Bisphosphonates for postmenopausal osteoporosis

Bisphosphonates are effective in reducing bone turnover, increasing BMD and reducing fracture risk in postmenopausal women with osteoporosis. The licensed bisphosphonates exhibit some differences in potency and speed of onset and offset of action. These differences mean that different agents may be more advantageous in different situations. Uncertainties still exist around the optimum duration of treatment and treatment holidays, how best to use bisphosphonates with anabolic treatments, and the benefits of treatment in patients who do not have a BMD T-score below -2.5.     

鲑鱼降钙素对绝经后骨质疏松症的治疗

目的 评价鲑鱼降钙素治疗绝经后骨质疏松症近期骨痛及中期改善骨量的作用.方法 绝经1年以上骨质疏松妇女43例,年龄48～77岁,每周定期注射鲑鱼降钙素针剂(密盖息(R)针剂,诺华制药生产,50 iu/支)3次和每日服用元素钙600 mg、维生素D125国际单位.对比治疗前后VAS值及腰椎和髋部的BMD值.结果本组患者2周...     

Placebo therapy for postmenopausal osteoporosis

Eighteen postmenopausal osteoporotic (PMO) women on placebo therapy were followed for 1 year. Serial measurements of calcium balance and kinetics, bone histomorphometry, photon absorptiometry, and radiogrammetry were obtained. Few significant changes in balance and kinetics or bone histology were seen in these women over time. Photon absorptiometry and radiogrammetry of the femoral cortex showed a significant annual bone loss however. When compared with premenopausal and healthy postmenopausal women, the annual bone loss in those with PMO was significantly greater. The ability of balance studies, photon absorptiometry, and radiogrammetry to predict the magnitude of this bone loss was similar. Finally, there was an illustration of the use of the estimated variance provided by this study for estimating sample size for future studies.     

绝经后骨质疏松症流行病学研究进展

本文以电子检索结合手工检索的方式检索我国绝经后骨质疏松症患病率或发病率及费用的文献,转换成EXCEL数据库文件,并根据试验特征进行分类统计,综述绝经后骨质疏松症患病率、骨折的发生率及疾病的负担等流行病学研究进展。     

Level of evidence and citation index in current neurosurgical publications

Systematic clinical reviews or meta-analyses offer scientifically valid sources of clinical information. They provide information in a concise form and can contribute to clinical quality management. Such studies, however, are only able to reflect the quality of the articles reviewed. The aim of this study was to evaluate the quality of the neurosurgical literature according to evidence-based medicine (EBM) standards. We reviewed all articles published in 1999 in three major neurosurgical journals. These articles were subdivided according to the level of evidence (LOE) scale (from 0 to V), article type, and citation index. Nine hundred eighty-two articles were published in these journals in 1999. Of these, 346 (35%) were clinical studies, 287 (29%) case reports, 153 (16%) experimental studies, 122 (13%) technical reports, and 74 ( 8%) other types. Subdivision according to LOE was: Ia 0.3%, Ib 2.5%, IIa 0.2%, IIb 4.3%, IIc 9.5%, IIIa 0.1%, IIIb 3.9%, IV 22.4%, and V 1.6%. Fifty-five percent of all published studies were case reports, experimental studies, technical reports, or others and thus could not be subdivided according to the EBM standards. The number of articles published with high LOE seems to be rather low in 1999. If these data reflect overall publication practice, it seems unclear whether enough articles with high LOE are published to propose scientifically sound clinical treatment suggestions according to EBM standards.     

Compliance with drug therapy for postmenopausal osteoporosis

Introduction Patient compliance with pharmacotherapy for osteoporosis is typically poor in clinical practice; less frequent dosing with bisphosphonates may improve compliance.Methods Using data from 49 US health plans, we identified all women aged ≥45 years with osteoporosis who initiated therapy with a bisphosphonate, calcitonin, estrogen, or raloxifene. Compliance was examined alternatively in terms of incidence of adherence failure (medication days <80% of possible) and persistence failure (gap in therapy ≥90 days), and was compared across treatment groups using Kaplan-Meier methods and Cox proportional hazards models.Results The study population included 18,822 women, 48% of whom initiated weekly bisphosphonate therapy. Overall risk of adherence failure was 47% at 3 months, 70% at 1 year, and 84% at 3 years. Risk of persistence failure was 47% at 1 year, and 77% at 3 years. In multivariate analyses, risk of adherence failure was higher for calcitonin (hazard ratio=2.7 vs weekly bisphosphonate therapy, p<0.01), but comparable for all other therapies. Relative risks of persistence failure were generally similar.Conclusions Approximately three-quarters of women who initiate osteoporosis drug therapy are non-adherent with treatment within 12 months, and almost 50% have discontinued such therapy by this time. Compliance with weekly bisphosphonate therapy is generally no better than that with osteoporosis medications requiring more frequent dosing.Funding for this research was provided by Amgen, Inc., Thousand Oaks, California.     

Anabolic agents for treating postmenopausal osteoporosis.

