骨化三醇干预绝经后骨质疏松妇女静态平衡功能

Effects of calcitriol on the static balance function in postmenopausal osteoporotic women

目的探讨不同剂量的骨化三醇干预对绝经后骨质疏松妇女静态平衡功能(跌到风险)的影响。方法静态平衡功能测试提示跌倒中高风险161名绝经后骨质疏松妇女,采用数字表法随机分成A、B两组,给予不同剂量的骨化三醇治疗。A组81例,骨化三醇0.25μg/d,B组80例,骨化三醇0.5μg/d;所有患者在接受骨化三醇治疗的同时,每天补充元素钙600 mg和维生素D 125 IU。疗效评价包括:跌倒风险指数;血清钙磷、25羟维生素D(25 hydroxy vitamin D,25OHD)、甲状旁腺素、肾功能;尿钙;泌尿系统超声及相关不良反应。结果本研究两组患者最终随访人数分别为A组73例(90%),B组74例(93%)。经3个月骨化三醇治疗后,两组患者的静态平衡功能测试提示,跌倒风险指数均有所降低,较干预前自身比较,差异有统计学意义(A组t=2.37,P=0.050;B组t=2.06,P=0.030),组间比较差异无统计学意义(P>0.05);治疗6个月后,两组患者跌倒风险指数进一步下降,B组人群跌倒风险降低明显优于A组,差异有统计学意义(t=2.11,P=0.030)。所有患者研究期间肾功能正常,未见血清25OHD水平显著变化,无高钙血症、高尿钙症及泌尿系统新结石发生。结论骨化三醇干预可有效改善绝经后骨质疏松患者的静态平衡功能,降低跌倒风险;骨化三醇0.5μg/d较0.25μg/d对降低绝经后骨质疏松妇女跌到风险效果更明显。

Objective To evaluate the effectiveness of different doses of calcitriol intervention in the static balance function（ risk of falls index） of postmenopausal osteoporotic women. Methods 161 postmenopausal osteoporotic patients had middle or height risk of falls index on the basis of the static balance testing. After informed consent,they were randomly divided into A and B group. The patients received different doses of calcitriol. 81 patients in group A received calcitriol 0. 25 μg/d,and 80 patients in group B received calcitriol 0. 5 μg/d. All of patients were supplement with calcium 600 mg and 125 IU vitamin D daily. Safety evaluation included serum levels of calcium and phosphate,25 hydroxy vitamin D（ 25 OHD）,parathyroid hormone,renal function,urinary levels calcium,urinary system ultrasound scan and related adverse reactions. Results There were 73 patients in A group（ 90%） and 74 patients in B group（ 93%） in the eventually follow-up. After three months treatment of calcitriol,the risk of falls index in two groups were reduced,which was significantly lower than that of base line in two groups（ group A： t = 2. 37,P = 0. 050; group B： t = 2. 06,P =0. 030）,and without significant differences between two groups. After six months of treatment,the risk of falls index was further reduced in two groups. The effectiveness of intervention for the static balance function（ risk of falls index） of postmenopausal osteoporotic women in group B was superior to group A,and the difference was statistically significant（ t =2. 11,P = 0. 030）. During the research,all patients had normal renal function,without adverse effects such as hypercalcemia or metastatic calcification,or hypercalciuria. Conclusions Calcitriol can effectively improve the static balance function of patients with postmenopausal osteoporosis. For the target of reducing the risk of falls in postmenopausal osteoporotic patients,0. 5 μg/d calcitriol was more effectiveness than 0. 25 μg/d calcitriol.