1例老年混合型骨质疏松伴骨痛的药物治疗及相关文献复习  

A CASE OF DRUG THERAPY ABOUT THE OLD AGE MIXED PATTERN OSTEOPOROSIS COMBINED WITH OSTALGIA PATIENT AND LITERATURE REVIEW

作　　者：刘可欣[1] 朱兰[1] 唐尧[1] 

机构地区：[1]四川大学华西医院药剂科,成都610041

出　　处：《现代预防医学》2011年第4期785-787,共3页Modern Preventive Medicine

摘　　要：[目的]针对1例老年混合型骨质疏松伴骨痛患者,检索当前最佳证据,为患者实施药物治疗或姑息手术治疗提供依据,力争减少患者症状,提高生活质量。[方法]按PICO原则,将临床问题转化为可回答的形式,通过计算机系统检索Cochrane Library(2008.8)、MEDLINE(1950.1～2008.8)和ACP Journal Club(1991.1～2008.8)等数据库,查找与骨质疏松伴骨痛治疗相关的系统评价和随机对照试验,并对相关证据进行评价。[结果]降钙素和双膦酸盐均能有效缓解骨痛、骨质疏松等症状,更多文献显示增加骨密度方面双磷酸盐疗效确切,降钙素在这方面证据欠缺。但在减少疼痛方面起效迅速,证据优于双膦酸盐。但骨质疏松治疗方案目前还仅仅是经验性治疗,不同地区差异明显,应结合患者情况进行考虑。最终,我们以文献检索结果为基础,告知患者及家属不同治疗方案的优势和副作用,征得患者及家属同意,为患者制定了个体化治疗方案。[结论]对混合性骨质疏松伴骨痛患者,当前证据显示以减轻患者疼痛症状,降钙素治疗有效,但是否采用双膦酸盐口服增加骨密度,远期治疗效果上还缺乏大样本的随机对照试验。应充分考虑患者情况和医生临床经验进行用药。[Objective] To aim directly at a case of aged patient with mixed pattern osteoporosis combined with ostalgia,to search optimization evidence at present,supply evidence for carrying out drug treatment or palliative operation.To reduce symptom of patient and elevate quality of patient＇s life.[Methods] According to the PICO principle,converted clinical problem to answer style.Retrieved the Cochrane Library（2008.8）,MEDLINE（1950.1-2008.8） and ACP Journal Club（1991.1-2008.8） by computer.Searched system evaluation and randomized controlled trial,then evaluated the related evidence.[Results] Both calcitionin and diphosphonate can relieve symptom about bone ache and bone rarefaction,but diphosphonate was found more useful in many literature.However,calcitionin decreased the bone ache more quickly than diphosphonate.We based on literatures,combined the all information of patient,told advantages and disadvantages about every program to patient and relatives,then gave an individualized treatment.[Conclusion] The evidence shows calcitionin is useful for abating bone ache,but whether to use diphosphonate to increase bone lacks of large sample randomized controlled trial,so we should consider medication after thinking over the information of patient and clinical experience form doctor.

关 键 词：骨质疏松 骨痛 降钙素 双膦酸盐 

分 类 号：R969[医药卫生—药理学]