高龄老年女性骨质疏松患者骨代谢特点及使用双膦酸盐的疗效

Clinical characteristics of bone metabolism in elderly women patients with osteoporosis and the effect of bisphosphonate

目的研究高龄（≥80岁）老年女性骨质疏松患者骨代谢特点及使用双膦酸盐的疗效。方法回顾2005年8月至2013年8月在上海交通大学附属第一人民医院骨质疏松门诊就诊的初诊患者,所有患者均接受双膦酸盐药物治疗≥12个月,用药前后测骨密度（bone mineral density,BMD）和骨转换指标（bone turnover marker,BTM）等,≥80岁的高龄老年女性骨质疏松患者232例（高龄老年组）和47~65岁的绝经后女性骨质疏松患者454例（对照组）。记录所有纳入患者的年龄、身高,体质量、体质量指数（body mass index,BMI）,用药时间,治疗前后骨密度、血钙、血磷、血清25-羟维生素D（25-hydroxy-vitamin D,25OHD）、骨钙素（bone gamma-carboxyglutamic-acid-containing proteins,BGP）和Ⅰ型胶原羧基端肽（Ⅰtype collagen pyridine cross-linked final peptide,β-CTx）等临床资料。结果两组治疗前BMI、血钙、血磷和L1-4BMD差异无统计学意义;高龄老年女性骨质疏松患者的骨转换水平、股骨颈BMD、全髋BMD和25OHD明显低于对照组（P〈0.05）。双膦酸盐治疗12个月后,两组BMD和25OHD水平均增加,骨转换指标均下降。高龄老年组L1-4BMD升高3.29%,股骨颈BMD升高1.24%,全髋关节BMD升高1.00%;对照组L1-4BMD升高3.51%,股骨颈BMD升高1.18%,全髋关节BMD升高1.58%。两组BMD升高程度比较差异无统计学意义（P〉0.05）;老年组BGP下降23.63%,β-CTx下降40.62%,对照组BGP下降36.65%,β-CTx下降60.26%,两者下降程度比较差异有统计学意义（P〈0.05）;老年组25OHD升高17.85%,对照组升高8.97%;双膦酸盐治疗12个月后,两组血钙和血磷比较差异无统计学意义（P〉0.05）。结论高龄老年骨质疏松患者骨转换水平处于低骨转换状态,对于不同骨转换水平的骨质疏松患者,双膦酸盐增加BMD的作用相似,双膦酸盐可以应用于80岁以上的老年骨质疏松患者。

Objective To investigate the clinical characteristics of bone metabolism in elderly women patients with osteoporosis（ over 80 years） and the effect of bisphosphonate. Methods Back from August 2005 to August 2013 in Shanghai First People＇s Hospital out-patient,treatment with bisphosphonates more than 12 months,there were 232 elderly women patients with osteoporosis at the age of over 80（ the elder group） and 454 non old postmenopausal women patients with osteoporosis at the age of 47- 65（ the control group）,who have been measured the bone mineral density and bone metabolism before and after treatment. Record their ages,heights,weights,treatment period,bone mineral density（ BMD）,serum osteocalcin,serum phosphorus,25-hydroxy-vitamin D（ 25OHD）,bone metabolism markers,and other clinical datas before and after treatment. Results There was no significant difference in body mass index,serum calcium,phosphorus,and lumbar spine BMD between two groups before treatment. The level of 25 OHD,body tarnover marker,femoral neck BMD and total hip BMD in the elder group were significantly lower than those in the control group before treatment（ P〈0. 05）. BMD and 25 OHD increased after bisphosphonate treatment for 12 months. The percentage changes in the lumbar spine,femoral neck,and total hip were 3. 29%,1. 24%,and 1. 00 %（ P〈0. 05） in elder group,3. 51%,1. 18%,and 1. 58 %（ P〈0. 01） in the control group. There was a significant difference in the percentage decrease in bone gamma-carboxyglutamic-acid-containing proteins and Ⅰtype collagen pyridine cross-linked final peptide in the two groups（ P〈0. 05）. There was no significant difference in the percentage changes in the serum calcium and phosphorus after bisphosphonate treatment for 12 months. Conclusion Senile patients with osteoporosis was in a relatively low bone turnover state. Bisphosphonate had the similar effects for different levels of bone turnover. Bisphosphonate might be used in the elderly patients（ ≥80） with osteoporosis.