雷奈酸锶对骨质疏松性骨痛及骨密度疗效评价

目的研究雷奈酸锶联合钙剂在骨质疏松症治疗中对骨痛、骨密度及骨质疏松性骨折风险的作用,评价其疗效和安全性。方法 124例老年骨质疏松症患者被随机分为雷奈酸锶+钙剂组(SR+Ca组,62例)和钙剂组(Ca组,62例),进行开放、对比研究。雷奈酸锶+钙剂组:雷奈酸锶2g/d,口服,同时口服钙剂600mg/d;Ca组:钙剂600mg/d,口服。治疗前后分别测定两组患者腰背部自发性疼痛的VAS评分、L1-L4椎体、股骨颈、Wards三角、桡骨远端的BMD值及T值,并观察两组骨质疏松性骨折的发生率及服药后的不良反应。结果治疗后雷奈酸锶+钙剂组VAS评分明显改善,低于钙剂组,但骨痛缓解过程较为缓慢;雷奈酸锶+钙剂组L1-L4椎体、股骨颈、Wards三角、桡骨远端的BMD值及T值在治疗后6月及12月较治疗前上升显著,明显优于钙剂组(P<0.01)。骨质疏松脆性骨折的发生率钙剂组明显高于雷奈酸锶+钙剂组。雷奈酸锶的主要不良反应为恶心及腹泻,钙剂组主要为便秘。结论雷奈酸锶对骨痛的缓解作用较为缓慢,但经过足够的疗程依然能达到令人满意的效果。它能有效提高骨质量,降低骨质疏松脆性骨折的发生率,副反应少,是治疗骨质疏松症的良好选择。     

老年女性桡骨远端骨折与骨密度的相关性及药物治疗的临床效果

目的 研究老年女性桡骨远端骨折与其骨密度(BMD)的相关性及骨折后不同抗骨质疏松治疗方案的临床效果,为老年患者桡骨远端骨折的防治提供理论依据.方法 自2004年1月到2006年1月,共收集老年妇女桡骨远端骨折117例,平均年龄67.5岁,随机分成两组,A组在进行常规桡骨远端骨折治疗同时应用钙剂+阿法迪三;B组在进行常规桡骨远端骨折治疗同时应用钙剂+阿法迪三+降钙素,药物治疗疗程1年.106名未骨折的老年妇女为对照组.所有患者均进行了随访,应用DEXA分别对健侧桡骨远端、腰椎和髋部的BMD进行检测;摄X线片以了解骨折愈合情况及全身其他部位再次发生与骨质疏松相关的骨折情况.将所得数据进行统计学分析.结果 在所有发生桡骨远端骨折的老年妇女中83%的患者腰椎和髋部的BMD低,89%的患者健侧桡骨远端的BMD低,能诊断骨质疏松者为59%,均较对照组降低,差别有显著性(P<0.05);而A、B组之间BMD无显著性差异.在骨折后一年,A组患者腰椎、髋部和健侧桡骨远端的BMD有不同程度的降低,而B组患者腰椎、髋部和对侧桡骨远端的BMD有不同程度的升高,两组之间的差别有显著性(P<0.05);A、B组骨折临床愈合时间比较差别无显著性(P＞0.05).首次骨折2年内 A组患者其他部位再次发生与骨质疏松相关的骨折6例,再骨折率10.2%;B组患者再骨折2例,再骨折率3.5%.结论 老年妇女桡骨远端骨折的发生与腰椎、髋部的BMD 的降低明显相关,特别是健侧桡骨远端的BMD;在进行骨折治疗中,在应用钙剂加阿法迪三基础治疗的同时应用降钙素可能更好地降低再骨折的发生.     

鲑鱼降钙素对绝经后骨质疏松症的治疗

目的 评价鲑鱼降钙素治疗绝经后骨质疏松症近期骨痛及中期改善骨量的作用.方法 绝经1年以上骨质疏松妇女43例,年龄48～77岁,每周定期注射鲑鱼降钙素针剂(密盖息(R)针剂,诺华制药生产,50 iu/支)3次和每日服用元素钙600 mg、维生素D125国际单位.对比治疗前后VAS值及腰椎和髋部的BMD值.结果本组患者2周...     

