Teriparatide improves bone quality and healing of atypical femoral fractures associated with bisphosphonate therapy
Teriparatide improves bone quality and healing of atypical femoral fractures associated with bisphosphonate therapy
复制标题
DOI：
10.1016/j.bone.2012.10.006
复制
发表时间：
2013-01-01
期刊：
影响因子：
4.1
通讯作者：
Seeman, Ego
中科院分区：
文献类型：
--
作者：
Chiang, Cherie Ying;Zebaze, Roger M. D.;Seeman, Ego
骨重塑抑制剂，如双膦酸盐，减少骨质流失，减缓结构腐烂的进展。由于重建去除了受损的骨，当重建抑制延长时，骨质量可能会受到损害，容易发生微损伤积累和非典型股骨骨折。本研究的目的是确定特立帕肽治疗是否有助于骨折愈合和改善双膦酸盐相关非典型股骨骨折患者的骨质量。一项前瞻性研究涉及14例连续2年出现非典型股骨骨折的患者。除非有禁忌症，所有患者均给予特立帕肽治疗。招募年龄和性别匹配的对照组，无脆性骨折或抗再吸收治疗。使用新软件（StrAx1.0, StrAxCorp, Australia）分析了基线和服用特立帕肽6个月时桡骨远端和胫骨远端高分辨率外围微计算机断层扫描（HRpQCT）的皮质骨组织矿化密度。14例患者中，有5例患者连续6个月每日皮下注射20 μ g特立帕肽，其骨重塑标志物升高2-3倍（p = 0.01），骨折愈合。在桡骨远端，矿化程度较低的骨比例增加了29.5% (p = 0.01)，而较老、矿化程度较高的骨比例减少了16.2% （p = 0.03）。在胫骨远端也进行了类似的观察。在9例采用保守或手术治疗的患者中，7例骨折愈合不良并持续疼痛，1例对侧非典型骨折，1例1年后骨折愈合。特立帕肽可能有助于非典型骨折的愈合和骨质量的恢复。爱思唯尔公司版权所有版权所有。
Bone remodelling suppressants like the bisphosphonates reduce bone loss and slow progression of structural decay. As remodelling removes damaged bone, when remodelling suppression is protracted, bone quality may be compromised predisposing to microdamage accumulation and atypical femoral fractures. The aim of this study was to determine whether teriparatide therapy assists in fracture healing and improves bone quality in patients with bisphosphonate associated atypical femoral fractures.A prospective study was conducted involving 14 consecutive patients presenting during 2 years with atypical femoral fracture. All patients were offered teriparatide therapy unless contraindicated. Age and sex matched control subjects without fragility fractures or anti-resorptive treatment were recruited. High resolution peripheral micro-computed tomography (HRpQCT) scans of the distal radius and distal tibia were analysed for their cortical bone tissue mineralisation density using new software (StrAx1.0, StrAxCorp, Australia) at baseline and 6 months after teriparatide.Administration of 20 mu g of teriparatide subcutaneously daily for 6 months to 5 of the 14 patients was associated with 2-3 fold increase in bone remodelling markers (p = 0.01) and fracture healing. At the distal radius, the proportion of less densely mineralised bone increased by 29.5% (p = 0.01), and the proportion of older, more densely mineralised bone decreased by 16.2% (p = 0.03). Similar observations were made at the distal tibia. Of the nine patients managed conservatively or surgically, seven had poor fracture healing with ongoing pain, one sustained a contralateral atypical fracture and one had fracture union after 1 year. Teriparatide may assist in healing of atypical fractures and restoration of bone quality. Crown Copyright (C) 2012 Published by Elsevier Inc. All rights reserved.