个体化维生素D补充治疗绝经后妇女骨质疏松症的临床应用

The clinical application of individualized vitamin D supplementation for the treatment of osteoporosis in postmenopausal women

目的探讨绝经后骨质疏松症患者血清25-羟维生素D的水平,在患者中进行个体化维生素D补充的临床应用价值与意义。方法回顾性分析2021年6月至2023年6月于河南科技大学第一附属医院诊断为骨质疏松症并接受地舒单抗治疗的绝经后妇女患者的临床数据。86例初次诊断为绝经后骨质疏松症的患者纳入研究。根据维生素D补充方式将患者分为两组,对照组45例(固定剂量组)和观察组41例(个体化剂量组:依据患者血清维生素D水平,以≥30ng/mL为目标进行补充)。观察并对比两组患者骨密度值及骨代谢情况。结果治疗前两组患者在年龄、身高、体重、血清25(OH)D浓度、BMI和腰椎股骨颈的骨密度方面均无显著性差异(P>0.05)。治疗后观察组β-1型胶原交联羧基端肽(β-CTX)、1型原胶原氨基端前肽(P1NP)水平降低较对照组更显著,25羟维生素D水平高于对照组,差异有统计学意义(t值分别为2.052,2.608和9.167,P<0.05);观察组股骨颈、腰椎L2节段骨密度水平均高于对照组,差异有统计学意义(t值分别为2.275,2.560,P<0.05)。结论接受地舒单抗药物治疗的绝经后骨质疏松症患者中,补充维生素D与骨密度值增加相关,且个体化补充能够取得更多获益,值得临床推广。

Objective To investigate the serum 25-hydroxyvitamin D levels in postmenopausal patients with osteoporosis and the value and significance of the clinical application of individualized vitamin D supplementation in patients.Methods Clinical data of postmenopausal women patients diagnosed with osteoporosis and treated with denosumab at The First Affiliated Hospital of Henan University of Science and Technology from June 2021 to June 2023 were retrospectively analyzed.A total of 86 patients who were first diagnosed with postmenopausal osteoporosis were enrolled in the study.The patients were divided into two groups according to the method of vitamin D supplementation,45 patients in the control group(fixed-dose group)and 41 patients in the observation group(individualized-dose group:supplementation was based on the patient's serum vitamin D level,with a target of≥30 ng/mL).Bone density values and bone metabolism were observed and compared between the two groups.Results Before treatment,there were no significant differences in age,height,weight,serum 25(OH)D concentration,BMI,and bone mineral density of lumbar spine and femoral neck between the two groups(P<0.05).After treatment,the levels of carboxy-terminal cross-linked telopeptide ofβ-type-1 collagen(β-CTX)and procollagen type 1 N-terminal prope-ptide(P1NP)in the observation group were reduced more significantly than those in the control group,and the level of 25 hydroxy-vitamin D was elevated higher than that of the control group,the difference was statistically significant(t=2.052,2.608,and 9.167,respectively,P<0.05).The levels of bone mineral density in the femoral neck and lumbar vertebrae at the L2 segment of the observation group were higher than those of the control group,the difference was statistically significant(t=2.275 and 2.560,respectively,P<0.05).Conclusions Vitamin D supplementation is associated with increased bone mineral density values in postmenopausal osteoporosis patients treated with denosumab,and individualized supplementation can achieve more benefits,which is worthy of clinical promotion.