目的:作者试图评估特立帕肽治疗后Hounsfield单位(HU)是否增加,并通过双能X线骨密度仪(DEXA)测量比较HU增加与骨矿物质密度(BMD)的变化。
方法:从1997年到2018年,在我们机构的所有校园进行了回顾性图表审查。作者确定了接受过至少6个月特立帕肽治疗的患者,并比较了治疗前后DEXA扫描测得的HU和BMD。
结果:确定了52名患者进行分析(46名女性和6名男性,平均年龄67岁)接受平均20.9±6.5个月的特立帕肽治疗。整个腰椎(L1-4)的平均±标准偏差HU增加从109.8±53到133.9±61HU(22%,95%CI1.2-46,p值=0.039)。根据DEXA的结果,腰椎骨密度从0.85增加到0.93g/cm2(+9%,p值=0.044)。腰椎T评分从-2.4±1.5提高到-1.7±1.5(p值=0.03)。平均股骨颈T评分从-2.5±1.1提高到-2.3±1.0(p值=0.31)。
结论:特立帕肽治疗可增加腰椎DEXA的HU和BMD,股骨BMD无变化.HU的22%改善超过DEXA确定的9%改善。这些结果支持一些外科医生的主观感觉,特立帕肽治疗后的术中骨质量优于DEXA结果。就作者所知,这是第一项证明特立帕肽治疗HU增加的研究.
The authors sought to assess whether Hounsfield units (HU) increase following teriparatide treatment and to compare HU increases with changes in bone mineral density (BMD) as measured by dual-energy x-ray absorptiometry (DEXA).
A retrospective chart review was performed from 1997 to 2018 across all campuses at our institution. The authors identified patients who had been treated with at least 6 months of teriparatide and compared HU and BMD as measured on DEXA scans before and after treatment.
Fifty-two patients were identified for analysis (46 women and 6 men, average age 67 years) who underwent an average of 20.9 ± 6.5 months of teriparatide therapy. The mean ± standard deviation HU increase throughout the lumbar spine (L1-4) was from 109.8 ± 53 to 133.9 ± 61 HU (+22%, 95% CI 1.2-46, p value = 0.039). Based on DEXA results, lumbar spine BMD increased from 0.85 to 0.93 g/cm2 (+9%, p value = 0.044). Lumbar spine T-scores improved from -2.4 ± 1.5 to -1.7 ± 1.5 (p value = 0.03). Average femoral neck T-scores improved from -2.5 ± 1.1 to -2.3 ± 1.0 (p value = 0.31).
Teriparatide treatment increased both HU and BMD on DEXA in the lumbar spine, without a change in femoral BMD. The 22% improvement in HU surpassed the 9% improvement determined with DEXA. These results support some surgeons\' subjective sense that intraoperative bone quality following teriparatide treatment is better than indicated by DEXA results. To the authors\' knowledge, this is the first study demonstrating an increase in HU with teriparatide treatment.