阿仑膦酸钠在甲状腺功能亢进症继发骨质疏松症中的临床应用

目的:评价阿仑膦酸钠在甲状腺功能亢进继发性骨质疏松症治疗中的有效性及安全性。方法:2008年4月至2009年11月门诊收治经双能X线骨吸收仪(DXA)证实有骨质疏松或骨量减少的27例甲状腺功能亢进患者,男7例,女20例;年龄30～61岁,平均(41.52±10.7)岁。根据随机数字表将患者随机分成A、B两组。A组14例,抗甲状腺药物加钙尔奇D口服治疗,抗甲状腺药物随着甲状腺功能的变化调整剂量,钙尔奇D每天600mg;B组13例,抗甲状腺药物加钙尔奇D加阿仑膦酸钠口服治疗,抗甲状腺药物、钙尔奇D治疗方法与A组一致,阿仑膦酸钠每周1次,每次70mg。同时选取21例健康自愿者作为对照组,不予任何干预。治疗1年后复查A、B两组患者腰椎、股骨颈、桡骨远端一般资料,比较A、B两组治疗前后骨密度(T值、Z值、BMD)及一般资料的变化,并与对照组比较,观察是否可达到完全恢复。结果:A组仅股骨颈、桡骨远端1/3处的BMD较治疗前明显上升(P值均为0.000),而B组腰椎、股骨颈、桡骨远端1/3处的T值、Z值、BMD均较治疗前明显上升(P<0.05),但均不能恢复至正常人群水平。A组腰椎、股骨颈、桡骨远端1/3处的BMD较治疗前分别升高(4.34±10.5)%、(3.21±1.38)%、(1.95±0.44)%;B组腰椎、股骨颈、桡骨远端1/3处的BMD较治疗前分别升高(6.10±8.12)%、(4.10±5.64)%、(3.10±3.23)%,各部位BMD上升的幅度,两组之间有统计学差异(P<0.05)。两组一般资料治疗后较治疗前相比,AKP均下降,体重、BMI均上升,甲状腺功能均下降至正常(P均<0.05)。结论:阿仑膦酸钠联合抗甲状腺药物治疗甲状腺功能亢进引起的骨量丢失,对骨密度的改善,较单用抗甲状腺药物更有效,而且较安全。

Clinical application of alendronate for osteoporosis/osteopenia secondary to hyperthyroidism

Objective: To evaluate the efficacy and safety of alendronate for the treatment of osteoporosis/osteopenia secondary to hyperthyroidism. Methods: From April 2008 to November 2009,27 patients with hyperthyroidism with osteoporosis/osteopenia measured by dual energy X-ray absorptiometry(DXA) were included in this study,and then they were randomly divided into two groups(group A and group B)by simple random sampling. Group A consisted of 14 patients treated with antithyroid drug and caltrate D,the antithyroid drug change with thyroid function,and caltrate D 600 mg per day. Group B consisted of 13 patients treated with antithyroid drug,caltrate D and alendronate,antithyroid drug and caltrate D the same as group A,and alendronate 70 mg weekly. Meanwhile,21 healthy voluntary adults were chosen as control group. And compared with the control group which was treated with nothing. Followed-up for one year,the bone mineral density(including T-score,Z-score,BMD) in lumbar spine(LS),femoral neck (FN) and distal radius(DR) and general information,were compared before and after treatment. Results: BMD at FN and DR were significantly higher at 12 months after treatment than at the baseline in group A(P=0.000);T-score,Z-score,and BMD at the LS,FN and DR were all significantly higher at 12 months after treatment than at the baseline in group B(P<0.05),but these data could not arrive to normal level. In group A,the percentage increased in BMD at the LS,FN,and DR were(4.34±10.5)%,(3.21±1.38)%,(1.95±0.44)%,respectively,at 12 months after treatment. In group B,the percentage increased in BMD at the LS,FN,and DR were(6.10±8.12)%,(4.10±5.64)%,(3.10±3.23)%,respectively,at 12 months after treatment. There was significant difference in the rate of increase between two groups (P<0.05). AKP decreased,weight,BMI increased,and thyroid function decreased,after treatment than those before in both of the two groups.(P<0.05). Conclusion: Alendronate can significantly increase BMD in treating patients with hyperthyroidism and osteoporosis/osteopenia. Compared with anti-thyroid drugs alone,treatment with alendronate can obtain more clinical effect and also very safety.