Risk factors for osteoporosis

SUMMARY

Background: Although postmenopausal African–American women are at lower risk for osteoporosis-related fractures compared with white women, fractures in African–American women are associated with significantly higher morbidity and mortality. Therefore, early diagnosis and treatment of osteoporosis in this population is just as important as it is for other ethnic groups and worthy of the attention of physicians and healthcare organizations.

Objective: The purpose of this study was to evaluate risk factors for osteoporosis in postmenopausal African–American women.

Design: This was a retrospective, case-control study in 201 postmenopausal African–American women at a community-based osteoporosis center. Spine and hip bone mineral density measurements were obtained by dual-energy x-ray absorptiometry. Patient and family medical history, past and present pharmaceutical use, and dietary and exercise habits were collected using a patient self-administered questionnaire.

Results: Using the manufacturer's African–American referent database, 56 women had osteoporosis, 99 had osteopenia, and 46 had normal bone mineral density. Risk factors more common in the osteoporotic group compared with the normal group included sedentary lifestyle (P < 0.03), family history of osteoporosis (P < 0.03), low body mass index (P < 0.05), and history of bilateral oophorectomy (P < 0.03). Polyarthritis was more prevalent in the normal versus the osteoporotic group (P < 0.001). In addition, premenopausal use of oral contraceptives (P < 0.005) and postmenopausal use of estrogen therapy (P < 0.05) were more common in the normal compared with the osteoporotic group.

Conclusions: Many risk factors for osteoporosis in African–American women are similar to those in white women and can aid in the selection of patients in need of bone density testing.     

Present and future pharmacotherapy for osteoporosis

Although neither calcium nor vitamin D has been shown to prevent osteoporosis in postmenopausal women alone, the combination does. Both calcium and vitamin D are commonly used in the treatment of osteoporosis. The estrogens and raloxifene both prevent bone loss in postmenopausal women, and the estrogens probably also decrease the risk of first fracture. There is good evidence that raloxifene prevents further fractures in postmenopausal women who have already had fractures and some evidence that estrogen does as well. Calcitonin increases bone mineral density in early postmenopausal women and men with idiopathic osteoporosis, and also reduces the risk of new fractures in osteoporotic women. The bisphosphonate alendronate prevents bone loss and reduces fractures in healthy and osteoporotic postmenopausal women, and in osteoporotic men. Risedronate is more potent and has fewer upper gastrointestinal side effects than alendronate, and reduces the incidence of fractures in osteoporotic women. Intermittent use of the potent bisphosphonate zoledronate also increases bone mineral density and may become an alternative in the prevention and treatment of osteoporosis. All of the agents discussed above prevent bone resorption, whereas teriparatide increases bone formation and is effective in the treatment of osteoporotic women and men. In the treatment of secondary osteoporosis associated with the use of glucocorticoids to treat inflammation or prevent rejection after transplantation, the bisphosphonates are effective. The agents that have undergone some clinical trialing as new or alternative drugs for the treatment of osteoporosis include tibolone, new SERMs, androgens, growth hormone, insulin-like growth factor-1 and stontium ranelate. The targets/drugs that are being developed to inhibit bone resorption include the OPG/ RANKL/RANK system, cathepsin K inhibitors, vitronectin receptor antagonists, estren, the interleukin-6 and gp130 system, cytokines and growth factors. New drugs/targets to promote bone formation include the commonly used lipid-lowering statins and the calcilytic release of PTH.     

