雷尼酸锶治疗骨质疏松症的研究进展

雷尼酸锶（Strontium Ranelate，SR）由一个有机酸（雷尼酸）和两个非放射性锶原子组成。SR具有双向调节作用，能诱导骨重建的解偶联，增加骨形成，减少骨吸收，但不抑制骨转换，是非常有潜力的新药，目前被认为是有效治疗骨质疏松症的药物之一。但国内相关研究还很少。     

芪骨胶囊治疗绝经后骨质疏松症的分子机制

目的 运用网络药理学的方法探究芪骨胶囊治疗绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)的活性成分与潜在分子机制.方法 从BATMAN-TCM数据库中获取芪骨胶囊的主要活性成分及其对应的靶点,在GeneCards数据库和GEO数据库中筛选PMOP疾病靶点,将药物靶点与疾病靶点取交集...     

金乌骨通胶囊治疗原发性骨质疏松症的临床观察

目的 探讨中成药金乌骨通胶囊治疗原发性骨质疏松症的临床应用价值.方法 将门诊69例原发性骨质疏松症患者随机分为两组,实验组口服金乌骨通胶囊,对照组口服金乌骨通胶囊及骨代谢调节剂,进行回顾性临床随访,对其临床效果进行统计学分析.结果 69例患者均获得随访,随访时间平均4.5个月.随访功能评级:优38例,良20例,可4例,无效3例.总优良率为89%,两组的有效率无显著统计学差异.骨密度改善亦无明显差异.结论 金乌骨通胶囊治疗原发性骨质疏松症具有疗效明显、毒副作用低等优点,为治疗该疾病的有效药物之一.     

双重抗骨质疏松药雷尼酸锶

不同于其他抗骨质疏松药,雷尼酸锶是新型具有双重药理作用的抗骨质疏松药物,即抑制骨吸收和促进骨形成.雷尼酸锶可改变骨微结构,增加骨密度和骨强度,从而降低骨折风险,改善患者生活质量.临床研究显示,它能降低绝经后骨质疏松患者椎体和非椎体骨折的风险,并具有作用长久、安全性好、耐受性好的特点.     

鲑鱼降钙素联合低频脉冲电磁场治疗绝经后妇女骨质疏松症的临床观察

目的 通过对鲑鱼降钙素联合低频脉冲电磁场(pulsed electromagnetic fields,PEMFs)治疗绝经后骨质疏松症患者疗效的观察及分析,为绝经后骨质疏松症寻找到安全可靠,更具有良好疗效的治疗方案。方法 选择90个病例,随机分为3组：A组为试验组：联合应用鲑鱼降钙素及低频电磁场组(30人);B组为对照组1：单纯应用低频电磁场组(30人);C组为对照组2：单纯应用鲑鱼降钙素组(30人),每组同时每日给予一定剂量的钙剂及维生素D;A、C组肌注鲑鱼降钙素（CT）50 U,1次/d,连续1w,然后隔天1次,连续1w,最后每周2次至疗程结束;A 、B组均采用天津市同业科技发展有限公司生产的TY-PEMF-B型OP治疗仪实施低频电磁场治疗,频率8~16Hz,每次治疗40 min,共治疗30 次; 治疗前及治疗后第2、4、8周分别测定患者视觉模拟痛疼评分(VAS),并对3组患者进行治疗前及治疗后3、6个月腰椎及股骨颈BMD的测量。结果 鲑降钙素联合骨质疏松治疗仪与单纯使用降钙素治疗或骨质疏松治疗仪治疗相比骨密度显著提高,试验组与对照组对比P<0.05。结论 鲑降钙素联合骨质疏松治疗仪治疗绝经后妇女骨质疏松症疗是一种安全、疗效更好的方法。     

