不同剂量骨化三醇联合钙剂对绝经后骨质疏松患者跌倒风险的影响

Effects of different doses of calcitriol combined with calciumon the fall risk in postmenopausal osteoporosis patients

目的分析不同剂量骨化三醇联合钙剂对绝经后骨质疏松患者跌倒风险的影响。方法选择2016年8月至2018年3月在江苏省老年病医院就诊的绝经后骨质疏松患者为研究对象,根据不同的用药方式将其分为A组和B组,A组患者采用0.25 μg·d^-1活性维生素D(骨化三醇)联合钙剂治疗,B组患者采用0.5 μg·d^-1骨化三醇联合钙剂治疗,比较2组患者的跌倒风险指数、血清钙、25-羟维生素D3(25-OHD3)、甲状旁腺素水平,并观察治疗期间患者的不良反应。结果干预3和6个月后,2组患者跌倒风险指数均明显低于干预前(P均<0.05),且B组患者干预6个月后的跌倒风险指数(12.32±2.98)明显低于A组(13.86±1.87)(P<0.05);2组患者血钙水平均明显高于干预前(P均<0.05),2组间血钙比较无明显差异(P>0.05);2组患者血清25-OHD3水平与干预前比较均无明显差异(P>0.05),但血清甲状旁腺素水平均明显低于干预前(P均<0.05),2组患者血清25-OHD3和甲状旁腺素水平比较无明显差异(P均>0.05)。干预期间,2组患者均无明显不适,均未发现泌尿系统结石、高钙血症、高钙尿症,仅3例患者(A组2例,B组1例)用药6 d后出现食欲不振、腹泻,且经饮食调节和对症处理后好转。结论不同剂量的活性维生素D联合钙剂均可降低绝经后骨质疏松患者的跌倒风险,且均具有较高的安全性,其中0.5 μg·d^-1骨化三醇降低跌倒风险的效果优于0.25 μg·d^-1的骨化三醇。

ObjectiveThis study was designed to analyze the effects of different doses of calcitriol combined with calcium on fall risk in postmenopausal osteoporosis patients.MethodsPostmenopausal osteoporosis patients who were treated in our hospital were selected from August 2016 to March 2018,and they were divided into Group A and Group B according to different medication methods.Patients in Group A were treated with 0.25 μg·d^-1 active vitamin D(calcitriol)combined with calcium,while patients in Group B were treated with 0.5 μg·d^-1 calcitriol combined with calcium.Fall risk index,levels of serum calcium,25-hydroxyvitamin D3(25-OHD3),and parathyroid hormone were compared between the two groups,and adverse reactions during treatment were observed.ResultsAfter 3 and 6 months of intervention,fall risk indexes of two groups were significantly lower than those before intervention(all P<0.05),and fall risk index of Group B after 6 months of intervention was 12.32±2.98,significantly lower than that of Group A 13.86±1.87(all P<0.05). The levels of serum calcium in the two groups were significantly higher than that before intervention(all P<0.05),and there was no significant difference in the levels of serum calcium between the two groups(all P>0.05). There was no significant difference in the level of serum 25-OHD3 in the two groups compared with that before intervention(P>0.05). The levels of serum parathyroid hormone in the two groups were significantly lower than those before intervention(all P<0.05),and there was no significant difference in the levels of serum 25-OHD3 and parathyroid hormone between the two groups(all P>0.05). During the intervention period, no obvious discomfort,no urinary calculi,hypercalcemia and hypercalciuria were found,only 3 patients(2 in Group A and 1 in Group B)developed anorexia and diarrhea after 6 days of medication,and improved after dietary adjustment and symptomatic treatment.ConclusionDifferent doses of active vitamin D combined with calcium could reduce the fall risk in postmenopausal osteoporosis patients with high safety,and the efficacy of 0.5 μg·d^-1 calcitriol in reducing fall risk was much better than 0.25 μg·d^-1 calcitriol.