Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지
DOI QR코드

DOI QR Code

Persistency and Change of the Bone Mineral Density with Alendronate Treatment after Hip Fracture

고관절 주위 골절 환자에서 알렌드로네이트 투여 후 복용 지속성 및 골밀도의 변화

  • Hwang, Kyu-Tae (Department of Orthopedic Surgery, College of Medicine, Hanyang University) ;
  • Yoo, Byeong-Wook (Department of Orthopedic Surgery, College of Medicine, Hanyang University) ;
  • Kim, Yee-Suk (Department of Orthopedic Surgery, College of Medicine, Hanyang University) ;
  • Choi, Il-Yong (Department of Orthopedic Surgery, College of Medicine, Hanyang University) ;
  • Kim, Young-Ho (Department of Orthopedic Surgery, College of Medicine, Hanyang University)
  • 황규태 (한양대학교 의과대학 정형외과학교실) ;
  • 유병욱 (한양대학교 의과대학 정형외과학교실) ;
  • 김이석 (한양대학교 의과대학 정형외과학교실) ;
  • 최일용 (한양대학교 의과대학 정형외과학교실) ;
  • 김영호 (한양대학교 의과대학 정형외과학교실)
  • Published : 2010.12.31
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study was to evaluate the effects of alendronate on bone mineral density (BMD) and to determine the persistency and side effects of alendronate treatment after hip fractures. Materials and Methods: 452 patients who underwent surgery for hip fractures from March 2000 to February 2007 were retrospectively included. The hip fractures consisted of 218 cases of femur neck fractures and 234 cases of intertrochanteric fractures. There were 254 women and 198 men with a mean age of 73.4 years (range: 60~95 years) at the time of surgery. The BMD was assessed in 398 patients and 348 were diagnosed with osteoporosis, while 102 received alendronate for treatment. The persistency with alendronate treatment and change of the BMD were evaluated annually. We also evaluated the side effects and reasons for discontinuation. Results: The prescription rate of alendronate was 29.3% and the persistency rate over 1 year was 33%. The annual BMD of the lumbar spine showed a 9.11% increase the first year, a 4.5% increase the second year and a 3.5% increase the third year, while negative changes were noted in the proximal femur as a 1.89% decrease the first year, a 1.38% decrease the second year and a 0.97% decrease the third year. The BMD changes were 11%(L: Lumbar spine) and 1.1%(F: Femur) for the T-scores <-4.0, 6.3%(L) and 0.9%(F) for the T-scores -3.0~-4.0, and 3.8%(L) and -3.5%(F) for the T-scores >-3.0, respectively. The BMD changes in the patients with femur neck fractures and who were treated with hemiarthroplasty were 15.6%(L) and -3.9%(F). The BMD changes in the patients with intertrochanteric hip fractures and who were treated with compression hip screws or hemiarthroplasty were 18.7%(L), 0.77%(F), 24.2%(L) and 1.19%(F), respectively. Gastrointestinal problems(19.1%) were the most common cause for discontinuation of alendronate. Conclusion: It is important for doctors to approach osteoporosis more carefully and educate patients to follow the prescriptions in order to improve the low prescription and persistency rates for the management of osteoporotic hip fractures. Administration of alendronate may have a positive influence on the BMD of the proximal femur by lowering the rate of decreased BMD more than would be expected.

목적: 고관절 주위 골절 후 골다공증을 진단받은 환자에서 알렌드로네이트 투여 후 골밀도의 변화와 복용 지속성 및 부작용에 대해 알아보고자 하였다. 대상 및 방법: 2000년 3월부터 2007년 2월까지 고관절 주위 골절로 수술을 시행한 452명을 대상으로 후향적 연구를 시행하였으며 대퇴 경부 골절 218예, 대퇴 전자간 골절 234예이었다. 평균 연령은 73.4세(60~95세)이었으며 남자 198명, 여자 254명이었다. 입원 중 골밀도 검사 후 골다공증으로 진단된 환자는 348명이었으며 이 중 알렌드로네이트를 처방 받았던 환자는 102명이었다. 약물 복용 지속성에 대해 조사하였으며 1년 이상 복용한 환자들의 골밀도 변화를 분석하였다. 최초 골밀도 검사시 측정된 T-점수 및 수술 방법에 따른 골밀도의 변화를 조사하였다. 또한 알렌드로네이트의 부작용 및 복용 중지 사유를 알아보았다. 결과: 고관절 주위 골절 후 골다공증을 진단받은 환자의 알렌드로네이트 처방률은 29.3%이었으며 1년 이상의 복용 지속률은 33%이었다. 골밀도 변화량은 요추부는 각각 9.11%, 4.5%, 3.5%로 매년 증가 양상을 나타내었으며 근위 대퇴부는 각각 -1.89%, -1.38%, -0.97%로 매년 감소 양상을 나타내었다. 최초 측정된 T-점수에 따른 요추(L) 및 근위 대퇴부(F) 골밀도의 변화량은 T-점수<-4.0인 경우, 11%(L), 1.1%(F)로 나타났으며, T-점수 -4.0~-3.0인 경우, 6.3%(L), 0.9%(F)이었으며, T-점수>-3.0인 경우, 3.8%(L), -3.5%(F)이었다. 대퇴 경부 골절로 인공 관절 부분치환술을 시행한 경우, 골밀도 변화량은 최종 추시시 15.6%(L), -3.9%(F)이었다. 대퇴 전자간 골절로 압박고 나사 고정술을 시행한 경우는 변화량이 18.7%(L)와 0.77%(F) 이었으며, 인공 관절 부분치환술을 시행한 경우는 24.2%(L)와 1.19%(F)이었다. 약물 복용 중단 사유는 위장관계 부작용(19.1%)이 가장 많았다. 결론: 골다공증이 동반된 고관절 주위 골절의 경우 알렌드로네이트 처방률과 복약 지속률이 낮으므로 적극적인 골다공증 치료제의 처방과 지속적인 복약을 하도록 교육하는 것이 필요할 것으로 생각된다. 또한 알렌드로네이트 투여 후에도 대퇴 근위부 골밀도에 경도의 감소가 있었으나 고관절 골절 수술 후 알렌드로네이트의 투여는 급격한 골밀도 감소 예방에 기여하였을 것으로 사료된다.

