阿仑膦酸钠治疗绝经后骨质疏松症50例临床观察

目的观察阿仑膦酸钠对绝经后骨质疏松症的治疗效果与安全性。方法100例绝经后骨质疏松症患者，随机分为治疗组及对照组各50例，两组在年龄、体重指数（BMI）、绝经年限等方面差异均无显著性（p〉0．05）。治疗组服用阿仑膦酸钠片10mg／d，每日早餐前至少30min空腹用200ml以上温开水送服，服药后至餐前保持立位，对照组每晚服钙尔奇（含元素钙500mg和VitD3）1片，两组受试者均连续服药12个月。观察骨痛、骨密度变化及安全性指标。结果治疗后治疗组骨痛症状评分下降，骨痛缓解，腰椎1～4及股骨颈、大转子和Ward氏三角区的骨密度增加与对照组比较差异有显著性；治疗期间无新骨折发生；服药前后血、尿、便常规及肝肾功能、电解质结果均在正常范围内波动，消化道反应轻均能耐受未停药。结论阿仑膦酸钠对绝经后骨质疏松症具有缓解骨痛浪高生活质量、增加骨密度、降低再骨折发生的作用，是有效、安全的药物。     

阿仑膦酸钠治疗绝经后骨质疏松症的临床观察

目的研究绝经后骨质疏松症与血清白细胞介素-6 (IL-6)及肿瘤坏死因子-α(TNF-α)浓度的关系,并探讨阿仑膦酸钠的治疗效果。方法选取2014年2月-2016年3月该院收治的绝经后骨质疏松症患者82例(观察组),另取同期绝经后非骨质疏松症妇女82例(对照组),分别对比两组血清IL-6及TNF-α水平。同时对绝经后骨质疏松症患者予以阿仑膦酸钠治疗,比较治疗前后患者肝肾功能、骨代谢指标以及骨密度水平变化情况。结果观察组妇女血清IL-6及TNF-α水平均高于对照组,差异均有统计学意义(均P<0. 05)。观察组患者治疗前谷丙转氨酶(ALT)、谷草转氨酶(AST)、尿素氮(BUN)、尿肌酐(Cr)水平分别与治疗后比较,差异均无统计学意义(均P> 0. 05)。观察组患者治疗后碱性磷酸酶(ALP)、骨钙素(BGP)、尿Ⅰ型胶原N端肽(NTX)水平均低于治疗前(均P<0. 05)。观察组患者治疗后腰椎L2～L4、股骨颈、Wards三角骨密度均高于治疗前(均P<0. 05)。结论血清IL-6及TNF-α水平在绝经后骨质疏松症的发生、发展过程中发挥着极其重要的作用,而阿仑膦酸钠治疗绝经后骨质疏松症的效果显著。     

治疗绝经后骨质疏松症的良药——阿仑膦酸钠

骨质疏松症是老年人的五大常见病之一。此病患者多为绝经后的女性。临床实践证实，绝经后的骨质疏松症患者除了应使用雌激素替代疗法、补充钙剂和维生素D以外，还可根据病情的轻重选用骨吸收抑制剂双膦酸盐制剂进行治疗。     

