唑来膦酸治疗绝经后女性骨质疏松疗效及再骨折风险分析

The analysis of efficacy and re-fracture risk in postmenopausal osteoporosis women treated with zoledronic acid

目的观察唑来膦酸治疗绝经后女性骨质疏松疗效及再骨折风险。方法收集2010年7月至2013年6月绝经后骨质疏松患者120例,按照治疗药物分为唑来膦酸组(A组)56例,阿仑膦酸钠组(B组)64例。治疗疗程3年,两组均在治疗基线及治疗后每年评估1次。采用双能X射线骨密度仪测量患者腰椎及全髋骨密度,评估椎体及髋关节骨折情况。比较治疗后骨密度变化及骨折发生情况。结果两组治疗后VAS评分较基线均明显降低(P<0.05)。两组治疗后腰椎及全髋骨密度均高于基线(P<0.05),A组腰椎骨密度治疗次年均高于前1年,A组腰椎及全髋骨密度每年均优于B组(P<0.05)。两组治疗后再骨折风险无明显差异(P>0.05)。结论口服及静脉双磷酸盐均可减轻骨质疏松骨痛,提高绝经后女性骨质疏松骨密度,静脉用唑来膦酸临床效果优于阿仑膦酸钠。两者均可降低骨质疏松再骨折发生风险。

Objective To observe the efficacy of zoledronic acid in the treatment of postmenopausal women with osteoporosis and the risks of re-fracture.Methods We collected 120 patients with primary postmenopausal osteoporosis from July 2010 to June 2013.They were divided into zoledronic acid group （Group A,n= 56） and alendronate sodium group （Group B,n= 64） according to the administered drugs.The treatment course was 3 years.The both groups were assessed every year.Dual energy X-ray absorptiometry was used to measure the bone mineral density of lumbar and total hip to assess the fracture of centrum and hip joint.The bone mineral density changes and the fracture status before and after treatment were compared.Results The post-treatment VAS scores in the both groups were significantly decreased when compared to the baseline （P〈0.05）. Bone mineral densities of lumbar and total hip in the both groups were improved after treatment when compared to the baseline （ P〈0.05 ） . The bone mineral density of lumbar in the group A was improved one year after treatment when compared to the previous year （P=0.026 ,0.032 and 0.041 Respectively） ,and the bone mineral density of lumbar and total hip each year in the group A was superior to the group B （ P〈0.05 ）.There was no significant difference in re-fracture risk after treatment between the two groups （ P 〉0.05 ） .Conclusion Oral or intravenous administration of biphosphonate can relieve the osteoporotic ostealgia and improve the bone mineral density in postmenopausal women with osteoporosis.The clinical efficacy of intravenous administration of zoledronic acid is superior to alendronate sodium.Both drugs can reduce the re-fracture risk of these patients.