Bazedoxifene acetate for the management of postmenopausal osteoporosis

Osteoporosis is a gender-related disease that is especially prevalent in postmenopausal women. New drugs have been developed led by issues of interest and concerns about this disease, each one striving to be more effective and safer than the previous one. Bazedoxifene acetate is a new, third-generation, selective estrogen receptor modulator. This drug is used to treat postmenopausal osteoporosis in women with a high risk of fracture. Bazedoxifene acetate significantly prevents bone mass loss at 20 mg/day in healthy postmenopausal women with normal or low bone mineral density. The risk of vertebral fractures in women with osteoporosis was reduced by 42% (P < 0.05) after 3 years in a pivotal study. Five years later, the reduction was still 35% (P = 0.014). Post hoc analysis in women with a high risk of fractures showed a 50% reduced risk of nonvertebral fractures (P = 0.02) after 3 years and a 37% reduction (P = 0.06) after 5 years. Bazedoxifene acetate shows anti-fracture potential in the first few years after menopause and a greater antiestrogen effect at the level of the uterus. This has made this compound an appropriate option in young postmenopausal women with osteoporosis and a risk of fractures.     

Osteodensitometry in healthy postmenopausal women

(1) Osteodensitometry is the standard method for measuring bone mineral density. Since the 1990s, diagnosis of osteoporosis has been defined, by convention, by a bone density T score cut-off of less than -2.5. This threshold, based on population statistics, is appropriate for the diagnosis of osteoporosis in Caucasian postmenopausal women in Europe and North America but may not be suitable for other populations. (2) To determine whether measurement of bone mineral density is useful in the prevention of fractures in postmenopausal women, we reviewed the relevant literature using our established in-house methodology. (3) Two meta-analyses of cohort follow-up studies involving tens of thousands of women showed a statistically increased risk of fracture in women with low bone density, especially in those with osteoporosis diagnosed by means of osteodensitometry. However, the majority of postmenopausal fractures occur in women without osteoporosis. (4) Routine bone density measurement has no proven impact on fracture prevention. (5) Some drugs designed for primary fracture prevention have been tested in postmenopausal women selected on the basis of their bone mineral density. In these patients, alendronic acid and raloxifene were both effective in the prevention of asymptomatic vertebral fractures: about 2 fractures prevented per 100 women treated for 3 to 4 years. A rather shaky retrospective subgroup analysis suggests that alendronic acid can also prevent symptomatic fractures in women with osteoporosis diagnosed by means of osteodensitometry. The screening for osteoporosis in postmenopausal women, or exposing large numbers of women to the adverse effects of these drugs. (6) Severe osteoporosis in postmenopausal women is defined by the presence of both low bone mineral density and a history of fragility fractures following low-energy trauma. Alendronic acid is the best-assessed drug in these women, preventing about 3 symptomatic vertebral fractures and 1 hip fracture when 100 patients are treated for 3 years. After a first fracture, women should be asked questions designed to assess the severity of the trauma, and should undergo osteodensitometry to document osteoporosis before exposure to the potential adverse effects of bisphosphonates.     

Strontium ranelate for osteoporosis?

In the UK, there are around 200,000 osteoporotic fractures each year. National guidelines in the UK recommend preventative treatment in patients who are at high risk of fracture on the basis of age, fracture history, bone mineral density and other risk factors. For secondary prevention, an oral bisphosphonate, such as alendronate or risedronate, is the drug of choice but may not be tolerated, particularly because of unwanted upper gastrointestinal effects. Raloxifene provides a potential oral alternative in women. National guidelines also suggest subcutaneous teriparatide for women aged more than 65 years with severe osteoporosis who have failed to tolerate or respond to a bisphosphonate; however, we believe use of this drug is problematic. Strontium ranelate (Protelos-Servier) is a new oral treatment for women with postmenopausal osteoporosis that is promoted as "the first dual action bone agent" and "the only drug to simultaneously increase bone formation and decrease bone resorption". Here we review the evidence for strontium ranelate and consider whether it has a role in postmenopausal osteoporosis.     

