Clinical efficacy of bisphosphonates and monoclonal antibodies on bone mineral density following skeletal fractures |
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| Institution: | 1. Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Shields, NE34 0PL, United Kingdom;2. Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle-upon-Tyne, NE2 4HH, United Kingdom;1. Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110 076, India;2. Formerly with CSIR-NISTADS, New Delhi, 110 012, India;3. Government First Grade College, Jagalur, 577528, Karnataka, India;1. Department of Trauma & Orthopaedic Surgery, Queen Elizabeth Hospital Birmingham, UHB, Mindelsohn Way, Birmingham, B15 2GW, UK;2. Department of Radiology, Queen Elizabeth Hospital Birmingham, UHB, Mindelsohn Way, Birmingham, B15 2GW, UK;3. Department of Radiology, Royal Orthopaedic Hospital, Birmingham, Bristol Rd S, Northfield, Birmingham, B31 2AP, UK;1. Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands;2. Maastricht University, Faculty of Health Medicine & Life Sciences, Maastricht, the Netherlands;3. School of Care and Public Health Research Institute, Faculty of Health, Medicine & Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands;1. Georgetown University School of Medicine, 3700 Reservoir Rd NW, Washington, DC, 20007, USA;2. Department of Orthopaedic Surgery, University of California San Francisco, 1500 Owens St, San Francisco, CA, 94158, USA;3. Department of Plastic and Reconstructive Surgery, University of Missouri School of Medicine, University Hospital One Hospital Dr., Columbia, MO, 65212, USA;4. Department of Orthopaedic Surgery, Duke University, 200 Trent Dr, Durham, NC, 27710, USA |
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| Abstract: | BackgroundBisphosphonates and monoclonal antibodies are drugs primarily developed to inhibit osteoclast-mediated bone resorption and are used to treat an array of skeletal pathologies. Their use is aimed at increasing bone health and therefore reducing fracture risks. The aim of this study was to evaluate the effectiveness of bone protection therapy on improving bone mineral density (BMD) in patients following a fracture.MethodsInclusion criteria consisted of patients who sustained a skeletal fracture and were subsequently commenced on bone protection therapy. Dual-energy X-ray Absorptiometry (DEXA) scans were performed at baseline and following a consented period of drug therapy. Bone health data included T-Scores, Z-Scores, FRAX Major, FRAX Hip and BMD. The clinical effectiveness of four bisphosphonates (alendronate, risedronate, pamidronate and zoledronate) and one monoclonal antibody (denosumab) were evaluated.ResultsA total of 100 patients were included in the study. Overall, bone protection therapy significantly improved Z-score Hip, Z-score Spine, T-score Spine and BMD Spine (p < 0.05). There was a marked difference between drug therapies. Denosumab and zoledronate were associated with the greatest treatment effect size. Alendronate only improved Z-score Spine and Z-score Hip (p < 0.05). Pamidronate and risedronate did not demonstrate any statistically significant improvement across any DEXA parameter.ConclusionOverall, bisphosphonates/monoclonal antibodies confer beneficial effects on bone health as measured by DEXA scans in patients following skeletal fractures. However, the magnitude of improvement varies among the commonly used drugs. Alendronate, zoledronate and denosumab were associated with greatest therapeutic benefit. Bone protection therapy did not improve fracture risk of patients (FRAX scores). |
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| Keywords: | Bisphosphonate Monoclonal antibodies DEXA Fracture Bone mineral density |
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