5mg唑来膦酸治疗绝经后骨质疏松及其骨折

5 mg zoledronic acid for treatment of postmenopausal women with osteoporosis and osteoporoticfracture

目的探讨5mg唑来膦酸每年1次在干预绝经后妇女不同原因所致骨质疏松及其骨折的作用。方法2009年10月至2009年12川收治且符合纳入标准的绝经后妇女骨质疏松患者89例，根据病情分为两组：A组（原发性骨质疏松）47例，年龄47-83岁，平均63．7岁；其中骨折患者27例，6个川内均未服用影响骨代谢的药物。B组（继发性骨质疏松）44例，年龄45-78岁，平均62．5岁；其中骨折患者28例；同时伴仃类JxI湿关节炎（6例）、乳腺癌术后（9例）、子宫内膜癌术后（3例）、消化系统溃疡（7例）、溃疡性结肠炎（3例）。所有患者均接受5mg唑来膦酸，30min静脉注射治疗，每年1次，骨化萨醇0．25μg和钙刹600mg及维生素D125IU，1次／d。分别比较两组患者治疗前和治疗后12个月时腰椎和髋μ部骨密度及跌倒风险指数（F1），观察患者治疗依从性和药物小良反应。结果所有新鲜骨折患者在治疗3个月后随访，骨折愈合良好，末出现骨折延迟愈合或不愈合。治疗12个川后，A、B组分别仃43例、42例患者扶得随访，A组骨密度增加：腰椎5．8％、股骨颁2．9％、Words区5．2％、大转子5．3％和髋邪总量3．9％，FI降低26．1％；B组骨密度增加：腰椎3．4％、股骨颈2．1％、Words区3．2％、大转子3．0％和髋部总量2．5％，FI降低21．8％。与治疗前自身比较差肄均有统计学意义（P〈0．05）。A、B组各有1例发生骨折，均仃保守治疗。两组患暂血钙、血磷测定均在正常范围内，部分患者有不良反应。结论每年1次5mg唑来膦酸治疗绝经后骨质疏松可显著提高腰椎、髋部及股什颈的骨密度，降低跌倒风险，是一种方便高效的临床骨质疏松治疗予段。

Objective To investigate the effect of once yearly zoledronie acid of 5 mg on post- menopausal women with osteoporosis uf different causes. Methods From October 2009 to Dee.ember 2009. a total of 89 postnlenopattsal women with osteoporosis were enrolled and assigned into 2 grnups. There were 45 cases of primal postmenopausal osteoporosis, including 27 eases of fresh fi＇acture, in group A. They were aged from 47 to 83 years, with an average of 63.7 years. There were 44 eases of seeondat7 pnst- menopausal osteoporosis, including 28 c, ases of fresh fi＇aeture, in group B. All patients were given a single 30-minnte intravenous injection of zoledronie acid （5 rag）, supplemented bv 1, 25-dihydroxyvitamfll D of 0.25 IJ-g and calcium of 600 mg with VitD125 IU daily. At pre-intervention and 12 months after intervention re- spectively, bone mineral density （BMD） was nteasured by dual-X-ray at）surptiometry （DXA） at the lumbar spine and hip. and a balance test（Sunlight Tetrax- Ⅱ） was performed to evahmte the risk of falling, intervention eom- plianee of the patients and adverse events related to zoledronie acid infusion were observed. Results All cases of fresh fraeture healed well at 3-month follow-up. At 12 months, 43 subjects in group A anti 42 st,bjeets in group B completed the follow-up. In group A, BMD increased by 5.8% at the lumbar spine, by 2, 9% at the femoral neck, by 5.2% at the Words area, by 5.3% at the greater troehanter and l）y 3.9% at the total hip while the risk of falling decreased by 26. 1% ： in group B, BMD increased bv by 3.4% at the lumbar spine, by 2. 1% at the femoral neck, by 3.2% at the Words area, by 3.0% at the greater troehanter and by 2.5% at the total hip while the risk of fillling decreased by 21.8%. The differences between pre-intervention and post-intervention were significant in both groups （P 〈 0.05）. No intolerable adverse events oeeurred in both groups except that one new fracture happened in each group but responded to conservative treatment. Conclusion A once-yearly infnsion of zoledronie arid of 5 mg is a convenient and effective therapy for treatment of usteoporosis in poshnenopausal women.