骨吸收抑制剂治疗绝经后骨质疏松的临床评价

目的　评价不同类型骨吸收抑制剂在临床原发性骨质疏松症治疗中的疗效。方法　30 0例原发性骨质疏松症患者分成三组 ,每组 10 0例 ,所有患者均排除继发性骨质疏松。性激素类组 :服用利维爱 2 5mg ,隔日 1次 ;降钙素组 :密钙息 5 0IU ,肌注 ,第 1周每天 1次 ,第 2周隔日 1次 ,以后每周 2次 ;二膦酸盐组 :阿仑膦酸钠 10mg ,每天 1次。治疗 2年后随访 :腰椎骨密度 (BMD)、胫骨骨超声 (QUS)、尿羟脯氨酸 (HOP)、骨钙素和新骨折。结果　临床骨痛降钙素缓解速度最快 ,性激素类药物可迅速有效地缓解妇女更年期症状。治疗 2年后 ,腰椎骨密度明显上升 (P <0 0 5 ) ,二膦酸盐组上升 5 1% ,性激素类组上升 4 2 % ,降钙素上升 0 97% ;胫骨骨超声显著提高 (P <0 0 5 ) ,性激素组上升 2 1% ,降钙素组 1 8% ,二膦酸盐组 1 7% ;新骨折共 4例 :二膦酸盐组 2例 ,降钙素组和性激素组各 1例 ;尿羟脯氨酸仅二膦酸盐组明显下降 ;骨钙素各组无明显变化。结论　骨吸收抑制剂是骨质疏松治疗的重要手段 ,性激素类药物是治疗伴有绝经后综合症骨质疏松患者的首选药物 ,二膦酸盐对骨量较低且伴有骨痛的患者有良好的疗效 ,降钙素治疗骨质疏松疼痛临床疗效显著。

Clinical efficacy of antiresorptive treatment in patients with osteoporosis

Objective To evaluate the clinical efficacy of antiresorptive treatment in patients with osteoporosis.Methods 300 patients with osteoporosis were divided randomly into three groups.There are 100 patients in each group and for all of them secondary osteoporosis were excluded HRT group (tibolone 1 25mg/day),calcitonin group (Miacalcic was injected intramuscularly,50IU/day in first week,50IU/two days in second week and 50IU/twice/week later)and bisphosphonae group (alendronate 10mg/day).Bone mineral density(BMD) on lumbar spine,speed of sound(SOS) on tibia,urine hydroxyproline(HOP),osteocalcin and new fragile fracture were followed up after 2 year treatment.Results Clinical results showed that calcitonin relieved bone pain quickly and HRT had good efficacy in postmenopausal syndrome.After 2 year treatment,BMD of lumbar spine had significant increase( P< 0 05)in bisphosphonate group (7 1%),HRT group (4 2%)and calcitonin group (1 0%).SOS of tibia also had significant improvement ( P< 0 05)in HRT group (2 1%),calcitonin group (1 8%)and bisphosphonate group (1 7%).Four cases had suffered from new fragile fracture in bisphosphonate group (2 cases),HRT group (1 case)and calcitonin group (1 case).HOP decreased significantly only in bisphosphonate group.Osteocalcin had no significant change in each group.Conclusion There are beneficial clinical efficacy of antiresorptive treatment in patients with osteoporosis.HRT is the best choice for the patients with postmenopausal syndrome with osteoporosis.For low BMD with bone pain bisphosphonate treatment is a good therapy.There is special clinical effect of calcitonin treatment on bone pain in osteoporosis.