Yamamoto Kana, Kishino Maiko, Nakamura Shinichi, Tokushige Katsutoshi
Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Japan.
Intern Med. 2019 Apr 15;58(8):1049-1056. doi: 10.2169/internalmedicine.1271-18. Epub 2019 Jan 10.
Objective The incidence of osteoporosis is increasing with the rapid aging of the Japanese population. Bisphosphonates are first-line agents used for the treatment of osteoporosis, but they can cause upper gastrointestinal mucosal injury. This study investigated symptoms and upper gastrointestinal mucosal injury associated with oral bisphosphonates. Methods Symptoms were evaluated using the F-scale questionnaire, and esophageal mucosal injury and gastroduodenal ulceration were assessed by endoscopy. Patients were stratified by the type of bisphosphonate (alendronate, risedronate, or minodronate), treatment schedule (once weekly or every four weeks), and the concomitant use of other medications [antithrombotic agents, nonsteroidal anti-inflammatory drugs (NSAIDs), or acid suppressants]. Patients The subjects included 221 patients treated with oral bisphosphonates for at least one month. Results The median F-scale total score was 4 (0-34), reflux score was 2 (0-20), and the mean dyspepsia score was 2 (0-16). Endoscopy showed esophageal mucosal injury of Grade A or worse (Los Angeles classification) in 22/221 patients (10.0%) and gastroduodenal ulcers in 9 patients (4.1%). The dyspepsia score in patients who took minodronate every four weeks was significantly lower (p<0.05) in comparison to patients who took other bisphosphonates. The dyspepsia score was significantly higher (p<0.05) and mucosal injury was significantly more frequent in patients who also used antithrombotic agents and NSAIDs. Conclusion Symptoms and upper gastrointestinal mucosal damage were not necessarily frequent or severe in patients treated with bisphosphonates. However, the concomitant use of bisphosphonates with antithrombotic agents and NSAIDs increased both symptoms and mucosal injury. The symptoms were milder in patients using minodronate once monthly.
目的 随着日本人口的快速老龄化，骨质疏松症的发病率正在上升。双膦酸盐是用于治疗骨质疏松症的一线药物，但它们可导致上消化道黏膜损伤。本研究调查了与口服双膦酸盐相关的症状和上消化道黏膜损伤。方法 使用F量表问卷评估症状，并通过内镜检查评估食管黏膜损伤和胃十二指肠溃疡。患者按双膦酸盐类型（阿仑膦酸钠、利塞膦酸钠或米诺膦酸）、治疗方案（每周一次或每四周一次）以及其他药物[抗血栓药物、非甾体抗炎药（NSAIDs）或抑酸剂]的联合使用情况进行分层。患者 受试者包括221例接受口服双膦酸盐治疗至少1个月的患者。结果 F量表总分中位数为4（0 - 34），反流评分为2（0 - 20），消化不良平均评分为2（0 - 16）。内镜检查显示，221例患者中有22例（10.0%）存在A级或更严重的食管黏膜损伤（洛杉矶分类），9例患者（4.1%）有胃十二指肠溃疡。与服用其他双膦酸盐的患者相比，每四周服用一次米诺膦酸的患者消化不良评分显著更低（p<0.05）。同时使用抗血栓药物和NSAIDs的患者消化不良评分显著更高（p<0.05），黏膜损伤也更频繁。结论 双膦酸盐治疗的患者症状和上消化道黏膜损伤不一定频繁或严重。然而，双膦酸盐与抗血栓药物和NSAIDs联合使用会增加症状和黏膜损伤。每月使用一次米诺膦酸的患者症状较轻。