阿仑膦酸钠序贯唑来膦酸对围绝经期骨质疏松症患者骨代谢相关指标的影响

目的探究阿仑膦酸钠序贯唑来膦酸对围绝经期骨质疏松症患者骨代谢相关指标的影响。方法选取2018年1月—2022年1月天津市第五中心医院收治的围绝经期骨质疏松症患者100例为研究对象,随机分为对照组和观察组,每组各50例。对照组患者口服阿仑膦酸钠治疗,观察组患者采用阿仑膦酸钠序贯静滴唑来膦酸治疗,两组患者均治疗12个月。比较两组患者治疗前、治疗12个月后各部位骨密度、骨代谢、生化指标及生活质量评分的差异,并评价治疗的安全性。结果治疗12个月后,观察组患者腰椎1~4、股骨颈及全髋骨密度分别为(0.79±0.07)g/cm^(2)、(0.72±0.02)g/cm^(2)及(0.83±0.04)g/cm^(2),对照组患者分别为(0.73±0.05)g/cm^(2)、(0.70±0.03)g/cm^(2)及(0.76±0.10)g/cm^(2),观察组患者上述部位骨密度均大于对照组,差异均有统计学意义(t=4.932、3.922及4.596,均P<0.05)。治疗12个月后,观察组患儿血清骨碱性磷酸酶(BALP)、抗酒石酸酸性磷酸酶-5b(TRACP-5b)、Ⅰ型胶原C端肽(CTX-Ⅰ)及骨钙素(BGP)水平分别为(20.19±3.18)μg/L、(3.85±1.04)U/L、(0.27±0.10)μg/L及(9.80±0.78)μg/L,对照组患者分别为(24.10±3.90)μg/L、(5.00±1.34)U/L、(0.41±0.12)μg/L及(8.00±0.12)μg/L,观察组患者BALP、TRACP-5b及CTX-Ⅰ水平均低于对照组,BGP水平高于对照组,差异均有统计学意义(t=5.494、4.794、6.338及9.912,均P<0.05)。治疗12个月后,观察组患者血清钙(Ca)、磷(P)、甲状旁腺激素(PTH)及25羟维生素D[25-(OH)D]水平分别为(2.34±0.05)mmol/L、(1.19±0.05)mmol/L、(31.40±6.25)pg/ml及(33.14±6.23)ng/ml,对照组患者分别为(2.29±0.08)mmol/L、(1.15±0.08)mmol/L、(35.68±7.31)pg/ml及(30.54±8.27)ng/ml,观察组患者Ca、P及25-(OH)D水平均高于对照组,PTH水平低于对照组,差异均有统计学意义(t=3.748、2.998、2.093及3.147,均P<0.05)。治疗12个月后,观察组患者社会功能、心理状态、活力及身体疼痛评分分别为(74.62±7.00)分、(73.65±7.27)分、(75.10±6.00)分及(80.00±4.18)分,对照组患者分别为(65.10±4.39)分、(63.29±6.30)分、(66.59±6.43)分及(71.26±5.90),观察组患者社会功能、心理状态、活力及身体疼痛评分均高于对照组,差异均有统计学意义(t=8.147、7.615、6.842及8.547,均P<0.05)。两组患者不良反应的发生率(10.00%vs.14.00%)比较,差异无统计学意义(χ^(2)=0.379,P>0.05)。结论阿仑膦酸钠序贯唑来膦酸治疗可提高围绝经期骨质疏松症患者的骨密度,改善其骨代谢和生化指标,不良反应发生率较低,具有较高的临床应用价值。     

利塞膦酸钠在防治退休护士绝经后骨质疏松症中的作用

骨质疏松症已成为危害老年人健康的主要慢性病之一，其治疗主要通过抑制骨吸收及促进骨形成。护士这个职业在我国几乎都是女性，她们在退休后容易患骨质疏松症，既往常用雌激素替代治疗(HRT)来防治骨质疏松症，但2002-07美国停止对健康绝经期后妇女激素替代治疗的临床试验，因HRT可使乳腺癌、冠心病、脑卒中等的发病率增加。为此有必要观察其他副作用少的防治骨质疏松药物。     

治疗绝经后骨质疏松症的临床分析

目的探讨阿法骨化醇联合阿仑膦酸钠治疗绝经后骨质疏松症的临床疗效。方法选取2010年2月至2012年2月间于万宁市妇幼保健院接受诊断和治疗的绝经后骨质疏松症患者84例,随机分为观察组与对照组,每组42例。对照组给予常规补钙治疗,观察组给予阿法骨化醇联合阿仑膦酸钠治疗。治疗周期6个月,比较两组患者骨密度值及临床疗效情况。结果观察组患者治疗后的骨密度值为（0．94±0．11）g/cm2,明显高于治疗前的（0．82±0．08）g/cm2和对照组的骨密度值（0．84±0．08）g/cm2（t值分别为9．131、8．441,均P＜0．05）。观察组治疗的显效率为66．67％,明显高于对照组的28．58％（χ2＝9．784,P＜0．05）;无效率为9．52％,明显低于对照组的35．71％（χ2＝8．561,P＜0．05）。结论阿法骨化醇联合阿仑膦酸钠治疗绝经后骨质疏松症临床疗效显著,值得推广应用。     

