Iwamoto Jun, Takeda Tsuyoshi, Sato Yoshihiro, Uzawa Mitsuyoshi
Department of Sports Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Yonsei Med J. 2004 Aug 31;45(4):676-82. doi: 10.3349/ymj.2004.45.4.676.
The purpose of this study was to determine factors that could predict the one-year response of the lumbar bone mineral density (BMD) to alendronate treatment in elderly Japanese women with osteoporosis. Eighty-five postmenopausal women with osteoporosis, all of whom were between 55-88 years of age, were treated with alendronate (5 mg daily) for 12 months. Serum calcium, phosphorus, and alkaline phosphatase (ALP) and urinary NTX levels were measured at the baseline and 6 months, and lumbar (L1-L4) BMD was measured by dual energy X-ray absorptiometry at the baseline and 12 months. Multiple regression analysis was used to determine factors that were correlated with the percent change in lumbar BMD at 12 months. Lumbar BMD increased by 8.1 % at 12 months with a reduction in the urinary NTX level by 51.0 % at 6 months. Baseline lumbar BMD (R2=0.226, p < 0.0001) and percent changes in serum ALP and urinary NTX levels (R2=0.044, p < 0.05 and R2=0.103, p < 0.001, respectively) had a negative correlation with the percent change in lumbar BMD at month 12, while the baseline number of prevalent vertebral fractures (R2=0.163, p < 0.001), serum ALP level, and urinary NTX level (R2=0.074, p < 0.05 and R2=0.160, p < 0.001, respectively) had a positive correlation with it. However, baseline age, height, body weight, body mass index, years since menopause, serum calcium and phosphorus levels, and percent changes in serum calcium and phosphorus levels at 6 months did not have any significant correlation with the percent change in lumbar BMD at 12 months. These results suggest that lumbar BMD was more responsive to one-year of alendronate treatment in elderly osteoporotic Japanese women with lower lumbar BMD, more prevalent vertebral fractures, and higher bone turnover, who showed a greater decrease in bone turnover at 6 months, regardless of age, years since menopause, and physique. Alendronate may be efficacious in elderly Japanese women with evident osteoporosis that is associated with high bone turnover, and the percent changes in serum ALP and urinary NTX levels at 6 months could predict the one-year response of lumbar BMD to alendronate treatment.
本研究的目的是确定能够预测老年日本骨质疏松女性腰椎骨密度（BMD）对阿仑膦酸盐治疗1年反应的因素。85名绝经后骨质疏松女性，年龄均在55 - 88岁之间，接受阿仑膦酸盐（每日5毫克）治疗12个月。在基线和6个月时测量血清钙、磷、碱性磷酸酶（ALP）和尿NTX水平，并在基线和12个月时通过双能X线吸收法测量腰椎（L1 - L4）骨密度。采用多元回归分析确定与12个月时腰椎骨密度百分比变化相关的因素。12个月时腰椎骨密度增加了8.1%，6个月时尿NTX水平降低了51.0%。基线腰椎骨密度（R2 = 0.226，p < 0.0001）以及血清ALP和尿NTX水平的百分比变化（分别为R2 = 0.044，p < 0.05和R2 = 0.103，p < 0.001）与12个月时腰椎骨密度的百分比变化呈负相关，而基线时椎体骨折的数量（R2 = 0.163，p < 0.001）、血清ALP水平和尿NTX水平（分别为R2 = 0.074，p < 0.05和R2 = 0.160，p < 0.001）与12个月时腰椎骨密度的百分比变化呈正相关。然而，基线年龄、身高、体重、体重指数、绝经年限、血清钙和磷水平以及6个月时血清钙和磷水平的百分比变化与12个月时腰椎骨密度的百分比变化均无显著相关性。这些结果表明，对于腰椎骨密度较低、椎体骨折更普遍且骨转换较高的老年日本骨质疏松女性，腰椎骨密度对1年阿仑膦酸盐治疗的反应更明显，这些女性在6个月时骨转换下降幅度更大，且不受年龄、绝经年限和体格的影响。阿仑膦酸盐可能对伴有高骨转换的明显骨质疏松的老年日本女性有效，6个月时血清ALP和尿NTX水平的百分比变化可预测腰椎骨密度对阿仑膦酸盐治疗的1年反应。
