分娩后骨质疏松及其治疗:31例临床报告  

Post-pregnancy osteoporosis and its treatment

作　　者：林华[1] 包丽华[2] 朱秀芬[1] 陈新[1] 钱程[1] 

机构地区：[1]南京大学医学院附属鼓楼医院骨病中心,南京210008 [2]江苏省人民医院,南京210029

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2010年第2期100-104,共5页Chinese Journal Of Osteoporosis And Bone Mineral Research

摘　　要：目的评价31例分娩后出现骨质疏松患者的临床表现和抗骨质疏松治疗效果。方法将31例分娩后出现骨质疏松的患者随机分为2组:阿仑膦酸钠组,16例,接受阿仑膦酸钠(福善美)70 mg,1次/周治疗;阿法骨化醇组,15例,接受阿法骨化醇(阿法迪三)0.25μg,2次/d治疗。31例患者均口服元素钙600 mg和维生素D 125 IU(钙尔奇D)600 mg,1次/d。以腰背痛和骨密度变化为观察指标,分别于治疗前和治疗半年、1年和2年随访时进行骨密度测定和X线胸腰椎正侧位摄片。结果阿仑膦酸钠组入组16人,治疗2年最终随访12人。阿法骨化醇组入组15人,治疗2年最终随访11人。经4周治疗后2组患者的腰背疼痛均有不同程度减轻。阿仑膦酸钠组患者治疗半年后腰椎骨量[(0.768±0.183)g/cm^2]与治疗前[(0.739±0.140)g/cm^2])比较明显升高,差异有统计学意义(P<0.05),治疗1年后股骨颈骨量[(0.750±0.227)g/cm^2]与治疗前[(0.728±0.175)g/cm^2]比较明显增加,差异有统计学意义(P<0.05);阿法骨化醇组患者治疗1年后腰椎骨量[(0.785±0.214)g/cm^2]与治疗前[(0.752±0.167)g/cm^2]比较明显增加,差异有统计学意义(P<0.05);治疗2年后股骨颈骨量[(0.761±0.243)g/cm^2)]与治疗前[(0.743±0.191)g/cm^2]比较明显上升,差异有统计学意义(P<0.05)。结论应重视哺乳期出现反复持续的腰背疼痛。分娩后哺乳的前5个月是骨丢失的高峰期,分娩后骨质疏松症患者服用活性维生素D和双膦酸盐后骨量明显改善,并以阿仑膦酸钠治疗骨质疏松效果显著。Objective To evaluate the clinical features and outcomes in 31 patients with post-pregnancy osteoporosis. Methods 31 subjects were randomized to either the group A or the group B. 16 patients in group A were treated by alendronate （Foxamas, 70 mg, once weekly） and 15 patients in group B were treated by alfacalcidol（AlfaD3,0.25 μg, Bid）. All patients were supplemented calcium 600 mg and VitD 125 IU daily. Clinical outcomes were changed in backache and bone mineral density （BMD）. During two years of intervention, BMD was measured by DXA on lumbar spine and proximal femur at pre-intervention, 6 months, 12 months and 24 months. Results After two years, 12 subjects in group A and 11 subjects in group B were completed the follow-up. The backache gradually relieved after four weeks treatment in both groups. There were significant differences as a result of its own comparison ： In group A, BMD on lumbar spine increased significantly （0. 768 ± 0. 183 ） g/cm^2/（0. 739 ± 0. 140） g/cm^2, P 〈 0. 05 ） at 6 months, and BMD on femoral neck increased visibly（ 0. 750 ± 0. 227 ） g/cm^2/（ 0. 728 ± 0. 175 ） g/cm^2, P 〈 0. 05 ） at 12 months ; In group B, BMD on lumbar spine increased significantly（0. 785 ± 0. 214）g/cm^2/（0. 752 ± 0. 167）g/cm^2, P 〈 0. 05 ）at 12 months, and BMD on femoral neck increased visibly （ 0. 761 ± 0. 243 ） g/cm^2/（ 0. 743 ± 0. 191 ） g/cm^2, P 〈 0. 05 ） at 24 months. Conclusion Repeated and persistent back pain during the first pregnancy and lactation in women should be pay more attention. BMD loss was higher during the first 5 months following delivery in the lactating women. The effect of alendronate sodium treatment for pest-pregnancy osteoperosis is obvious.

关 键 词：妊娠 骨质疏松 阿仑膦酸钠 治疗 

分 类 号：R683[医药卫生—骨科学]