阿伦膦酸钠治疗原发性骨质疏松症的疗效分析

目的观察阿伦膦酸钠治疗原发性骨质疏松症的疗效。方法选择原发性骨质疏松患者138例,年龄40～91岁,连续服用国产阿伦膦酸钠10mg/d,6～36月,观察治疗前后患者症状、骨密度变化和安全性。结果治疗后患者骨痛缓解,活动能力增加;骨密度明显上升,骨密度平均增长率分别为3.23%(Neck)、5.19%(Troch)、4.48%(Inter)、4.18%(Total)和11.59%(Ward's);治疗期间新发骨折3例,再骨折率为2.17%;上腹部不适发生率为7.97%,坚持服药自行缓解。结论阿伦膦酸钠对原发性骨质疏松症具有缓解骨痛、提高生活质量、增加骨密度、降低再骨折发生的作用,是有效、安全的药物。     

阿伦膦酸钠对骨质疏松症的疗效观察

目的观察阿伦膦酸钠治疗绝经后骨质疏松症的临床疗效。方法选取100例绝经后骨质疏松症患者应用阿伦膦酸钠治疗12个月,于治疗前后测定肝肾功能、ALP、骨钙素、尿NTX及腰椎、股骨颈、wards三角区骨密度。结果应用阿伦膦酸钠治疗12个月后患者骨密度较前升高（P〈0．01）,尿NTX及ALP（碱性磷酸酶）较治疗前降低（P〈0．05）。结论阿伦膦酸钠对绝经后骨质疏松症患者的治疗是有效的。     

绝经后骨质疏松症综合治疗效果分析

目的探讨绝经后骨质疏松症(PMOP)患者的综合治疗效果。方法按照随机数字表法选取2014年6月-2015年12月吉林大学第一医院74例PMOP患者分为常规治疗组和综合治疗组,每组37例。常规治疗组调节体内钙的代谢和促进钙的吸收(雌激素替代疗法、服用钙尔奇D、骨化三醇胶丸、阿仑膦酸钠及鼻喷鲑鱼降钙素喷鼻剂)、止痛治疗等。综合治疗组是在常规治疗组的基础上,配合健康教育、物理疗法和运动疗法,比较治疗前和治疗6个月后两组患者腰椎L2~4和股骨颈的骨密度及治疗6个月后两组患者的生活质量。结果治疗6个月后,两组患者的L2~4和股骨颈的骨密度均高于治疗前,且综合治疗组明显高于常规治疗组(P0.05);综合治疗组患者的生活质量明显高于常规治疗组,差异有统计学意义(P0.05)。结论综合治疗可有效提高绝经后骨质疏松症患者的骨密度、改善患者的生活质量。     

唑来膦酸钠辅助治疗方案对慢性骨髓炎患者VAS评分及骨愈合率的影响

目的 探讨唑来膦酸钠辅助治疗方案对慢性骨髓炎患者疼痛评分及骨愈合率的影响。方法 选取慢性骨髓炎患者105例,均接受外科手术治疗,根据辅助治疗方法分组,参照组(n=50,常规抗生素),研究组(n=55,唑来膦酸钠联合抗生素)。观察两组疼痛情况、炎症因子、骨愈合率及不良反应。结果 治疗后,研究组患者1、3及6个月疼痛评分低于对照组(P<0.05);研究组患者不良反应发生率低于对照组(P<0.05);研究组患者骨愈合率高于对照组(P<0.05);研究组白介素-6、肿瘤坏死因子-α及C-反应蛋白水平均低于对照组(P<0.05);研究组血清碱性磷酸酶水平高于对照组(P<0.05)。结论 临床上唑来膦酸钠辅助治疗方案对促进慢性骨髓炎患者康复有积极意义,有效健康患者术后疼痛水平,减轻炎症反应,促进骨愈合,改善其预后。     

中医药和运动防治绝经后骨质疏松症的研究现状

绝经后骨质疏松症是绝经后妇女的常见病,本文就该病在中医药及运动二方面取得的一些研究成果做一简要综述。认 为中医药在防治该病许多方面具有西医难以比拟的优越性;运动则在延缓骨丢失,增加骨骼强度等方面效果显著。中医药能 否在运动健身的基础之上巩固和加强其疗效,将会是未来研究的一个热点。     

Vitamin D Boosts Alendronate Tail Effect on Bone Mineral Density in Postmenopausal Women with Osteoporosis

