Gallacher S J, Fenner J A, Anderson K, Bryden F M, Banham S W, Logue F C, Cowan R A, Boyle I T
University Department of Medicine, Glasgow Royal Infirmary.
Thorax. 1992 Nov;47(11):932-6. doi: 10.1136/thx.47.11.932.
Bisphosphonates have been shown to be effective agents in the treatment of postmenopausal osteoporosis. Because corticosteroid associated osteoporosis is often associated with increased bone turnover, the effect of intermittent intravenous infusions of pamidronate on this condition has been investigated.
Seventeen patients (five male) with chronic corticosteroid dependent lung disease (15 asthma, two sarcoidosis) were treated with infusions of 30 mg pamidronate once every three months for one year. These patients had been taking an average of 14 (range 7.5-40) mg prednisolone a day for an average of 14 (range 3-30) years. Bone density measurements, by dual energy x ray absorptiometry, and radiography of the dorsolumbar spine were carried out before and one year after treatment. Bone formation was assessed by measurement of serum alkaline phosphatase and bone resorption by measurement of the fasting urinary hydroxyproline: creatinine ratio at the same time as densitometry and radiography were performed.
Pretreatment density of L2-4 and the neck of the femur was significantly lower in these patients compared with a cohort of 100 age and sex matched controls (L2-4 (mean (SEM)): 0.906 (0.050) g/cm2 v 1.142 (0.016) g/cm2; neck of femur: 0.793 (0.030) g/cm2 v 0.936 (0.013)) g/cm2. After treatment there was a significant fall in serum alkaline phosphatase activity from (mean (SEM)) 220 (16) U/1 to 174 (9) U/1 (normal 80-280 U/1) and in the fasting urinary hydroxyproline:creatinine ratio from (mean (SEM) 0.040 (0.006) to 0.024 (0.003) (normal < 0.033). A significant rise was noted in L2-4 density to 0.927 (0.047) g/cm2; mean rise of 3.4%). No change was noted in density of the neck of the femur.
Intermittent infusions of intravenous pamidronate would seem to be effective in both reducing turnover of bone and increasing bone density in corticosteroid induced osteoporosis associated with chronic lung disease. Longer term controlled studies are indicated.
双膦酸盐已被证明是治疗绝经后骨质疏松症的有效药物。由于皮质类固醇相关的骨质疏松症通常与骨转换增加有关，因此已经研究了帕米膦酸间歇静脉输注对这种情况的影响。
17例（5例男性）慢性皮质类固醇依赖型肺部疾病（15例哮喘，2例结节病）患者接受每三个月一次30mg帕米膦酸输注，共一年。这些患者平均每天服用14（范围7.5 - 40）mg泼尼松龙，平均服用14（范围3 - 30）年。在治疗前和治疗一年后通过双能X线吸收法进行骨密度测量，并对胸腰椎进行X线摄影。在进行骨密度测量和X线摄影的同时，通过测量血清碱性磷酸酶评估骨形成，通过测量空腹尿羟脯氨酸：肌酐比值评估骨吸收。
与100名年龄和性别匹配的对照组相比，这些患者的L2 - 4和股骨颈的治疗前密度显著降低（L2 - 4（均值（标准误））：0.906（0.050）g/cm²对1.142（0.016）g/cm²；股骨颈：0.793（0.030）g/cm²对0.936（0.013）g/cm²）。治疗后血清碱性磷酸酶活性从（均值（标准误））220（16）U/L显著降至174（9）U/L（正常80 - 280 U/L），空腹尿羟脯氨酸：肌酐比值从（均值（标准误））0.040（0.006）降至0.024（0.003）（正常<0.033）。L2 - 4密度显著升高至0.927（0.047）g/cm²；平均升高3.4%。股骨颈密度未见变化。
帕米膦酸间歇静脉输注似乎在降低与慢性肺部疾病相关的皮质类固醇诱导的骨质疏松症的骨转换和增加骨密度方面均有效。需要进行长期对照研究。