Potential role of FRAX analysis in postmenopausal women with osteopenia

Early diagnosis of osteoporosis and estimation of subjects that are at high risk for fracture, is neccesary for osteoporosis treatment. Dual-energy X-ray absorptometry (DXA) is a modern method for bone mineral density (BMD) evaluation. However, along BMD, clinical risk factors may significantly influence fracture development. Therefore, FRAX algorithm was designed for the assessment of a ten-year risk for serious osteoporotic fractures (SOF), as well as hip fractures. In the current study, we tried to evaluate the possible lumbal spine and hip BMD influence on ten year risk for SOF and hip fractures and potential role of FRAX in predicting the therapy in postmenopausal women with osteopenia. We performed the study on 385 postmenopausal women. According to the DXA measurements, at the lumbal (L) spine (L1–L4) and hip (femor neck), patients were then classified as normal, osteopenic, or osteoporotic. BMD evaluation included the L spine and the hip (subgroup 1), and only on the L spine (subgroup 2). By filling up the FRAX questionnaire, a ten-year risk for SOF fracture and hip fracture was calculated. BMD evaluation, in complete patient’s group and in subgroup 1, resulted in the highest number of osteoporosis (61.04%, 48.08%, retrospectively), while ospeopenia was a main finding in subgroup 2. In the subgroup 1, a high risk for SOF and hip fracture was detected in 16.45% and with high risk for hip fracture in 11.38% subjects. In subgroup 2, only high risk for hip fracture was observed in 3.16% subjects, indicating the active medicament treatment. Simultaneously, correlation of BMD results with FRAX values for SOF and hip fracture, showed significant negative correlation (p<0.001). Obtained results showed significant role of femur neck BMD evaluation in predicting the future factors, which may, together with FRAX analysis, improve the therapy approach in postmenopausal women with ospeopenia.     

唑来膦酸联合鲑降钙素对绝经后骨质疏松性骨折的影响

目的 研究唑来膦酸联合鲑降钙素对绝经后骨质疏松性骨折的影响。方法 将60例绝经后脊柱压缩性骨折患者随机分为对照组和观察组,2组均口服维D钙咀嚼片,皮下注射鲑降钙素注射液,观察组在此基础上静脉滴注唑来膦酸注射液。治疗前和治疗6个月后,对所有患者进行腰锥的骨密度(BMD)测定,运用视觉模拟评分法(VAS)进行疼痛监测,用功能障碍指数(ODI)的变化来评价功能障碍改善情况。结果 治疗6个月后,与治疗前相比,2组BMD、VAS评分、ODI均有所改善,差异有统计学意义(P<0.01)。与对照组相比,观察组的BMD增加,ODI下降更加明显,差异有统计学意义(P<0.05)。结论 唑来膦酸与鲑降钙素联合用药具有增加绝经后骨质疏松症患者BMD,减轻患者疼痛,提高患者生活质量的作用。     

Osteoporosis Risk in Premenopausal Women

Although clinically significant bone loss and fractures in healthy premenopausal women are rare, more women are seeking evaluation for osteoporosis from their health care providers. As pharmacists are in an ideal position to influence the management of premenopausal women with osteoporosis, it is important that pharmacists understand the available data on bone loss, fractures, and risk factors and secondary causes for osteoporosis, as well as when to recommend testing and treatment in premenopausal women. Limited data are available; therefore, we conducted a MEDLINE search of the literature from January 1993-August 2008. Studies evaluating bone loss, fractures, and fracture risk in healthy premenopausal women were targeted and summarized; most recommendations are based on expert opinion. A small but statistically significant loss in bone mineral density of 0.25-1%/year by dual-energy x-ray absorptiometry is seen healthy premenopausal women; the clinical significance of this is unknown. Whereas absolute fracture risk is low, premenopausal fractures appear to increase postmenopausal fracture risk by 1.5-3-fold. Risk factors for low bone density appear to be similar between pre- and postmenopausal women. Bone density screening in healthy premenopausal women is not recommended, but bone mineral density testing is advisable for those who have conditions or who receive drug therapy that may cause secondary bone loss. Lifestyle modification emphasizing bone-healthy habits such as adequate calcium and vitamin D nutrition, regular exercise, limitation of caffeine and alcohol consumption, and avoidance of tobacco are essential to the management of osteoporosis risk. The efficacy and safety of osteoporosis drugs have not been adequately demonstrated in premenopausal women. Therefore, pharmacologic interventions cannot be recommended in young women with low bone mass but may be considered in those having a more significant fracture risk, such as those with a previous low-trauma fracture or an identified secondary cause for bone loss.     

