长期护理的老年人停用地诺单抗后唑来膦酸对骨密度和小梁评分的影响。

IF 3.3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Nami Safai Haeri, Subashan Perera, Susan L Greenspan
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引用次数: 0

摘要

停用denosumab可导致反弹性骨质流失和椎体骨折风险增加。在长期护理社区(ltcc)的骨质疏松症患者中,关于停药后风险管理的数据有限。我们研究了单剂量唑来膦酸对2年地诺单抗治疗后骨密度和微结构的影响。在一项为期两年的双盲、安慰剂对照、随机临床试验之后的一项开放标签、为期一年的扩展研究中,39名65岁及以上的老年人,他们是ltcc的居民,并且是PROUD(使用Denosumab预防骨质疏松症)试验的参与者,在PROUD试验期间完成4次剂量的Denosumab 60mg后,接受了单次5mg剂量的唑来膦酸。我们的目的是评估单次5mg剂量唑来膦酸对腰椎、全髋关节、股骨颈和三分之一桡骨的骨密度(BMD)以及脊柱小梁骨评分(TBS)的影响,为期一年。此外,我们还调查了骨折患者。我们的研究包括27名女性和12名男性,平均年龄为81.5岁。服用唑来膦酸12个月后,从denosumab试验结束时的平均百分比变化显示,女性和男性的任何骨密度部位都没有明显下降。在女性中,平均百分比变化如下:脊柱0.97 (95% CI: -0.7至2.7,p = 0.242),全髋-0.10 (95% CI: -2.3至2.1,p = 0.927)。在男性中,脊柱的变化为-0.32 (95% CI: -3.7至3.1,p = 0.832),全髋关节的变化为1.79 (95% CI: -0.7至4.3,p = 0.139)。这些发现表明没有证据表明反弹骨质流失。在女性中,TBS显著增加3.9% (95% CI: 0.8 ~ 5.8, p = 0.007),表明骨微结构得到改善。在男性中,TBS有改善的趋势,增加了3.3% (95% CI: -4.0至13.0,p = 0.054)。在denosumab后期间,没有报道参与者发生脆性骨折。在患有骨质疏松症的ltcc患者中,在接受了两年的地诺单抗治疗后,接受单次5mg剂量的唑来膦酸治疗,我们没有发现骨密度或TBS下降的证据。此外,参与者经历了增强的骨微结构。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of Zoledronic Acid on Bone Mineral Density and Trabecular Score Following Denosumab Discontinuation in Older Adults in Long-Term Care.

Discontinuation of denosumab can result in rebound bone loss and increased vertebral fracture risk. In residents of long-term care communities (LTCCs) with osteoporosis, there is limited data on managing the risks after discontinuation. We investigated the impact of a single dose of zoledronic acid on bone density and microarchitecture following two years of denosumab treatment. In an open-label, one-year extension study following a two-year double-blind, placebo-controlled, randomized clinical trial, 39 older adults aged 65 years and above, who were residents of LTCCs and participants in the PROUD (PReventing Osteoporosis Using Denosumab) trial, received a single 5 mg dose of zoledronic acid after completing four doses of denosumab 60 mg during the PROUD trial. We aim to evaluate the effects of a single 5 mg dose of zoledronic acid on bone mineral density (BMD) at the lumbar spine, total hip, femoral neck, and one-third radius, as well as on the spine trabecular bone score (TBS), over a one-year period. Additionally, we surveyed patients for fractures. Our study included 27 women and 12 men, with a mean age of 81.5 years. Twelve months after the administration of zoledronic acid, the mean percent changes from the end of the denosumab trial showed no significant decline in any of the BMD sites in both women and men. In women, the mean percent changes were as follows: spine 0.97 (95% CI: -0.7 to 2.7, p = 0.242) and total hip -0.10 (95% CI: -2.3 to 2.1, p = 0.927). In men, the changes were -0.32 (95% CI: -3.7 to 3.1, p = 0.832) for the spine and 1.79 (95% CI: -0.7 to 4.3, p = 0.139) for the total hip. These findings indicate no evidence of rebound bone loss. In women, TBS significantly increased by 3.9% (95% CI: 0.8 to 5.8, p = 0.007), suggesting improved bone microarchitecture. In men, there was a trend toward improvement in TBS, with an increase of 3.3% (95% CI: -4.0 to 13.0, p = 0.054). There were no reported fragility fractures among participants during the post-denosumab period. In residents of LTCCs with osteoporosis receiving a single 5 mg dose of zoledronic acid following two years of denosumab, we found no evidence of a loss in BMD or TBS. Further, participants experienced enhanced bone microarchitecture.

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来源期刊
Calcified Tissue International
Calcified Tissue International 医学-内分泌学与代谢
CiteScore
8.00
自引率
2.40%
发文量
112
审稿时长
4-8 weeks
期刊介绍: Calcified Tissue International and Musculoskeletal Research publishes original research and reviews concerning the structure and function of bone, and other musculoskeletal tissues in living organisms and clinical studies of musculoskeletal disease. It includes studies of cell biology, molecular biology, intracellular signalling, and physiology, as well as research into the hormones, cytokines and other mediators that influence the musculoskeletal system. The journal also publishes clinical studies of relevance to bone disease, mineral metabolism, muscle function, and musculoskeletal interactions.
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