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目的 探讨不同抗骨质疏松药物治疗对急性骨质疏松性脊柱骨折(osteoporotic spinal fracture, OSF)后放射学特征和临床结果的影响。方法 前瞻性纳入120例拟接受保守治疗的老年OSF病人,根据随机数字表将病人分为对照组(40例)、骨吸收抑制剂组(40例)和甲状旁腺激素(parathyroid hormone, PTH)组(40例),分别在保守治疗的基础上接受安慰剂、双膦酸盐、特立帕肽治疗3个月。比较三组病人治疗前后的数字分级法(numerical rating scale, NRS)疼痛评分、Oswestry功能障碍指数(Oswestry disability index, ODI)、骨折椎体高度丢失比、后凸角和椎骨隐裂(intravertebral cleft, IVC)发生情况。结果 经过3个月治疗,PTH组的NRS评分、ODI均明显低于对照组和骨吸收抑制剂组,骨吸收抑制剂组的上述指标也显著低于对照组,差异均有统计学意义(P均<0.05)。PTH组和骨吸收抑制剂组的椎体高度丢失比均低于对照组,差异均有统计学意义(P均<0.05);但骨吸收抑制剂组和PTH组比较,差异无统计学意义(P>0.05)。三组病人治疗后的后凸角比较,差异无统计学意义(P>0.05)。PTH组的IVC发生率显著低于对照组(P<0.05),但骨吸收抑制剂组和对照组比较,差异无统计学意义(P>0.05)。单因素及多因素Logistic回归分析显示MRI Ⅱ型[OR=3.531,95% CI(2.300,5.628),P<0.001]是导致骨折愈合不良的独立危险因素,PTH[OR=0.826,95% CI(0.703,0.966),P=0.018]和骨吸收抑制剂[OR=0.853,95% CI(0.768,0.962),P=0.006]是预防骨折愈合不良的独立保护性因素。结论 PTH类合成代谢药物可以有效促进骨折愈合、减少椎体塌陷,并显著减轻病人疼痛和促进脊柱功能恢复。  相似文献   
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In subjects older than 50 years, the presence of clinical risk factors (CRFs) for fractures or a recent fracture is the cornerstone for case finding. In patients who are clinically at high short- and long-term risk of fractures (those with a recent clinical fracture or with multiple CRFs), further assessment with bone mineral density (BMD) measurement using dual-energy absorptiometry (DXA), imaging of the spine, fall risk evaluation and laboratory examination contributes to treatment decisions according to the height and modifiability of fracture risk. Treatment is available with anti-resorptive and anabolic drugs, and from the start of treatment a lifelong strategy is needed to decide about continuous, intermittent, and sequential therapy. Implementation of guidelines requires further initiatives for improving case finding, public awareness about osteoporosis and national policies on reimbursement of assessment and therapy.  相似文献   
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Antiresorptive drugs are widely used to prevent osteoporotic fractures in men and women. Large clinical trials have shown vertebral fracture risk reductions up to 50%, resulting from relatively small increases of 3–8% in bone mineral density (BMD). We developed a computer model that mimics bone turnover in human vertebral cancellous bone during menopause and antiresorptive treatment. This model links cell activity in trabeculae to changes in bone volume and mechanical properties. We asked whether treatment started shortly after menopause is better than treatment started late after menopause. In order to answer this question we used the model to simulate menopause and 5 years of anti-resorptive treatment with two different agents: one incorporated in the tissue, one not incorporated. We found that late treatment can result in almost the same bone mass as early treatment, but early treatment is much better in conserving the strength and stiffness of the cancellous bone. The effect of the incorporation of drugs in the tissue (giving the drugs a long half-life) was small. After discontinuation of treatment, bone was lost slower, but after 20 years the difference between the incorporated and the not incorporated drug in stiffness and bone volume was below 3%. This kind of simulation model may be used to preclinically test new pharmaceuticals and treatment protocols and to predict long-term effects of treatment before patient data become available.  相似文献   
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骨质疏松症的药物治疗   总被引:1,自引:0,他引:1  
骨质疏松症是一种骨退行性病变,其发生主要与骨吸收和骨重建失衡有关。根据骨质疏松症的发病机制的不同,临床治疗药物主要分为基本补充剂、抗骨吸收药物和促骨形成药物。钙剂和维生素D是药物治疗的基础;抗骨吸收药物包括双磷酸盐、雌激素及其受体调节剂、降钙素;甲状旁腺激素为促骨形成药物;锶盐、维生素K2等兼有抗骨吸收和促骨形成的作用。特殊人群以及不同类型的骨质疏松症治疗要注意药物的适用性和针对性。  相似文献   
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SUMMARY Calcitonin (CT) and other bone-active peptides have been restrained in clinical use by the need for parenteral administration. Although nasal and other transmucosal routes can be used for CT treatment, bioavailability and bioactivity of the peptide thus delivered are limited. We have evaluated the intrapulmonary route (IP) for the delivery of salmon calcitonin (SCT) in normal subjects. SCT was administered with a dry powder delivery inhaler. For comparison, each subject also received intramuscular (IM) SCT. Inhaled SCT produced significant hypocalcemia in all subjects as did injected SCT, and the peptide could be readily measured in serum by immunoassay. Compared by dose, IP SCT had 66% of the bioactivity and 28% of the bioavailability of IM SCT. This intrapulmonary route of administration should enhance the clinical acceptability of SCT and could also be applicable to other bone-active peptides. Received: 16 December 1996 / Accepted: 25 April 1997  相似文献   
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Bisphosphonates reduce the risk of major osteoporotic fractures and are the most commonly used medications for the prevention and treatment of osteoporosis. Although these medications are well tolerated and safe during large-scale clinical trials, several rare and serious adverse events are suspected to be associated with long-term bisphosphonate use. These adverse events include osteonecrosis of the jaw, atypical fractures, and esophageal cancer. This review summarizes studies examining the association between bisphosphonate use and these adverse outcomes, with a focus on large case series and controlled epidemiologic studies.  相似文献   
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Major advancements in the treatment of osteoporosis have occurred over the last decade. Therapies including the anti-resorptive drugs such as alendronate and risedronate have been shown in randomized placebo-controlled trials to increase bone mineral density and reduce fracture risk. Anabolic therapy in the form of parathyroid hormone has been introduced as the first treatment to build bone mass. However, gaps in our knowledge about specific management issues that arise frequently among primary care providers persist. In this paper, three common clinical scenarios are discussed: a postmenopausal woman with only slightly reduced bone mineral density; an osteoporotic woman on anti-resorptive therapy for more than 5 years; and a woman who continues to fracture despite treatment. Evidence gaps in each treatment scenario are presented, and rational approaches to management are suggested.  相似文献   
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