降钙素对骨质疏松症治疗的临床观察

目的 研究降钙素在骨质疏松症（OP）治疗中对骨密度（BMD）的作用。方法 198例根据自愿选择分为钙剂组92例，降钙素＋钙剂组102例，其中各组按疗程分为3个月和6个月两个亚组；钙剂组：每日口服元素钙600mg，维生素D125U。降钙素＋钙剂组：每日口服元素钙600mg，维生素D125U；鲑降钙素50IU（商品名密钙息，北京诺华制药有限公司），肌肉注射，每d1次，连续14d，接着隔日1次，连续14次，以后为每周2次直至完成疗程。治疗前及疗程结束后，采用双能X线骨密度仪测定前后位k。腰椎及非优势侧（左）股骨颈骨密度。结果 降钙素＋钙剂组缓解疼痛快而有效。降钙素＋钙剂组腰椎和股骨颈骨密度在3个月和6个月治疗后均有显著提高，6个月组骨密度提高大3个月组（P〈0．01），腰椎疗效优于股骨颈。结论 降钙素治疗骨质疏松症有明显疗效，选择适当的长疗程患者受益更大。     

鲑鱼降钙素对骨质疏松大鼠骨折愈合的影响

目的　探讨鲑鱼降钙素 (密盖息 )对骨质疏松大鼠胫骨骨折愈合的影响。方法　Wis tar雌性大鼠卵巢摘除后 3个月开始制作左胫骨中段骨折模型 ,从术前 1周至术后 8周 ,连续每天皮下注射密盖息 2IU/kg。分别于术后 2 ,4,8周行X片检查和骨折处骨痂的组织学检查。 9周后检测腰椎和左侧胫骨中段的BMD、左胫骨扭转实验、腰椎体生物力学凹入实验。观察鲑鱼降钙对骨折愈合的影响 ,并和卵巢摘除组、雌激素注射组及假手术对照组进行比较。结果　密盖息组治疗 9周后BMD值明显升高 (P <0 0 5) ,骨折局部BMD明显高于治疗前 (P <0 0 5)。X片及组织学检查提示密盖息组比骨质疏松组的骨痂量多 ,愈合时间提前。密盖息组的凹入力和凹入应力明显高于骨质疏松组 (P <0 0 5) ,最大扭矩、剪切应力明显高于骨质疏松组 (P <0 0 5)。结论　鲑鱼降钙素能减少骨量丢失 ,促进矿化 ,加快骨痂的形成 ,促进骨折愈合 ,同时能提高骨生物力学特性和抗骨折能力     

骨质疏松性骨折的研究进展

骨质疏松性骨折的研究进展田纪伟刘传军＊⒇综述沈志鹏审校骨质疏松症是以骨量降低，骨组织显微结构发生退变，导致骨脆性增加，骨强度下降，最终使骨折危险性增大为特征的一种老年性疾病。它通常引起髋部骨折，腰椎压缩性骨折以及桡骨远端骨折，这些骨折及其并发症给...     

阿仑膦酸钠对类风湿关节炎合并骨质疏松患者骨强度的影响

目的 分析阿仑膦酸钠对类风湿关节炎（rheumatoid arthritis,RA）合并骨质疏松（osteoporosis,OP）患者骨强度的影响。方法 选取华北理工大学附属医院骨质疏松门诊2012年6月至2020年6月诊治的OP患者120例,分为RA+OP组（60例）和OP组（60例）,且均口服阿仑膦酸钠联合骨化三醇、钙尔奇D持续12个月。比较治疗前后表征髋部力学结构强度的参数值CSA、CSMI、Z、CT和BR值（分别代表股骨颈抗轴向压缩力、骨骼刚度、抗屈曲负荷系数、皮质骨厚薄及屈曲比）、骨密度（BMD）、骨折发生率、炎性指标及临床体征。结果 经治疗6月、12月后,除RA+OP组全髋部位BMD外,OP组全髋、两组患者腰椎、股骨颈BMD、CSA、CSMI、Z、CT值均高于治疗前（P＜0.05）,BR值均低于治疗前（P＜0.05）;治疗12月后,RA+OP组股骨颈、全髋BMD、CSA、CSMI、Z值均低于OP组（P＜0.05）,腰椎BMD、CT、BR值无差异;治疗6至12月期间,RA+OP组股骨颈、全髋BMD增长率低于OP组（P＜0.05）;RA+OP组治疗前骨折发生率显著高于OP组,所有RA患者疾病活动性控制良好。结论 阿仑膦酸钠联合骨化三醇和钙剂可明显提升RA患者骨密度及髋部骨强度,提高骨骼稳定性,这种提升随疗程延长比正常骨质疏松患者缓慢。     

