帕米膦酸二钠治疗绝经后妇女骨质疏松症3年临床观察

摘要

Objective To observe the efficacy of pamidronate disodium for the 3-year treatment of postmenopausal osteoporosis (PMOP). Methods Ninety-seven cases of PMOP from August 2007 to June 2008 were selected. The patients were treated with intravenous pamidronate disodium (30mg, 3 times per month) , and supplemented with 800-1200 mg calcium and 0. 25 μg vitamin D daily, for 3 years. BMD of the lumbar vertebra, the femoral neck, and the total tip and the bone turnover markers including serum CTX, urine CTX, NTX, and serum TRACP5b, were measured before and after the treatment. Results 1) BMD of the lumbar vertebra, the femoral neck, and the total tip increased significantly after the 3-year treatment, comparing to BMD before the treatment ( P <0. 001) . 2) Serum CTX and NTX, urine CTX/Cr, NTX/Cr, PYD/Cr, DPYD/Cr, and serum TRAP significantly decreased after 6-month treatment, comparing to those before the treatment ( P < 0. 01). The bone turnover markers remained in a low level and did not decrease further thereafter. Pearson' s correlation analysis showed that the changes of PYD, DPYD, and PRAP in 6 months after the treatment were negatively associated with the changes of BMD of the lumbar vertebra, the femoral neck, and the total tip in 3-year after the treatment (P <0. 01 ). 3) The pain was significantly ameliorated and the life quality was significantly improved after the treatment. Two new fractures occurred during the treatment. Conclusion Pamidronate disodium was efficient and safe in the treatment ofPMOP. The decline of bone turnover markers in early stage was negatively correlated with the improvement ofBMD in 3 years after the treatment.%目的 观察帕米膦酸二钠治疗绝经后妇女骨质疏松症3年疗效。方法 选取2007年8月至2008年6月PMOP患者97例.每月三次静脉输注帕米膦酸钠30mg.同时每天补充钙剂800 mg～1200mg和活性维生素D 0.25ug.疗程3年。定期测定治疗前后的腰椎、股骨颈与全髋骨密度值(BMD)及骨转换标记物(血清CTX、尿CTX、NTX、血清TRACP5b)。结果 ①治疗3年后.腰椎、股骨颈和全髋部位BMD均较治疗前显著提高(P＜0.001)；②治疗6个月，血清Ⅰ型胶原交联羧基端肽(CTX)、Ⅰ型胶原交联氨基端肽(NTX)、尿CTX/Cr、尿NTX/Cr、尿吡啶啉/肌酐(PYD/Cr)、尿脱氧吡啶啉/肌酐(DPYD/Cr)和血浆抗酒石酸酸性磷酸酶均较治疗前显著下降(P＜0.01)，其后各骨转换标记物仍维持较低水平，但无进一步下降。Pearson相关分析显示治疗6个月时尿吡啶啉和脱氧吡啶啉、血浆抗酒石酸酸性磷酸酶的变化与3年后腰椎、股骨颈和全髋部位BMD的变化值均呈负相关(P＜0.01)。③治疗后疼痛明显缓解生活能力明显改善，治疗期间新发骨折2例。结论 帕米膦酸二钠是治疗PMOP安全有效，早期骨转换标记物的下降与3年后骨密度的改善呈负相关。