Polymorphisms in the CYP19 gene that influence bone mineral density

Osteoporosis is a prevalent disease with a strong genetic component. Estrogens play a critical role in bone homeostasis. The aromatization of androgenic precursors is the main source of estrogens in men and postmenopausal women. Thus, aromatase is an attractive osteoporosis candidate gene. In this paper the influence of aromatase activity and aromatase gene variants on skeletal homeostasis is reviewed. The results of studies regarding the association between some common polymorphisms of the aromatase gene and bone mineral density and the risk of osteoporotic fractures are described. The mechanisms involved and the potential usefulness of those genetic data in the prevention and management of osteoporosis are discussed.     

Correlation between total cardiovascular risk and bone density in postmenopausal women

The aim of the paper was to examine the correlation between the total risk of cardiovascular events, determined by the SCORE (Systematic Coronary Risk Evaluation) system, and bone density in postmenopausal women. Examinees and method: The research involved 300 postmenopausal women. On the basis of bone density measurements, the participants were divided into three groups: group I — 84 examinees had osteoporosis, group II — 115 examinees had osteopenia, and group III — 101 examinees had normal bone mineral density (BMD). Results: Participants with high SCORE risk were statistically significantly older compared to low-risk women (60±3 vs. 55±5; p<0.001). They had significantly lower BMD and T scores (?1.09±0.94 vs. ?2.86±0.63; p<0.001). Elevation of the SCORE risk by 1% caused a BMD decrease of 0.033 g/cm²(0.029 to 0.036 gr/cm²). Multivariate logistic regression analysis showed that the following factors caused a significant increase in the risk of decreasing BMD: every year of life by 20%, menopause duration by 26%, increase in systolic blood pressure (BP) by 1 mm Hg by 7%, increase in SCORE risk by 1% by 5.31 times, physical inactivity by 5.96 times, and osteoporosis in the family history by 3.91 times. Conclusion: Postmenopausal women who are at high risk for cardiovascular diseases have a lower BMD than those who are not at high risk for cardiovascular diseases.     

Clinical use of denosumab for the treatment for postmenopausal osteoporosis

Abstract

Denosumab is a fully human monoclonal antibody with high affinity and specificity for human receptor activator of nuclear factor kappa B ligand (RANKL), the principal regulator of osteoclastic bone resorption. By binding to RANKL, denosumab prevents it from binding to its receptor on the cell surface of pre-osteoclasts and mature osteoclasts, thereby reducing the formation, activity, and survival of osteoclasts and inhibiting osteoclastic bone resorption. In a large, randomized, placebo-controlled clinical trial in postmenopausal women with osteoporosis, denosumab 60?mg administered subcutaneously every 6 months reduced levels of bone turnover markers, increased bone mineral density, and reduced the risk of vertebral fractures, hip fractures, and non-vertebral fractures. There was no significant difference between denosumab and placebo in the overall risk of adverse events or serious adverse events. Denosumab was associated with a significant increase in the risk of eczema and cellulitis, and a significant decrease in the risk of falling and concussions. Denosumab recently received regulatory approval for the treatment of postmenopausal women with osteoporosis at high risk for fracture, with no dose adjustment in patients with renal impairment. Denosumab is a new therapeutic option to reduce fracture risk in women with postmenopausal osteoporosis, especially for those with impaired renal function or with intolerance or poor response to oral therapy.     