鲑鱼降钙素在骨质疏松性椎体压缩骨折椎体后凸成形术后的应用

目的观察鲑鱼降钙素对骨质疏松性椎体压缩骨折行椎体后凸成形术后骨密度及腰背痛症状的改善情况。方法将行椎体后凸成形术后的骨质疏松性椎体压缩骨折患者79例分成两组,鲑鱼降钙素组44例,予以鲑鱼降钙素肌肉注射,术后每天1次100IU,连用3 d后,改为50 IU隔天1次,连用1个月,间歇1个月后再重复,共半年,同时加服维D2磷葡钙;对照组35例,单纯口服维D2磷葡钙,疗程半年。两组治疗前后均测定腰1～腰4椎体及股骨颈骨密度(BMD);并观察患者腰背痛的情况。结果:鲑鱼降钙素组有6例因肌注降钙素出现面部潮红和皮肤瘙痒等反应停止疗程,其余38例和对照组35例得到了随访。鲑鱼降钙素组腰椎及股骨颈BMD较治疗前明显升高(P<0.01),对照组各部位骨密度较治疗前无明显改变(P>0.01)。鲑鱼降钙素组没有病例再次出现腰背痛,而对照组在半年内有7例再次出现腰背痛,经腰椎MRI证实发生其他节段的椎体压缩骨折。结论:鲑鱼降钙素与钙剂联合治疗行椎体后凸成形术后的骨质疏松性椎体压缩骨折患者,可以提高患者的骨量,降低再骨折的风险。     

骨折患者长期卧床骨质改变与降钙素的预防

目的探讨青壮年骨折患者长期卧床与骨量丢失、骨强度减低的关系及鲑鱼降钙素的预防作用。方法对68例20~35岁严重骨折患者,36例入院即给予鲑鱼降钙素加元素钙治疗,32例单纯元素钙治疗,持续治疗到患者卧床结束。于入院当时及入院后1、2、3个月测量患者腰椎双能X线骨密度(bone mineral density,BMD)、胫骨超声骨强度(speed of sound,SOS)并检测血清骨钙素(bone glaprotein,BGP)、尿钙(calcium,Ca)与尿肌酐(creatinie,Cr)。将卧床超过3个月者纳入最终研究对象,其中鲑鱼降钙素加元素钙组31例,单纯元素钙组27例,共58例。结果鲑鱼降钙素加元素钙组,入院后1、2、3个月腰椎BMD与入院时相比差异均无显著性(P>0.05);单纯元素钙组,入院后1个月BMD无明显变化,入院后2个月与3个月BMD分别为0.765±0.191和0.598±0.187,显著(或非常显著)低于入院时(P<0.05或P<0.01)。胫骨中段SOS检测结果与BMD相似。两组入院后1、2、3个月血清BGP与入院时相比差异均无显著性(P>0.05)。鲑鱼降钙素加元素钙组,入院后各时间点尿Ca/Cr比值与入院时相比差异均无显著性(P>0.05);单纯元素钙组,入院后1个月Ca/Cr比值无明显变化,入院后2个月与3个月尿Ca/Cr比值分别为0.853±0.434和1.011±0.546,显著(或非常显著)高于入院时(P<0.05或P<0.01)。结论青壮年骨折病人长期卧床可引起骨量丢失、骨强度减低,主要由骨吸收引起,鲑鱼降钙素能预防该种骨量丢失与骨强度减低。     

