鲑鱼降钙素在骨质疏松性椎体压缩骨折椎体后凸成形术后的应用

目的观察鲑鱼降钙素对骨质疏松性椎体压缩骨折行椎体后凸成形术后骨密度及腰背痛症状的改善情况。方法将行椎体后凸成形术后的骨质疏松性椎体压缩骨折患者79例分成两组,鲑鱼降钙素组44例,予以鲑鱼降钙素肌肉注射,术后每天1次100IU,连用3 d后,改为50 IU隔天1次,连用1个月,间歇1个月后再重复,共半年,同时加服维D2磷葡钙;对照组35例,单纯口服维D2磷葡钙,疗程半年。两组治疗前后均测定腰1～腰4椎体及股骨颈骨密度(BMD);并观察患者腰背痛的情况。结果:鲑鱼降钙素组有6例因肌注降钙素出现面部潮红和皮肤瘙痒等反应停止疗程,其余38例和对照组35例得到了随访。鲑鱼降钙素组腰椎及股骨颈BMD较治疗前明显升高(P<0.01),对照组各部位骨密度较治疗前无明显改变(P>0.01)。鲑鱼降钙素组没有病例再次出现腰背痛,而对照组在半年内有7例再次出现腰背痛,经腰椎MRI证实发生其他节段的椎体压缩骨折。结论:鲑鱼降钙素与钙剂联合治疗行椎体后凸成形术后的骨质疏松性椎体压缩骨折患者,可以提高患者的骨量,降低再骨折的风险。     

74例老年骨质疏松患者应用鲑鱼降钙素联合阿仑膦酸钠治疗的疗效观察

目的　评估联合应用鲑鱼降钙素与阿仑膦酸钠治疗缓解老年性骨质疏松症患者骨关节疼痛及血清骨钙素(BGP)、降钙素(CT)及骨密度(BMD)水平的变化。方法 联合应用鲑鱼降钙素和阿仑膦酸钠治疗本院收治的74例老年性骨质疏松症患者,给予鲑鱼降钙素50IU肌肉注射,隔日1次,连续使用15次后改为口服阿仑膦酸钠1粒/周,共经6个月治疗,采用数字模拟评分法(VAS)比较治疗前、后全身骨关节疼痛程度,治疗前、后骨钙素、降钙素及第2～第4腰椎(L2-4 )、股骨颈、Ward区骨密度水平的变化,并进行统计学分析。结果 鲑鱼降钙素联合阿仑膦酸钠治疗老年性骨质疏松症患者6个月后,对缓解骨关节疼痛症状疗效良好,治疗前与治疗后比较差异显著(P<0.01);治疗前后骨密度、血清骨钙素和降钙素水平均有显著差异（P<0.05）。结论 鲑鱼降钙素联合阿仑膦酸钠治疗老年性骨质疏松症使血清降钙素的水平明显升高,骨钙素水平明显降低,能显著减轻患者骨关节疼痛,改善症状,并增加骨密度,对老年性骨质疏松症有明显的疗效。     

鲑鱼降钙素结合脉冲电磁场治疗脊髓损伤致骨质疏松症的临床效果

目的观察鲑鱼降钙素联合低频脉冲电磁场治疗脊髓损伤所致骨质疏松症的临床效果。方法 2012年9月至2015年9月本科收治的脊髓损伤致骨质疏松症患者90例,按随机数字表法将其分为降钙素组(n=30)、电磁场组(n=30)及联合治疗组(n=30)。降钙素组给予鲑鱼降钙素治疗,电磁场组给予低频脉冲电磁场进行治疗,联合治疗组给予低频脉冲电磁场联合鲑鱼降钙素治疗,共3个月。测定治疗不同时间段患者疼痛视觉模拟评分(VAS),腰椎及股骨颈骨密度(BMD)及甲状旁腺素(PTH)、骨钙素(BGP)、1,25-双羟维生素D3[1,25-(OH)2D3]等生化指标的变化情况。结果治疗1、2、3个月及6个月后联合治疗组患者VAS评分显著低于降钙素组及电磁场组。治疗后,联合治疗组腰椎及股骨颈骨密度均显著高于降钙素组及电磁场组(P0.05);联合治疗组PTH、BGP均显著低于降钙素组及电磁场组(P0.05),1,25-(OH)2D3显著高于降钙素组及电磁场组(P0.05)。结论低频脉冲电磁场联合鲑鱼降钙素可有效减轻脊髓损伤所致骨质疏松症患者的骨性疼痛程度,提升患者骨密度。     