绝经后妇女椎体骨折与骨密度的关系

目的探讨绝经后妇女骨质疏松性椎体骨折与骨密度(BMD)的关系。方法对骨质疏松性椎体骨折的绝经后妇女280例(骨折组)和无椎体骨折的绝经后妇女280例(对照组)行胸腰椎正侧位X线摄片,并用双能X线骨密度测量仪(DEXA)检测腰椎(L2~L4)和左髋部BMD和T值。结果骨折组腰椎及髋部BMD和T值均低于对照组(P<0.01)。随着年龄的增加,两组BMD均逐渐下降。结论绝经后妇女的骨质疏松性椎体骨折与腰椎BMD下降相关;随着年龄的增加,椎体骨折的危险性增加;对绝经后妇女应重视BMD和胸腰椎X线片检查。     

Denosumab: a review of its use in the treatment of postmenopausal osteoporosis

Denosumab (Prolia?) is a human recombinant monoclonal antibody that is approved for the treatment of postmenopausal osteoporosis in women at high or increased risk of fracture in the US, the EU and several other countries. Denosumab has a novel mechanism of action; it binds to receptor activator of nuclear factor κB ligand and inhibits bone resorption by inhibiting osteoclast formation, function and survival. In postmenopausal women with osteoporosis, denosumab reduced the risk of vertebral, nonvertebral and hip fractures compared with placebo over 3 years in the large, phase III FREEDOM study. In postmenopausal women with low bone mineral density (BMD) or osteoporosis, treatment with denosumab increased BMD and decreased markers of bone turnover more than alendronate in those who were essentially treatment-naive in the 1-year DECIDE study and also in the 1-year STAND study, in which women were switched from alendronate to denosumab or continued alendronate treatment. Denosumab was generally well tolerated in clinical trials, although long-term effects of very low bone turnover remain to be established. Denosumab is administered once every 6 months via subcutaneous injection, which may be a preferred method of administration and may improve adherence to treatment compared with other osteoporosis treatments. Denosumab is a valuable new option for the treatment of postmenopausal osteoporosis in women at increased or high risk of fractures, and may be useful as a first-line treatment in women at increased risk of fractures who are unable to take other osteoporosis treatments.     

应用64排128层螺旋CT骨密度测量对骨质疏松与椎体骨折的研究分析

目的本研究旨在应用64排128层螺旋CT骨密度测量探讨椎体骨质疏松与骨折的相关性。方法选择200例50岁以上中老年病例，进行骨密度（BMD）测定，分析他们脊柱QCT检查资料，将有骨折的一组作为研究组，将没有骨折的一组作为对照组，然后进行统计学处理。结果骨折组的椎骨BMD明显低于无骨折组，BMD与椎体骨折呈负相关性，BMD越低，骨质疏松的程度越严重，发生骨折的几率就越高。结论64排128层螺旋CT骨密度测定（QCT）是一种非常准确的骨密度测量方法，利用这种检查方法可早期发现骨质疏松、积极干预，从而预防椎体骨折的发生。     

Closing the osteoporosis management gap in primary care: a secondary prevention of fracture programme

