Seeman Ego
Austin Health, University of Melbourne, Melbourne, Australia.
Curr Opin Rheumatol. 2006 Jun;18 Suppl 1:S17-20. doi: 10.1097/01.bor.0000229523.89546.32.
Fractures are common at the spine and hip, but at least half the morbidity and mortality of fractures in the community come from fractures that involve other sites. Over half of all fractures arise in individuals without osteoporosis, whereas the highest risk group for fractures are individuals over 80 years of age. Reducing the burden of fractures should thus include an assessment of drug efficacy against all fractures in a wide range of individuals. For vertebral fractures, in the phase III Spinal Osteoporosis Therapeutic Intervention study of 1649 postmenopausal women with osteoporosis, 2 g strontium ranelate a day produced a risk reduction of 49% in the first year and 41% during 3 years. In the TReatment Of Peripheral OSteoporosis study, which was designed to examine the effect of strontium ranelate on non-vertebral fractures, of the 5091 patients, 3640 had spine X-rays. The vertebral fracture risk reduction was 45% at one year and 39% over 3 years. In a preplanned pooling of the above two studies, 1170 patients had vertebral osteopenia. Strontium ranelate reduced the risk of vertebral fracture in 3 years by 40% in these patients. In 409 patients with lumbar or femoral neck osteopenia, strontium ranelate reduced the risk of vertebral fractures by 62% over 3 years. In the pre-planned pooling of data from the two studies, in 1488 women aged between 80 and 100 years (mean age 84 +/- 3 years), the risk of vertebral fractures was reduced in one year by 59% and by 32% over 3 years. For non-vertebral fractures, in the TReatment Of Peripheral OSteoporosis study, treatment for 3 years reduced the fracture risk by 16%, and by 19% for major fragility fractures. In a post-hoc analysis of 1977 women at high risk of hip fracture (aged > or = 74 years and with a femoral neck bone mineral density T-score < or = -2.4) the hip fracture risk was reduced by 36%. In patients aged 80 and over in the pre-planned pooling of data from the two studies, the risk of an incident non-vertebral fracture was reduced by 41% in the first year and by 31% over 3 years. Strontium ranelate, a new anti-osteoporosis agent, has a broad range of antifracture efficacy.
骨折在脊柱和髋部很常见，但社区中至少一半的骨折发病率和死亡率来自其他部位的骨折。超过一半的骨折发生在没有骨质疏松症的个体中，而骨折风险最高的群体是80岁以上的人群。因此，减轻骨折负担应包括评估药物对广泛个体中所有骨折的疗效。对于椎体骨折，在针对1649名绝经后骨质疏松症女性的III期脊柱骨质疏松治疗干预研究中，每天服用2克雷奈酸锶，第一年骨折风险降低49%，3年内降低41%。在旨在研究雷奈酸锶对非椎体骨折影响的外周骨质疏松症治疗研究中，5091名患者中有3640人进行了脊柱X光检查。椎体骨折风险在1年内降低45%，3年内降低39%。在上述两项研究的预先计划汇总中，1170名患者存在椎体骨量减少。雷奈酸锶使这些患者3年内椎体骨折风险降低40%。在409名腰椎或股骨颈骨量减少的患者中，雷奈酸锶使3年内椎体骨折风险降低了62%。在两项研究数据的预先计划汇总中，1488名年龄在80至100岁之间（平均年龄84±3岁）的女性中，椎体骨折风险在1年内降低59%，3年内降低32%。对于非椎体骨折，在外周骨质疏松症治疗研究中，治疗3年使骨折风险降低16%，主要脆性骨折风险降低19%。在对1977名髋部骨折高风险女性（年龄≥74岁且股骨颈骨密度T值≤-2.4）的事后分析中，髋部骨折风险降低了36%。在两项研究数据的预先计划汇总中，80岁及以上患者中，新发非椎体骨折风险在第一年降低41%，3年内降低31%。雷奈酸锶，一种新型抗骨质疏松药物，具有广泛的抗骨折疗效。
