J Bone Metab.  2016 May;23(2):85-93. 10.11005/jbm.2016.23.2.85.

Difference in Bone Mineral Density Change at the Lateral Femoral Cortices according to Administration of Different Bisphosphonate Agents

• Kim S
• Bang HH
• Yoo H
• Park IH
• Yang KH
• Lim H
• Jung WS

• KMID: 2165122
• DOI: http://doi.org/10.11005/jbm.2016.23.2.85

Abstract

BACKGROUND
To retrospectively assess whether the response of subtrochanteric lateral cortex (STLC) is different according to the bisphosphonate agents in terms of bone mineral density (BMD) change.
METHODS
A total of 149 subjects, who had 2- to 4-year interval follow-up of BMD using dual energy X-ray absorptiometry (DXA), were included in this retrospective study divided into following 3 groups: control group (no consumption of any anti-osteoporotic drugs, n=38), alendronate group (naïve alendronate users, n=48), risedronate group (naïve risedronate users, n=63). BMD was measured at the STLC and subtrochanteric medial cortex (STMC) in each patient by drawing rectangular ROIs at the bone cortices. The percent change of BMD at the STLC were compared between the aforementioned 3 groups by using analysis of covariance model to control five independent variables of age, body mass index, percent change of STMC, hip axis length, time interval between DXA examinations.
RESULTS
The least square mean values±standard deviation of the percent change of BMD in the control, alendronate, and risedronate groups were 1.46±1.50, 2.23±1.26, and 6.96±1.11, respectively. The risedronate group showed significantly higher change of BMD percentage compared with the control (adjusted P=0.012) or alendronate (adjusted P=0.016) groups.
CONCLUSIONS
The percent change of BMD at the STLC in the risedronate user group was greater than the alendronate and control groups. The implication of these changes needs to be further verified.

Keyword

Alendronate; Bone density; Femur; Risedronate

MeSH Terms

Absorptiometry, Photon
Alendronate
Body Mass Index
Bone Density*
Femur
Follow-Up Studies
Hip
Humans
Retrospective Studies
Risedronate Sodium
Alendronate
Risedronate Sodium

Figure

• 

  Fig. 1 Selection of the study population. Of the 2,278 patients who underwent dual energy X-ray absorptiometry (DXA) from January 2004 through December 2012, a total of 149 patients were selected after excluding patients who were already bisphosphonate (BP) users, who underwent DXA examination just once, who were ineligible due to an inadequate follow-up period, or who had an underlying metabolic disorder or took a medication that affects bone metabolism. Among those enrolled, 38 control patients did not take a BP or other agents that can affect bone metabolism, 48 patients took alendronate, and 63 patients took risedronate at the time of the first DXA examination.

• 

  Fig. 2 Bone mineral density (BMD) measurement of the subtrochanteric cortices and measurement of the hip axis length (HAL). HAL was measured along and extended femoral neck axis until the bone edge was reached in each direction (solid line with rounded end; Faulkner 1993). The BMD of the subtrochanteric cortices were measured at both the medial and lateral cortices at the level just distal to the lesser trochanter. Rectangular regions of interest (ROIs; square 1 and 2) were drawn at the cortices. As for the width, ROIs were drawn so as not to violate the boundary of the cortices. The proximal to distal length of the ROI was unified as 1 cm.

• 

  Fig. 3 Between-group comparison of the least square means of the percentage changes in bone mineral density (BMD) of the spine and the hip. After controlling for the dependent variables, including age, body mass index (BMI), subtrochanteric medial cortex (STMC) percentage change, hip axis length (HAL), and the time interval between dual-energy X-ray absorptiometry (DXA) examinations, the control group showed a statistically significant lower percentage change in the BMD assessment of the spine (A) and hip (B) than did the risedronate and alendronate groups.

• 

  Fig. 4 Bone mineral density (BMD) assessment of the subtrochanteric lateral cortex (STLC). The risedronate group showed a statistically significant higher percentage change in the STLC BMD than the control (adjusted P=0.012) and alendronate (adjusted P=0.016) groups.

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