阿仑膦酸盐在继发于甲状腺功能亢进的骨质疏松症/骨质减少中的临床应用

[Clinical application of alendronate for osteoporosis/osteopenia secondary to hyperthyroidism].

作者信息

Yang Li-Juan, Shen Fei-Xia, Zheng Jing-Chen, Zhang Hai-Ling

机构信息

Department of Endocrinology, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, Zhejiang, China.

出版信息

Zhongguo Gu Shang. 2012 Feb;25(2):133-7.

PMID:22577718

Abstract

OBJECTIVE

To evaluate the efficacy and safety of alendronate for the treatment of osteoporosis/osteopenia secondary to hyperthyroidism.

METHODS

From April 2008 to November 2009, 27 patients with hyperthyroidism with osteoporosis/ osteopenia measured by dual energy X-ray absorptiometry (DXA) were included in this study, and then they were randomly divided into two groups (group A and group B) by simple random sampling. Group A consisted of 14 patients treated with antithyroid drug and caltrate D, the antithyroid drug change with thyroid function, and caltrate D 600 mg per day. Group B consisted of 13 patients treated with antithyroid drug, caltrate D and alendronate, antithyroid drug and caltrate D the same as group A, and alendronate 70 mg weekly. Meanwhile, 21 healthy voluntary adults were chosen as control group. And compared with the control group which was treated with nothing. Followed-up for one year, the bone mineral density (including T-score, Z-score, BMD) in lumbar spine (LS), femoral neck (FN) and distal radius (DR) and general information, were compared before and after treatment.

RESULTS

BMD at FN and DR were significantly higher at 12 months after treatment than at the baseline in group A (P = 0.000); T-score, Z-score, and BMD at the LS, FN and DR were all significantly higher at 12 months after treatment than at the baseline in group B (P < 0.05), but these data could not arrive to normal level. In group A, the percentage increased in BMD at the LS, FN, and DR were (4.34 +/- 10.5)%, (3.21 +/- 1.38)%, (1.95 +/- 0.44)%, respectively, at 12 months after treatment. In group B, the percentage increased in BMD at the LS, FN, and DR were (6.10 +/- 8.12)%, (4.10 +/- 5.64)%, (3.10 +/- 3.23)%, respectively, at 12 months after treatment. There was significant difference in the rate of increase between two groups (P < 0.05). AKP decreased, weight, BMI increased, and thyroid function decreased, after treatment than those before in both of the two groups. (P < 0.05).

CONCLUSION

Alendronate can significantly increase BMD in treating patients with hyperthyroidism and osteoporosis/osteopenia. Compared with anti-thyroid drugs alone, treatment with alendronate can obtain more clinical effect and also very safety.

摘要

目的

评估阿仑膦酸钠治疗继发于甲状腺功能亢进症的骨质疏松症/骨质减少症的疗效和安全性。

方法

2008年4月至2009年11月，纳入27例经双能X线吸收法（DXA）测量诊断为甲状腺功能亢进症合并骨质疏松症/骨质减少症的患者，通过简单随机抽样将其随机分为两组（A组和B组）。A组14例，接受抗甲状腺药物及钙尔奇D治疗，抗甲状腺药物根据甲状腺功能调整，钙尔奇D每日600mg。B组13例，接受抗甲状腺药物、钙尔奇D及阿仑膦酸钠治疗，抗甲状腺药物及钙尔奇D与A组相同，阿仑膦酸钠每周70mg。同时，选取21名健康成年志愿者作为对照组，与未接受任何治疗的对照组进行比较。随访1年，比较治疗前后腰椎（LS）、股骨颈（FN）和桡骨远端（DR）的骨密度（包括T值、Z值、BMD）及一般情况。

结果

治疗12个月后，A组FN和DR处的骨密度显著高于基线水平（P = 0.000）；B组治疗12个月后LS、FN和DR处的T值、Z值及骨密度均显著高于基线水平（P < 0.05），但这些数据未达到正常水平。治疗12个月后，A组LS、FN和DR处骨密度增加的百分比分别为（4.34±10.5）%、（3.21±1.38）%、（1.95±0.44）%。B组治疗12个月后LS、FN和DR处骨密度增加的百分比分别为（6.10±8.12）%、（4.10±5.64）%、（3.10±3.23）%。两组间增加率有显著差异（P < 0.05）。两组治疗后碱性磷酸酶（AKP）均降低，体重、体重指数（BMI）均增加，甲状腺功能均下降（P < 0.05）。