Effects of salmon calcitonin on the bone loss induced by ovariectomy

Summary We present the results of a 12-month clinical study assessing the effects of synthetic salmon calcitonin (sCT) on a group of fertile white women who had undergone ovariectomy for uterine fibromatosis. The study was performed to verify whether CT can prevent the loss of bone mass and the changes in calcium-phosphorus metabolism associated with acute estrogen deficiency. The study consisted of an initial double-blind phase of 6 months, followed by a 6-month open period. Treated patients were given 100 MRC U of synthetic salmon CT injected i.m. in the morning, every other day, starting on the 7th day after the operation and continued for 12 months. Control patients received a placebo injection for the first 6 months; subsequently, they too were treated with sCT i.m. every other day for 6 months at the same dose as the 12 month-treated group. All patients received 500 mg of elementary calcium p.o., b.i.d. Bone mineral content (BMC) was measured at the extreme distal radius of the nondominant arm by a dual photon bone densitometer which utilizes two radio nuclides, 241 Am and 125 I, with energies of about 60 and 30 KeV. Biochemical parameters of the calcium-phosphorus metabolism were also measured. After 12 months of study, no significant changes of BMC were observed in the 12 months sCT treated group, while control patients, treated 6 months after the ovariectomy, showed a significant decrease in BMC values. Total hydroxyproline/ creatinine (OHPr/Cr) ratio, which increased after ovariectomy, returned to normal after the first month of sCT administration in the continuously treated group whereas it remained high in the control group up to the 6th month of observation, declining thereafter in coincidence with sCT treatment. The behavior of Bone GLA-protein (BGP), like that of the nondializable OHPr/Cr ratio, was substantially similar in both treated and control groups for the entire period of observation. These results show that prophylactic administration of salmon CT in ovariectomized women prevent estrogen deficiency-induced bone loss, inhibiting skeletal resorption and allowing osteogenesis to occur normally.     

降钙素在老年不稳定型股骨转子间骨折应用

 目的 比较采用股骨近端防旋转髓内钉(proximal femoral nail antirotation, PFNA)联合鲑鱼降钙素与单纯行 PFNA治疗老年不稳定型股骨转子间骨折的临床疗效。方法 前瞻性研究2009年1月至2011年12月,采用PFNA治疗 120例老年不稳定型股骨转子间骨折患者资料。术前随机将患者分为降钙素组(PFNA治疗联合应用鲑鱼降钙素)和对照组(单纯PFNA治疗)。降钙素组60例,男28例,女32例;年龄71~82岁,平均75.1岁;Evans?Jensen分型：ⅡA型20例,ⅡB 型32例,Ⅲ型8例。对照组60例,男27例,女33例;年龄70~83 岁,平均74.9岁;Evans?Jensen分型：ⅡA型22例,ⅡB型32 例,Ⅲ型6例。两组患者均为低能量损伤。术后观察骨折愈合情况,测量健侧髋关节骨密度,记录患者Harris评分及SF?12 量表评分,记录手术相关并发症、药物不良反应与其他部位骨折等情况。结果 113例患者获得至少2年以上的完整随 访,降钙素组55例,对照组58例。除对照组4例骨折延迟愈合外,其余患者术后6个月X线片均示骨折愈合良好;术后1年,所有患者骨折均愈合。术前降钙素组健侧髋部平均骨密度T值为-2.54±0.35,对照组为-2.53±0.27;术后6个月、1年、2年降钙素组健侧髋部平均骨密度T值分别为-1.82±0.27、1.33±0.23、-1.17±0.16,对照组分别为-2.14±0.32、-1.91±0.23 、-2.01±0.27,降钙素组患者骨密度明显提高。术后两组患者Harris评分和术后1年SF?12量表评分比较,差异均无统计学意义 。术后2年两组患者SF?12量表评分比较,差异有统计学意义。降钙素组仅1例患者术后3个月发生桡骨远端骨折,对照组 术后13~23个月,4例发生腰椎压缩性骨折,1例发生桡骨远端骨折,1例发生健侧髋部骨折。结论 PFNA治疗老年不稳 定型股骨转子间骨折具有固定牢靠,骨折愈合率高等优点,而联合鲑鱼降钙素治疗,可有效改善患者骨密度,提高骨折愈 合质量,降低再骨折风险,提高患者生活质量。     