The main efficacy criterion for drugs against osteoporosis is protection against fractures. Many resorption-inhibiting agents meet this criterion, including estrogens, alendronate, risedronate, raloxifene, calcitonin, and calcium-vitamin D supplements). Conversely, among anabolic agents, only parathyroid hormone (PTH) is known to reduce the fracture risk, the mechanism being increased bone matrix production by osteoblasts with no alterations in the mechanical properties of bone. Although fluoride salts induce a marked increase in bone mineral density (BMD), there is no evidence that this protects against vertebral or peripheral fractures. Growth hormone, IGF-I, statins, and strontium ranelate are under investigation. A recent controlled clinical trial in 1,637 women with osteoporosis showed that daily subcutaneous injections of PTH (1-34) (20 or 40 microg) for 21 months reduced the fracture risk. With 20 microg/day, the reductions were 65% for vertebral fractures and 57% for extravertebral fractures, 11% of patients had moderate postinjection hypercalcemia, and BMD increased by 9% at both the lumbar spine and the femoral neck. These findings open up the exciting possibility that PTH used alone or in combination with resorption-inhibiting agents may be helpful. To date, PTH is the only anabolic agent that has proved capable of reducing the risk of vertebral and extravertebral fractures in women with established postmenopausal osteoporosis.     

基质GLA蛋白与绝经后骨质疏松症

基质GLA蛋白（matrix gla protein MGP）是体内软骨内骨形成和血管内钙化的重要调节因子，是矿盐沉积的重要抑制物。近年来发现绝经后妇女在发生骨质疏松症的同时还常伴有血管的钙化，认为两者可能存在着密切的联系。MGP抑制血管钙化同时与骨代谢密切相关。笔者对MGP与绝经后骨质疏松症的关系进行了简要的综述。     

伊班膦酸钠和阿仑膦酸钠对绝经后骨质疏松的干预研究

目的评价伊班膦酸钠和阿仑膦酸钠对绝经后骨质疏松骨量变化的作用。方法 64例年龄47～80岁,的绝经后骨质疏松妇女随机分为两组,Ⅰ组予以口服伊班膦酸钠150 mg,每月一次;Ⅱ组服用阿仑膦酸钠70 mg,每周一次,两组患者均每天服用钙剂0.6 g及维生素D 200 IU,治疗时间1年,治疗前后测量腰椎及髋部骨密度,评价伊班膦酸钠及阿仑磷酸钠对绝经后骨质疏松骨量变化的作用。结果Ⅰ组治疗半年和1年后,患者腰椎骨量较治疗前分别增加了6.25%和9.64%,(P<0.05),Ⅱ组治疗半年和1年后,患者腰椎骨量较治疗前分别增加了6.82%和11.4%,(P<0.05),两组患者治疗1年后髋部骨量较治疗前也有所增加,以腰椎骨量增加最为明显。结论两种双磷酸盐治疗绝经后骨质疏松均能显著改善患者骨量,临床疗效相近,但伊班膦酸钠临床耐受性较好。     

绝经后骨质疏松症影响因素的Meta分析

目的 系统评价绝经后骨质疏松症的危险因素及保护因素.方法 以电子检索结合手工检索及索引检索的方式检索所有绝经后骨质疏松症影响因素的病例对照研究、队列研究的中英文研究文献,对纳入的文献进行质量评价后提取数据信息,采用专用软件RevMan 5.0完成系统评价过程.结果 共纳入13篇临床研究.家族骨折史、个人骨折史、绝经年限(≥5年)、经常吸烟、文化程度低、体重指数(≥25)、激素替代疗法、补充钙剂、少量饮酒、经常运动等与绝经后骨质疏松症的发生有关.结论 初步得出家族骨折史、个人骨折史、绝经年限(≥5年)、经常吸烟、文化程度低能够促进绝经后骨质疏松症的发生,而体重指数(≥25)、激素替代疗法、补充钙剂、少量饮酒、经常运动等有助于预防绝经后骨质疏松症的发生.     

Understanding risk factors, screening, and treatment of postmenopausal osteoporosis

Between 30% and 50% of American women will endure a clinical fracture during their lifetime due to the loss of bone mineral density that occurs with menopausal estrogen loss. This article is part one in a two-part series on osteoporosis. Part two will appear in the August 2008 issue of ORTHOPEDICS.     

妇疏宁丸治疗绝经后骨质疏松症的实验研究

目的 :观察妇疏宁丸对去卵巢大鼠骨质疏松症的疗效 ,探讨其作用机理。方法 :雌性SD大鼠 40只 ,随机分为 4组 (每组 10只 )假手术组、模型组、妇疏宁组和雌二醇组 ,后 3组手术摘除卵巢 ,3个月后妇疏宁组和雌二醇组分别给以妇疏宁丸和雌二醇治疗 ,治疗 3个月后称重、查血清钙、磷、碱性磷酸酶及雌二醇 ;处死动物取出子宫及双侧股骨 ,右侧股骨进行骨钙磷测定 ,左侧股骨行组织学检查。结果 :妇疏宁组骨密度、骨皮质厚度及髓腔面积与模型组比较有显著性差异 (P <0 0 5 ) ,与雌二醇组比较无显著性差异 (P >0 0 5 ) ;妇疏宁组大鼠体重、子宫重量与模型组比较均有显著性差异 (P <0 0 5、P<0 0 1) ,而与雌二醇组比较无显著性差异 (P >0 0 5 )。结论 :妇疏宁丸可能通过提高雌激素水平而起到防治骨质疏松的作用     

