静脉补钙治疗骨质疏松症的疗效和安全性

Clinical efficacy and safety of intravenous calcium for osteoporosis

目的:探讨静脉补钙治疗骨质疏松症(osteoporosis,OP)的疗效和安全性。方法:选取963例OP患者,分为对照组、口服补钙组、静脉补钙组和联合补钙组。补钙疗程均超过2年。对比4组患者的一般资料、骨密度(bone mineral density,BMD)、疼痛、运动功能、相关生化指标、骨质疏松指标、颈动脉内膜中层厚度(intima-media thickness,IMT)的改变情况、关节置换手术率、脱牙率以及骨折、心脑血管病、腰椎间盘突出症(lumbar disc herniation,LDH)、感染、恶性肿瘤的发病率。结果:4组患者基线水平无显著性差异(P>0.05)。补钙治疗后,4组患者间的肝肾功异常、胆结石及肾结石、冠心病、心衰、心血管钙化、高钙血症及恶性肿瘤的发病率及IMT无显著性差异(P>0.05)。与对照组相比,口服补钙组的腰椎和髋部BMD均明显升高(P<0.05),碱性磷酸酶(alkaline phosphatase,ALP)、视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、骨折发病率均显著下降(P<0.05),而关节置换手术率、脱牙率以及心律失常(早搏、心动过速、心房颤动)、LDH、感染及脑梗死的发病率在2组间无显著性差异(P>0.05);与对照组和口服补钙组相比,接受静脉补钙治疗的2组患者的腰椎和髋部BMD均明显升高(P<0.01),而ALP、VAS、ODI、骨折发病率、关节置换手术率、脱牙率以及心律失常、LDH、感染及脑梗死的发病率均显著下降(P <0.01);静脉补钙组与联合补钙组的上述指标均无显著性差异(P>0.05)。结论:长期口服钙剂或者静脉补钙均是治疗骨质疏松症的有效方法,其中静脉补钙的疗效更好。

Objective:To analyze the clinical efficacy and safety of intravenous calcium for osteoporosis(OP).Methods:A total of 963 OP patients were divided into control group,oral calcium group,intravenous calcium group and combination calcium group.Calcium treatments lasted for more than 2 years.Medical record was collected to compare demographic data,changes in bone mineral density(BMD),improvements of pain and function,changes of biochemical parameters,OP parameters and intima-media thickness(IMT),fractures,rate of total arthroplasty and tooth loss,incidence of cardiovascular and cerebrovascular diseases,incidence of lumbar disc herniation(LDH),infection and tumors.Results:There was no group difference at baseline(P>0.05).In the four groups,the incidence of liver and kidney abnormalities,gallstones and kidney stones,coronary heart disease(CHD),heart failure,cardiovascular calcification,hypercalcemia and tumors,and IMT had no statistically significant difference after2 years of calcium treatment(P> 0.05).Compared to the control group,the BMDs of the lumbar vertebrae and hip in the oral calcium group were significantly increased(P <0.05),alkaline phosphatase(ALP),visual analogue scale(VAS),Oswestry disability index(ODI),and incidence of fractures in the oral calcium group were significantly decreased(P<0.05).There were no statistically significant differences between the rate of total arthroplasty and tooth loss,incidence of arrhythmia(premature beats,tachycardia,atrial fibrillation),LDH,infection and cerebral infarction of the control group and oral calcium group(P>0.05).Compared to the control group and the oral calcium group,the BMDs of the lumbar vertebrae and hip in the intravenous calcium group and combination anti-osteoporosis group were significantly increased(P <0.01),ALP,VAS,ODI,incidences of fractures,rate of total arthroplasty and tooth loss,incidence of arrhythmia,LDH,infection and cerebral infarction in the intravenous calcium group and combination anti-osteoporosis group were significantly decreased(P<0.01).There was no significant difference between the intravenous calcium group and combination calcium group(P>0.05).Conclusion:Long-term administration of oral calcium or intravenous calcium is effective for the treatment of OP,and the clinical efficacy of intravenous calcium is better.