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目的探讨阿仑膦酸钠治疗老年女性严重骨质疏松症患者的临床疗效。方法回顾性分析华北理工大学附属医院骨质疏松门诊2013年1月至2015年8月期间诊治的骨质疏松伴陈旧骨折的老年女性患者52例,年龄60~86岁,平均(69±7)岁,平均绝经时间(16±6)年。均在每日联用骨化三醇0.25 ug和碳酸钙D3片600 mg的基础上,每周1次口服阿仑膦酸钠70 mg,连续治疗1年。随访并记录患者治疗前后不同时间的骨密度(BMD)及其变化率、疼痛视觉模拟评分(VAS)、生化指标、影像学资料等评估治疗效果,观察再骨折和不良反应情况。结果 52例患者均获得完整随访,随访时间为(12.7±1.2)个月。与治疗前相比,腰椎和股骨颈部位的BMD值在治疗后3、6、12个月时均明显增加,差异具有统计学意义(F=102.633,F=25.413,P<0.05),VAS评分均明显降低,差异具有统计学意义(F=76.499,P<0.05),6个月内骨痛明显改善,但6个月后骨痛有增加趋势;安全性评价显示治疗前后血尿常规、肝肾功能、钙、磷、碱性磷酸酶等生化指标检测均在正常范围;治疗期间3例再发椎体骨折,无严重不良反应出现。结论阿仑膦酸钠可有效治疗老年女性严重骨质疏松症,增加骨量,缓解骨痛,短期内无严重不良反应发生,但长期服用的安全性、有效性还有待于进一步观察。
Objective To investigate the clinical efficacy of alendronate in elderly patients with severe osteoporosis. Methods 52 elderly female patients with osteoporosis complicated with old fractures diagnosed as osteoporosis clinics affiliated to North China University Hospital from January 2013 to August 2015 were retrospectively analyzed. The average age was 69 ± 7 years Years old, the average menopause time (16 ± 6) years. All patients were treated with 0.25 μg of calcitriol and 600 mg of calcium carbonate D3 daily, and 70 mg of alendronate orally once a week for 1 year. The bone mineral density (BMD) and its rate of change, pain visual analogue scale (VAS), biochemical parameters and imaging data were evaluated at the same time before and after treatment. The fracture healing and adverse reactions were observed. Results All 52 patients were followed up for (12.7 ± 1.2) months. Compared with those before treatment, the BMD of lumbar spine and femoral neck were significantly increased at 3, 6 and 12 months after treatment (F = 102.633, F = 25.413, P <0.05) The score was significantly lower, the difference was statistically significant (F = 76.499, P <0.05), bone pain within 6 months significantly improved, but the bone pain increased after 6 months; safety evaluation showed that before and after treatment of hematuria, liver Renal function, calcium, phosphorus, alkaline phosphatase and other biochemical indicators were detected in the normal range; 3 cases of recurrent vertebral fractures during treatment, no serious adverse reactions. Conclusion Alendronate can effectively treat severe osteoporosis in elderly women, increase bone mass, ease bone pain, and avoid serious adverse reactions in short term. However, the safety and efficacy of alendronate should be further observed.