阿仑膦酸钠疗效与维生素D血清水平的相关性

Association between the efficacy of alendronate and serum level of vitamin D in patients with osteoporosis

目的 通过研究阿仑膦酸钠治疗绝经后骨质疏松妇女的有效性与血清维生素D水平的相关性,探讨维生素D对阿仑膦酸钠疗效的影响,为阿仑膦酸钠治疗骨质疏松症获得最优疗效提供依据.方法 回顾2011年1月至2013年8月在本院骨质疏松门诊就诊,且接受阿仑膦酸钠治疗时间≥18个月,用药期间每3～5个月测25-羟维生素D(25-OHD)的绝经后骨质疏松妇女579例.检测血清维生素D,记录所有被纳入者的身高、体重、用药时间、血清25-OHD水平、基础骨密度、治疗后骨密度、有无新发脆性骨折等临床资料.根据复泰奥欧洲研究(EUROFORS)标准将上述患者分为治疗无效组以及治疗有效组.对2组间的25-OHD水平进行比较及t检验,采用多元回归分析法分析阿仑膦酸钠疗效与维生素D水平之间的相关性.结果 共579例患者纳入本次研究,其中治疗有效者437例(75.5％),治疗无效者142例(24.5％);2组患者血25-OHD水平分别为(59.96±12.56) nmol/L、(47.50±9.92) nmol/L,差异有统计学意义(P＜0.01);多元logisitic回归分析结果提示,阿仑膦酸钠治疗骨质疏松症的疗效与维生素D水平显著相关(P＜0.01),25-OHD水平升高治疗有效率显著升高,当25-OHD ≥50 nmol/L时获益最大.结论 绝经后骨质疏松症妇女服用阿仑膦酸钠治疗期间25-OHD水平应维持在50 nmol/L以上.

Objective To examine the association between vitamin D and alendronate response,and to investigate the proper vitamin D levels for the efficacy of alendronate treatment of osteoporosis.Methods In this retrospective study,559 post-menopausal women with osteoporosis were devided into two groups:non-responders and responders,based on the European Study of Forsteo (EUROFORS).Demographic and clinical data including mean 25-hydroxy vitamin D (25-OHD) levels between dual-energy X-ray absorptiometry (DEXA) scans were obtained.Mean 25-OHD levels were compared between responders and non-responders and multiple logistic regression analysis was performed to identify factors associated with non-response.Results There were 437 (75.5％) responsers to alendronate therapy and 142 (24.5％) non-responders.Responders with a mean serum 25-OHD level of (59.96 ±12.56) nmol/L,obtained a more favorable result than non-responders,whose serum 25-OHD level was (47.50 ±9.92) nmol/L (P＜0.01).25-OHD level was significantly associated with response.Conclusion Patients with a mean 25-OHD ≥50 nmol/L had a substantially greater likelihood of maintaining bisphosphonate response.