唑来膦酸在骨质疏松性椎体压缩骨折椎体后凸成形术后的应用

Application of zoledronic acid in kyphoplasty for osteoporotic vertebral compression fractures

目的:观察唑来膦酸辅助椎体后凸成形术(kyphoplasty,KP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的疗效。方法 :符合条件的KP术后患者,随机分为A组42例(应用唑来膦酸,同时口服活性维生素D和钙剂)和B组40例(仅给予活性维生素D和钙剂)。治疗前和治疗后3、12个月行VAS评分、骨代谢指标及骨密度测定、并发症观察。结果 :治疗后2组VAS评分显著下降,治疗12个月后A组进一步下降,B组有所上升,与3个月时比较有明显差异。两组治疗后BAP及25-羟基维生素D明显升高,TRACP-5b在A组明显升高,B组变化不明显。治疗后A组骨密度显著增加,B组显著降低。A组25例出现药物相关不良反应,未发生新骨折,但B组发生新骨质疏松骨折2例。结论 :唑来膦酸辅助KP治疗OVCF可进一步缓解疼痛,抑制骨量丢失,增加骨密度,降低骨折风险。

Objective To investigate the efficacy of zoledronic acid in assisted kyphoplasty （KP） for osteoporotic vertebral compression fractures （OVCF）. Methods Eighty-two patients diagnosed as OVCF and on KP therapy were randomly divided into two groups： group A （n = 42） and group B （n = 40）. Group A received zoledronic acid （Aclasta） and oral active vitamin D and calcium, while group B received oral active vitamin D and calcium alone. The VAS score, bone metabolism markers, and bone mineral density （BMD） were measured; drug- related adverse reactions and newly occurred fractures were assessed during follow-up. Results The VAS score decreased significantly in both groups, while group A improved more markedly. Levels of BAP and 25-OH-VD significantly increased in both groups, and level of TRACP-5b significantly increased in group A but did not change significantly in group B. BMD significantly increased in group A while significantly decreased in group B after treatment. In group A no newly occurrd fractures were found and adverse reactions occurred in 25 patients. Osteoporotic fractures occurred in two patients in group B but no significant drug-related complications were observed. Conclusions Uses of zoledronic acid may further relieve pain, inhibit bone loss, increase bone density, and reduce risks of fracture in the treatment of osteoporotic vertebral compression fractures.