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骨质疏松症氟化物治疗期间的脊柱骨折：与脊柱骨密度的关系

Spinal fractures during fluoride therapy for osteoporosis: relationship to spinal bone density.

作者信息

Farley S M, Wergedal J E, Farley J R, Javier G N, Schulz E E, Talbot J R, Libanati C R, Lindegren L, Bock M, Goette M M

机构信息

Department of Medicine, Loma Linda University, California.

出版信息

Osteoporos Int. 1992 Sep;2(5):213-8. doi: 10.1007/BF01624143.

DOI:10.1007/BF01624143
PMID:1392258
Abstract

Recent studies report that fluoride therapy for osteoporosis increases spinal bone density without improving vertebral fracture rate, challenging the notion that restoration of bone mass improves bone fragility. To further evaluate this issue, the relationship between spinal bone density and vertebral fracture rate was examined in a large number of fluoride-treated, osteoporotic patients. A retrospective assessment was made of clinical data collected from our observations of 389 osteoporotics treated with fluoride 30 +/- 8 mg/day (mean +/- SD) (equivalent to 66 +/- 17 mg NaF/day) and calcium 1500 mg/day for 28 +/- 18 months. Fracture rate and bone density were assessed in the same region of the spine (i.e., T12 through L4) using quantitative computed tomography (QCT). Spinal bone density increased with time on fluoride, but the relationship was hyperbolic (r = 0.99, p less than 0.0001; asymptote = 167 mg/cc on double-reciprocal plot), suggesting a plateau in the response. The spinal fracture rate decreased as a function of time on therapy (r = -0.83, p less than 0.01), and was inversely related to spinal bone density during fluoride therapy (r = 0.70, p less than 0.001 on arithmetic plot; r = -0.79, p less than 0.001 on semi-log plot). The subgroup of patients who responded to treatment with a significant increase in spinal bone density had a 48% reduction in spinal fracture rate compared with non-responders (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

近期研究报告称，用于治疗骨质疏松症的氟化物疗法可增加脊柱骨密度，但并未提高椎体骨折率，这对骨量恢复可改善骨脆性这一观念提出了挑战。为进一步评估该问题，我们对大量接受氟化物治疗的骨质疏松症患者的脊柱骨密度与椎体骨折率之间的关系进行了研究。回顾性分析了我们观察的389例骨质疏松症患者的临床数据，这些患者每天服用30±8毫克（平均±标准差）氟化物（相当于每天66±17毫克氟化钠）和1500毫克钙，治疗28±18个月。使用定量计算机断层扫描（QCT）在脊柱的同一区域（即T12至L4）评估骨折率和骨密度。脊柱骨密度随氟化物治疗时间增加，但这种关系呈双曲线（r = 0.99，p<0.0001；双倒数图上的渐近线为167毫克/立方厘米），表明反应存在平台期。脊柱骨折率随治疗时间下降（r = -0.83，p<0.01），并且在氟化物治疗期间与脊柱骨密度呈负相关（算术图上r = 0.70，p<0.001；半对数图上r = -0.79，p<0.001）。与无反应者相比，脊柱骨密度显著增加的治疗反应亚组患者的脊柱骨折率降低了48%（p<0.001）。（摘要截断于250字）