Total and regional bone mineral content and fracture rate in postmenopausal osteoporosis treated with salmon calcitonin: A prospective study

Seventy-two postmenopausal osteoporotic women having more than one nontraumatic vertebral crush fracture were studied. Thirty-six of them, aged 68.8±1.2 years (18±4 YSM-years since menopause), were treated with 100 IU/day of salmon calcitonin i.m. plus 500 mg of elemental calcium for 10 days each month. The remaining 36 patients, aged 69.6±1.4 years (19±3 YSM), were given only 500 mg of elemental calcium for 10 days each month. All patients underwent clinical and analytical evaluation every 3 months. Radiological evaluation, assessment of vertebral deformities, and metacarpal radiogrammetry were done every 6 months. Densitometric measurements of total and regional bone mass were made every 12 months. At 24 months, the calcitonin group showed a 60% reduction in the number of new fractures and the group receiving only calcium had a 45% increase (P<0.001). The incidence of vertebral fractures was 0.07 per patient-year in the group treated with calcitonin and 0.45 per patient-year in the group treated with calcium (P<0.001). At 2 years, the calcitonin group showed a 12% increase in cortical bone mass on metacarpal radiogrammetry, a 16% increase in the axial skeleton on trunk densitometry, a 3.5% increase in total body bone mineral content, a 30.7% increase in pelvic bone mineral content, and a 6.2% increase in arm bone mineral content (all P<0.001). In the group treated with calcium alone there was a loss of bone mass in every region. These findings suggest that salmon calcitonin is effective in the treatment of osteoporosis and show that it acts on cortical and trabecular bone.     

Prevention of Osteoporosis in Heart Transplant Recipients: A Comparison of Calcitriol with Calcitonin and Pamidronate

Bone loss and osteoporotic fractures are common in cardiac transplant recipients. To compare two prophylactic medical regimens after heart transplantation, 26 consecutive heart transplant recipients were randomized to receive either continuous oral calcitriol (0.5 μg/day) combined with nasal salmon calcitonin (200 U/day) for the first 3 months (group A) or intermittent intravenous pamidronate (0.5 mg/kg body weight) every third month (group B). Bone mineral density (BMD) and biochemical indices of bone turnover were measured at baseline and 3, 6, 12, and 18 months after transplantation. The mean pretransplant BMD, measured by dual energy X-ray absorptiometry (DXA) was significantly lower in the patients compared with age-matched healthy controls. During the first year of treatment, rates of bone loss at the lumbar spine and femoral neck were slightly but significantly slower in the patients treated with pamidronate, but there was no longer a significant difference between the two groups after 18 months of heart transplantation. Irrespective of the mode of osteoporosis prevention, osteocalcin levels increased whereas urinary deoxypyridinoline decreased after transplantation, and significant bone loss was observed in both treatment groups. We found no relationship between initial BMD, markers of bone turnover, cumulative glucocorticoid dose, or cyclosporine levels and the rate of bone loss after cardiac transplantation. In summary, we found that the rapid and severe bone loss following heart transplantation could be attenuated by two preventive measures, pamidronate or calcitriol with calcitonin. Received: 26 December 1997 / Accepted: 10 February 2000     

