唑来膦酸对老年骨质疏松性骨折及骨关节炎患者骨代谢的影响

The effect of Zoledronic acid on bone metabolism in elderly people with osteoporotic fractures or osteoarthritis

目的了解老年骨质疏松性骨折及骨关节炎患者应用唑来膦酸抗骨质疏松治疗后自身骨代谢变化特点。方法回顾性分析2013年5月至2014年11月北京医院骨科接受唑来膦酸治疗的105例老年患者（骨质疏松性骨折患者54例，骨关节炎患者51例），其骨代谢生化标志物总I型前胶原氨基端肽（tP1NP）、NMID骨钙素（OCN）和I型胶原羧基端肽口特殊序列（p—CTX）在治疗前、治疗后1周及治疗后1年的水平，并于治疗前、治疗后1年采用双能X线骨密度仪（DXA）测定患者腰椎及髋部骨密度。结果骨折患者治疗后1周较治疗前tP1NP升高（P〈0．05），骨关节炎患者治疗后1周较治疗前无明显变化（P〉0．05）；所有患者治疗后1年较治疗前tP1NP降低（P〈0．001）；所有患者治疗后1周较治疗前OCN降低（P〈0．05）、口CTX降低（P〈0．001），治疗后1年较治疗前OCN、pCTX均降低（P〈0．001），且骨折患者p-CTX降低幅度更为明屉（P〈0．05）；所有患者治疗后1年与治疗前相比，髋部骨密度无明显变化（P〉0．05），腰椎骨密度增高（P〈0．05）。结论唑来膦酸作为骨吸收抑制剂能够有效降低骨科老年患者骨代谢水平，对于骨折患者的骨吸收抑制作用尤为明显，并能增加患者腰椎骨密度。

Objective To analyze the effects of treatment with Zoledronic acid on the characteristics of hone metabolism in elderly people with osteoporotic fractures versus osteoarthritis. Methods The 105 patients treated with Zoledronic acid （54 osteoporotic fractures patients, 51 osteoarthritis patients） were retrospectively analyzed from May 2013 to November 2014. The serum levels of total procollagen type 1 amino-terminal propeptide （tP1NP）, N-MID osteocalcin（OCN）, and β-crossLaps（β-CTX） were measured by ECLIA in all patients before and 1 week and 1 year after the treatment. Bone mineral density （BMD） was measured by dual energy X-ray densitometer （DXA） before and 1 year after the treatment. Results One week after treatment, tPlNP level were increased in osteoporotic fractures patients （P〈 0.05）, while it was unchanged in osteoarthritis patients, OCN and 13 CTX level in all patients were decreased, especially in osteoporotic fractures patients（all P〈0.05）. One year after treatment, tP1NP,OCN and β-CTX level in all patients were decreased（all P〈0. 001）, BMD in lumber were increased（P〈0.05）while BMD in hip didn＇t change significantly（ P 〉 0.05 ）. Conclusions The treatment of Zoledronic acid can decrease bone metabolism in elderly people of orthopaedics effeetively, especially in osteoporotic fractures patients through inhibiting bone resorption, and can improve BMD in lumber significantly.