Abu-Jwead Alaa, Fisher David L, Goldabart Adi, Yoel Uri, Press Yan, Tsur Anat, Fraenkel Merav, Baraf Lior
Goldman Medical School at the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel.
Endocrinology, Soroka University Medical Center, Beer Sheva 84101, Israel.
J Endocr Soc. 2024 Oct 7;8(11):bvae172. doi: 10.1210/jendso/bvae172. eCollection 2024 Sep 26.
To assess the safety of zoledronic acid (ZOL) and denosumab (Dmab) administered following hip fracture in a hospital setting.
Patients older than 65 years were treated by a fracture liaison service following hip fracture. Generally, patients who had a glomerular filtration rate (eGFR) > 35 mL/min were treated with ZOL, whereas patients who had previously received bisphosphonates or had a eGFR between 20 and 35 mL/min were treated with Dmab. Adverse events included hypocalcemia (calcium corrected for albumin less than 8.5 mg/day), renal functional impairment (0.5 mg/dL or more increase in serum creatinine) within 30 days of treatment, or a fever (>38 °C) within 48 hours of drug administration.
Two hundred twenty-eight and 134 patients were treated with ZOL and Dmab, respectively. Mean body temperature was elevated following ZOL administration (0.18 °C < .001) but remained below 38 °C. Hypocalcemia occurred in 18% and 29% of the ZOL and Dmab groups, respectively ( = .009). Renal functional impairment was observed in 9 and 6 patients (4% and 5%) in the ZOL and Dmab groups, respectively ( = .8). Pretreatment calcium above 9.3 mg/dL was associated with a lower risk of posttreatment hypocalcemia (odds ratio 0.30, 95% confidence interval 0.13-0.68, = .004). While the absolute risk of hypocalcemia was higher in the Dmab group, multivariate analysis did not find that the choice of drug was predictive of hypocalcemia.
In-hospital parenteral osteoporosis treatment was rarely associated with fever or renal function impairment but was associated with hypocalcemia. Posttreatment hypocalcemia risk did not vary significantly between patients receiving ZOL or Dmab.
评估在医院环境中髋部骨折后给予唑来膦酸（ZOL）和地诺单抗（Dmab）的安全性。
65岁以上患者在髋部骨折后由骨折联络服务进行治疗。一般来说，肾小球滤过率（eGFR）>35 mL/分钟的患者接受ZOL治疗，而先前接受过双膦酸盐治疗或eGFR在20至35 mL/分钟之间的患者接受Dmab治疗。不良事件包括低钙血症（校正白蛋白后的钙低于8.5 mg/天）、治疗后30天内肾功能损害（血清肌酐增加0.5 mg/dL或更多）或给药后48小时内发热（>38°C）。
分别有228例和134例患者接受了ZOL和Dmab治疗。给予ZOL后平均体温升高（0.18°C <.001），但仍低于38°C。ZOL组和Dmab组低钙血症的发生率分别为18%和29%（ = 0.009）。ZOL组和Dmab组分别有9例和6例患者（4%和5%）出现肾功能损害（ = 0.8）。治疗前钙水平高于9.3 mg/dL与治疗后低钙血症风险较低相关（比值比0.30，95%置信区间0.13 - 0.68， = 0.004）。虽然Dmab组低钙血症的绝对风险较高，但多因素分析未发现药物选择可预测低钙血症。
院内肠外骨质疏松治疗很少与发热或肾功能损害相关，但与低钙血症相关。接受ZOL或Dmab治疗的患者治疗后低钙血症风险无显著差异。
