骨质疏松症患者治疗好转停药后最佳再评估时间  

Best time to re-evaluate the treatment of osteoporosis after discontinuation of bisphosphonate when osteoporosis was improved

作　　者：谷文莎 潘凌[1] 游利[1] 陈瑾瑜[1] 陈琳[1] 彭永德[1] 

机构地区：[1]上海交通大学附属第一人民医院内分泌代谢科(骨质疏松专科),上海200080

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2016年第4期346-352,共7页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：上海市自然科学基金(13ZR1433700)

摘　　要：目的通过分析骨质疏松症患者使用抗骨质疏松药物治疗好转停药后骨密度和骨转换指标的变化,探讨骨质疏松症患者停药后的最佳评估时间。方法收集2008年8月至2011年10月134例在上海市第一人民医院骨质疏松门诊初诊为骨质疏松症(T值≤-2.5),并使用双膦酸盐药物治疗(疗程≥3年)好转停药后的患者,根据评估时间将患者分为3组:A组停药6个月评估(n=62例);B组停药12个月评估(n=55例);C组停药6个月和12个月均评估(n=17例)。回顾性分析所有被纳入者的年龄、体质量指数(body mass index,BMI)、用药时间、治疗终点和停药后不同时间的骨密度(bone mineral density,BMD)、血钙、血磷、血清25羟维生素D(25 hydroxy-vitamin D,25OHD)、骨钙素(bone gamma-carboxyglutamic-acid-containing proteins,BGP)和Ⅰ型胶原交联羧基末端肽(cross-linked carboxy-terminal telopeptide of typeⅠcollagen,CTX)等临床资料。结果 62例停药6个月评估患者,腰椎、股骨颈和全髋骨密度[分别为(1.063±0.13)、(0.817±0.08)和(0.896±0.080)g/cm2]较治疗终点的基线骨密度均有降低趋势,其中腰椎和全髋骨密度变化,差异有统计学意义(P<0.05),但变化值小于骨密度仪的最小有意义变化值(least significant change,LSC),则无临床意义。55例停药12个月评估患者,腰椎、股骨颈、全髋骨密度[分别为(1.071±0.09)、(0.815±0.08)和(0.887±0.07)g/cm2]较治疗终点的基线骨密度降低更为明显,其中腰椎、全髋骨密度变化差异有统计学意义(P<0.05);股骨颈骨密度有明显的降低(P=0.085)。17例停药6个月和12个月均评估的患者,停药6个月时腰椎、股骨颈、全髋骨密度有降低趋势,停药12个月的骨密度相对于停药6个月的骨密度进一步降低。各组患者的骨转换指标(bone turnover marker,BTM)较治疗终点的基线骨转换指标均有明显的上升,且差异均有统计学意义(P<0.05)。结论骨质疏松患者治疗好转停药1年时评估骨Objective To investigate the changes of bone mineral density and bone turnover biomarker after dis- continuation of treatment when osteoporosis was improved, and to explore the best time to assess the changes of bone mineral density and bone turnover marker after drug withdrawal. Methods Collecting these osteoporotic out-patients （T ≤2. 5 ） from 2008 August to 2011 October in Shanghai First People＇s hospital treated with bisphosphonate more than or equal to 3 years. Group A ： assessment of patients after drug withdrawal for 6 months （ n = 62） ; Group B ： assessment of patients after drug withdrawal for 12 months （ n = 55 ） ; Group C ： assessment of patients after drug withdrawal for 6 months and 12 months （n = 17 ）. All clinical data included the age, body mass index （BMI） , treatment time, bone mineral den- sity （BMD）, serum calcium, serum phosphorus, serum 25 hydroxyvitamin D （25-OHD）, bone gamma-carboxyglutamic- acid-containing proteins （BGP） , type I collagen cross-linked carboxy terminal peptide （CTX） and so on at the end of therapy and after discontinuation. Results Group A： compared to baseline, the lumbar vertebrae, femoral neck and to- tal hip bone mineral densities were decreased after drug withdrawal for 6 months （ P 〈 0.05 ） ; But the changes were less than the least significant change （LSC） , then these changes had no clinical significance. Group B ： compared to baseline, the lumbar vertebrae, total hip bone mineral densities were significantly decreased after drug withdrawal for 12 months （P 〈0. 05）. After drug withdrawal for 6 months and 12 months, bone mineral densities of lumbar spine, femoral neck and hip were decreased. Compared to baseline, bone turnover markers （BTM） were increased significantly （ P 〈 0. 05 ）. Conclusion Assessment of bone mineral density and bone turnover after discontinuation of bisphosphonate for 12 months is advantageous to early prediction and assessment of the outcome.

关 键 词：骨质疏松症 停药时限 骨密度 骨转换 

分 类 号：R681[医药卫生—骨科学]