广州市多社区1529名中老年人骨质疏松患病率及骨质疏松性骨折发生率分析

目的调查了解广州市社区中老年人骨量减少、骨质疏松症(osteoporosis,OP)的患病率及骨质疏松性骨折发生率,分析近年来骨质疏松患病率的增减趋势。方法采用现场问卷调查了解受试者的基本资料(包括性别、年龄、身高、体重、骨折史等),并用美国双能X线骨密度仪测量1529例40～87岁中老年人群的腰椎正位和左髋部骨密度(bone mineral density,BMD),以性别、年龄分组进行分析。结果随着年龄递增,各组髋部BMD值逐渐下降,而腰椎BMD值并未随着增龄而呈现递减的趋势,60岁以上中老人髋部BMD值显著低于腰椎BMD值(P0.05)。根据腰椎BMD值计算,中老年人OP总患病率为30.7%,其中女性为34.2%,明显高于男性的17.9%(P0.05)。低骨量(osteopenia,OPA)总患病率为41.8%,男女分别为42.4%和41.6%(P0.05)。根据髋部BMD值计算,OP总患病率更高,达到38.2%,女性为39.4%,高于男性的33.9%(P0.05)。OPA总患病率为47.4%,男性为52.7%,女性为46.0%(P0.05)。受调查的中老年男性中有骨折史的为82例,女性为357例,OP患者骨折发生率为37.8%,远高于非OP患者23.1%(P0.01),再骨折发生率OP患者为6.2%,高于非OP患者的2.64%(P0.01)。结论广州市社区中老年人骨质疏松患病率和脆性骨折发生率较高,且其发生率均较以往有明显增高的趋势,建议早筛查、早诊断、早治疗。根据髋部BMD值进行骨质疏松评估的敏感性更高,应该首选髋部作为骨密度测量的部位。     

阿仑膦酸钠对维持性血液透析骨质疏松患者骨密度的影响

目的 观察口服阿仑膦酸钠对维持性血液透析（MHD）患者骨密度的影响。 方法 选取MHD伴肾性骨病骨质疏松患者28例，随机分为服药组（n＝13）和未服药组（n＝15）。服药组患者口服阿仑膦酸钠片70 mg，1次/周。观察服药组患者服药后6、12、18个月与未服药组随访18个月时的临床情况。应用双能X线骨密度仪测定腰椎正位（L1～L4）、左股骨近端、左股骨颈骨密度，计算T值及Z值。测定透前肝肾功能、血常规、血钙、血磷、血全段甲状旁腺素、碱性磷酸酶，计算Kt/V。记录新骨折发生情况。 结果 （1）骨密度：服药组治疗18个月后L1～L4、左股骨近端及左股骨颈骨密度有所下降，但与治疗前差异无统计学意义。未服药组随访18个月时，L1～L4、左股骨近端及左股骨颈骨密度显著低于治疗前（P < 0.01）；左股骨近端骨密度及T值显著低于同期服药组（P < 0.01）。（2）骨折：服药组新发生骨折1例 （1/13）；未服药组新发生骨折5例（5/15）。（3）不良反应：服药组1例首次服阿仑膦酸钠片后出现上腹部不适，2周后缓解。 结论 口服阿仑膦酸钠治疗有助MHD肾性骨病患者骨密度的稳定，且耐受性较好。     

Changes in bone mineral density and selected metabolic parameters over 24 months following renal transplantation

Our aim was to evaluate changes in serum levels of selected bone metabolism indicators and bone density over 24 months following renal transplant. A partial objective was assessment of the effectiveness of prophylactic administration of vitamin D and calcium preparations to prevent progression of osteopathy after kidney transplantation. Forty patients after kidney transplantation were prophylactically given vitamins A and D (800 IU) and calcium (1000 mg) a day. During monitoring, the serum creatinine in all recipients was <200 micromol/L (subgroup A with creatinine concentration < 120 micromol/L versus subgroup B with creatinine 120 to 200 micromol/L). The concentration of serum parathormone, serum level of bone fraction of alkaline phosphatase, serum concentrations of phosphorus and calcium urinary 24-hour excretion of phosphorus and calcium were examined at 2 weeks and 2 years after transplantation. In the same time period, radiographs of thoracic, lumbar spine, and hip joints were obtained. Bone density (BMD) of the lumbar (L) spine and the hip was determined by dual-energy X ray (Lunar Prodigy). Two years after transplantation in subgroup A, the BMD showed decrease in 80% of recipients in the L spine area but hip showed a 15% BMD increase. In subgroup B, the BMD decreased in 95% recipients in L and hip and only 25% showed a BMD increase. No clinical or radiographic sign of fracture was detected in this group. We conclude that prophylactic administration of vitamin D and calcium is not sufficient to prevent the progression of osteopathy after renal transplantation. Changes in bone density evaluated after the kidney transplantation are affected by graft function.     

