| Objective This study,by analyzing the commonly used anti-osteoporosis medience(calcium + vitamin D preparations,teriparatide,zoledronic acid)for the treatment of postmenopausal osteoporosis with different fracture risks,to assess the differences in the effects of different anti-osteoporosis medience regimens on fracture risk and to inform clinicians in the development of anti-osteoporosis treatment regimens.Methods The 1506 postmenopausal osteoporosis patients were collected as study subjects and divided into very high risk of fracture-teriparatide group(352 patients),very high risk of fracture-zoledronic acid group(226 patients),high risk of fracture-zoledronic acid group(350 patients),medium risk of fracture-basic treatment group(314 patients),and low risk of fracture-basic treatment group according to the fracture risk and initial treatment regimen(264 cases).General clinical data were collected from all study subjects: age,height,weight,BMI,NRS scores before and after 24 months of treatment,history of previous fractures,history of hormone used,history of recurrent/new fractures during treatment;tests:serum iron(Fe),magnesium(Mg),calcium(Ga),phosphorus(P),25-hydroxyvitamin D(25-OH-D),parathyroid hormone(PTH),type I collagen amino-terminal peptide(PINP),alkaline phosphatase(ALP),and femoral neck BMD;the risk of fracture was calculated for each study subject using the FRAX(?).Compare the statistical differences in different fracture risk groups;the changes in different stages of treatment in the same fracture risk group;the efficacy of different anti-osteoporosis drugs in the same fracture risk group;compare the efficacy of the same anti-osteoporosis drugs in different fracture risk groups.Results 1.Comparison between different fracture risk groups Age,PINP,and ALP were negatively correlated with BMD and positively correlated with fracture risk,BMI was positively correlated with BMD and negatively correlated with fracture risk,and BMD was negatively correlated with fracture risk;Fe,Mg,Ca,P,25-OH-D were not correlated with BMD,Mg was negatively correlated with fracture risk,and 25-OH-D was positively correlated with fracture risk.Age and BMD were well correlated with fracture risk,and Spearman rank correlation coefficients were 0.419 and-0.728,respectively.General data: Age: extremely high risk(69 years)and high risk(67 years)were greater than intermediate risk(64 years)and greater than low risk(60 years);BMI: The low-risk fracture risk group(25.33Kg/m2)was higher than the middle-risk fracture risk group(23.94Kg/m2),the high-risk fracture risk group(24.00Kg/m2)and the extremely high-risk fracture risk group(23.44 kg/m2)respectively(P < 0.05).Pretreatment NRS scores: The low-risk fracture risk group had the largest number of people without pain symptoms,26.14%,the lowest number of moderate and severe pain symptoms(26.14% / 3.03%),and the lowest number of the fracture risk group(3.46%).previous Fracture rate:The incidence of previous fractures in the extremely high-risk fracture group(39.27%)was higher than that in the high-risk fracture group(26.86%)(P < 0.05),and there was no previous fracture history in the middle and low-risk fracture groups.Testing and inspection indicators:Serum Mg(0.90mmol/L)in high risk fracture risk group is less than high risk(0.91 mmol/L)and intermediate risk fracture risk group(0.92mmol/L);PINP and ALP concentrations(61.42ng/ml,75.00IU/L)in the former group were greater than those in the latter two groups(54.79ng/ml,67.00IU/L/58.45ng/ml,69.00IU/L);Serum P(1.17mmol/L)in high risk group was greater than intermediate risk(1.11 mmol/L)and low risk group(1.14 mmol/L);The very high risk group had the lowest BMD(-3.4)and the largest fracture risk(11% / 5.85%),followed by high risk(7.4% / 3.10%),intermediate risk(5.10% / 1.30%)and low risk fracture risk(2.8% / 0.2%) 2.Comparison between various stages of anti-osteoporosis treatment in different fracture risk groups25-OH-D and BMD increased annually in each group with the course progression.PTH,PINP and ALP in the extremely high-risk fracture risk-teriparatide group showed an increase and then a decrease,and higher than before treatment;PTH in the very high-risk fracture risk-zoledronic acid group decrease after treatment,PINP showed a decrease and then an increase,and was lower than before,and ALP decrein appears early in treatment;PTH in the high-risk fracture risk-zoledronic acid group and the intermediate-risk fracture risk-basic treatment group started to decrease after treatment,and PINP decreased early in treatment;PTH and PINP in the low-risk fracture risk-basic treatment group started to decrease after 12 months of treatment,In the low-risk fracture risk-basic treatment group PTH decreased after treatment,and PINP increased after treatment.All groups were able to reduce pain NRS scores after treatment.After 24 months of treatment the incidence of fractures decreased from40.91% to 9.94% in the very high risk of fracture-teriparatide group,from 36.73% to 14.15%in the very high risk of fracture-zoledronic acid group,from 26.86% to 10.86% in the high risk of fracture-zoledronic acid group,and no previous fractures occurred in either the medium or low risk of fracture-basic treatment group.After 24 months of treatment,the incidence of new fractures was 4.17% and 8.60%.3.Very high risk of fracture-comparison between teriparatide group and very high risk of fracture-zoledronic acid group After 24 months of treatment,PINP and ALP increased in the very high-risk fracture risk-teripat group,decreased in the very high-risk fracture group,25-OH-D and BMD increased after both treatment,and BMD was higher(12.83%)than the posterior group(6.67%).4.Very high risk of fracture-zoledronic acid group versus high risk of fracture--zoledronic acid group After 24 months of treatment,PINP and ALP decreased than the former group in the group with very high fracture risk-zoledronic acid and high bone risk-zoledronic acid group(33.71%,28.48%)was greater than the posterior group(15.86%,0.00),BMD increased,the former group(6.67%)was less than the posterior group(20.69%),fracture rate decreased in the former group(22.57%)was greater than the posterior group(16.57%).5.Intermediate-risk fracture risk-basic treatment group versus low-risk fracture risk-basic treatment group After 24 months of treatment,PINP and ALP decreased compared with the former group,the former group(8.61%,2.11%)was less than the posterior group(12.24%,5.69%),and BMD increased than the former group(25.00%)was greater than the latter(11.11%).Conclusion 1.For postmenopausal people with very high risk of fracture risk of osteoporosis,teriparatide can increase BMD and reduce the fracture risk to a greater extent than zoledronic acid,and has better efficacy than zoledronic acid,but the subsequent treatment effect is poor.2.For postmenopausal people with extremely high-risk and high-risk fracture risk of osteoporosis,zoledronic acid can increase BMD and reduce the fracture risk,which has significant efficacy on high-risk fracture risk groups3.For postmenopausal patients with intermediate-risk and low-risk fracture risk of osteoporosis,calcium and sufficient dose of vitamin D preparation can improve BMD,among which the moderate-risk fracture risk is more significantly increased in BMD. |