Recommendations for monitoring antiresorptive therapies in postmenopausal osteoporosis

Antiresorptive agents are effective in preventing and treating postmenopausal osteoporosis, provided they are taken as directed. Regular physical examinations including height measurements may fail to ensure optimal compliance. Bone mineral density (BMD) measurement is indispensable for determining whether treatment is warranted. The measurement can be repeated after 2 years at least, provided quality-control procedures are adequate. BMD changes over time should be compared to the least significant change calculated from the in vivo BMD reproducibility at the measurement center. However, BMD changes are not correlated with the fracture risk reduction induced by antiresorptive treatment. Biochemical markers for bone turnover can be monitored after only 3-6 months provided steps are taken to control for intraindividual variability. They are useful when patient compliance is poor or the treatment response inadequate.     

A comprehensive review of treatments for postmenopausal osteoporosis

 The aim of this review is to assess the efficacy of treatments for postmenopausal osteoporosis in women with low bone mass or with an existing vertebral fracture. We searched the literature for studies (randomized, double-masked, placebo-controlled and prospective) that reported on drugs registered in Europe or North America. We included 41 reports on 12 agents. To assess the consistency among the studies for each drug, we plotted the percent change in bone mineral density (BMD) for the control group against the percent change in BMD for the treated group for lumbar spine and femoral neck. We used methods of cluster analysis to determine consistency among the studies. For each agent we summarized the relative risk for vertebral fracture (patients with new fracture) and for hip fractures. The duration of the studies ranged from 1 to 4.3 years. The proportion of patients who discontinued treatment ranged from 4% to 80%. Most of the studies reported on change in BMD. Twenty-six studies (10 drugs) provided data on new vertebral fractures and 12 (6 drugs) on hip fractures. Apart from fluoride effects on spine BMD, increases in BMD with bisphosphonates were greater than those seen with the remaining treatments. Generally, for each agent the changes in BMD (relative to placebo) were consistent among the studies. The exceptions were calcitriol and calcitonin for changes in BMD of the spine and of the femoral neck. Alendronate, calcitonin, risedronate and raloxifene caused significant reductions in the risk of vertebral fractures. Alendronate, risedronate or the combination of calcium plus vitamin D had a significant effect on the risk of hip fracture. Most therapies are effective in increasing BMD; some decrease the risk of vertebral fracture. For hip fracture, alendronate and risedronate reduce the risk in women with osteoporosis, and calcium and vitamin D reduce the risk in institutionalized patients. Received: 15 October 2001 / Accepted: 18 July 2002 Acknowledgement We acknowledge the invaluable help of J. Jeger, MD, for useful discussion, D. Thompson, PhD, for statistical advice, and D. Koch for data collection. We thank Mrs M. Perez for secretarial assistance. This work was partially supported by a grant from the Merck Sharp and Dohme-Chibret Company (Glattbrugg, Switzerland).     

绝经妇女骨质疏松的多层次个体化防治

目的　探讨绝经妇女骨质疏松的有效防治措施和方法。方法　采用双能X线骨密度仪测定股骨颈骨密度 ,采用肌肉功能分析仪测定下肢肌力及股骨颈抗骨折能力 ,根据WHO的标准综合分析诊断骨质疏松的程度 ;选择诊断为骨量减少或骨质疏松的绝经健康妇女 ,有绝经相关症状需要激素补充治疗 ,又无激素补充治疗的禁忌证者 60例 ,随机分为 3组 :A组为激素补充治疗 +定量营养 +运动 ;B组为单纯激素补充治疗 ;C组为对照组 (没进行任何治疗者 )。于治疗前和治疗后 1年分别测定各组股骨颈骨密度 ,下肢肌力及股骨颈抗骨折能力等 ,比较各组疗效。结果　A组股骨颈骨密度平均增加 5 72 % ,下肢肌力增加 2 1 97% ,股骨颈抗骨折能力增加 1 6 % ;B组上述指标分别增加2 57% ,1 3 9% ,1 2 % ;C组上述指标分别下降 3 6 % ,2 8% ,5 6 %。A组股骨颈骨密度、下肢肌力及股骨颈抗骨折能力均明显优于B组 (P <0 0 5) ,B组上述指标均明显优于C组 (P <0 0 5)。结论　对绝经妇女骨质疏松症防治采用激素补充治疗 ,合理定量营养及适当运动等多层次个体化的措施和方法可能是目前最有效而安全的选择。合理的激素补充疗法对防治绝经妇女骨质疏松症亦有一定疗效     

Development and validation of a disease model for postmenopausal osteoporosis

Summary  

This article describes the development of a model for postmenopausal osteoporosis (PMO) based on Swedish data that is easily adaptable to other countries.