Salmon calcitonin in the prevention of bone loss at perimenopause

The objective of this study was to determine whether intranasal salmon calcitonin prevents physiological bone loss at perimenopause. A double-blind study of 120 perimenopausal women without present or past disease or medication that could affect bone metabolism were studied. The subjects were randomized in two groups and provided with nasal spray bottles containing either placebo (excipient only) or active compound (excipient plus 50 international units (IU) salmon calcitonin per dose). Subjects took one puff from the nasal spray in each nostril every morning. All subjects took one soluble tablet of calcium (1000 mg) per day. Serum biochemistry, dual-energy X-ray absorptiometry of lumbar spine and proximal femur, quantitative computed tomography of lumbar spine, and single photon attenuation of forearm were used to evaluate bone mineral density (BMD). There were no differences in demographic characteristics or hormone status at entry. No fractures were recorded during the study period. Serum calcium increased and serum dihydroxyvitamin D and osteocalcin decreased in both groups. There was no difference in biochemical parameters between the groups. The BMD of upper femur did not change during the study, but it was decreased in the lumbar spine in both groups. The mineral content of distal radius increased in both groups. In conclusion, nasal salmon calcitonin, 100 IU daily, has no protective effect on bone mass and does not modify bone metabolism at perimenopause.     

74例老年骨质疏松患者应用鲑鱼降钙素联合阿仑膦酸钠治疗的疗效观察

目的　评估联合应用鲑鱼降钙素与阿仑膦酸钠治疗缓解老年性骨质疏松症患者骨关节疼痛及血清骨钙素(BGP)、降钙素(CT)及骨密度(BMD)水平的变化。方法 联合应用鲑鱼降钙素和阿仑膦酸钠治疗本院收治的74例老年性骨质疏松症患者,给予鲑鱼降钙素50IU肌肉注射,隔日1次,连续使用15次后改为口服阿仑膦酸钠1粒/周,共经6个月治疗,采用数字模拟评分法(VAS)比较治疗前、后全身骨关节疼痛程度,治疗前、后骨钙素、降钙素及第2～第4腰椎(L2-4 )、股骨颈、Ward区骨密度水平的变化,并进行统计学分析。结果 鲑鱼降钙素联合阿仑膦酸钠治疗老年性骨质疏松症患者6个月后,对缓解骨关节疼痛症状疗效良好,治疗前与治疗后比较差异显著(P<0.01);治疗前后骨密度、血清骨钙素和降钙素水平均有显著差异（P<0.05）。结论 鲑鱼降钙素联合阿仑膦酸钠治疗老年性骨质疏松症使血清降钙素的水平明显升高,骨钙素水平明显降低,能显著减轻患者骨关节疼痛,改善症状,并增加骨密度,对老年性骨质疏松症有明显的疗效。     

骨密度在髋部骨质疏松性骨折风险评估中的价值

目的评估骨密度在髋部脆性骨折风险预测中的临床价值。方法回顾性研究2014年6月至2019年6月在我院创伤骨科住院的老年髋部骨折患者72例,作为病例组,其中股骨转子间骨折31例,股骨颈骨折41例;对照组选择同期我院骨外科门诊老年体检者63例。使用DXA方法测量患者腰椎和健侧髋部(全髋部、转子间、股骨颈、Ward’s区)的骨密度;对照组测量腰椎和左侧髋部骨密度,统计分析测量结果。结果①骨折组腰椎、髋部骨密度均显著低于对照组,差异有统计学意义(P0.01);②转子间骨折组和股骨颈骨折组在腰椎和髋部区域骨密度比较差异均无统计学意义(P 0.05);③骨折组与对照组在转子间区的T值降低比例最大为122.1%,腰椎降低幅度最小为31.3%,余髋部的T值均有不同程度降低;④骨折后髋部和腰椎T值比存在倒置现象;⑤对照组和骨折组髋部骨质疏松程度比较,差异有统计学意义(P0.01);两组患者腰椎骨质疏松程度比较,差异无统计学意义(P0.05)。结论①髋部骨折患者骨密度均显著低于体检者,提示骨密度与髋部骨折具有一定相关性,但与髋部骨折类型无关;②在髋部骨折风险评估中,髋部骨密度相比腰椎更有价值;③当髋部与腰椎T值比出现倒置时,将不可避免发生髋部骨折;④骨量正常的部分患者发生了脆性骨折,而骨质疏松的部分患者却未发生骨折,表明影响骨折发生的因素除了骨密度外,可能和骨骼的微结构有关。     