雷尼酸锶促进大鼠股骨骨质疏松性骨折愈合的研究

目的 探讨雷尼酸锶(strontium ranelate,SR)对大鼠股骨骨质疏松性骨折愈合的影响。方法 6个月龄Wistar雌性处鼠66只,切除双侧卵巢制作骨质疏松动物模型,模型建立成功后,在大鼠股骨中段横行截骨,制作大鼠股骨骨质疏松性骨折动物模型,术后死亡6只,然后将剩余60只大鼠随机分为实验组(SR干预治疗组）和空白对照组,每组30只。骨折术后第一天起,实验组给予SR 400 mg/(kg d)灌胃,对照组给予同等体积的生理盐水灌胃。通过影像学、组织学和免疫组织化学（骨形态发生蛋白-2,BMP-2)观察,骨组织形态计量学、骨密度（bone mineral density,BMD)和生物力学测量,观察骨折愈合情况。结果 实验组腰4、5椎体BMD、BMP-2阳性表达细胞数、骨小梁面积比、骨小梁平均宽度、最大负荷和最大桡度高于同时期对照组,差异有统计学意义(P <0. 01);骨小梁平均间隔小于同期对照组,差异有统计学意义(P <0. 01)。结论 SR具有抑制骨吸收和促进骨形成的双重作用,能增加BMD,加快骨痴形成,促进骨质疏松性骨折愈合,改善骨的显微结构,提高骨折愈合后骨的生物力学特性。     

金乌骨通胶囊治疗骨质疏松67例临床观察

目的 评价金乌骨通胶囊用于骨质疏松治疗的有效性和安全性.方法 收集67例临床骨质疏松患者,进行为期3个月的用药疗效观察,通过对治疗前后的症状分级量化评分进行疾病疗效判定.结果 金乌骨通胶囊具有较好的改善患者临床症状治疗骨质疏松的作用,能有效地减轻患者腰背、关节疼痛,有效率达92.5%以上.治疗后腰椎骨密度测定略有增加,但差异无显著性差异.结论 金乌骨通胶囊用于骨质疏松治疗效果确切,安全性良好.     

雷尼酸锶对尾吊大鼠失重性骨质疏松的防治作用

目的观察雷尼酸锶(SR)对尾吊大鼠血清骨代谢指标、骨密度、骨生物力学的影响。方法选用3月龄雄性健康SD大鼠30只,随机分为5组:全程对照组(A组)、尾吊时服用SR组(B组)、尾吊后服用SR组(C组)、全程服用SR组(D组)、尾吊后对照组(E组),共8周(其中尾吊4周)。分别检测血清骨代谢指标,行骨密度检查及骨生物力学实验。结果尾吊后对照组碱性磷酸酶和骨钙素活性明显高于其余各组(P0.05)。骨密度、最大压缩载荷、最大三点弯曲载荷均比A组低,经过SR治疗后各组指标均有不同程度提高(P0.05),但尾吊后服用SR组和全程服用SR组效果相当且优于尾吊时服用SR组。结论雷尼酸锶对尾吊大鼠骨质疏松有防治作用。     

绝经后妇女骨质疏松症的治疗进展

近年来,骨质疏松症治疗的研究进展发展很快。本文针对绝经后妇女的骨质疏松症,从诊疗方案的设计原则到具体药物的治疗进展进行综述。     

社区绝经后妇女骨质疏松症的健康教育探索

［目的］普及和增强社区内绝经后妇女对骨质疏松的认识和预防。［方法］对802名,平均年龄(60±8.9)岁,来自广东省深圳市罗湖区社区的绝经骨质疏松妇女进行社区教育。教育形式包括：学习了解骨质疏松症,学习合理饮食和营养,学习加强身体锻炼,学习保持规律生活和健康习惯,学习防治剧烈的肢体冲击和配备拐杖。［结果］骨松诊断标准认识率由课程前的11.9％提高到课程后的69.8％(P≤0.01),预防认识率从课程前的14.9%提升到课程后的87.7%(P≤0.01),治疗方法认识率由课程前的4.9%提高到60.8%(P≤0.01),对危险因素的意识由课程前的9.9%提高到78.8%(P≤0.01)。同时,在饮食营养、锻炼、生活习惯(规律服药)和自我保护(配拐杖)等出现有显著意义变化(P≤0.01)。 ［结论］ 社区教育取得了较好的效果;今后应加强社区教育,科学的认识、预防、治疗骨质疏松,将提高骨质疏松患者的生存质量和幸福。     

