阿仑膦酸钠对类风湿关节炎合并骨质疏松患者骨强度的影响

目的 分析阿仑膦酸钠对类风湿关节炎（rheumatoid arthritis，RA）合并骨质疏松（osteoporosis，OP）患者骨强度的影响。方法 选取华北理工大学附属医院骨质疏松门诊2012年6月至2020年6月诊治的OP患者120例，分为RA+OP组（60例）和OP组（60例），且均口服阿仑膦酸钠联合骨化三醇、钙尔奇D持续12个月。比较治疗前后表征髋部力学结构强度的参数值CSA、CSMI、Z、CT和BR值（分别代表股骨颈抗轴向压缩力、骨骼刚度、抗屈曲负荷系数、皮质骨厚薄及屈曲比）、骨密度（BMD）、骨折发生率、炎性指标及临床体征。结果 经治疗6月、12月后，除RA+OP组全髋部位BMD外，OP组全髋、两组患者腰椎、股骨颈BMD、CSA、CSMI、Z、CT值均高于治疗前（P＜0.05），BR值均低于治疗前（P＜0.05）；治疗12月后，RA+OP组股骨颈、全髋BMD、CSA、CSMI、Z值均低于OP组（P＜0.05），腰椎BMD、CT、BR值无差异；治疗6至12月期间，RA+OP组股骨颈、全髋BMD增长率低于OP组（P＜0.05）；RA+OP组治疗前骨折发生率显著高于OP组，所有RA患者疾病活动性控制良好。结论 阿仑膦酸钠联合骨化三醇和钙剂可明显提升RA患者骨密度及髋部骨强度，提高骨骼稳定性，这种提升随疗程延长比正常骨质疏松患者缓慢。

Effect of alendronate on bone strength in patients with rheumatoid arthritis and osteoporosis

Objective To analyze the effect of alendronate on bone strength in patients with rheumatoid arthritis (RA) and osteoporosis (OP). Methods A total of 120 OP patients diagnosed and treated in Osteoporosis Clinic of the Affiliated Hospital of North China University of Science and Technology from June 2012 to June 2020 were selected and divided into RA+OP group (60 cases) and OP group (60 cases) accordingly. Patients in both groups received alendronate combined with calcitriol and Calcic D for 12 months. The changes of CSA, CSMI, Z, CT, BR, BMD, fracture incidence, inflammatory indicators and clinical signs were compared before and after the treatment. Results After 6 months and 12 months of treatment, except for total hip BMD in RA + OP group, BMD of the lumbar spine and femoral neck, CSA, CSMI, Z, and CT values in both groups and BMD of the total hip in OP group were all higher than those before the treatment (P<0.05), and BR values were lower than before (P<0.05). After 12 months, BMD of the femoral neck and total hip, CSA, CSMI, and Z values in the RA+OP group were lower than those in the OP group (P<0.05), and there was no difference in BMD of the lumbar spine, CT, and BR values. From 6 to 12 months, the BMD growth rate of the femoral neck and total hip in the RA+OP group was lower than that in the OP group (P<0.05). The incidence of fractures before treatment in the RA+OP group was significantly higher than that in the OP group. The disease activity of all RA patients was well controlled. Conclusion Alendronate combined with calcitriol and calcium significantly increases bone mineral density and hip bone strength of patients with RA and OP, and improves the bone stability. This increase may be slower than that in normal osteoporosis patients with the extension of the treatment course.