Factors associated with bisphosphonate treatment failure in postmenopausal women with primary osteoporosis
Factors associated with bisphosphonate treatment failure in postmenopausal women with primary osteoporosis
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DOI：
10.1007/s00198-014-2619-3
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发表时间：
2014-04-01
影响因子：
4
通讯作者：
Chiodini, I.
中科院分区：
文献类型：
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作者：
Cairoli, E.;Eller-Vainicher, C.;Chiodini, I.
在97例原发性骨质疏松症、钙和维生素D补充充足、对36个月双膦酸盐治疗依从性良好的绝经后妇女中，25.8%的患者反应不足。为了评估原发性骨质疏松症（PO）妇女双膦酸盐治疗失败的患病率及其可能的相关因素，我们研究了97例绝经后妇女，这些妇女患有PO和脆性骨折和/或FRAXA（R）10-在使用阿仑膦酸钠或利塞膦酸钠和适当的维生素D补充剂治疗36个月之前和之后，每年发生严重骨质疏松性骨折的概率为千分之7.5%，依从性良好。在基线和36个月后，腰椎（LS）和股骨骨矿物质密度（BMD）通过双能X线吸收测定法进行评估，椎体骨折通过脊柱X线片进行评估。计算脊柱畸形指数（SDI）。治疗失败的定义是每千日元2中有一部分发生脆性骨折和/或BMD下降大于最小显著变化。在25.8%的患者中观察到双膦酸盐治疗失败。年龄、体重指数、绝经年限、熟悉的髋部骨折史、福尔斯次数、使用的双膦酸盐类型、25-羟维生素D水平、BMD、SDI和FRAXA（R）评分在基线时应答者和应答不足者之间没有差异。治疗失败与当前吸烟有关（OR 3.22，95% CI 1.10-9.50，P = 0.034）和基线碱性磷酸酶总活性水平a千分之66.5 U/L（OR 4.22，95% CI 1.48-12.01，P = 0.007），不考虑年龄、福尔斯次数、LS BMD和基线SDI。25.8%的PO绝经后妇女对双膦酸盐反应不充分，尽管对治疗的依从性良好，25 OHVitD水平正常。目前吸烟和骨转换在正常范围的上部与双膦酸盐的反应不足有关。
Among 97 postmenopausal women with primary osteoporosis, adequate calcium and vitamin D supplementation, and good compliance to a 36-month bisphosphonate treatment, the 25.8 % of patients are inadequate responders. Current smoking and a bone turnover in the upper part of the normal range increase the risk of treatment failure.To evaluate the prevalence of the bisphosphonate treatment failure and its possible associated factors in women with primary osteoporosis (PO).We studied 97 previously untreated postmenopausal women with PO and fragility fractures and/or a FRAXA (R) 10-year probability of a major osteoporotic fracture a parts per thousand yen7.5 %, before and after a 36-month treatment with alendronate or risedronate and adequate vitamin D supplementation with good compliance. At baseline and after 36 months, lumbar spine (LS) and femoral bone mineral density (BMD) were assessed by Dual X-ray absorptiometry and vertebral fractures by spinal radiographs. Spinal deformity index (SDI) was calculated. Treatment failure was defined by the presence of a parts per thousand yen2 incident fragility fractures and/or a BMD decrease greater than the least significant change.Bisphosphonate treatment failure was observed in 25.8 % of patients. Age, body mass index, years since menopause, familiar history of hip fracture, number of falls, type of bisphosphonate used, 25-hydroxyvitamin D levels (25OHVitD), BMD, SDI, and FRAXA (R) score at baseline were not different between responders and inadequate responders. Treatment failure was associated with current smoking (OR 3.22, 95 % CI 1.10-9.50, P = 0.034) and baseline alkaline phosphatase total activity levels a parts per thousand yen66.5 U/L (OR 4.22, 95 % CI 1.48-12.01, P = 0.007), regardless of age, number of falls, LS BMD, and baseline SDI.The 25.8 % of PO postmenopausal women inadequately responds to bisphosphonates, despite a good compliance to therapy and normal 25OHVitD levels. The current smoking and bone turnover in the upper part of the normal range are associated with the inadequate response to bisphosphonates.