Long- and short-term side effects and safety of calcitonin in man: A prospective study

Summary Forty-three patients were treated for a total duration of 301 patient-years with calcitonin (CT) (range 3–16 years, median duration 6 years 6 months). Eighty-four percent of patients were suffering from complications associated with Paget's disease and the remainder from osteoporosis. In the majority of patients, CT was administered by the subcutaneous route and one patient was psychologically dependent on calcitonin injections. There were no long-term side effects associated with CT therapy. In a separate group of 105 patients consisting of 83 patients on human CT and 22 patients on salmon CT, injections showed short-term side effects in 77% and 64% of these patients, respectively (NS). Side effects associated with nasally administered salmon CT in 25 patients were mild and of low incidence (32%). Long-term administration of calcitonin in humans is safe and devoid of any serious or long-term side effects.     

Effect of long-term calcitonin administration on steroid-induced osteoporosis after cardiac transplantation.

BACKGROUND: Early, rapid bone loss and fractures after cardiac transplantation are well-documented complications of steroid administration; therefore, we undertook this study on the effects of long-term calcitonin on steroid-induced osteoporosis. METHODS: Twenty-three heart transplant recipients on maintenance immunosuppression with cyclosporine, mycophenolate mofetil and prednisone were retrospectively studied. All patients received long-term prophylactic treatment with elemental calcium and vitamin D. Twelve (52.2%) patients also received long-term intranasal salmon calcitonin, whereas 11 (47.8%) received none. Bone mineral density and vertebral fractures were assessed at yearly intervals. Statistical comparisons between each group's bone loss during the first year and in the early (1 to 3 years), intermediate (4 to 6 years) and late (7+ years) post-transplantation periods were done. RESULTS: Lumbar spine bone loss was significant during the early follow-up period in the group not receiving calcitonin (0.744 +/- 0.114 g/cm(2) vs 0.978 +/- 0.094 g/cm(2) [p = 0.002]). The calcitonin group showed bone mineral density (BMD) levels within normal average values throughout the study period. BMD increased in the no-calcitonin group during the intermediate (4 to 6 years) and late (7+ years) follow-up periods, with values approaching normal average and no significant difference between the 2 groups (0.988 +/- 0.184 g/cm(2) vs 0.982 +/- 0.088 g/cm(2) [p = 0.944] and 0.89 +/- 0.09 g/cm(2) vs 1.048 +/- 0.239 g/cm(2) [p = 0.474], respectively). CONCLUSIONS: Prophylactic treatment with intranasal salmon calcitonin prevents rapid bone loss associated with high-dose steroids early after cardiac transplantation. Long-term administration does not seem warranted in re-establishing BMD.     

