −1.02 SD below control values. The mean SOS was −0.97 SD and the mean Stiffness was −1.12 SD below control
values.
Femoral bone mineral density (BMD) at the neck, Ward’s triangle and the trochanter, the total-body BMD and L2–4 BMD were
measured with dual-energy X-ray absorptiometry (DXA) and found to be significantly lower in fracture patients (p<0.0001). All correlation coefficients between ultrasound parameters and DXA measurements were >0.5 and statistically significant
(p<0.0001). A stepwise logistic regression with presence or absence of vertebral fracture as the response variable and all ultrasound
– DXA parameters as the explanatory variables indicated that the best predictor of fracture was Stiffness, with additional
predictive ability provided by spine BMD. Sensitivity and specificity of all measures were determined by the areas under the
receiver operating characteristic (ROC) curve, which were 0.76 ± 0.04 for BUA, 0.77 ± 0.04 for SOS, 0.78 ± 0.04 for Stiffness
and 0.78 ± 0.03 for spine BMD. The areas under the ROC curves of BUA, SOS, Stiffness and spine BMD were compared and it was
found that Stiffness and spine BMD were significantly better predictors of fracture than BUA and SOS. These results support
many recent studies showing that ultrasound measurements of the os-calcis have diagnostic sensitivity comparable to DXA, and
also demonstrated that Stiffness was a better predictor of fracture than spine BMD.
Received: 23 September 1997 / Accepted: 10 April 1998 相似文献
18.
E. Vega G. Ghiringhelli C. Mautalen G. Rey Valzacchi H. Scaglia C. Zylberstein 《Calcified tissue international》1998,62(5):465-469
The bone mineral density (BMD) at the lumbar spine, proximal femur, and total skeleton was evaluated in 38 men with primary
osteoporosis and vertebral fractures. BMD of the patients was significantly reduced over all skeletal areas compared with
controls. The Z-score of the lumbar spine (−2.8 ± 0.9) was less than that of the other areas (P < 0.001) except the legs (−2.5 ± 1.1) (p.n.s.) showing that bone loss had a tendency to be greater over the axial skeleton.
Vertebral dimensions compared with age-matched controls were as follows: projected L2–L4 area (cm 2): 45.7 ± 5.6 versus 53.7
± 3.6 (P < 0.001); vertebral width (cm): 4.37 ± 0.44 versus 4.90 ± 0.36 (P < 0.001). Serum biochemical parameters and testosterone levels were similar between osteoporotic and control men. We conclude
that men with vertebral osteoporotic fractures have reduced vertebral BMD and vertebral dimensions compared with age-matched
controls. Thus, these findings indicate that the achievement of a reduced bone size at the end of the growth period or a failure
of periosteal increase during adult life is likely to contribute to the pathogenesis of the vertebral fractures observed in
older men.
Received: 31 January 1997 / Accepted: 2 July 1997 相似文献
19.
J. M. Le Parc P. Plantin G. Jondeau M. Goldschild M. Albert C. Boileau 《Osteoporosis international》1999,10(6):475-479
Sixty adult patients (40 women, 20 men) with Marfan syndrome (MFS) according to the Berlin criteria had a full clinical examination
and bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry of the hip and nondominant forearm. BMD was
expressed as a Z-score and compared with the reference population of the Hologic database. In MFS men, BMD (g/cm2) was compared with the BMD of 45 normal tall Caucasian adults. Osteocalcin was measured by radioimmunoassay. In patients
with MFS, BMD was compared between patients with and without previous fractures and according to the phenotypic severity of
MFS. The mean age of the patients was 32.9 ± 9.3 years (women 32.5 ± 9.7, men 33.4 ± 8.6), mean height was 180.3 ± 10.3 cm
(women 176.3 ± 9.2, men 188.1 ± 7.5) and mean body mass index 20.9 ± 3.6 kg/m2 (women 20.8 ± 3.4, men 20.95 ± 3.97). Hyperlaxity score (Beighton criteria) was 6.9 ± 1.1. Six patients (10%) had a previous
fracture. Thirty per cent of patients had had at least one previous operation for scoliosis, aortic dilatation or eye problems.
BMD values in the 60 patients were as follows: Z-score of the hip, −1.26 ± 0.93, p<10−9 (neck, −0.93 ± 1.09, p<10−9; trochanter, −1.31 ± 0.85, p<10−9; intertrochanter, −1.39 ± 0.99, p<10−9; Ward’s triangle, −0.93 ± 1.88, p<10−9); Z-score of the radius: −1.6 ± 1.06, p<10−9 (1/3 proximal, −1.29 ± 1.03; mid-radius, −1.94 ± 1.04; ultradistal, −0.68 ± 1.1, p<10−9). The decrease in BMD was similar in men and women at both the hip and the radius. BMD in MFS patients was significantly
decreased at cortical compared with trabecular sites (radius 1/3 proximal vs ultradistal, p<0.0001; total femur vs Ward’s triangle, p<0.0005). No difference in BMD was found between MFS patients with or without previous fractures and those with severe or
less severe phenotypic expression of MFS. An influence of height and weight in MFS on BMD is suspected. Osteocalcin was not
increased in our group of MFS patients. Thus both men and women with MFS have a significant deficit of BMD at the hip and
radius. The decrease in BMD is present equally in both sexes and is more pronounced at predominantly cortical sites. In our
group of patients we found no increase in fractures and no relation between decreased BMD and phenotypic expression of the
syndrome.
Received: 30 October 1998 / Accepted: 26 May 1999 相似文献
20.
S. S. Freitas E. Barrett-Connor K. E. Ensrud H. A. Fink D. C. Bauer P. M. Cawthon L. C. Lambert E. S. Orwoll 《Osteoporosis international》2008,19(5):615-623
Summary We examined the rate of clinical vertebral fractures, and the circumstances associated with the fractures, in a cohort of
5,995 US older men. Fractures were more common in the most elderly men, and were usually associated with falls and other low-energy
trauma.
Introduction Little is known about clinical vertebral fractures in older men. We postulated that clinical vertebral fractures occur with
falls, affect men with osteoporosis, and are more common as age increases.
Methods Five thousand nine hundred and ninety-five men aged ≥65 years were followed prospectively for an average of 4.7 years. Men
with incident clinical vertebral fractures were compared to controls.
Results One percent (n = 61) sustained incident clinical vertebral fractures (2.2/1,000 person-years). The rate of fracture rose with age (0.7%
in men 65–69 years and 5% ≥85 years). Fractured men were more likely frail (8.2% vs. 2.2%), more often fell (36.1% vs. 21%)
and had lower total hip and lumbar spine BMD (all p values ≤0.002). In 73.8% of cases fractures were precipitated by no known trauma or by low-energy trauma, including falls
in 57.3% Fractures were thoracic in 33% and lumbar in 56%. Men with an incident vertebral fracture were more likely to be
osteoporotic (13% vs. 2%, p < 0.0001), but most men with incident fractures did not have osteoporosis.
Conclusions Incident clinical vertebral fractures were relatively common in older men and the rate increased after age 80 years. Fractures
were usually associated with minimal trauma, most commonly a fall.
The Osteoporotic Fractures in Men (MrOS) is supported by the National Institutes of Health. The following Institutes provide
support: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Institute on Aging
(NIA), and the National Cancer Institute (NCI), under the following grant numbers: UO1 AR45580, UO1 AR45614, UO1 AR45632,
UO1 AR45647, UO1 AR45654, UO1 AR45583, UO1 AG18197 and M01 RR000334. 相似文献