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1
Spinal fractures during fluoride therapy for osteoporosis: relationship to spinal bone density.骨质疏松症氟化物治疗期间的脊柱骨折：与脊柱骨密度的关系
Osteoporos Int. 1992 Sep;2(5):213-8. doi: 10.1007/BF01624143.
2
The increase in spinal bone density that occurs in response to fluoride therapy for osteoporosis is not maintained after the therapy is discontinued.骨质疏松症患者接受氟化物治疗后脊柱骨密度会增加，但治疗停止后这种增加无法维持。
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J Bone Miner Res. 1990 Mar;5 Suppl 1:S37-42. doi: 10.1002/jbmr.5650051350.
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6
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Avoidance of vertebral fractures in men with idiopathic osteoporosis by a three year therapy with calcium and low-dose intermittent monofluorophosphate.通过三年的钙和低剂量间歇性单氟磷酸治疗避免特发性骨质疏松男性发生椎体骨折。
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Efficacy of long-term fluoride and calcium therapy in correcting the deficit of spinal bone density in osteoporosis.长期氟化物与钙剂治疗对纠正骨质疏松症脊柱骨密度不足的疗效
J Clin Epidemiol. 1989;42(11):1067-74. doi: 10.1016/0895-4356(89)90048-6.
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[Fluoride in osteoporosis: still an experimental and controversial treatment].[氟化物治疗骨质疏松症：仍是一种实验性且存在争议的治疗方法]
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Comparison of nonrandomized trials with slow-release sodium fluoride with a randomized placebo-controlled trial in postmenopausal osteoporosis.非随机缓释氟化钠试验与随机安慰剂对照试验在绝经后骨质疏松症中的比较。
J Bone Miner Res. 1996 Feb;11(2):160-8. doi: 10.1002/jbmr.5650110204.

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本文引用的文献

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Precise measurement of vertebral mineral content using computed tomography.使用计算机断层扫描精确测量椎体矿物质含量。
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Treatment of osteoporosis with fluoride, calcium, and vitamin D.使用氟化物、钙和维生素D治疗骨质疏松症。
骨质疏松症患者接受氟化物治疗后脊柱骨密度会增加，但治疗停止后这种增加无法维持。
Osteoporos Int. 1996;6(6):442-7. doi: 10.1007/BF01629576.
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In corticosteroid-treated respiratory diseases, monofluorophosphate increases lumbar bone density: a double-masked randomized study.在接受皮质类固醇治疗的呼吸系统疾病中，单氟磷酸可增加腰椎骨密度：一项双盲随机研究。
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Spine and femur BMD by DXA in patients with varying severity spinal osteoporosis.采用双能X线吸收法（DXA）测量不同严重程度脊柱骨质疏松症患者的脊柱和股骨骨密度。
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Fluoride increases net 45Ca uptake by SaOS-2 cells: The effect is phosphate dependent.氟化物增加SaOS-2细胞对45Ca的净摄取：该效应依赖于磷酸盐。
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Pharmacokinetic profile of a new fluoride preparation: sustained-release monofluorophosphate.一种新型氟制剂：缓释单氟磷酸酯的药代动力学特征。
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Comparison of alendronate and sodium fluoride effects on cancellous and cortical bone in minipigs. A one-year study.阿仑膦酸盐与氟化钠对小型猪松质骨和皮质骨影响的比较。一项为期一年的研究。
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Effect of the fluoride/calcium regimen on vertebral fracture occurrence in postmenopausal osteoporosis. Comparison with conventional therapy.氟化物/钙疗法对绝经后骨质疏松症患者椎体骨折发生率的影响。与传统疗法的比较。
N Engl J Med. 1982 Feb 25;306(8):446-50. doi: 10.1056/NEJM198202253060802.
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Monitoring fluoride therapy in osteoporosis by dual photon absorptiometry.
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The effect of fluoride and calcium on spinal bone mineral content: a controlled, prospective (3 years) study.氟化物和钙对脊柱骨矿物质含量的影响：一项对照性前瞻性（3年）研究。
Calcif Tissue Int. 1987 Jun;40(6):315-7. doi: 10.1007/BF02556692.
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Safe and effective treatment of osteoporosis with intermittent slow release sodium fluoride: augmentation of vertebral bone mass and inhibition of fractures.间歇性缓释氟化钠对骨质疏松症的安全有效治疗：增加椎骨骨量并抑制骨折
J Clin Endocrinol Metab. 1989 Jan;68(1):150-9. doi: 10.1210/jcem-68-1-150.
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Risk-benefit ratio of sodium fluoride treatment in primary vertebral osteoporosis.原发性椎体骨质疏松症中氟化钠治疗的风险效益比。
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The response of vertebral bone mineral density during the treatment of osteoporosis with sodium fluoride.氟化钠治疗骨质疏松症过程中椎骨骨密度的反应
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