甲状旁腺素、降钙素和阿仑膦酸钠治疗绝经后妇女骨质疏松症的疗效比较

目的：比较甲状旁腺素、鲑降钙素、阿仑膦酸钠对绝经后妇女骨质疏松症的疗效.方法：对110位确诊患有骨质疏松症的绝经后妇女进行随机分组,分别接受甲状旁腺素20 μg/d皮下注射（36例）或鲑降钙素200 IU/d鼻内给药（36例）或阿仑膦酸钠70 mg/周口服（38例）,共24周.测定主要指标为从基线到终点腰椎骨密度（BMD）变化量；次要指标为从基线到终点全髋BMD变化量及血清骨钙素含量的变化.对结果进行分析比较.结果：共100例患者完成治疗,10例患者中途退出研究.甲状旁腺素组（n=36）在增加患有骨质疏松症的绝经后中国妇女腰椎BMD及血清骨钙素含量方面明显优于降钙素组（n=31）及阿仑膦酸钠组（n=33）,在改变全髋BMD方面与降钙素组及阿仑膦酸钠组无明显差别.结论：与降钙素及阿仑膦酸钠相比,甲状旁腺素在促进患有骨质疏松症的绝经后妇女的骨形成方面的效果更佳.

Comparison of effectiveness of parathyroid hormone, calcitonin and alendronate in the treatment of established osteoporosis for postmenopausal women

Objective：To compare the clinical efficacy of parathyroid hormone,calcitonin and alendronate in the treatment of Chinese postmenopausal women with established osteoporosis.Methods：One hundred and ten women with established osteoporosis were randomized to receive one of the three medicines：36 persons received 20 μg/d parathyroid hormone subcutaneously,36 persons received 200 IU/d salmon calcitonin intranasally,38persons received 70 mg/week alendronate orally.The primary objective was to measure the change of bone mineral density（BMD） of lumbarspine from baseline to endpoint.The secondary objective were the change of BMD of total hip from baseline to endpoint and the change of serum osteocalcin （biochemical marker） from baseline to endpoint.The changes were compared and analyzed.Results：One hundred persons finished the treatment,and 10 persons quited for some reasons.Parathyroid hormone was found to be superior to calcitonin and alendronate in increasing the amounts of lumbar spine BMD in postmenopausal women,and the same conclusion can be found in increasing the serum osteocalcin levels.There were no statistically or clinically significant differences among the three groups about the change of total hip BMD.Conclusion：Parathyroid hormone is more effective on bone formation than salmon calcitonin and alendronate.