阿伦膦酸钠对绝经后骨量减少和骨质疏松妇女骨密度变化的影响

目的　观察绝经后骨量减少和骨质疏松妇女在阿伦膦酸钠 (福善美 )治疗和停药后的骨密度变化。方法　 4 0例绝经后骨质疏松和骨量减少的妇女 ,每日口服福善美 10mg和元素钙 5 0 0mg,分为服药 6个月组 2 5例 ,服药 12个月组 15例。停药后仅应用元素钙 5 0 0mg/d。观察服药期间和停药后的骨密度变化。结果　服药 6个月组 :腰椎 2～ 4和髋部的BMD值于服药 6个月时较服药前均有明显升高 ,其中腰椎 2～ 4升高 5 3% (P <0 0 0 1)。停药 13± 4个月后 ,腰椎 2～ 4和髋部的BMD值与服药 6个月时比较未见降低 ,大转子部位的BMD值较服药 6个月还有进一步升高。服药 12个月组 ,服药 6个月时 ,除Wards三角外 ,其他 3个部位的BMD值较用药前明显升高 ,其中腰椎 2～ 4升高4 2 % (P <0 0 0 1) ;服药 12个月时 ,腰椎 2～ 4的BMD较服药前升高 6 1% (P <0 0 0 1) ,而髋部的BMD较服药前未见明显改变。停药 2 3± 7个月后 ,腰椎和髋部的BMD与服药 12个月时相比均无明显变化。结论　阿伦膦酸钠治疗绝经后骨量减少和骨质疏松妇女 ,可以明显升高腰椎及髋部的骨密度 ,以腰椎部位升高更显著 ,停药后骨密度可维持 13～ 2 3个月。

Alendronate in postmenopausal women with osteopenia and osteoporosis: effects on bone mineral density during treatment and after withdrawal

OBJECTIVE: To determine the efficacy of alendronate (Fosamax) administration and withdrawal on the bone mineral density (BMD) in postmenopausal women with osteopenia and osteoporosis. METHODS: Alendronate (10 mg) and calcium carbonate (containing calcium 500 mg) were administered daily to 25 Chinese menopausal women with osteopenia and osteoporosis for 6 months and to 15 women for 12 months. After the withdrawal of alendronate, calcium carbonate was administered continuously. Follow-up was made three times for the 6-month group: before treatment, 6 months after treatment, and 13 +/- 4 months (6 - 24 months) after aldoronate withdrawal, and was made four times for the 12-month group: before treatment, 6 months and 12 months after treatment, and 23 +/- 7 months (14 - 36 months) after alendronate withdrawal to determine the BMD of lumbar spine 2 approximately 4, neck of femur, Wards triangle, and greater trochanter and blood alkaline phosphatase (ALP). RESULTS: Compared to the baseline value, the BMD in lumbar spine and hip increased significantly 6 months after treatment in 6-month group, with the BMD in lumbar spine 2 - 4 increased by 5.3% (P < 0.001). In the 6 month group, no significant decline was found in the BMD in lumbar spine and hip 13 +/- 4 months after alendronate withdrawal, the BMD in greater trochanter even increased further compared with that 6 months after treatment. In the 12-month group, the BMD significantly increased except in the Wards triangle after 6 months' treatment with an increase by 4.2% in lumbar spine 2 - 4 (P < 0.001). After 12 months' treatment the increment of BMD in lumbar spine 2 - 4 was 6.1% (P < 0.001) and the BMD of the hip remained unchanged. 23 +/- 7 months after the alendronte withdrawal the values of BMD in lumbar spine and hip were almost the same as that 12 months after treatment. CONCLUSION: Alendronate increases the BMD in spine and hip, especially in lumbar spine. The skeletal benefits are maintained for at least 13 - 23 months in spine and hip after withdrawal of alendrenate.