鲑鱼降钙素联合手术治疗骨质疏松性桡骨远端背侧不稳定性骨折对患者术后疗效及骨密度改变的分析

目的 观察鲑鱼降钙素联合手术治疗老年骨质疏松性桡骨远端背侧不稳定性骨折患者术后疗效及骨密度的改变.方法 45例桡骨远端背侧不稳定性骨折患者,其中男10例,女35例,年龄60～83岁,平均(68.5±6.8)岁,按AO/ASIF分型如下:A3型2例,B2型6例,B3型8例,C1型13例,C2型10例,C3型6例.将患者随机分为研究组(24例)及对照组(21例),均采用掌侧锁定加压钢板(LCP)结合经皮克氏针撬拨技术手术治疗,术后研究组予肌注鲑鱼降钙素及口服钙尔奇D600抗骨质疏松治疗,对照组仅口服钙尔奇D600,两组药物给予时间均为3个月.根据Stewart等改良的Sarmiento评分标准及改良的Mcbride腕关节功能评价标准分别行影像学及腕关节功能评估,测定两组患者术前及术后3个月时骨密度值,比较两组术后疗效、骨折愈合时间及骨密度,并对结果进行统计学分析.结果 所有病例均在门诊获得随访,随访时间8 ～ 32个月,平均16个月.改良的Sarmiento影像学评分研究组优17例(70.8％),良7例(29.2％);对照组优13例(61.9％),良8例(38.1％).改良的Mcbride腕关节功能评分研究组优16例(66.7％),良6例(25.0％),可2例(8.3％);对照组优7例(33.3％),良9例(42.9％),可5例(23.8％).骨折愈合时间分别为:研究组(6.5±1.4)周,对照组(8.3±2.1)周,差异有显著性(P＜0.05).研究组骨密度术前(0.618 ±0.105) g/cm2,术后药物治疗3个月后为(0.660±0.092) g/cm2,差异有显著性(P＜0.05);对照组骨密度术前(0.621±0.085)g/cm2,术后药物治疗3个月后为(0.627±0.089)g/cm2,差异无显著性(P＞0.05);两组术后3个月时骨密度比较差异有显著性(P＜0.05).结论 掌侧LCP结合经皮克氏针撬拨技术是治疗老年骨质疏松性桡骨远端背侧不稳定性骨折的一种有效方法,背侧骨块复位满意,固定牢靠,可减少复位丢失、结构性植骨,术后联合使用鲑鱼降钙素抗骨质疏松治疗可增加骨密度,进一步加强内固定效果,促进骨折愈合,提高腕关节功能.     

Prevention of further bone mass loss by nasal calcitonin in patients on long term glucocorticoid therapy for asthma: a two year follow up study.

BACKGROUND--Injectable calcitonin is effective in reducing spinal bone loss in steroid-dependent asthma but side effects are frequent. In contrast, a nasal spray presentation has been shown to be effective and well tolerated in involutional osteoporosis. To test the efficacy of nasal calcitonin a two year prospective trial was conducted in 44 steroid-dependent asthmatic patients. METHODS--All patients received a calcium supplement of 1000 mg and were allocated randomly into two groups treated with either salmon calcitonin nasal spray (200 IU every other day, n = 22) or calcium alone (n = 22) for two years. All patients completed the first year of the study. Five patients in each group dropped out during the second year. In the calcitonin group one patient developed generalised pruritus and four lost steroid dependence, and in the calcium alone group five were no longer dependent on steroids. The efficacy of treatment was evaluated as follows: bone turnover assessed by biochemical markers, bone loss assessed by serial measurement of lumbar spine density, and rates of bone fractures. RESULTS--The bone mass in the calcitonin group increased by 2.7% in the first year while in the group receiving calcium alone it decreased by 2.8%; this difference was significant. Calcitonin prevented more bone loss during the second year while the calcium alone group continued losing bone mass (-7.8%). The difference between means was 0.1077 (95% CI 0.0381 to 0.1773). Three new fractures occurred in both groups. No changes in biochemical parameters were detected in either group. CONCLUSIONS--Calcitonin given intranasally increased spinal bone mass during the first year of treatment and maintained bone mass in a steady state during the second year. These results suggest that calcitonin may be a useful agent to prevent steroid-induced osteoporosis. However, the lack of effect of calcitonin on the rate of vertebral fractures does not permit its recommendation for routine use in preventing steroid-induced osteoporosis.     