BACKGROUND: Effective treatments are available to reduce fracture risk in patients with osteoporosis. Prioritisation of assessment and treatment for those patients at highest risk of fracture will and treatment for those patients at highest risk of fracture will will ensure the optimal utilisation of healthcare resources. OBJECTIVES: To confirm prior fracture to be a strong predictor of osteoporosis, evaluate a simple means of identifying patients with osteoporosis, assess the current management gap in this high risk patient group and to enable initiation of treatment where appropriate.Research design and methods: All women >/=65 years of age living at home and registered with a general practitioner (GP) in Coatbridge, Lanarkshire, Scotland (4045) were mailed an osteoporosis questionnaire. Participants were from an area of generally low socioeconomic background, where 16% of the population are over >/=65 years and >/=99% are Caucasian. Those who had sustained a fracture or had >/=2 osteoporosis risk factors and had not previously been screened for osteoporosis were invited for a Dual energy X-ray Absorptiometry scan. A second group of women at high risk of osteoporosis were referred by their GP for a scan. Bone mineral density (BMD) was determined and treatment was reviewed and prescribed according to national guidelines. RESULTS: 2386/4045 women returned the questionnaire (response rate 59%); 2286 were correctly completed and made up the sample size. Eight hundred and fifty two had sustained >/=1 fracture(s), of whom 43 (5%) had previously had BMD testing and 80 (9.4%) were receiving treatment. There were 1434 women with no history of fracture that had >/=2 risk factors for osteoporosis. Of 395 women referred by their GP, 113 had sustained fractures. Following the audit, 1054 women were scanned, including 463 women who had not sustained fractures that had >/=2 osteoporosis risk factors. Of the 1054, 591 women had sustained 763 fractures: 46 (6.0%) hip, 284 (37.2%) wrist, 37 (4.8%) humerus and 396 (51.9%) other bones (mainly ankle or rib). Eighty (13.5%) women with a fracture history had normal BMD, 204 (34.5%) were osteopenic and 307 (51.9%) were osteoporotic. Older women were more likely to have osteoporosis: overall, 12.8%, 46.8% and 63.0% of women were osteoporotic in age groups <65 years, 65-75 years and >75 years, respectively. Treatment was prescribed according to Lanarkshire's osteoporosis guidelines for 670 (63.6%) patients: 90.0% received bisphosphonate + calcium/vitamin D and 10% received calcium/vitamin D. CONCLUSIONS: A simple scan identified patients with prior fracture and with osteoporosis. Prior fracture was confirmed to be a strong predictor of osteoporosis; 86.4% of women with a fracture history had low BMD and 51.9% had osteoporosis. Similar disease management programmes elsewhere in primary care to identify high risk patients and ensure appropriate prescribing would, in addition to implementing national guidelines, be pharmaco-economically prudent and improve management of patients with fragility fracture across the UK.     

Benefit-risk assessment of raloxifene in postmenopausal osteoporosis.

Raloxifene, a nonsteroidal benzothiophene, is a second-generation selective estrogen receptor modulator (SERM) that is an antiresorptive agent. Raloxifene is a non-hormonal agent that binds to the estrogen receptor and results in estrogen agonist effects on bone and the cardiovascular system and estrogen antagonist effects on endometrial and breast tissue. Raloxifene has diverse pharmacodynamic properties due to its differential interactions with the estrogen receptor and tissue selectivity. Raloxifene was the first SERM to be approved for the prevention and treatment of postmenopausal osteoporosis. In this review, we conducted a systematic search of the literature for trials that evaluated the following outcomes: bone density, fractures, quality of life, cardiovascular outcomes, safety and adverse events. Raloxifene at the approved dosage of 60 mg/day increased lumbar spine bone density by 2.5% relative to control after 2 years of therapy. A large fracture prevention trial confirmed that treatment with raloxifene 60 mg/day for 3 years decreased the relative risk of incident vertebral fractures by 30-50% in women with prevalent fractures or osteoporosis. Extraskeletal effects of raloxifene include a reduction in total cholesterol and low density lipoprotein cholesterol levels. Assessment of the safety profile revealed that raloxifene was not associated with endometrial hyperplasia and that there was a 72% reduction in the incidence of invasive breast cancer in raloxifene-treated postmenopausal women with osteoporosis. Adverse events associated with raloxifene included an increase in the absolute risk of venous thromboembolism and an increase in the risk of hot flashes and leg cramps. In comparison to other osteoporosis therapies, raloxifene has a lesser impact on bone mineral density, a similar effect on the occurrence of vertebral fractures, but no effect on the frequency of non-vertebral fractures. Raloxifene can be recommended for the prevention of vertebral fractures in women with osteopenia/osteoporosis who are not at high risk of non-vertebral fractures and who do not have a past history of venous thromboembolism.     

