Observation on application effect of denosumab in elderly patients with osteoporotic vertebral compression fracture

English Keywords:Osteoporotic vertebral compression fracture  Elderly  Denosumab injection  Bone mineral density  Bone metabolism

English Abstract:

  【Abstract】 Objectives: To observe the effect of applying denosumab after percutaneous vertebroplasty(PVP) in the treatment of osteoporotic vertebral compression fracture(OVCF) in elderly patients. Methods: 217 elderly patients(male 84, female 133; aged 60-80 years old) with OVCF who received PVP in the hospital from October 2022 to January 2024 were selected and numbered according to the order of admission, and they were divided into control group(n=73), zoledronic acid sodium group(n=72) and denosumab group(n=72) at a ratio of 1:1:1 by random number table method. The control group was treated with calcium carbonate D3 tablets and calcitriol capsules(oral administration, 1 tablet/capsule every day for 12 months) after surgery, and the zoledronic acid sodium group was added with zoledronic acid sodium injection(5mg, intravenous infusion, once every 12 months) on the basis of the control group, and the denosumab group was treated with denosumab(60mg, subcutaneous injection, once every 6 months) based on the control group. The pain visual analog scale(VAS) score, bone mineral density, bone metabolism indicators such as serum beta collagen degradation products(β-CTX) and procollagen type Ⅰ N-terminal propeplide(PⅠNP), Oswestry disability index(ODI) and fracture recurrence rate were compared between the three groups before treatment and at 6 months and 12 months after treatment. Results: 3 cases were lost in the control group, and 2 cases were lost in both zoledronic acid sodium group and denosumab group. Finally, 70 patients were enrolled in each group. There were no statistical differences in gender ratio, age and fracture site between the three groups(P>0.05). No significant differences were found in VAS score, bone mineral density, serum β-CTX, PⅠNP and ODI between the three groups before treatment(P>0.05). At 6 months and 12 months after treatment, the VAS score and ODI score in the three groups of patients were significantly improved compared with those before surgery(P<0.05), and the improvements in denosumab group were better than those in zoledronic acid sodium group and control group(P<0.05). The levels of serum β-CTX and PⅠNP in denosumab group and zoledronic acid sodium group at 6 months and 12 months after treatment were significantly decreased(P<0.05) while the bone mineral density was significantly increased(P<0.05), and there were no significant changes in control group(P>0.05). After treatment, serum β-CTX and PⅠNP in denosumab group were lower than those in zoledronic acid sodium group(P<0.05), while the bone mineral density was significantly higher than that in zoledronic acid sodium group(P<0.05). The incidence rate of fracture recurrence in denosumab group(4.29%) was significantly lower than that in control group(17.14%) at 12 months after treatment(P<0.05), and there was no significant difference compared to zoledronic acid sodium group(P>0.05). Conclusions: Denosumab injection after PVP in elderly patients with OVCF can relieve pain, reduce the levels of bone metabolism indicators, enhance the bone mineral density, relieve the lumbar dysfunction and reduce the fracture recurrence rate.