老年骨质疏松患者接受双膦酸盐治疗急性期不良反应分析

Analysis of acute phase side-effects of diphosphonate treatment in elderly patients with primary osteoporosis

目的 探究原发性骨质疏松症老年患者应用双膦酸盐抗骨质疏松治疗急性期的不良反应及其影响因素.方法 选择2011年1月1日至2015年11月30日期间收治的原发性骨质疏松老年患者208例,根据病情及意愿,将患者分为唑来膦酸组134例、阿伦膦酸钠组57例与帕米膦酸二钠组17例,采用相应的双膦酸盐类药物治疗,观察各组在用药后3d与7d不良反应.结果 唑来膦酸组用药后3 d（59/134,44.03％）与7 d（60/134,44.78％）不良反应发生率明显高于帕米膦酸二钠（3/17,17.65％;3/17,17.65％）及阿伦膦酸钠组（1/57,1.75％;1/57,1.75％,P均＜0.05）.使用静脉唑来膦酸及帕米磷酸二钠治疗的患者在用药后3d及7d内不良反应发生率在不同年龄段分组之间差异无统计学意义（P＞0.05）.唑来膦酸组,用药后7d出现肾功能受损3例,低钾血症3例.结论 老年骨质疏松患者接受不同双膦酸盐抗骨质疏松治疗方案,其急性期的不良反应发生存在明显差异;使用唑来膦酸中肾脏安全性以及低钾血症问题,应引起足够重视.

Objective To investigate the acute phase adverse effects and influencing factors of adverse effects of diphosphonate treatment in the elderly patients with primary osteoporosis.Methods A total of 208 patients [male 25 patients,female 183 patients,age 60 - 93 with a average of （75.51 ± 7.73） years] with primary osteoporosis were selected from 1 Jan 2012 to 30 Nov 2015,admitted to Department of Geriatrics.According to the serious condition of osteoporosis and willingness of patients,208 patients were divided into zoledronic acid treatment group,alendronate treatment group,and pamidronic acid group,and received corresponding diphosphonate treatment.All kinds of adverse reactions of diphosphonate in each treatment group were closely to be observed after administration of diphosphonate in 3 days and 7 days.Results The incidence rate of adverse reactions in the zoledronic acid treatment group （59/134,44.03%;60/134,44.78%） was obviously higher than that in the alendronate treatment group （1/57,1.75%;1/57,1.75%）,and the pamidronic acid group （3/17,17.65%;3/17,17.65%） after treatment of diphosphonate in three and seven days （P 〈 0.05）.In different generations,the incidence rate of adverse reactions in the zoledronic acid group and the pamidronic acid group after treatment of diphosphonate in three and seven days was not statistically significant （P 〉 0.05）.There were three patients suffering from severe acute kidney injure （AKI） and three patients suffering from hypokalemia in the 134 patients treatment with zoledronic acid.Conclusions There are obvious differences in the incidence rate of acute phase adverse reactions in the osteoporosis patients who received different treatment policy （P 〈 0.05）.The safety issues in the kidney function and electrolyte abnormality （such as hypokalemia） should be paid much enough attention in the primary osteoporosis patients who receive zoledronic acid treatment.