Keywords

References

  1. Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. 1999;353:878-82. https://doi.org/10.1016/S0140-6736(98)09075-8
  2. Randell AG, Nguyen TV, Bhalerao N, Silverman SL, Sambrook PN, Eisman JA. Deterioration in quality of life following hip fracture: a prospective study. Osteoporos Int. 2000;11:460-6. https://doi.org/10.1007/s001980070115
  3. van Staa TP, Leufkens HG, Cooper C. Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int. 2002;13:624-9. https://doi.org/10.1007/s001980200084
  4. Colon-Emeric C, Kuchibhatla M, Pieper C, et al. The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies. Osteoporos Int. 2003;14:879-83. https://doi.org/10.1007/s00198-003-1460-x
  5. Lonnroos E, Kautiainen H, Karppi P, Hartikainen S, Kiviranta I, Sulkava R. Incidence of second hip fractures. A population-based study. Osteoporos Int. 2007;18:1279-85. https://doi.org/10.1007/s00198-007-0375-3
  6. Berry SD, Samelson EJ, Hannan MT, et al. Second hip fracture in older men and women: the Framingham Study. Arch Intern Med. 2007;167:1971-6. https://doi.org/10.1001/archinte.167.18.1971
  7. Riggs BL, Melton LJ 3rd. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. 1995;17 Suppl:505-11.
  8. Reginster JY, Bruyere O, Audran M, et al. Do estrogens effectively prevent osteoporosis-related fractures? The Group for the Respect of Ethics and Excellence in Science. Calcif Tissue Int. 2000;67:191-4. https://doi.org/10.1007/s002230001135
  9. Bellantonio S, Fortinsky R, Prestwood K. How well are community-living women treated for osteoporosis after hip fracture? J Am Geriatr Soc. 2001;49:1197-204. https://doi.org/10.1046/j.1532-5415.2001.49237.x
  10. Recker RR, Gallagher R, MacCosbe PE. Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women. Mayo Clin Proc. 2005;80:856-61. https://doi.org/10.4065/80.7.856
  11. Cramer JA, Amonkar MM, Hebborn A, Altman R. Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Curr Med Res Opin. 2005;21:1453-60. https://doi.org/10.1185/030079905X61875
  12. Lyles KW, Colo'n-Emeric CS, Magaziner JS, et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007;357:1799-809. https://doi.org/10.1056/NEJMoa074941
  13. Orimo H, Sugioka Y, Fukunaga H, et al. Diagnostic criteria of primary osteoporosis. Osteoporosis Japan. 1996; 4:643- 653.
  14. Sambrook P, Cooper C. Osteoporosis. Lancet. 2006;367:2010-8. https://doi.org/10.1016/S0140-6736(06)68891-0
  15. Cranney A, Guyatt G, Griffith L, Wells G, Tugwell P, Rosen C. Meta-analyses of therapies for postmenopausal osteoporosis. IX: Summary of meta-analyses of therapies for postmenopausal osteoporosis. Endocr Rev. 2002;23:570-8. https://doi.org/10.1210/er.2001-9002
  16. Schnitzer T, Bone HG, Crepaldi G, et al. Therapeutic equivalence of alendronate 70 mg once-weekly and alendronate 10 mg daily in the treatment of osteoporosis. Alendronate Once-Weekly Study Group. Aging. 2000;12:1-12.
  17. Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA. Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am. 2000;82-A:1063-70.
  18. Rabenda V, Mertens R, Fabri V, et al. Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women. Osteoporos Int. 2008;19:811-8. https://doi.org/10.1007/s00198-007-0506-x
  19. Rietbrock S, Olson M, van Staa TP. The potential effects on fracture outcomes of improvements in persistence and compliance with bisphosphonates. QJM. 2009;102:35-42. https://doi.org/10.1093/qjmed/hcn130
