阿仑膦酸钠治疗老年女性骨质疏松性椎体压缩骨折的疗效分析

Efficacy analysis of alendronate in the treatment of osteoporotic vertebral compression fracture in senile women

目的探讨阿仑膦酸钠治疗老年女性骨质疏松性椎体压缩骨折的临床疗效。方法回顾性分析华北理工大学附属医院骨质疏松门诊2012年5月至2016年12月期间诊治的骨质疏松性椎体压缩骨折患者73例,年龄60~85岁,平均(68±8)岁。均在每日联用骨化三醇(罗盖全)0.25 ug和钙尔奇D600 mg的基础上,每周1次口服阿仑膦酸钠(福善美)70 mg,连续治疗10~16个月。随访并记录治疗前后骨密度(BMD)及其变化率、疼痛视觉模拟评分(VAS)、Beaujon脊柱功能评分、生化指标检测、影像学评价等方法评估治疗效果,观察再骨折和不良反应情况。结果 73例患者均获得随访,随访时间为10~16个月,平均(13±2)个月,与治疗前相比,腰椎和股骨颈BMD值明显增加,差异有统计学意义(t=12.034,t=6.418,P<0.05);腰背痛和胸背痛明显改善,VAS评分显著降低,差异有统计学意义(t=28.055,P<0.05);日常生活质量和脊柱功能明显提高,Beaujon功能评分明显改善,差异有统计学意义(t=10.301,P<0.05)。治疗前后血尿常规、肝肾功能、钙、磷、碱性磷酸酶生化指标检测治疗前后未见明显异常;治疗期间影像学发现有5例再发椎体骨折,无严重药物不良反应出现。结论阿仑膦酸钠联合基础补钙措施可有效治疗老年女性严重骨质疏松性椎体压缩骨折,增加骨量,缓解骨痛,改善脊柱功能。

Objective To investigate the clinical efficacy of alendronate in the treatment of osteoporotic vertebral compression fractures in elderly females.Methods A retrospective review was conducted in73elderly females with osteoporotic vertebral compression fractures from May2012to December2016.The average age was68±8years(60-85years).All patients took an oral medication of0.25ug calcitriol and600mg calcium carbonate with Vitamin D3per day as a basic treatment,in addition with70mg alendronate once a week and last for10-16months.Bone mineral density(BMD),visual analogue scale(VAS),Beaujon functional score,imaging analyses and biochemical tests were recorded to evaluate the clinical efficacy before and after alendronate intervention at different time point.The adverse events and fracture occurrence were also observed.Results All73patients were followed up for13±2months.Compared with that before treatment,BMD of lumbar vertebrae(t=12.034,P<0.05)and femoral necks(t=6.418,P<0.05)were both significantly increased.VAS scores were significantly decreased(t=28.055,P<0.05),while Beaujon functional score was markedly elevated at the endpoint(t=10.301,P<0.05).All biochemical markers including blood and urinary tests,hepatic and renal function,calcium phosphorus and alkaline phosphatase maintained within normal range before and after the treatment.Radiological evaluation found5re-fractures of vertebral bodies,no serious adverse effects were found during the treatment.Conclusion Combined with basic calcium supplement,Alendronate can effectively treat osteoporotic vertebral compression fracture,increasing bone mass,relieving skeletal pains and improving spinal function.