| Objectives To investigate the therapeutic effect of alendronate combined with calcitriol and calcium on bone mineral density(BMD)and hip mechanical structure parameters in patients with rheumatoid arthritis(RA)and osteoporosis(OP)and to analyze the effect of RA osteoporosis therapy.Methods 120 patients diagnosed with OP in the osteoporosis outpatient and inpatient departments of the Affiliated Hospital of North China University of Technology from June 2015 to December 2021 were included and were divided into two groups(RA+OP group,n=60 and OP group,n=60).Patients in both groups were given the anti-OP combination of alendronate(70mg/dose,1 time/week),calcitriol(0.25μg/dose,1 time/day)and calcium(600 mg/does,1 time/day)for 12 months.General data such as age,sex,height,weight,and fracture history before treatment were recorded for all included individuals,and patients in the RA+OP group were required to record RA disease and treatment history(including data on disease duration,clinical signs,serum factors and inflammatory indexes,and RA medications).The data of lumbar spine(L1-L4,total lumbar spine)BMD,hip(femoral neck and total hip)BMD and hip mechanical structural parameters were compared between the two groups before treatment,at 6 months and 12 months of treatment.The main parameters included femoral neck cross-sectional area(CSA),cross-sectional moment of rotation(CSMI),cross-sectional modulus(Z),cortical thickness(CT)and bending ratio(BR).All subjects were monitored for serum chemistries(including blood calcium,phosphorus,parathyroid hormone and other indicators)and adverse drug reactions during treatment.Results 1 Before treatment,there was no significant difference in the baseline values of general information,bone mineral density and mechanical structural parameters of the femoral neck between the RA+OP and OP groups(P>0.05).2 After 6 and 12 months of treatment,the lumbar BMD,femoral neck BMD,CSA,CSMI,Z,and CT values were significantly higher and the BR values were significantly lower in both groups than before treatment,except for no increase in total hip BMD in the RA+OP group(P>0.05),and the differences were statistically significant(P<0.05).3 After 6 months of treatment,there was no statistical difference between all values in the two groups(P>0.05).After 12 months of treatment,the femoral neck BMD,total hip BMD,CSA,CSMI,and Z values were significantly lower in the RA+OP group(P<0.05),and there was no statistical difference between the other values of the two groups(P>0.05).4 The total hip BMD growth values after 6 and 12 months of treatment and CSA growth values after 12 months of treatment in the RA+OP group were lower than those in the OP group,and there were no significant differences in the change values of other parameters between the two groups(P>0.05).5 During the treatment period,the BMD growth rate of the lumbar spine was significantly higher than that of the hip in both groups(P<0.05).No statistical difference in the rate of change in the values of all parameters between the two groups during the period 0-6 months of treatment(P>0.05).The growth rates of total hip BMD,femoral neck BMD,CSA,CSMI,and Z values during treatment 6-12 and total hip BMD,CSA,and CSMI values during treatment 0-12 months were significantly lower in the RA+OP group than in the OP group,and the difference was statistically significant(P<0.05).6 After treatment,the incidence of fracture decreased in both groups,and the clinical signs(morning stiffness,joint pain,swelling)and serum laboratory indices of patients in the RA+OP group were better than before.7 There were 19 cases in the RA+OP group who received hormone therapy.After treatment,the femoral neck BMD and femoral neck structural parameters remained stable in hormonal RA patients(P>0.05)but were significantly elevated in hormone-free RA patients(P<0.05).However,there was no difference in BMD and hip structural parameters between the two groups of RA patients at all sites(P>0.05).Conclusions 1 The combination of anti-OP drugs significantly improved the bone density of the lumbar spine and femoral neck in patients with RA and OP,and the improvement was better for the lumbar spine than for the hip.It was equally significant for the enhancement of the mechanical parameters of the femoral neck bone strength.2RA delayed the improvement of total hip BMD and femoral neck bone strength in patients treated with anti-OP combination drugs,and it is crucial to enhance prevention of hip fracture in RA patients.3 Hip mechanical structural parameters can be a useful supplement to the evaluation of bone quality in addition to BMD in RA patients after anti-OP therapy.Figure0;Table16;Reference 141... |
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