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Журнал "Біль. Суглоби. Хребет" 1 (09) 2013

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Intravenous Ibandronate Treatment of 24 Months Increases Cancellous and Cortical Bone Mineralization Density in Male Patients with Idiopathic Osteoporosis

Автори: B.M. Misof1, J.M. Patsch2, P. Roschger1, C. Muschitz3, I. Pollhammer3, T. Wögerbauer3, E.P. Paschalis1, A. Nader1, K. Klaushofer1, P. Pietschmann3, H. Resch2, 1 Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria, 2 Department of Radiology, Medical University of Vienna, Vienna, Austria, 3 Medical Department with Osteology/Rheumatology & Gastroenterology, KH Barmherzige Schwestern (St. Vincent Hospital) Vienna, Academic Teaching Hospital of the Medical University Vienna, VINforce study group, Vienna, Austria

Рубрики: Ревматологія, Травмотологія та ортопедія

Розділи: Медичні форуми

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Тезисы докладов Международной школы-семинара «Остеопороз в травматологии и ортопедии»
4–8 февраля 2013 года, г. Яремче, Украина

Therapeutic options and clinical trials for men with osteoporosis are still limited. We aimed to study the effect of 24 months ibandronate (IBA) treatment (3 mg/3 ml intraveneous) in 19 male subjects with idiopathic osteoporosis within an open­label, single­center, prospective phase III study. Patients (aged 36–80 yrs) were included if they had low BMD (FN T­score < –2 and LS T­score < –1) and/or prevalence of at least one low trauma fracture and no secondary cause of osteoporosis. Primary endpoint was to evaluate the effect of treatment on the bone mineralization density distribution (BMDD) based on quantitative backscattered electron imaging (qBEI) analysis of paired biopsy samples (baseline, after 24 months of IBA).

IBA caused significant changes in cancellous (Cn.) and cortical (Ct.) BMDD variables. Wilcoxon signed rank comparison to baseline revealed significant increases in average calcium concentrations (Cn. CaMean +2.4 %, p < 0.001; Ct. CaMean +3.0 %, p = 0.002) and in mode calcium concentrations (Cn. CaPeak +3.1 %, p = 0.027; Ct. CaPeak 2.3 %, p = 0.030). The heterogeneity of mineralization (Cn. CaWidth –14 %, p = 0.044; Ct. CaWidth –16 %, p = 0.001) and the proportion of low mineralized bone areas (Cn. CaLow –28 %, Ct. CaLow –45 %, both p < 0.001) were reduced. We found a strong dependency of the absolute treatment induced changes in Cn. and Ct. CaMean on the baseline values of Cn. and Ct. CaMean respectively (linear regression R = 0.68 for Cn. and R = 0.82 for Ct. bone, both p < 0.001). Absolute changes in CaMean for cancellous vs. cortical bone were found not significantly differentsimilar (p = 0.465) but being significantly correlated well with each other (Spearman coefficient R = 0.78, p < 0.001).

Our findings are in line with the antiresorptive/anticata­bolic effect of IBA and with previously observed bisphosphonate effects on BMDD in postmenopausal osteoporosis: Less bone is formed and the existing bone packets have prolonged time for secondary mineralization, causing an increase in ave­rage and mode mineralization densities, together with a decrease in the proportion of low mineralized areas and the well known transient reduction in the heterogeneity of calcium concentrations. The dependency of the treatment­induced change in CaMean on its baseline value suggests that the patients with very low mineralization densities at baseline are having the largest increase during treatment. The similari­ty of changes in Cn. and Ct. bone indicates that both IBN exerts treatment effects in both compartments are prone to treatment effects in our cohort.

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