Monitoring strontium ranelate therapy in patients with osteoporosis

Purpose  The purpose of this study was to review the monitoring of strontium ranelate osteoporosis therapy. Methods  The method used in this study was comprehensive literature review with clinical perspectives. Results  Changes in bone turnover markers (BTM) or bone mineral density (BMD) have been documented in osteoporosis clinical trials. However, neither BMD nor BTM changes fully explain the observed fracture risk reduction in treated patients. If changes in BMD or BTM on therapy would be easily discernable in individual patients, and were strongly associated with fracture risk reduction, monitoring individuals would be more useful. BMD changes in patients on strontium ranelate are of a greater magnitude and hence can be easily determined in an individual patient. In addition, there exists a better correlation between fracture risk reduction and increases in BMD. Conclusions  The strong correlation between measured BMD increases and fracture risk reduction in patients on strontium ranelate therapy will be of clinical benefit to physicians wishing to evaluate both treatment persistence and fracture risk reduction.     

Effect of long-term treatment with strontium ranelate on bone strontium content

AimTo investigate the kinetics and magnitude of human bone strontium uptake and retention during and after long-time treatment with strontium ranelate (SrR).MethodsBone strontium was measured by a novel DPA method developed by us. 32 osteoporotic female patients volunteered to participate in a 3 years open study of the effect on bone Sr. The group was treated with 2 g SrR/day, 17 of the group had received active treatment for 4–5 years before the study. DXA BMD measurements and DPA measurements of the relative bone strontium hydroxy apatite termed %Sr (SrHA / (CaHA + SrHA)) were done simultaneously ultra-distally (UD) on the non-dominant radius every six months during the study and three and six months after treatment stop.ResultsThe highest relative Sr content was found in patients who had been treated for 7–8 years. The variability was pronounced; a mean of 1.1 % Sr was measured at the end of treatment. No effect was demonstrated on distal radius relative bone Ca hydroxy apatite. Bone strontium uptake and retention data were compatible with a power function model. Withdrawal of SrR resulted in a decline in bone Sr, but 73 %Sr and 67 %Sr, respectively remained in UD-radius three and six months after drug withdrawal.ConclusionThe rise in bone Sr content measured by DPA as well as BMD measured by DXA was most marked initially. After the treatment was stopped bone Sr decreased rapidly only during the first months. In UD-radius the apparent BMD corrected for the influence of %Sr measured by DPA showed a slight decline like in an untreated population. Strontium containing drugs may influence DXA bone mineral measurements several years after treatment withdrawal. According to the power function model the skeletal retention three and six months after stopping the treatment would average 66% and 58%, respectively after three years of treatment, and 76% and 70%, respectively after eight years of treatment. However, individual predictions are uncertain due to large inter-individual variations, and the values cannot be extrapolated to other bone sites.     

Cost-utility of long-term strontium ranelate treatment for postmenopausal osteoporotic women

Summary  

The results of this study suggested that long-term treatment with strontium ranelate over 5 years is cost-effective compared to no treatment for postmenopausal osteoporotic women.     

