Effect of hormone replacement, alendronate, or combination therapy on hip structural geometry: A 3-year, double-blind, placebo-controlled clinical trial
Effect of hormone replacement, alendronate, or combination therapy on hip structural geometry: A 3-year, double-blind, placebo-controlled clinical trial
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DOI：
10.1359/jbmr.050508
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发表时间：
2005-09-01
影响因子：
6.2
通讯作者：
Parker, RA
中科院分区：
文献类型：
--
作者：
Greenspan, SL;Beck, TJ;Parker, RA
简介：骨折复位仅部分由BMD增加解释。本研究的目的是检查髋关节的结构几何形状的变化，来自DXA在绝经后妇女治疗后antiresorptive agents.Materials和方法：这是一个双盲，安慰剂对照，随机临床试验的373名妇女年龄超过65岁，谁被随机激素替代治疗，阿仑膦酸钠，联合治疗，或安慰剂3年。结果包括Beck的DXA衍生髋关节结构分析程序，这是DXA数据的工程解释。指标包括横截面积、截面模量（弯曲强度的测量）、外径、皮质厚度和屈曲比（皮质骨稳定性的指标）。属性进行了测量，在横截面区域穿过股骨的最后一点上的股骨颈，转子间区域，和近端shaft.Results：在股骨颈，改善髋关节结构分析指标普遍显着大于联合治疗比任何单一疗法;增加也更大的转子间相比，激素替代疗法。例如，在联合治疗组，股骨粗隆间和窄颈的截面模量分别增加了10.6%和10.3%，阿仑膦酸钠组分别增加了9.1%和7.3%，激素替代治疗组分别增加了5.8%和6.9%，安慰剂组分别增加了3.4%和3.2%（四组间p < 0.01）。屈曲比增加，表明在安慰剂组的稳定性下降，而有没有变化或显着改善（p < 0.05）在每个积极的治疗group.Conclusions：我们得出结论，骨质量的分布的变化，潜在的密度与抗吸收剂的组合或单独的改善有积极的影响，在股骨近端的结构强度和稳定性。这项研究提供了额外的信息的潜在机制，骨折复位抗吸收剂。
Introduction: Fracture reduction is only partially explained by increased BMD. The aim of this study was to examine changes in structural geometry of the hip, derived from DXA in postmenopausal women after treatment with antiresorptive agents.Materials and Methods: This was a double-blind, placebo-controlled, randomized clinical trial of 373 women over the age of 65 years, who were randomized to hormone replacement therapy, alendronate, combination therapy, or placebo for 3 years. The outcomes included the DXA-derived hip structure analysis program by Beck, which is an engineering interpretation of the DXA data. The indices included cross-sectional area, section modulus (a measure of bending strength), outer diameter, cortical thickness, and buckling ratio (an index of cortical bone stability). Properties were measured in cross-sectional regions traversing the femur at the narrowest point on the femoral neck, the intertrochanteric region, and the proximal shaft.Results: In the femoral neck, improvement in the hip structure analysis indices were generally significantly greater with combination therapy than either monotherapy; increases were also greater at the intertrochanter compared with hormone replacement therapy. For example, the section modulus at the intertrochanter and narrow neck increased 10.6% and 10.3%, respectively, with combination therapy, 9.1% and 7.3% with alendronate, 5.8% and 6.9% with hormone replacement therapy, and 3.4% and 3.2% with placebo (p < 0.01 across the four groups). Buckling ratio increased, suggesting decreased stability in the placebo group, whereas there was either no change or significant improvements (p < 0.05) in each active treatment group.Conclusions: We conclude that changes in the distribution of bone mass underlying the improvements in density with antiresorptive agents in combination or alone have positive effects on structural strength and stability at the proximal femur. This study provides additional information on the potential mechanisms for fracture reduction with antiresorptive agents.