[Effect of bone anabolic therapy on bone remodeling and bone density in geriatric patients with osteoporosis and falling syndrome].

Q4 Medicine Problemy endokrinologii Pub Date : 2022-04-04 DOI:10.14341/probl13079

N O Khovasova, E N Dudinskaya, A V Naumov, O N Tkacheva, L V Machekhina, Ju S Onuchina

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Abstract

Background: Older adults with severe osteoporosis are the most vulnerable group of geriatric patients. They are shown the purpose of anti-osteoporotic therapy, which should be effective and safe. Teriparatide showed a decrease in the risk of fractures, an increase in BMD. In Russia, the use of teriparatide in the geriatric population is extremely scarce.

Aim: assess clinical course, bone metabolism parameters and efficacy of bone-anabolic therapy in elderly and senile patients with severe osteoporosis and falls.

Materials and methods: The longitudinal prospective study included 100 patients 60 years and older with severe osteoporosis who had one or more falls within the last year. All patients were prescribed calcium and vitamin D preparations and bone-anabolic therapy (teriparatide 20 mg daily subcutaneously). The duration of follow-up was 24 months and included 3 visits: screening, at 12 and 24 months. The effectiveness of bone-anabolic therapy was carried out on the basis of assessing the frequency of new fractures, reduction of pain, changes in BMD according to X-ray densitometry, dynamics of bone metabolism markers.

Results: All patients had severe osteoporosis and aggravated comorbidity status, suffered a fall within the last year, and also low-energy fractures in the past. One in three patients had a vertebral fracture, one in five had a proximal femoral fracture. Prior to the start of the study, 61 patients received antiosteoporotic therapy. During the follow-up, 4 patients died, 96 patients completed the study. Against the background of teriparatide therapy, a decrease in the number of new cases of low-energy fractures and the number of patients with chronic pain was obtained. An increase in BMD was noted in the lumbar spine after 24 months and in the femoral neck after 12 months. There was no negative dynamics of the BMD. Also after 12 months, an increase in P1NP and C-terminal telopeptide of collagen type 1 was noted, after 24 months - osteocalcin and C-terminal telopeptide.

Conclusion: The use of teriparatide can be recommended as an effective intervention to treat severe osteoporosis in geriatric patients with falls.

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[骨同化疗法对老年骨质疏松症和跌倒综合征患者骨重塑和骨密度的影响]。

背景：患有严重骨质疏松症的老年人是老年病患者中最脆弱的群体。对他们进行抗骨质疏松治疗的目的应该是有效和安全的。特立帕肽能降低骨折风险，增加骨密度。在俄罗斯，特立帕肽在老年群体中的使用极为罕见。目的：评估患有严重骨质疏松症和跌倒的老年患者的临床过程、骨代谢参数和骨合成代谢疗法的疗效：这项纵向前瞻性研究纳入了 100 名 60 岁及以上的严重骨质疏松症患者，这些患者在过去一年中发生过一次或多次跌倒。所有患者均接受了钙剂、维生素 D 制剂和骨质合成疗法（特立帕肽 20 毫克，每日皮下注射）。随访时间为 24 个月，包括 3 次就诊：筛查、12 个月和 24 个月。骨质同化疗法的有效性根据新骨折发生频率、疼痛减轻情况、X光骨密度测量法显示的骨密度变化、骨代谢标志物的动态变化进行评估：所有患者都患有严重的骨质疏松症，合并症加重，去年曾摔倒过，过去还发生过低能骨折。三分之一的患者有脊椎骨折，五分之一的患者有股骨近端骨折。研究开始前，61 名患者接受了抗骨质疏松治疗。在随访期间，4 名患者死亡，96 名患者完成了研究。在特立帕肽治疗的背景下，新发低能量骨折病例和慢性疼痛患者的人数有所减少。腰椎的 BMD 在 24 个月后有所增加，股骨颈的 BMD 在 12 个月后有所增加。BMD 没有出现负动态变化。此外，12 个月后，P1NP 和 1 型胶原的 C 端端肽有所增加，24 个月后，骨钙素和 C 端端肽有所增加：结论：推荐使用特立帕肽作为治疗老年跌倒患者严重骨质疏松症的有效干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Problemy endokrinologii Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

1.40

自引率

0.00%

发文量

期刊介绍： Since 1955 the “Problems of Endocrinology” (or “Problemy Endocrinologii”) Journal publishes timely articles, balancing both clinical and experimental research, case reports, reviews and lectures on pressing problems of endocrinology. The Journal is aimed to the most topical issues of endocrinology: to chemical structure, biosynthesis and metabolism of hormones, the mechanism of their action at cellular and molecular level; pathogenesis and to clinic of the endocrine diseases, new methods of their diagnostics and treatment. The Journal: features original national and foreign research articles, reflecting world endocrinology development; issues thematic editions on specific areas; publishes chronicle of major international congress sessions and workshops on endocrinology, as well as state-of-the-art guidelines; is intended for scientists, endocrinologists diabetologists and specialists of allied trade, general practitioners, family physicians and pediatrics.