Bone mineral density and back muscle strength in spinal osteoporotics

In the 63 patients with spinal osteoporosis who had been treated with vitamin D₃ and calcium supplement, back muscle strength was compared with the following parameters; bone mineral density (BMD) of the distal 1/6 and 1/3 of radius by single photon absorptiometry, BMD of lumbar spine and femoral neck by dual photon absorptiometry, body height, body weight and age. Back muscle strength correlated significantly with BMD of lumbar spine and BMD of radius (1/3), and less with BMD of femoral neck. The strength of back muscle also showed a significant negative correlation with age. Back muscle strength and the body weight were the significant predictors of the bone mineral density of the lumbar spine. These data suggest that back muscle strength has a possibility of affecting bone mineral density of the spine.     

A Prospective Study of Bone Loss and Turnover after Cardiac Transplantation: Effect of Calcium Supplementation With or Without Calcitonin

Cardiac transplantation exposes recipients to osteoporosis and increased risk of consequent fractures. The purpose of the present study was to examine the magnitude, timing and mechanism of bone loss following cardiac transplantation, and to establish whether bone loss can be prevented by calcium with or without calcitonin. Thirty patients (29 men, 1 woman), aged 26 – 68 years (mean 48 years), were randomized into three groups of 10 to receive either no additional treatment, oral calcium 1 g twice daily for 12 months or the same dose of calcium plus intranasal calcitonin 400 IU/day for the first month and then 200 IU/day for 11 months. Bone mineral density (BMD) at the lumbar spine and three femoral sites (femoral neck, trochanter, Ward’s triangle) was measured by dual-energy X-ray absorptiometry (DXA) at the time of transplantation and 6 and 12 months later. Markers of bone formation [serum bone-specific alkaline phosphatase (B-ALP), type I procollagen carboxyterminal propeptide (PICP) and aminoterminal propeptide (PINP)] and resorption [serum type I collagen carboxyterminal telopeptide (ICTP)], as well as serum testosterone in men, were assayed before transplantation and at 1 week and 1, 3, 6 and 12 months after transplantation. During the first 6 post-transplant months BMD calculated as a percent change from baseline decreased in the control group by 6.4% (p= 0.014) in the lumbar spine, by 6.0% (p= 0.003) in the femoral neck, by 5.0% (p= 0.003) in the trochanter and by 5.5% (p= 0.130) in Ward’s triangle. Between 6 and 12 months a further decline in BMD occurred only at the three femoral sites, ranging from 2.2% to 9.8% (p= 0.004-0.079). In comparison with the control group, the group receiving calcium alone lost less bone in the trochanter between 0 and 6 months (p= 0.019), and the group receiving calcium together with calcitonin lost less bone in the femoral neck (p= 0.068) and Ward′s triangle (p= 0.076) between 0 and 12 months. Seven (28%) of 25 assessable patients experienced vertebral compression fractures. Calcium with or without calcitonin had no effect on changes in biochemical parameters; consequently, the three study groups were combined. The markers of bone formation increased, the elevations in mean values being 59% for B-ALP at 1 month (p= 0.009), 152% for PICP at 1 week (p < 0.0001) and 27% for PINP at 1 week (p= 0.021). After a temporary decline at 3 months B-ALP (p= 0.0002) and PINP (p < 0.0001) at 1 year were nearly doubled compared with baseline values. Throughout the study the marker of bone resorption, serum ICTP, was above normal, with a peak (mean values 67–69% above baseline) at 1 week (p= 0.0002) to 1 month (p < 0.0001). The mean concentration of total testosterone was decreased by 48% (p < 0.0001) 1 week and by 28% (p= 0.0005) 1 month after transplantation, but this was mainly explained by the concomitant drop in serum albumin. High bone turnover underlies bone loss after cardiac transplantation. Bone loss is most rapid during the first 6 post-transplant months. In the upper femur this bone loss may be reduced by treatment with calcium and calcitonin. Received: 5 May 1998 / Accepted: 12 January 1999     

