Department of Medicine, Faculty of Medical and Health Science, University of Auckland and Bone Clinic, Endocrinology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand.
J Bone Miner Res. 2017 Apr;32(4):753-756. doi: 10.1002/jbmr.3029. Epub 2016 Nov 30.
There has been a marked secular trend in recent decades toward patients with Paget's disease presenting at a greater age and having less extensive skeletal involvement. Over a similar time frame more potent bisphosphonates with a long duration of effect have been developed, raising the prospect of many patients needing only once in a lifetime treatment. We studied a cohort of 107 patients who had been treated with intravenous zoledronate for the first time at a mean age of 76 years. Sequential measurements of the bone turnover marker procollagen-1 NT-peptide (P1NP) were made for up to 10 years. By 9 years, 64% showed some loss of zoledronate effect (defined as a doubling of P1NP from the nadir value after treatment), but only 14% had a biochemical relapse (defined as a P1NP value >80 μg/L). The mortality rate was substantially greater than the relapse rate-by 10 years more than half the cohort had died (p < 0.0001). We conclude that for the majority of older people with Paget's disease a single intravenous infusion of zoledronate will provide disease suppression for the remainder of their lives. © 2016 American Society for Bone and Mineral Research.
近几十年来，患有佩吉特病的患者呈现出就诊年龄更大、骨骼受累范围更小的明显趋势。在类似的时间框架内，开发出了更有效的、作用持续时间更长的双膦酸盐，这增加了许多患者只需接受一次终生治疗的可能性。我们研究了一组 107 名患者，他们在平均年龄为 76 岁时首次接受静脉注射唑来膦酸治疗。对骨转换标志物前胶原 1 N 端肽（P1NP）进行了长达 10 年的连续测量。9 年后，64%的患者显示出唑来膦酸作用的一些丧失（定义为治疗后 P1NP 从最低点增加两倍），但只有 14%的患者出现生化复发（定义为 P1NP 值>80μg/L）。死亡率大大高于复发率-到 10 年时，超过一半的患者已经死亡（p<0.0001）。我们得出结论，对于大多数患有佩吉特病的老年人来说，单次静脉注射唑来膦酸将在他们的余生中提供疾病抑制。©2016 美国骨骼与矿物质研究协会。
