Kaga Yoshimi, Ishii Sayaka, Kuroda Itaru, Kamiya Yuko, Nakamura Kousuke, Kanemura Hideaki, Sugita Kanji, Aihara Masao
No To Hattatsu. 2017 Mar;49(2):113-9.
Bone fractures in patients with severe motor and intellectual disabilities (SMIDs) have become an important problem to be solved. These fractures may result from disuse osteoporosis. Bisphosphonate administration is generally the most established treatment for patients with osteoporosis. However, traditional oral bisphosphonate use is associated with esophagitis as a side effect and may increase the risk of reflux esophagitis for bedridden patients. Intravenous alendronate, one of the bisphosphonates, was released in 2012 in Japan. Though it is appropriate for patients with SMIDs, there are no reports about the effects of intravenous alendronate on osteoporosis in SMID patients. Therefore, the efficacy of intravenous alendronate for osteoporosis was investigated in SMID patients.
The subjects were 62 SMID patients with osteoporosis (20 to 60 years old) in our hospital. They were divided two groups, bisphosphonate treatment group (32 patients) and age-matched controls (30 patients). Patients in bisphosphonate treatment groups were given 900μg intravenous alendronate once a month. All patients were also administered oral vitamin D3. Serial bone density, bone metabolism markers, and existence of fractures were compared in both groups before and after treatment (6 months, 1 years, and 2 years).
In bisphosphonate treatment group, the change rate of bone density was significantly increased and bone metabolism markers were improved at 6 months and 1 year after starting treatment. After a year, 16 patients in treatment group changed into other treatments, and 12 controls started bisphosphonate treatment. In remaining treatment group (16 patients), the change rate of bone density and bone metabolism markers were improved significantly at 2 years after starting treatment. A patient in control group had a bone fracture, but no patients in bisphosphonate treatment groups had fractures or severe adverse effects.
Intravenous alendronate is an effective treatment for osteoporosis in SMID patients.
重度运动和智力残疾（SMID）患者的骨折已成为一个亟待解决的重要问题。这些骨折可能由废用性骨质疏松症导致。双膦酸盐给药通常是骨质疏松症患者最常用的治疗方法。然而，传统口服双膦酸盐使用会伴有食管炎这一副作用，并且可能增加卧床患者反流性食管炎的风险。静脉注射阿仑膦酸钠作为双膦酸盐类药物之一，于2012年在日本上市。尽管它适用于SMID患者，但尚无关于静脉注射阿仑膦酸钠对SMID患者骨质疏松症影响的报道。因此，本研究对静脉注射阿仑膦酸钠治疗SMID患者骨质疏松症的疗效进行了研究。
研究对象为我院62例患有骨质疏松症的SMID患者（年龄在20至60岁之间）。他们被分为两组，双膦酸盐治疗组（32例患者）和年龄匹配的对照组（30例患者）。双膦酸盐治疗组患者每月静脉注射900μg阿仑膦酸钠一次。所有患者还口服维生素D3。在治疗前及治疗后6个月、1年和2年，比较两组患者的系列骨密度、骨代谢标志物及骨折情况。
在双膦酸盐治疗组中，开始治疗后6个月和1年时，骨密度变化率显著增加，骨代谢标志物得到改善。一年后，治疗组中有16例患者更换为其他治疗方法，12例对照组患者开始双膦酸盐治疗。在剩余的治疗组（16例患者）中，开始治疗后2年时，骨密度和骨代谢标志物的变化率显著改善。对照组中有1例患者发生骨折，但双膦酸盐治疗组中无患者发生骨折或出现严重不良反应。
静脉注射阿仑膦酸钠是治疗SMID患者骨质疏松症的有效方法。
