Loading modality and age influence teriparatide-induced bone formation in the human femoral neck.
Loading modality and age influence teriparatide-induced bone formation in the human femoral neck.
复制标题
加载方式和年龄影响特立帕肽诱导的人股骨颈骨形成。
DOI：
10.1016/j.bone.2020.115373
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发表时间：
2020
期刊：
影响因子：
4.1
通讯作者：
Cosman,Felicia
中科院分区：
文献类型：
--
作者：
Rooney,AmandaM;Bostrom,MathiasPG;Dempster,DavidW;Nieves,JeriW;Zhou,Hua;Cosman,Felicia
Teriparthrin（TPTD）降低了椎骨和非椎骨骨折的风险，但增加了脊柱的骨矿物质密度（BMD），而不是髋部。TPTD和机械负荷可能对BMD具有协同合成代谢作用，这可能有助于解释这些部位特异性差异。在正常的日常活动中，股骨颈（FN）处于弯曲状态，一侧处于拉伸状态，另一侧处于压缩状态。我们试图通过研究拉伸与压缩载荷对TPTD刺激的人FN骨形成指数的影响，进一步了解髋关节机械载荷与TPTD之间的关系。38例因骨关节炎接受全髋关节置换术的患者在术前随机接受安慰剂（PBO）或TPTD，平均治疗持续时间为6周，并给予双四环素标记以评估骨形成。在手术过程中收获FN，并分析皮质内和骨膜包膜的压缩和拉伸区域中的动态骨形成指数。还分析了将结局指标与患者特征（包括性别、年龄、体重和FN几何形状）相关的回归模型。总体而言，TPTD组皮质内表面的骨形成高于安慰剂组，但骨膜表面的骨形成则无差异。TPTD组和安慰剂组的骨形成水平在拉伸皮质内表面和压缩骨膜表面上更高。TPTD在压缩区域而非拉伸区域有皮质内侵蚀表面减少的趋势。患者年龄和性别解释了皮质内骨形成的最大变异性，患者体重和性别解释了骨膜骨形成的最大变异性。我们的数据代表了人类FN样本中两种负荷模式下特立帕鲁肽治疗的首次动态比较。未来的工作可以确定特定的髋关节负荷干预是否可以在临床环境中放大髋关节上的特立帕托的益处。
Teriparatide (TPTD) reduces risk of both vertebral and nonvertebral fracture, but increases bone mineral density (BMD) much more at the spine than the hip. TPTD and mechanical loading may have a synergistic anabolic effect on BMD, which may help explain these site-specific differences. Under normal daily activity, the femoral neck (FN) is under bending, placing one side under tension and the other under compression. We sought to further understand the relationship between mechanical loading and TPTD at the hip by investigating the effect of tensile versus compressive loading on TPTD stimulated bone formation indices in the human FN. Thirty-eight patients receiving total hip replacements for osteoarthritis were randomized to receive placebo (PBO) or TPTD for a mean treatment duration of 6 weeks prior to surgery, and double tetracycline labeling was administered to allow assessment of bone formation. The FN was harvested during surgery and analyzed for dynamic bone formation indices in the compressive and tensile regions of the endocortical and periosteal envelopes. Regression models relating outcome measures to patient characteristics including sex, age, body weight, and FN geometry were also analyzed. Overall, bone formation was higher with TPTD versus placebo on the endocortical surface, but not the periosteal surface. The level of bone formation in both TPTD and placebo groups was greater on the tensile endocortical surface and the compressive periosteal surface. There was a trend toward decreased endocortical eroded surface with TPTD in the compressive but not the tensile region. Patient age and sex explained the greatest variability in endocortical bone formation, and patient body mass and sex explained the greatest variability in periosteal bone formation. Our data represent the first dynamic comparison of teriparatide treatment under two loading modalities in human FN samples. Future work could determine whether specific hip loading intervention could amplify the benefits of teriparatide on the hip in clinical settings.