唑来膦酸与替勃龙治疗绝经后骨质疏松疗效比较及对骨折的预防作用

目的比较唑来膦酸与替勃龙治疗绝经后骨质疏松的临床疗效及对骨折的预防作用。方法将本院诊治的128例绝经后骨质疏松患者随机分入唑来膦酸组与替勃龙组,两组患者均接受骨化三醇、钙剂治疗,唑来膦酸组患者同时接受唑来膦酸5 mg/年静脉注射,替勃龙组患者接受替勃龙2.5 mg/d,口服。用药后2年比较两组髋部及腰椎骨密度变化、血清Ⅰ型前胶原肽（CTX）、骨碱性磷酸酶（BALP）及不良反应发生情况。结果两组治疗后2年腰椎L1-L4和髋部区、股骨颈、大转子骨密度均显著增加（P〈0.05）,唑来膦酸组L1-L4骨密度增加显著优于替勃龙组（P〈0.05）;治疗后两组CTX及BALP均显著下降,唑来膦酸组CTX显著低于替勃龙组（P〈0.05）;唑来膦酸组与替勃龙组新发骨折发生率分别为4.5%和8.1%,两组比较差异无统计学意义（P〉0.05）;唑来膦酸组不良反应发生率为19.7%,替勃龙组为11.3%,两组均未发生严重不良反应。结论唑来膦酸与替勃龙治疗绝经后骨质疏松均可获得理想的临床疗效,唑来膦酸组腰椎骨质密度增加更为显著,患者治疗依从性好。

Comparison of zoledronic acid and tibolone in treatment of postmenopausal osteoporosis and the preventive effect on fracture

Objective To compare the effect of zoledronic acid and tibolone in treatment of postmenopausal osteoporosis and the preventive effect on fracture.Methods 128 patients with postmenopausal osteoporosis were randomly divided into zoledronic acid group and tibolone group.All the subjects received calcitriol and calcium treatment.Zoledronic acid group was treated with zoledronic acid 5 mg every year infusion,and tibolone group were given oral tibolone 2.5 mg /d.Bone density of hip and lumbar,serum CTX and BALP and adverse reaction rate were compared between the two groups after 2 years treatment.Results After treatment,bone density of L1 ~ L4,femoral neck,the Words area and greater trochanter greatly increased in two groups（P〈0.05）.Increases of bone density at L1 ~ L4 in zoledronic acid group was superior to that in tibolone group（P〈0.05）;Serum CTX and BALP significantly decreased after treatment in two groups（P〈0.05）,and the CTX level in zoledronic acid group was much lower than that in tibolone group（P〈0.05）.The occurrence of fracture were 4.5% and 8.1% in zoledronic acid group and tibolone group without significant difference（P〉0.05）.The adverse reaction rates were 19.7% and 11.3% in zoledronic acid group and tibolone group（P〉0.05）.No serious adverse reaction occurred in two groups.Conclusion Both zoledronic acid and tibolone for postmenopausal osteoporosis have ideal effect,and increases of lumbar bone density are more significantly in the patients undergoing zoledronic acid with good treatment compliance.