联合间断用药方案治疗绝经后骨质疏松症的临床研究

Clinical research on the intermittent combined drug application for postmenopausal osteoporosis

目的研究降钙素+阿伦膦酸钠+尼尔雌醇+钙剂联合短期使用能否迅速改善经后骨质疏松症患者骨痛症状、维持患者骨量稳定。方法110例绝经后骨质疏松症(PMO)骨痛患者随机分为治疗组和对照组,其中对照组钙尔奇D片1片口服:每日1次(元素钙600mg,维生素D125U)持续1年,治疗组用鲑降钙素50IU(商品名密钙息,北京诺华制药有限公司),肌肉注射,隔日1次持续2周;阿伦膦酸钠10mg(商品名固邦,石家庄欧意药业有限公司)口服每日1次,持续12周;用尼尔雌醇片0.5mg阴道放置每周1次,持续12周;钙尔奇D片1片口服:每日1次(元素钙600mg,维生素D125U)持续1年。治疗前及1年结束后,采用超声骨量测定仪测跟骨骨量;观察两组骨痛改善的时间和有效率。结果治疗组缓解疼痛快而有效,两组疗效比较差异有显著性。治疗组骨量较治疗前有升高,但无统计学意义(P>0.05);对照组骨量较治疗前下降显著(P<0.05);两组治疗后骨量相差显著(P<0.01)。结论降钙素+阿伦膦酸钠+尼尔雌醇+钙剂联合短期使用能迅速改善PMO患者骨痛症状、停药后仍可在一段时间维持患者骨量稳定,提示间断用药治疗骨质疏松症有效。

Objective To study the effect of short-term combined drug application with Calcitonin, Mendronate, Nylestriol and calcium in fast relieving the bone pain and keeping the bone mass steady in women with postmenopausal osteoporosis （PMO）, Methods 110 women with PMO were randomly divided into 2 groups： the treatment group and the control group, 55 cases in each. Caltrate D （600 mg＋ Vit D 3 125 U, per os, QDX 365 d） was given to the control group while salmon Calcitonin （50 IU, IM, QOD ×14 d）, Mendronate （ 10 mg, per os, QD × 12W）, Nylestriol （0,5 mg, vaginal medication, QW × 12 W） and Cahrate D （600 mg ＋ Vit D 125 U, per os, QD ×365d） were given to the treatment group, Ultrasonic bone mass examination was made to both groups to detect the bone mass in calcaneus before and one year after treatment, The time for relieving bone pain and the curative effect were observed, Results The treatment group showed quick effect in relieving bone pain and the curative effect between the two groups was of significant difference, The bone mass in the treatment group was more after treatment than that before treatment but without statistical significance （P 〉 0,05）, the bone mass in the control group decreased obviously after treatment compared with that before treatment （ P 〈 0,05）, the bone mass in both groups after treatment was of significant difference （ P 〈 0.01 ）, Conclusions The short-term combined drug application with Calcitonin, Mendronate, Nylestriol and calcium can soon relieve the bone pain of the patients with PMO and can keep the bone mass steady in a certain period even after drug application, which indicates that intermittent drug application is effective for osteoporosis