Vitamin D modulates bisphosphonate (BP) efficacy, but its contribution to bone mineral density (BMD) after BP discontinuation is not known. To address this topic, we performed a retrospective analysis of postmenopausal women exposed to alendronate (ALN) to treat osteoporosis who regularly continued the supplementation of cholecalciferol or calcifediol at recommended doses. In the ninety-six recruited women (age 61.1 ± 6.9 years), ALN was administered for 31.2 ± 20.6 months and then discontinued for 33.3 ± 18.9 months. The modification of 25(OH)D serum levels over time was associated with a change of alkaline phosphatase (r = −0.22, p = 0.018) and C-terminal collagen type 1 telopeptide (r = −0.3, p = 0.06). Women in the tertile of the highest increase in 25(OH)D level showed a 5.7% BMD gain at lumbar spine, that was twice as great in comparison with participants with a lower 25(OH)D variation. At a multiple regression analysis, BMD change was associated with time since menopause (ß = 2.28, SE 0.44, p < 0.0001), FRAX score for major fracture (ß = −0.65, SE 0.29, p = 0.03), drug holiday duration (ß = −2.17, SE 0.27, p < 0.0001) and change of 25(OH)D levels (ß = 0.15, SE 0.03, p = 0.0007). After ALN discontinuation, improving the vitamin D status boosts the ALN tail effect on BMD.     

戊酸雌二醇预防围绝经期、绝经后骨质疏松的系统评价

目的 系统评价戊酸雌二醇(E2V)预防围绝经期、绝经后骨质疏松症(OP)的疗效和安全性.方法 计算机检索Medline(1950年1月至2012年3月),EMbase(1974年1月至2012年3月),Cochrane 图书馆临床试验资料库(2012年第1期),中国生物医学文献数据库(CBMdisc,1979年1月至2012年3月),中国期刊全文数据库[清华同方(CNKI)](1994年1月至2012年3月),中文科技期刊全文数据库[维普(VIP)](1989年1月至2012年3月).收集有关E2V预防围绝经期、绝经后妇女OP的疗效的文献,并比较E2V+甲羟孕酮(MPA)或E2V+醋酸环丙孕酮(CPA)(纳入E2V+ MPA组,E2V+ CPA组)与安慰剂(纳入对照组)预防围绝经期、绝经后妇女OP的随机对照试验(RCTs)结果.由2位评价员独立对纳入文献进行资料提取和质量评价,并采用RevMan 4.2.10统计学分析软件对相关预防围绝经期、绝经后妇女OP方案的疗效进行Meta分析.结果 本系统分析共纳入4个E2V预防围绝经期、绝经后妇女OPRCTs,包括764例研究对象.其中,E2V+ MPA组,E2V+ CPA组与对照组各纳入受试者为370例,231例和163例.Meta分析结果显示,有合并分析时采用异质性分析,有异质性的采用随机效应模式E2V+MPA组或E2V+ CPA组,增加妇女的腰椎(L2～L4)和股骨颈的骨密度(BMD)优于对照组.E2V+MPA组或E2V+CPA组的E2V剂量为1.5 mg或2.0 mg时,对于提高腰椎(L2～L4)及股骨颈BMD疗效有优于E2V剂量为1.0 mg的趋势,但差异无统计学意义(WMD=-9.80,95％CI:-21.66～2.06;P=0.11).有2项研究提供了不良反应结果的报道,显示E2V预防组与对照组的不良反应比较,差异均无统计学意义(RD=0.04,95％CI:-0.07～0.15,P=0.48).结论 采用E2V预防围绝经期、绝经后OP效肯定,能提高腰椎(L2～L4)及股骨颈的BMD,且不增加不良反应发生风险.     

Calcium-Enriched Pumpkin Affects Serum Leptin Levels and Fat Content in a Rat Model of Postmenopausal Osteoporosis

Because the world’s population is deficient in dietary calcium, it is important to search for new sources of this essential mineral for the bones and the entire body. One of the innovative foods that could act as such a source is pumpkin enriched with calcium lactate by means of osmotic dehydration. Providing the body with easily absorbable calcium may have beneficial effects on the reconstruction of bone tissue. Postmenopausal osteoporosis is associated with body weight and fat mass gain, and the aim of the present study was to evaluate the effect of consuming enriched pumpkin on the levels of adipokines and cytokines produced by the adipose tissue. This study was conducted on 12-month-old female Wistar rats that received nutritional intervention for 12 weeks. After termination of the rats, the levels of leptin, adiponectin, interleukin 31 and interleukin 33 in serum and adipose tissue were determined, and the femurs were examined histopathologically. It was demonstrated that calcium-enriched pumpkin reduced bone marrow femoral adipocytes and also markedly decreased serum leptin levels in groups of rats after ovariectomy, which was associated with a decrease of fat content. Additionally, it seems that calcium-enriched pumpkin may reduce body weight gain often observed after menopause.     