雷奈酸锶联合鲑鱼降钙素针剂对老年骨质疏松压缩性骨折疗效临床观察

目的探讨雷奈酸锶联合鲑鱼降钙素针剂治疗老年骨质疏松椎体压缩性骨折的疗效及对患者骨密度、骨代谢的影响。方法 80例老年椎体压缩性骨折患者随机分为对照组和治疗组。两组患者均进行保守治疗,治疗组在入院后第1天接受雷奈酸锶联合鲑鱼降钙素针剂治疗。分别在治疗前和治疗6个疗程后评定两组患者视觉模拟疼痛评分(VAS)及Oswestry功能障碍指数评分(ODI);检测患者骨密度及骨钙素(BGP)和β-胶原降解产物(β-Cross Laps);并观察治疗组药品不良反应发生情况。结果治疗6个疗程后两组患者VAS与ODI评分均较治疗前有明显改善(P0.05),且治疗组患者评分明显低于对照组(P0.05)。治疗6个疗程后,治疗组患者骨密度较术前显著改善(P0.05),血清BGP和β-Cross Laps较治疗前有显著改变(P0.05),且均明显优于对照组(P0.05);而对照组治疗前后上述指标无明显变(P0.05)。两组药品不良反应发生率比较,差异无统计学意义(P0.05)。结论雷奈酸锶联合鲑鱼降钙素针剂治疗老年骨质疏松椎体压缩性骨折疗效较好,能增加患者骨密度,降低血清BAP和CTX水平,值得推广。     

Cost-effectiveness of strontium ranelate in the treatment of male osteoporosis

Summary

The results of this study suggest that, under the assumption of same relative risk reduction of fractures in men as for women, strontium ranelate could be considered a cost-effective strategy compared with no treatment for the treatment of osteoporotic men from a Belgian healthcare payer perspective.

Introduction

This study was conducted to estimate the cost-effectiveness of strontium ranelate in the treatment of osteoporotic men.

Methods

A previously validated Markov microsimulation model was adapted to estimate the cost (€2,010) per quality-adjusted life-year (QALY) gained of strontium ranelate compared with no treatment. Similar efficacy data on lumbar spine and femoral neck bone mineral density (BMD) between men with osteoporosis at high risk of fracture (MALEO Trial) and postmenopausal osteoporotic women (pivotal SOTI, TROPOS trials) supports the assumption, in the base-case analysis, of the same relative risk reduction of fractures in men as for women. Analyses were conducted, from a Belgian healthcare payer perspective, in the population from the MALEO Trial who is a men population with a mean age of 73 years, and BMD T-score ≤?2.5 or prevalent vertebral fracture (PVF).

Results

In the MALEO population, strontium ranelate compared with no treatment was estimated at €49,798 and €25,584 per QALY gained using efficacy data from the intent-to-treat analysis and the per-protocol analysis including only adherent patients, respectively. In men with a BMD T-score ≤?2.5 or with PVF, the cost per QALY gained of strontium ranelate fall below thresholds of €45,000 and €25,000 per QALY gained based on efficacy data from the entire population of the clinical trial and from the per-protocol analyses, respectively.

Conclusions

The results of this study suggest that, under the assumption of same relative risk reduction of fractures in men as for women, strontium ranelate could be considered cost-effective compared with no treatment for male osteoporosis.     

雷尼酸锶治疗骨质疏松症的研究进展

目的 对雷尼酸锶在骨质疏松症中的临床应用、作用机制进行综述和评价.方法 从人群试验、动物试验、细胞培养和不良反应等方面进行综述.结果 雷尼酸锶具有抗骨吸收和增进骨形成双重作用,其作用可能通过CaSR和增加血清IGF-1、降低高半胱氨酸.结论 雷尼酸锶作为一种新型抗骨质疏松药物,对骨质疏松症具有良好的疗效,代表了骨质疏松症治疗的一个重要发展方向,但应注意其不良反应.     

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。     

金天格胶囊配合牵引治疗腰椎间盘突出症疗效观察

目的观察金天格胶囊配合牵引治疗腰椎间盘突出症的临床效果。方法将221例腰椎间盘突出症患者随机分成实验组112例和对照组109例,实验组采用金天格胶囊配合牵引治疗,对照组采用单纯牵引治疗。治疗60d后比较两者疗效。结果经治疗60d,实验组临床治愈58例,占51.78%,有效102例,总有效率91.07%;对照组的临床治愈33例,占30.27%,有效78例,总有效率71.56%;两组具有显著性差异(P<0.01)。结论金天格胶囊配合牵引治疗腰椎间盘突出症比单纯牵引治疗疗效好。