双膦酸盐类药物治疗骨质疏松症  

Effects of bisphosphonates in treatment of women with osteoporosis

作　　者：林华[1] 包丽华[2] 韩祖斌[1] 陈新[1] 孙燕芳[1] 

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

出　　处：《中国骨质疏松杂志》2004年第1期77-79,124,共4页Chinese Journal of Osteoporosis

基　　金：南京市医学科技重点发展基金资助项目(ZKG9913)

摘　　要：目的 评价不同类型双膦酸盐药物的临床疗效。方法 骨质疏松妇女360人,随机分成3组,所有患者每天在接受元素钙500 mg和维生素D200IU治疗的同时,分别接受羟乙膦酸钠、阿伦膦酸钠和利塞膦酸钠治疗,其中羟乙膦酸钠200 mg,bid,用2周,间歇11周后再次重复;阿伦膦酸钠10mg,qd;利塞膦酸钠5 mg,qd。3种药物治疗时间均为1年。观察内容包括:骨痛,尿N肽端交联Ⅰ型胶原,NTx和血清骨碱性磷酸酶,BAP,骨密度,不良反应,脊柱新骨折。结果 3组患者经1年治疗,与用药前比较,骨痛症状均有不同程度改善;骨代谢指标N肽端交联Ⅰ型胶原和骨碱性磷酸酶均明显下降(P<0.01);腰椎和髋部骨量均有显著上升(P<0.01):其中阿伦膦酸钠治疗组骨密度腰椎L2-4上升5.51％,股骨颈上升2.66％,股骨粗隆上升4.37％,Ward’s区上升3.13％;利塞膦酸钠治疗组骨密度腰椎L2-4上升4.18％,股骨颈上升2.05％,股骨粗隆上升2.81％,Ward’s区上升3.08％;羟乙膦酸钠治疗组骨密度腰椎L2-4上升3.70％,股骨颈上升1.84％,股骨粗隆上升1.96％,Ward’s区上升1.50％;新骨折发生羟乙膦酸钠组4人,阿伦膦酸钠和利塞膦酸钠组均为1人;各组均未见明显不良反应。 结论双膦酸盐治疗骨质疏松症疗效确切,新型双膦酸盐阿伦膦酸钠和利塞膦酸钠更方便、高效。Objective To study the clinical efficacy of bisphosphonates in treatment of postmenopausal os-teoporotic women. Methods A total of 360 postmenopausal women with lumbar spine bone mineral density (BMD) 2.5SD or more below the mean BMD in young adults were randomly divided into three groups, 120 in each:to group A, etidronate 200mg was given twice per day for 2 weeks at 11 weeks intervals; to group B, alendr-onate 10mg per day; and to group C, risedronate 5mg per day. All patients received cacium 500mg and Vit amin D 200IU daily. During one year of treatment, bone pain, markers of bone turnover(urinary N-telopeptide and serum bone-specific alkaline phosphatase), BMD, side-effect, and fresh vertebral fracture were assessed in every patient. Results Bone pain and quality of life improved significantly, marerks of bone turnover decreased, and BMD of lumbar spine(L2-4) and hip(fencoral neck, trochanter and Ward's friangle) significanty increased in all groups (alendronate group, L2-4 5.51% , fenoral neck 2.66% , trochanter 4.37% , Ward's friangle 3.13% ; re-sedronate group, L2-4 4.18% , fenoral neck 2.05%, trochanter 2.81%, Ward's friangle 3.08%; etidronate group, L2-4 3.70% , fenoral neck 1.84% , trochanter 1.96% , Ward' s friangle 1.50% ). Fresh vertebral fractures were seen in 4 patients in etidronate group, 1 patient in alendronate group and 1 patient in risedronate group. No serious side-effects were seen in any of the patients during follow-up. Conclusion Bisphosphonates have good clinical effects on postmenopausal osteoporosis; alendroniate and risedronate have higher efficacy.

关 键 词：双膦酸盐类药物 药物治疗 骨质疏松症 维生素D 羟乙膦酸钠 阿伦膦酸钠 利塞膦酸钠 

分 类 号：R681[医药卫生—骨科学]