Assessment of incident spine and hip fractures in women and men using finite element analysis of CT scans

Finite element analysis of computed tomography (CT) scans provides noninvasive estimates of bone strength at the spine and hip. To further validate such estimates clinically, we performed a 5‐year case‐control study of 1110 women and men over age 65 years from the AGES‐Reykjavik cohort (case = incident spine or hip fracture; control = no incident spine or hip fracture). From the baseline CT scans, we measured femoral and vertebral strength, as well as bone mineral density (BMD) at the hip (areal BMD only) and lumbar spine (trabecular volumetric BMD only). We found that for incident radiographically confirmed spine fractures (n = 167), the age‐adjusted odds ratio for vertebral strength was significant for women (2.8, 95% confidence interval [CI] 1.8 to 4.3) and men (2.2, 95% CI 1.5 to 3.2) and for men remained significant (p = 0.01) independent of vertebral trabecular volumetric BMD. For incident hip fractures (n = 171), the age‐adjusted odds ratio for femoral strength was significant for women (4.2, 95% CI 2.6 to 6.9) and men (3.5, 95% CI 2.3 to 5.3) and remained significant after adjusting for femoral neck areal BMD in women and for total hip areal BMD in both sexes; fracture classification improved for women by combining femoral strength with femoral neck areal BMD (p = 0.002). For both sexes, the probabilities of spine and hip fractures were similarly high at the BMD‐based interventional thresholds for osteoporosis and at corresponding preestablished thresholds for “fragile bone strength” (spine: women ≤ 4500 N, men ≤ 6500 N; hip: women ≤ 3000 N, men ≤ 3500 N). Because it is well established that individuals over age 65 years who have osteoporosis at the hip or spine by BMD criteria should be considered at high risk of fracture, these results indicate that individuals who have fragile bone strength at the hip or spine should also be considered at high risk of fracture. © 2014 American Society for Bone and Mineral Research.     

Nandrolone decanoate and intranasal calcitonin as therapy in established osteoporosis

This study used a randomized, 2 × 2 factorial design to evaluate over 2 years the effect of intranasal salmon calcitonin and intramuscular nandrolone decanoate on bone mass in elderly women with established osteoporosis. The study was double masked in relation to calcitonin and open in relation to nandrolone decanoate. One hundred and twenty-three women aged 60–88 years who had sustained a previous osteoporotic fracture, or had osteopenia, were recruited through an outpatient clinic. Women were assigned to one of four groups: (1) daily placebo nasal spray, (2) 400 IU intranasal calcitonin daily, (3) 20 intramuscular injections of 50 mg nandrolone decanoate (given as two courses of 10 injections) plus placebo nasal spray, or (4) 20 injections of 50 mg nandrolone decanoate plus 400 IU intranasal calcitonin daily. All subjects received 1000 mg calcium supplementation daily. Outcomes measured included changes in bone mineral density (BMD) at the lumbar spine, as measured by dual-energy quantitative computed tomography (DEQCT), in BMD of the proximal femur, and BMD and bone mineral content (BMC) of the lumbar spine and forearm, as measured by dual-energy X-ray absorptiometry (DXA). Significant positive changes from baseline in DXA BMC at the lumbar spine were observed over 2 years in the calcitonin group (5.0±1.9%, mean ± SE) and in the nandrolone deconate group (4.7±1.9%) but not in the placebo group (1.1±2.2%) or the combined therapy group (0.7±1.8%). Modelling based on the 2×2 factorial design revealed that nandrolone decanoate was associated with a 3.8±1.8% (p<0.05) gain in DXA BMD at the proximal femur. Modelling also revealed that calcitonin treatment was associated with a loss of 11.5±4.7% in DEQCT BMD at the lumbar spine and a loss of 3.7±1.8% in DXA BMD at the proximal femur (p<0.05). There was in vivo antagonism between the two medications of 7.9±3.9% for DXA BMC at the lumbar spine. Both agents caused positive changes from baseline in lumbar spine BMC. Nandrolone decanoate had beneficial effects on BMD at the proximal femur. This dose of intranasal calcitonin was associated with deleterious effects on trabecular BMD at the lumbar spine and total BMD at the proximal femur. There may be significant clinical antagonism between these two medications.