3种治疗方案对骨质疏松症患者骨密度的影响

目的观察以3种用药方案治疗老年骨质疏松症（osteoporosis，OP）1年埘骨密度（BMD）的影响。方法选取2008年10月至2009年6月经骨质疏松筛查T值〈-2．0的92例受试者，随机分为（1）中成药组（A组）：补骨脂颗粒（20g，Bid口服）单药连续使用3个月后，改用仙灵骨葆（3#，2次／d口服）单药连续使用9个月；（2）西药组（B组）：依降钙素（10U，2次／周肌注）单药连续使用3个月后，联合应用福善美（70mg，1次／周，口服）和阿法迪三（0．5μg，1次／d），口服）持续使用9个月；（3）中西药联合治疗组（C组）：中成药组＋西药组联合治疗。测定治疗前后腰椎、股骨颈与全髋的骨密度值（bonemin—eraldensity，BMD）。结果中药组：治疗后L1、L3、L4、L2-4、股骨颈、髋全部的BMD下降，股骨颈BMD治疗前后差异有统计学意义（P〈0．05），其余差异均无统计学意义（P〉0．05）；L2、粗隆的BMD治疗后上升，但治疗前后差异无统计学意义（P〉0．05）。西药组：治疗后L1、L2、L3、L4、L5、股骨颈、粗隆、髋全部的BMD均上升，其中L1、L2、L2-4、粗隆的BMD治疗前后差异有统计学意义（P〈0．05），其余差异无统计学意义（P〉0．05）。中西药联合治疗组：治疗后除L1外，L2、L3、L4、L2-4、股骨颈、粗隆、髋全部的BMD均上升，其中L1、粗隆治疗前后差异有统计学意义（P〈0．05），其余差异治疗前后均无统计学意义（P〉0．05）。3组治疗后BMD变化值（治疗后-治疗前）比较：L2-4、股骨颈BMD的变化值差异有统计学意义（P〈0．05）；两两比较结果显示，中药治疗组和西药治疗组差异均有统计学意义（P〈0．05）；中曲药联合治疗纰和西药治疗组差异无统计学意义（P〉0．05）；中西药联合治疗组和中药治疗组股骨颈BMD变化值差异有统计学意义（P〈0．05）。结论西药组治疗老年T值〈-2．0者疗效较好，可明显提高骨密度。中西药联合应用时中药可能干扰西药的疗效。

Comparison of the efficacy of three medications on osteoporosis: results of a one-year prospective study

Objective To compare the effects of three medications on senile osteoporosis after a one-year follow up. Methods A total of 92 patients with osteoporosis selected from October 2008 to June 2009 were assigned randomly into three protocols： A group （traditional Chinese medicine） ： patients received Bugu capsule （20 g Bid p. o. ） for the first 3 months, then changed to receive Xianling Gubao （3# Bid p. o. ） for 9 monthso B group （ Western medicine） ： patients received Elcatonin （10 U Biw i. m. ） for the first 3 months, then changed to receive both Fosamax （70 mg QW p. o. ） and alfacalcidol （0. 5 μg qd p. o. ） for 9 months; C group （integrated Chinese and Western medicine） ： patients received both A and B protocols. The outcome was the change in bone mineral density （BMD） of the lumbar spine, fem- oral neck, and total hip in 12 months. Results A group： Decrease in L1 , L3 , L4 , L24, femoral neck, and total hip BMD were observed before treatment. Increase in femoral neck BMD showed significant difference after treatment （P 〈 O. 05） while other positions showed no significant difference （ P 〉 O. 05）. Increase in L2 and troehanter BMD were observed, but without significant difference （ P 〉 O. 05 ） o B group ： Increase in L1 , L2 , L3 , L4 , L2-4, femoral neck, trochanter and total hip BMD were observed, among which L1 , L2 , L2-4, and trochanter showed significant difference （ P 〈 0.05） . C group： Increase in L2, L3, L4, L2-4, femoral neck, troehanter, total hip BMD were observed except L1. Significant difference was only observed in L3 and troehater BMD （ P 〈 O. 05 ）. Significant increase in L2.4 , femoral neck BMD were observed in all patients （ P 〈 0. 05 ） , regardless which protocols they received. Significant difference was observed in A group and B group （ P 〈 0. 05 ）. Without significant difference was observed in B group and C group （ P 〉 0. 05 ）. Significant difference of BMD （femoral neck） were observed in A group and C group （P 〈 0. 05 ）. Conclusion Western medicine treatment can significantly improve BMD in the population of T value 〈 - 2. 0. But effect of western medicine can be interfered when combined with traditional Chinese medicine.