The Cost-Effectiveness of Bisphosphonates in Postmenopausal Women Based on Individual Long-Term Fracture Risks

OBJECTIVES: Cost-effectiveness analyses are routinely based on data from group averages, restricting its generalizibility to those with below- or above-average risk. A pharmaco-economic model that used individualized risks for fractures was developed in order to take into account patient heterogeneity. METHODS: Data were obtained from The Health Improvement Network research database of general practitioners, comprising a UK general population of women aged more than 50 years (N = 330,000). Mortality and hip, vertebral, and other osteoporotic fracture risks for each individual were estimated by age, body mass index (BMI), smoking, and other clinical risk factors. Estimates on costs, EuroQol (EQ-5D) utilities, and treatment efficacy were obtained from a UK national report (the National Institute for Clinical Excellence) and outcomes were simulated over a 10-year period. RESULTS: It was found that the cost per quality-adjusted life-year (QALY) gained was lower in elderly women and in women with fracture history. There was a large variability in the cost-effectiveness with baseline fracture risk and with clinical risk factors. Patients with low BMI (<20) had considerable better cost-effectiveness than patients with high BMI (>or=26). Using a cost-acceptability ratio of 30k pounds per QALY gained, bisphosphonate treatment became cost-effective for patients with a 5-year risk of 9.3% (95% confidence interval [CI] 8.0-10.5%) for osteoporotic fractures and of 2.1% (95% CI 1.5-2.7%) for hip fractures. Including bone mineral density in the risk assessment, the cost per QALY gained was 35k pounds in women at age 60 with a fracture history and a T-score of -2.5 (at age 80, this was 3k pounds). CONCLUSION: A pharmacoeconomic model based on individual long-term risks of fracture improves the selection of postmenopausal women for cost-effective treatment with bisphosphonates.     

以全科医生团队为基础的老年骨质疏松症健康教育效果分析

目的探讨以全科医生团队为基础的系统健康教育效果.方法在前期课题所积累得到的322例60～80岁骨质疏松症患者中,随机抽取参加系统健康教育的患者79例作为干预组,未参加系统健康教育的患者103例作为对照组,对两组患者进行“骨质疏松知识问卷”的现场问卷调查.结果在28项问答中,有23项回答正确率干预组明显高于对照组（P＜0.05）,5项回答正确率接近（P＞0.05）.结论以全科医生团队为基础的系统健康教育对提高骨质疏松症患者的相关知识具有较大帮助,但健康教育内容与方式有待进一步改善.     

High Salt Intake Appears to Increase Bone Resorption in Postmenopausal Women but High Potassium Intake Ameliorates this Adverse Effect

A high-salt diet increases urinary calcium excretion. Its effect on bone, however, is less clear. Recent research suggests that a high-salt diet increases the rate of bone resorption in postmenopausal women over a 4-week period, but increased potassium intake (as potassium citrate) ameliorates this adverse effect. These findings may have implications for the development of dietary guidelines for osteoporosis prevention.     

The Impact of Risk on Preference Values: Implications for Evaluations of Postmenopausal Osteoporosis Therapy

