降钙素治疗骨质疏松症骨质量病变的研究

The effects of calcitonin treatment on bone quality in patients with osteoporosis

目的研究降钙素在骨质疏松症治疗中对骨密度bonemineraldensityBMD、骨强度及骨质疏松脆性骨折发生率的作用。方法为期1年的单中心、前瞻性、随机研究135例原发性骨质疏松症女性患者随机分成降钙素+钙剂组和钙剂组,进行开放、对比研究。降钙素+钙剂组66例鲑鱼降钙素50IU,肌内注射,第1周每天1次,第2周隔日1次,以后每周2次;同时口服元素钙600mg每天1次。钙剂组69例元素钙600mg每天1次。治疗前后分别进行血清钙、磷、碱性磷酸酶、骨钙素、尿羟脯氨酸、双能X线BMD和超声骨强度测量以及脊椎胸腰段正、侧位X线片比较。结果治疗1年后,降钙素+钙剂组53例获随访,与治疗前比较,腰椎BMD上升约1%P<0.05,髋部BMD无明显变化,桡骨和胫骨骨强度均明显改善;钙剂组59例获随访,腰椎、髋部BMD和桡骨、胫骨骨强度均较治疗前下降P<0.05。两组治疗前后各项生化检测指标无明显变化,骨质疏松脆性骨折的发生率钙剂组明显高于降钙素+钙剂组。结论降钙素治疗骨质疏松症有良好作用,不仅能有效地缓解骨痛,还能确实提高骨质量,降低骨质疏松脆性骨折的发生率。

Objective To study the effects of calcitonin on bone mineral density(BMD), bone strength and bone fragile fracture in osteoporosis. Methods This is a one year, single centered, prospective and randomized, opening study: 135 patients with osteoporosis were divided into calcitonin+calcium group and calcium group. Patients of calcitonin+calcium group received salmon calcitonin(Miacalcic was injected intramuscularly, 50 IU/day in first week, 50 IU/two days in second week and 50 IU/twice/week later) and calcium(calcium 600 mg/day), patients in another group received calcium(calcium 600 mg/day). The determination markers included serum calcium, serum phosphate, serum alkline phosphatase, osteocalcin and urine hydroxyproline before and after treatment, at same time all patients were examined by DEXA(lumbar, hip) and QUS(radius, tibia). Results After 1 year treatment, 53 patients of calcitonin+calcium group and 59 patients of calcium group were followed up. In calcitonin+calcium group, BMD of lumbar spine increased about 1%(P< 0.05), but BMD of hip had no change, bone strength of radius and tibia had significant improvement. In calcium group, BMD of lumbar spine, hip and bone strength of radius, tibia decreased significantly(P< 0.05), and the rate of fragile fracture was higher than that of calcitonin+calcium group. Conclusion There are beneficial effects of calcitonin treatment on bone in osteoporosis, it relieves pain, and improves bone quality and decrease the rate of fragile fracture.