  20. Harrington JT, Broy SB, Derosa AM, Licata AA, Shewmon DA. Hip fracture patients are not treated for osteoporosis: a call to action. Arthritis Rheum. 2002;47:651-4. https://doi.org/10.1002/art.10787
  21. Heaney RP, Yates AJ, Santora AC 2nd. Bisphosphonate effects and the bone remodeling transient. J Bone Miner Res. 1997;12:1143-51. https://doi.org/10.1359/jbmr.1997.12.8.1143
  22. Ravn P, Weiss SR, Rodriguez-Portales JA, et al. Alendronate in early postmenopausal women: effects on bone mass during long-term treatment and after withdrawal. Alendronate Osteoporosis Prevention Study Group. J Clin Endocrinol Metab. 2000;85:1492-7. https://doi.org/10.1210/jc.85.4.1492
  23. Chesnut CH 3rd, McClung MR, Ensrud KE, et al. Alendronate treatment of the postmenopausal osteoporosis woman: effect of multiple dosage on bone mass and bone remodeling. AM J Med. 1995;99:144-52. https://doi.org/10.1016/S0002-9343(99)80134-X
  24. Reginster JY, Adami S, Lakatos P, et al. Efficacy and tolerability of once-monthly oral ibandronate in postmenopausal osteoporosis: 2 year results from the MOBILE study. Ann Rheum Dis. 2006;65:654-61. https://doi.org/10.1136/ard.2005.044958
  25. Bone HG, Hosking D, Devogelaer JP, et al. Ten years' experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med. 2004;350:1189-99. https://doi.org/10.1056/NEJMoa030897
  26. Magnusson HI, Linden C, Obrant KJ, Johnell O, Karlsson MK. Bone mass changes in weight-loaded and unloaded skeletal regions following a fracture of the hip. Calcif Tissue Int. 2001;69:78-83. https://doi.org/10.1007/s002230020034
  27. van der Poest Clement E, van Engeland M, Ader H, Roos JC, Patka P, Lips P. Alendronate in the prevention of bone loss after a fracture of the lower leg. J Bone Miner Res. 2002;17:2247-55. https://doi.org/10.1359/jbmr.2002.17.12.2247
  28. Weinreb M, Rodan GA, Thompson DD. Osteopenia in the immobilized rat hind limb is associated with increased bone resorption and decreased bone formation. Bone. 1989;10:187-94. https://doi.org/10.1016/8756-3282(89)90052-5
  29. Pocock NA, Eisman JA, Yeates MG, Sambrook PN, Eberl S. Physical fitness is a major determinant of femoral neck and lumbar spine bone mineral density. J Clin Invest. 1986;78:618-21. https://doi.org/10.1172/JCI112618
  30. Pocock NA, Eisman JA, Hopper JL, Yeates MG, Sambrook PN, Eberl S. Genetic determinants of bone mass in adults. A twin study. J Clin Invest. 1987;80:706-10. https://doi.org/10.1172/JCI113125
  31. Cecilia D, Jodar E, Fernandez C, Resines C, Hawkins F. Effect of alendronate in elderly patients after low trauma hip fracture repair. Osteoporos Int. 2009;20:903-10. https://doi.org/10.1007/s00198-008-0767-z
  32. Cramer JA, Silverman S. Persistence with bisphosphonate treatment for osteoporosis: finding the root of the problem. Am J Med. 2006;119 Suppl:12-7.
  33. Hamilton B, McCoy K, Taggart H. Tolerability and compliance with risedronate in clinical practice. Osteoporos Int. 2003;14:259-62.
  34. Hans D, Downs RW Jr, Duboeuf F, et al. Skeletal sites for osteoporosis diagnosis: the 2005 ISCD Official Positions. J Clin Densitom. 2006;9:15-21. https://doi.org/10.1016/j.jocd.2006.05.003
  35. Mounach A, Abayi DA, Ghazi M, et al. Discordance between hip and spine bone mineral density measurement using DXA: prevalence and risk factors. Semin Arthritis Rheum. 2009;38:467-71. https://doi.org/10.1016/j.semarthrit.2008.04.001

Cited by

  1. Comparison of Femoral Morphology and Bone Mineral Density between Femoral Neck Fractures and Trochanteric Fractures in 65+ Females vol.24, pp.2, 2010, https://doi.org/10.5371/hp.2012.24.2.102