Successful treatment of low turnover osteoporosis resulting from prolonged reserpine therapy with intermittent calcitonin and phosphate therapy

Summary Coherence therapy, popularly known by the actonym ADFR (Activate, Depress, Free, Repeat), was designed to increase bone mass in osteopenic patients. Accordingly, we report a case of a hypogonadal male with histologically proven low bone turnover osteoporosis and a progressive vertebral fracture syndrome, who responded favorably to ADFR treatment with the use of salmon calcitonin and inorganic phosphate. Dramatic increments in bone mass were observed during a 68-month period of therapy. Serial quantitative computerized tomography demonstrated a 146% increase from baseline in bone mineral density for the first 30 months of treatment, and dual energy radiography yielded a 36.5% increase for the subsequent 31–68 months. Furthermore, no episode of fracture occurred since coherence therapy was initiated.     

降钙素治疗骨质疏松症骨质量病变的研究

目的研究降钙素在骨质疏松症治疗中对骨密度bonemineraldensityBMD、骨强度及骨质疏松脆性骨折发生率的作用。方法为期1年的单中心、前瞻性、随机研究135例原发性骨质疏松症女性患者随机分成降钙素 钙剂组和钙剂组,进行开放、对比研究。降钙素 钙剂组66例鲑鱼降钙素50IU,肌内注射,第1周每天1次,第2周隔日1次,以后每周2次;同时口服元素钙600mg每天1次。钙剂组69例元素钙600mg每天1次。治疗前后分别进行血清钙、磷、碱性磷酸酶、骨钙素、尿羟脯氨酸、双能X线BMD和超声骨强度测量以及脊椎胸腰段正、侧位X线片比较。结果治疗1年后,降钙素 钙剂组53例获随访,与治疗前比较,腰椎BMD上升约1%P<0.05,髋部BMD无明显变化,桡骨和胫骨骨强度均明显改善;钙剂组59例获随访,腰椎、髋部BMD和桡骨、胫骨骨强度均较治疗前下降P<0.05。两组治疗前后各项生化检测指标无明显变化,骨质疏松脆性骨折的发生率钙剂组明显高于降钙素 钙剂组。结论降钙素治疗骨质疏松症有良好作用,不仅能有效地缓解骨痛,还能确实提高骨质量,降低骨质疏松脆性骨折的发生率。     

Prevention of bone loss in early nonsurgical and nonosteoporotic high turnover patients with salmon calcitonin: The role of biochemical bone markers in monitoring high turnover patients under calcitonin treatment

Annual bone loss rate was estimated in a group of randomly selected 150 nonsurgical and nonosteoporotic early postmenopausal women, 42–56 years, with the use of the mathematical equation proposed by Christiansen et al. (OSTEOTREND-R) [1]. Fifty-six women were characterized as high turnover patients (estimated annual bone loss more than 2.7%). These high turnover patients were included in a double-blind, placebo-controlled clinical study. Patients were divided into two groups of 28 women each. The first group of patients received 100 IU of salmon calcitonin intranasally daily for 1 year and the second group intranasal spray of placebo daily. Blood and urine biochemical parameters as well as bone mineral content of the spine and proximal forearm were determined initially and at the end of 6 and 12 months. No other side effects were noted apart from discomfort of nasal mucosa in two patients (one in each group). The group of calcitonin-treated patients showed a dramatic decrease in bone loss rate as estimated with the use of biochemical bone markers at the end of 6 and 12 months (3.7% versus 0.8% and 0.0% at the end of 6 and 12 months, respectively, P<0.001) whereas in the placebo group, bone loss rate remained unchanged (4.2% versus 4.1% and 4.3% at the end of 6 and 12 months, respectively). The calcitonintreated patients showed a significant increase in bone mineral content of spine and proximal forearm (P<0.001 at the end of 6 and 12 months, respectively). On the other hand, a significant decrease in all measurement sites appeared in the placebo group. In conclusion, our results showed that nasal salmon calcitonin administration can prevent the increased postmenorpausal bone loss in selected high bone turnover patients. The predicted annual bone loss rate, as estimated with the combination of biochemical bone markers, is useful in monitoring the responsiveness of high turnover patients to calcitonin at short intervals.     