Efficacy and safety of alendronate and risedronate for postmenopausal osteoporosis

ABSTRACT

Introduction: This paper discusses the efficacy and safety of alendronate and risedronate in the treatment of postmenopausal osteoporosis.

Methods: The literature was searched with the PubMed from 1996 to the present, with respect to strictly conducted systematic reviews with homogeneity, meta-analyses with homogeneity, and randomized controlled trials (RCTs) with narrow Confidence Interval.

Results: According to the results of large randomized controlled trials (RCTs), bisphosphonates (alendronate, risedronate, and ibandronate), raloxifene, calcitonin, parathyroid hormone (PTH), and strontium ranelate effectively prevent vertebral fractures in postmenopausal women with osteoporosis. Because raloxifene has been shown to be effective in preventing the initial vertebral fracture in postmenopausal osteoporotic women without prevalent vertebral fractures, it is considered in the treatment of postmenopausal women with mild osteoporosis or osteopenia with some risk factors for fractures. RCTs have also demonstrated that alendronate, risedronate, PTH, and strontium are useful to prevent non-vertebral fractures and that alendronate and risedronate prevent hip fractures, thus alendronate or risedronate are primarily considered as the first-line drugs in the treatment of elderly women with osteoporosis having some risk factors for falls. While it has been suggested that PTH may be considered in patients with severe osteoporosis, the use of PTH in the treatment for osteoporosis is limited to 2 years or less, and it may be appropriate to use other anti-resorptive drugs after the completion of PTH treatment to maintain the skeletal effects gained during the treatment. RCTs have demonstrated that the incidence of gastrointestinal tract adverse events in postmenopausal osteoporotic women treated with bisphosphonates and placebo are similar, and also the long-term efficacy and safety of alendronate and risedronate.

Conclusion: The evidence derived from the literature, based on strict evidence-based medicine guidelines, suggests that there is long-term efficacy and safety with alendronate and risedronate in the treatment of osteoporosis in postmenopausal women.     

骨化三醇治疗女性绝经后骨质疏松性髋部骨折的效果及对骨代谢水平、骨密度影响

目的:探讨骨化三醇治疗女性绝经后骨质疏松性髋部骨折的效果及对骨代谢水平、骨密度影响。方法:选取某院2017年1月~2018年1月收治的120例绝经后骨质疏松性髋部骨折患者为研究对象,采用随机数字表方法分为治疗组和对照组各60例,对照组予以常规治疗,治疗组在对照组的基础上予以骨化三醇口服,两组均治疗9个月,比较两组的骨痛情况、治疗前后的骨代谢水平[骨型碱性磷酸酶(BALP)、抗酒石盐酸性磷酸酶异构体(TRACP-5b)]及骨密度。结果:治疗组的疼痛分级明显优于对照组(P<0.05);治疗组的BALP、TRACP-5b水平显著低于对照组(P<0.05);治疗组的骨密度显著大于对照组(P<0.05)。结论:骨化三醇治疗绝经后骨质疏松性髋部骨折能够明显改善骨痛症状,提高骨密度及骨强度。     

Zoledronate once-yearly increases bone mineral density--implications for osteoporosis

Osteoporosis is a major and growing problem for older women and men in western society. The bisphosphonates are used to treat postmenopausal osteoporosis because they decrease the risk of fractures. Oral bisphosphonates may cause oesophageal irritation and injury and are poorly absorbed. Intermittent intravenous bisphosphonates, including zoledronate, may be a way to avoid the problems associated with oral administration. Intravenous zoledronate increased bone mineral density while decreasing bone turnover and formation. Interestingly, the effects of a single dose (4 mg) of zoledronate were maintained over a year and were similar to those of three-monthly dosing with 0.25 - 1 mg zoledronate. If the increases in bone mineral density with zoledronate translate into reduced fractures, once-yearly intravenous zoledronate could be simple prophylaxis for postmenopausal osteoporosis.