Objective: The objective was to assess the impact of different levels of risk of disease on a woman's preferences for health states. Women were provided with health scenarios incorporating different levels of lifetime risks for breast cancer, hip fracture, and coronary heart disease (CHD). In this way, we were able to determine the incremental effect of changes in risks of each disease on preference values.
Methods and Data: Preference values and utility scores were obtained for six health scenarios by both the feeling thermometer (FT) and standard gamble (SG) methods. Scenarios presented the different lifetime risks of CHD, breast cancer, and hip fracture associated with and not associated with long-term use of hormone replacement therapy (HRT) and raloxifene. Risks of breast cancer were based on perceived risks and population risks. The sample population consisted of 40 healthy female volunteers aged between 45 and 65 years randomly selected from the Ottawa-Carleton district.
Results: Based on their perceived risk of breast cancer, the women had higher value scores for the raloxifene risk profile than for both HRT ( p = .002) and no therapy ( p = .003), with similar results for analyses based on population risks and from utility scores. Regression analysis showed that the risk of breast cancer ( p <.001) was the only disease risk that was statistically significantly associated with women's preferences.
Conclusions: Women had significant preferences over the different risk profiles, primarily due to the incremental effect on changes in values for the risk of breast cancer. Therefore, studies evaluating therapies for osteoporosis should consider patient preferences for living with different risk profiles.     

Factors Associated with the Treatment of Osteoporosis in Korean Postmenopausal Women

This retrospective study was designed to investigate the treatment rate of osteopenia and osteoporosis after diagnosis and determine factors related to osteoporosis treatment in Korea. This analysis included postmenopausal women who had visited the health promotion center from March 2010 to May 2011 (n = 375) and been diagnosed with osteoporosis (19.5%) or osteopenia (45.9%). Telephone surveys were performed one year after diagnosis. We employed multiple logistic regression to determine factors associated with treatment using clinical risk factors as covariates in a FRAX model. Receipt of osteoporosis treatment (nutrition, exercise, and medications) to prevent osteoporotic fracture was reported by 108 of 172 (63.4%) women with osteopenia and 66 of 73 (90.4%) with osteoporosis. Only consultation with a doctor for osteopenia or osteoporosis was significantly related to receiving osteoporosis treatment for osteopenia (odds ratio [OR], 5.01; 95% confidence interval [CI], 2.01–12.00) and osteoporosis (OR, 4.91; 95% CI, 1.16–20.75). In the osteopenic group, increased age, being a current smoker, having a history of parental fracture or previous fracture, and secondary osteoporosis were related to consultation with a doctor. Of women with osteopenia 36.6% and 64.4% with osteoporosis received consultation with a doctor. Consultation with a doctor for osteopenia or osteoporosis after being diagnosed could be an effective strategy to increase osteoporosis treatment.     

Bazedoxifene versus Oral Bisphosphonates for the Prevention of Nonvertebral Fractures in Postmenopausal Women with Osteoporosis at Higher Risk of Fracture: A Network Meta-Analysis

ObjectiveTo compare the efficacy of bazedoxifene and oral bisphosphonates for the prevention of nonvertebral fractures (NVFs) in women with higher risk of postmenopausal osteoporosis (i.e., the Fracture Risk Assessment Tool [FRAX] score ≥ 20%), based on currently available evidence from randomized controlled trials.MethodsRandomized controlled trials evaluating the NVF relative risk reduction (RRR) with oral bisphosphonates or bazedoxifene were identified by a systematic literature review and combined by means of a network meta-analysis. A subgroup of patients with a FRAX score of 20% or more in the bazedoxifene phase III osteoporosis study was selected as the population of interest on the basis of the bazedoxifene label. In one analysis (analysis 1), the placebo response of the subgroup with a FRAX score of 20% or more was the benchmark to select comparable bisphosphonate trials. Additional analyses incorporated the aggregate data from the bisphosphonate trials with all the FRAX subgroups (analysis 2) or with the individual patient data from the bazedoxifene trial (analysis 3).ResultsNine identified bisphosphonate trials (alendronate, ibandronate, risedronate; N = 23,440 patients) with a similar placebo response as observed for the subgroup of high risk patients in the bazedoxifene trial were included in analysis 1. The results of the network meta-analysis of this study set suggest that bazedoxifene is expected to have an RRR of 0.43 (95% credible interval [CrI] ?0.19 to 0.72) versus alendronate, 0.58 (95% CrI 0.05–0.81) versus ibandronate, and 0.39 (95% CrI ?0.29 to 0.70) versus risedronate. Analyses in which treatment effects with bisphosphonates were projected to a population with a FRAX score of 20% or more with meta-regression approaches (analysis 2 and analysis 3) provide similar findings.ConclusionBased on an indirect comparison of randomized trials, bazedoxifene is expected to have at least a comparable RRR of NVF as alendronate, ibandronate, and risedronate in women with higher risk of postmenopausal osteoporosis.