Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan;
Ther Clin Risk Manag. 2011;7:257-64. doi: 10.2147/TCRM.S22167. Epub 2011 Jun 29.
Combined treatment with alendronate and alfacalcidol is more useful to increase bone mineral density (BMD) than alendronate or alfacalcidol alone. A retrospective study was conducted to investigate the 3-year outcome of combined treatment with alendronate and alfacalcidol in patients with severe bone loss (BMD ≤ 50% of the young adult mean) and osteoporotic fracture.
Thirty-four patients (six men and 28 postmenopausal women) with primary or secondary osteoporosis who had been treated with alendronate and alfacalcidol for more than 3 years were analyzed. The lumbar spine or total hip BMD and bone turnover markers were monitored, and the incidence of osteoporotic fractures was assessed.
The urinary level of cross-linked N-terminal telopeptides of type I collagen and serum level of alkaline phosphatase significantly decreased (-42.5% at 3 months and -18.9% at 3 years), and the lumbar spine BMD, but not the total hip BMD, significantly increased (14.8% at 3 years), compared with the baseline values. However, the incidence of vertebral and nonvertebral fractures was 26.5% and 2.9%, respectively, suggesting a high incidence of vertebral fractures.
The results of the present study suggest that combined treatment with alendronate and alfacalcidol may be useful to reduce bone turnover and increase the lumbar spine BMD in patients with severe bone loss and osteoporotic fracture. However, its efficacy against vertebral fractures appears not to be sufficient. Thus, anabolic agents such as teriparatide should be taken into consideration as first-line drugs in patients with severe osteoporosis.
与单独使用阿仑膦酸钠或阿法骨化醇相比，联合使用阿仑膦酸钠和阿法骨化醇治疗更有助于增加骨密度（BMD）。本回顾性研究旨在探讨联合使用阿仑膦酸钠和阿法骨化醇治疗严重骨质流失（BMD 低于年轻成人平均值的 50%）和骨质疏松性骨折患者的 3 年疗效。
对 34 例原发性或继发性骨质疏松症患者（6 名男性和 28 名绝经后女性）进行分析，这些患者已接受阿仑膦酸钠和阿法骨化醇治疗超过 3 年。监测腰椎或全髋 BMD 和骨转换标志物，并评估骨质疏松性骨折的发生率。
与基线值相比，尿型胶原交联 N 末端肽和血清碱性磷酸酶水平显著下降（3 个月时下降 42.5%，3 年时下降 18.9%），腰椎 BMD 显著增加（3 年时增加 14.8%），但椎体和非椎体骨折的发生率分别为 26.5%和 2.9%，提示椎体骨折发生率较高。
本研究结果表明，联合使用阿仑膦酸钠和阿法骨化醇可能有助于降低骨质流失患者的骨转换率并增加腰椎 BMD，但对椎体骨折的疗效似乎不足。因此，在严重骨质疏松症患者中，应考虑使用特立帕肽等合成代谢药物作为一线药物。
