唑来膦酸在预防骨质疏松性髋部序贯性骨折中的治疗价值

Therapeutic value of zoledronic acid in the prevention of osteoporotic hip sequential fracture

目的探讨唑来膦酸(zoledronic acid, ZOL)在改善骨质疏松性髋部骨折预后和预防对侧髋部序贯性骨折发生中的应用价值。方法回顾性分析中国医科大学附属盛京医院诊断为髋部脆性骨折, 并接受手术和抗骨质疏松治疗的206例患者, 通过生存率分析总结ZOL治疗组患者的预后以及急性期发热反应(acute febrile reaction, AFR)的影响因素。应用卡方检验和二元logistic回归分析评价ZOL能否减少对侧序贯性骨折的发生。结果与对照组比较, ZOL治疗组患者的3年生存率更高(P=0.026), 而AFR发生率高达53.3%, 其中年龄[OR=0.786, P=0.027, 受试者工作特征(ROC)曲线下面积为0.724]和合并心肺疾病(OR=0.043, P=0.025, ROC曲线下面积为0.628)与AFR具有显著相关性。另一方面, ZOL治疗组中序贯骨折发生率明显低于对照组(χ2=4.356,P=0.037), 其中ZOL应用史(OR=0.160, P=0.007, ROC曲线下面积为0.586)和股骨颈骨折类型(OR=0.196, P=0.001, ROC曲线下面积为0.607)与序贯骨折的发生具有显著相关性。结论 ZOL能够改善骨质疏松性髋部骨折患者的预后, 降低髋部序贯骨折尤其是股骨颈序贯骨折的发生率。高龄和合并心肺疾病可能与ZOL应用后较低的AFR发生风险有关。

Objective To investigate the clinical value of zoledronic acid in improving the prognosis of osteoporotic hip fracture and preventing its sequential contralateral hip fracture.Methods A retrospective study of 206 patients diagnosed with hip fragile fractures in China Medical University Affiliated Shengjing Hospital and treated with anti-osteoporotic drugs after surgery was conducted.The prognosis of patients with hip fracture using survival rate analysis and the risk factors of acute febrile complications with multivariate analysis after zoledronic acid treatment were evaluated.Furthermore,chi-square test and multivariate analysis was used to explore whether zoledronic acid decreases the occurrence of the contralateral sequential fracture.Results The 3-year survival rate of patients with overall hip fracture was higher in zoledronic acid treatment group compared with control group(P=0.026),with the incidence of fever at 53.3%.The age[OR=0.786,P=0.027,the area under receiver operating characteristic(ROC)curve was 0.724]and cardiopulmonary complications(OR=0.043,P=0.025,the area under ROC curve was 0.628)were significantly correlated with the occurrence of acute febrile response.The incidence of sequential contralateral fractures in zoledronic acid treatment group was significantly lower than that in control group(χ2=4.356,P=0.037).The application of zoledronic acid(OR=0.160,P=0.007,the area under ROC curve is 0.586)and the type of femoral neck fracture(OR=0.196,P=0.001,the area under ROC curve is 0.607)were statistically associated with the occurrence of sequential fractures.Conclusion Zoledronic acid treatment improves the outcome of patients with osteoporotic hip fracture and reduces the incidence of sequential hip fractures,especially femoral neck fracture.Senile age and cardiopulmonary complications might be associated with lower risk of acute febrile reactions after zoledronic acid treatment.