Estimated long-term effect of calcitonin treatment in acute osteoporotic spine fractures

Summary A 12-month prospective controlled study was conducted in 28 patients with acute osteoporotic spine fractures to evaluate and compare the effect of calcitonin treatment and cyclical hormone replacement therapy on forearm bone mineral content (BMC) and bone turnover. We established two treatment groups and a control group of women with postmenopausal osteoporosis (n=28). Group A (n=10) received 100 U of calcitonin by subcutaneous self-application on alternate days and oral calcium (Ca) for 6–8 weeks. Group B (n=10) received cyclical estrogen/gestagen replacement therapy over 12 months and oral calcium. The control group (n=8) received analgetic treatment and 500 mg Ca daily. BMC was measured by single photon absorptiometry (SPA) [1] with I 125 before and 6 and 12 months after the onset of the therapies. Ca, phosphorus (P), alkaline phosphatase, and 2-hour urinary OH-proline excretion were measured to classify bone turnover. One year after the onset of the two therapies, forearm BMC measured by SPA showed a significant increase in the group under hormone replacement therapy (P<0.025) as well as in the calcitonin group (P<0.05), although the latter underwent treatment only over a short period (6–8 weeks). In the same period, BMC decreased significantly in the control group (P<0.025). These results demonstrate that short-term calcitonin treatment over 6–8 weeks is as effective as long-term hormone replacement therapy, both therapies increasing forearm BMC measured by SPA.     

鲑鱼降钙素联合金天格胶囊治疗老年性骨质疏松症的临床观察

目的观察鲑鱼降钙素联合金天格胶囊治疗老年性骨质疏松症的临床疗效。方法将46例骨质疏松的患者随机分为治疗组和对照组,每组23例,治疗组采用鲑鱼降钙素联合金天格胶囊治疗骨质疏松,连续3个月为1疗程,对照组单独采用鲑鱼降钙素肌肉注射治疗骨质疏松,连续3个月为1疗程;评价治疗前后的疼痛缓解情况和腰椎骨密度(BMD)变化。结果对照治疗2个疗程后总有效率与对照组比较差异有统计学意义(P0.05)。结论鲑鱼降钙素联合金天格胶囊治疗老年性骨质疏松症有效提高骨密度,缓解临床症状。     

鲑鱼降钙素联合恒古骨伤愈合剂治疗腰椎OPF疗效分析

目的 探讨鲑鱼降钙素联合恒古骨伤愈合剂治疗腰椎骨质疏松性骨折(OPF)的疗效.方法 自2007年11月至2009年12月简阳市人民医院骨科共收治82例腰椎骨质疏松性骨折,随机分成治疗组和对照组,治疗组42例给予鲑鱼降钙素和恒古骨伤愈合剂联合治疗,对照组40例仅给予鲑鱼降钙素治疗,比较2组的疼痛缓解效果.结果 82例治疗前用视觉模拟评分法(VAS)评分为6～9分,2组间的疼痛评分差异无统计学意义(P>0.05).治疗后3、5、8、15 d,2组疼痛VAS评分分别经秩和检验差异有统计学意义(P<0.01).治疗组不但疼痛缓解快,3个月后复查骨矿物密度改善程度亦明显优于对照组.结论 鲑鱼降钙素联合恒古骨伤愈合剂治疗腰椎骨质疏松性骨折具有良好止痛和促进成骨作用,是一种安全、有效的方法.     

