Sato Yoshihiro, Iwamoto Jun, Kanoko Tomohiro, Satoh Kei
Department of Neurology, Mitate Hospital, Tagawa, Japan.
Arch Intern Med. 2005;165(15):1743-8. doi: 10.1001/archinte.165.15.1743.
There is a high incidence of hip fractures in patients after hemiplegic stroke. Bone mineral density is decreased on the hemiplegic side in patients after stroke, correlating with the immobilization-induced bone resorption, the degree of paralysis, and hypovitaminosis D. The purpose of this study is to evaluate the effectiveness of risedronate sodium, an inhibitor of bone resorption, on osteoporosis and the risk of hip fractures in men 65 years or older after stroke.
We conducted an 18-month randomized double-blind trial. Of 280 male patients 65 years or older who were poststroke, 140 received a daily dose of 2.5 mg risedronate sodium and the other 140 received placebo. Incidence of hip fractures in the 2 groups was compared.
Ten patients sustained hip fractures in the placebo group, and 2 hip fractures occurred in the risedronate group. The relative risk of a hip fracture was 0.19 (95% confidence interval, 0.04-0.89). The number of patients needing the treatment was 16 (95% confidence interval, 9-32). Bone mineral density increased by 2.5% in the risedronate group and decreased by 3.5% in the placebo group (P<.001). Urinary deoxypyridinoline, a bone resorption marker, decreased by 58.7% in the risedronate group and by 37.2% in the placebo group.
Treatment with risedronate increases bone mineral density and reduces hip fractures in elderly men who are poststroke.
偏瘫性脑卒中患者髋部骨折的发生率较高。脑卒中后患者偏瘫侧的骨矿物质密度降低，这与制动引起的骨质吸收、瘫痪程度及维生素D缺乏有关。本研究的目的是评估骨吸收抑制剂利塞膦酸钠对65岁及以上男性脑卒中后骨质疏松及髋部骨折风险的疗效。
我们进行了一项为期18个月的随机双盲试验。280名65岁及以上的男性脑卒中患者中，140名每日服用2.5mg利塞膦酸钠，另外140名服用安慰剂。比较两组髋部骨折的发生率。
安慰剂组有10名患者发生髋部骨折，利塞膦酸钠组有2名患者发生髋部骨折。髋部骨折的相对风险为0.19（95%置信区间，0.04 - 0.89）。需要治疗的患者数量为16名（95%置信区间，9 - 32）。利塞膦酸钠组骨矿物质密度增加了2.5%，安慰剂组降低了3.5%（P <.001）。骨吸收标志物尿脱氧吡啶啉在利塞膦酸钠组降低了58.7%，在安慰剂组降低了37.2%。
利塞膦酸钠治疗可增加老年男性脑卒中后的骨矿物质密度并降低髋部骨折发生率。
