骨转换指标对阿仑膦酸钠治疗的绝经后骨质疏松症患者骨密度变化的早期预测价值

Early predictive value of bone turnover markers for the changes of bone mineral densities in postmenopausal patients with osteoporosis treated with alendronate

目的了解绝经后骨质疏松症患者使用阿仑膦酸钠的治疗效果, 探讨骨转换指标(bone turnover markers, BTMs)对绝经后骨质疏松症患者骨密度变化的早期预测价值。方法本研究为回顾性研究, 选取2012年至2020年在上海市第六人民医院骨质疏松与骨病专科门诊就诊的409例绝经后骨质疏松症患者作为研究对象, 年龄为(64.86±7.21)岁。收集所有患者治疗前后的骨密度、血清Ⅰ型胶原交联羧基端肽β特殊序列(β-CTX)和骨钙素(osteocalcin)等临床资料。结果与治疗前相比, 阿仑膦酸钠治疗1年后患者腰椎1~4、股骨颈和全髋部骨密度分别上升4.84%、2.13%和2.89%(P<0.05)。治疗6个月和1年后, 患者β-CTX和骨钙素分别下降77.7%、42.3%和78.2%、49.5%(P<0.05)。线性回归分析结果显示, 阿仑膦酸钠治疗6个月时, β-CTX的变化率每下降10%, 治疗1年后, 腰椎1~4、股骨颈和全髋部骨密度的变化率分别上升0.417%、0.127%和0.213%;骨钙素的变化率每下降10%, 治疗1年后, 腰椎1~4、股骨颈和全髋部骨密度的变化率分别上升0.582%、0.258%和0.375%。结论阿仑膦酸钠能够显著增加绝经后骨质疏松症患者的骨密度以及降低BTMs水平, BTMs对骨密度变化有早期预测作用, 能够用于监测阿仑膦酸钠的治疗效果。

Objective To investigate the effect of alendronate treatment and assess the value of bone turnover markers(BTMs)in predicting the changes of bone mineral densities(BMDs)in postmenopausal women with osteoporosis.Methods In this retrospective study,409 postmenopausal women with osteoporosis aged(64.86±7.21)years in the Department of Osteoporosis and Bone Disease,Shanghai Sixth People′s Hospital were enrolled from 2012 to 2020.BMDs at lumbar spine 1-4,femoral neck,and total hip,serumβcross-linked C-telopeptide of type 1 collagen(β-CTX),and osteocalcin(OC)were measured before and after treatment.Results After alendronate treatment for 1 year,BMDs at lumbar spine 1-4,femoral neck and total hip increased 4.84%,2.13%,and 2.89%,respectively(P<0.05).At 6 months and 1 year on treatment,β-CTX and OC levels decreased by 77.7%,42.3%and 78.2%,49.5%,respectively(P<0.05).Linear regression analysis showed that for every 10%decrease in the change ofβ-CTX at 6 months after alendronate treatment,the rate changes in BMDs at the lumbar spine 1-4,femoral neck,and total hip decreased by 0.417%,0.127%,and 0.213%at 1 year after alendronate treatment;for every 10%decrease in OC,the change rates in BMDs at the lumbar spine 1-4,femoral neck,and total hip decreased by 0.582%,0.258%,and 0.375%.Conclusions Alendronate significantly increases BMDs and decreases BTMs levels in elderly women with osteoporosis.BTMs have a predictive value for the changes of BMDs,allowing early monitoring for the effect of alendronate treatment.