Effects of salmon calcitonin in postmenopausal osteoporosis: A controlled double-blind clinical study

Summary In this paper we present the results of a 12-month double-blind clinical multicenter study assessing the effects of synthetic salmon cacitonin (CT) administration in a group of white postmenopausal osteoporotic women. Treated patients were given 100 MRC units of synthetic salmon CT injected i.m. in the morning every other day. Control patients received a placebo injection. All patients received 500 mg of elementary calcium p.o., b.i.d. Bone mineral content (BMC) was measured at the extreme distal radius of the nondominant arm by a dual photon bone densitometer which utilizes two radionuclides,²⁴¹Am and¹²⁵I, with energies of about 60 keV and 30 keV respectively. Biochemical parameters of calcium-phosphorus metabolism were also measured. After 12 months of treatment a significant mean increment of BMC and nondialyzable OHPr/creatinine values and a significant decrease of total OHPr/creatinine values were observed in the treated group, while controls showed a significant decrease in BMC values. These results, together with the observation that in some patients the decrease in total OHPr/creatinine values was not accompanied by an increment of BMC, show that long-term salmon CT treatment may be of benefit in postmenopausal osteoporosis and that the effects of CT on bone mass may be due not only to the inhibition of bone resorption but also to the stimulation of bone formation. The results of this study were partially reported in an abstract presented at the International Symposium “Calcitonin '84”, held in Milan on 2–4 October 1984.     

An effective regimen of intranasal salmon calcitonin in early postmenopausal bone loss

Summary In order to devise a convenient and effective therapeutic regimen of intranasal salmon calcitonin (sCT) for the treatment of early postmenopausal bone loss, we studied the effects of a 1-year course of sCT nasal spray on vertebral mineral content (VMC), assessed by dual photon densitometry, and bone turnover in 21 early postmenopausal osteoporotic women. Subjects enrolled in the study had a value above the normal average of at least one index of bone turnover: whole body retention (WBR) of ^99mTc-methylenedichloro-bisphosphonate (^99mTc-MDP), serum bone gla protein (BGP), urinary hydroxyproline/creatinine excretion (HOP/Cr). After baseline evaluation, patients were randomized for treatment with either sCT (200 IU every other day) or plabebo. Treatment with sCT significantly increased VMC by 2.7±0.9% at 6 months, and 3.3±0.8% at 1 year, whereas a progressive decline was observed in the placebo group (-2.6±0.5%, and -3.5±0.5% after 6 and 12 months, respectively). These changes were associated with a progressive and significant reduction of all parameters of bone turnover in the sCT-treated patients, whereas no changes were detected in the control group during the study period. The differences between the two groups were significant after 1 year for VMC, BGP, and WBR (P<0.05, one-way analysis of variance). Thus, 200 IU intranasal sCT administered on alternate days is adequate to stop the fast bone loss occurring early after the menopause in women with high bone turnover rates. This therapeutical modality represents an important addition to the available pharmacologic spectrum for the prevention and treatment of postmenopausal osteoporosis.     

Long-term treatment of established osteoporosis with intranasal calcitonin

We examined the long-term effects of intranasal administration of salmon calcitonin on bone and calcium metabolism in women with established osteoporosis (forearm fracture). Over a period of 5 years, 14 women received discontinuous calcitonin (200 IU) plus calcium (500 mg) daily for 3 years or 4 years. To allow assessment of the optimum duration of therapy, patients in whom treatment had been for shorter intervals were also included. At the end of the first 2 years, a group receiving placebo had lost significantly more bone from their spines and forearms than the group receiving calcitonin in the first year (P<0.01). In the 14 women who completed a further 3 years on calcitonin, the bone mineral contents of the spines increased continually. Bone loss in the forearm was arrested for 1 year. Treatment lasting for about 2 years prevented bone loss in both areas. Treatment for 3 years resulted in net gains in spinal bone but no further benefits in relation to forearms. Biochemical parameters of bone turnover (serum alkaline phosphatase levels, plasma bone Gla protein levels, and fasting urinary hydroxy-proline/creatinine levels) exhibited similar declines irrespective of the duration of treatment. It is concluded that longterm intranasal treatment with calcitonin produced net gains in spinal bone and that optimum response in forearms was achieved using discontinuous therapy. The ratio between periods with and without treatment was between 1∶2 and 2∶3.