Heilberg I P, Martini L A, Teixeira S H, Szejnfeld V L, Carvalho A B, Lobão R, Draibe S A
Nephrology Division, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, Brazil.
Nephron. 1998 Aug;79(4):430-7. doi: 10.1159/000045089.
Osteopenia is frequently found among calcium stone forming (CSF) patients with hypercalciuria. We investigated the effect of a 2-year therapeutic course of etidronate, a bone-sparing agent, in 7 young male CSF patients. The treatment consisted of a cyclic intermittent administration of phosphate followed by sodium etidronate and calcium supplementation every 74 days. Bone mineral density (BMD) measured at 12-month intervals and bone biopsies performed at baseline and after 2 years were the primary efficacy parameters. Mean lumbar spine BMD increased significantly after the 1st year by 2.6 +/- 1.0% (mean +/- SE, p < 0.05) and nonsignificantly after the 2nd year by 5.6 +/- 2.6%. Nonsignificant changes were observed for femoral neck mean BMD after either the 1st or the 2nd year (decrease of 2.0 +/- 1.0% and 2.0 +/- 3.0%, respectively). Mean histomorphometric parameters showed that bone volume, osteoid volume, and eroded surfaces did not differ from baseline (13.9 +/- 2.2 vs. 12.2 +/- 1.1%, 1.2 +/- 0.7 vs. 2.6 +/- 0.7%, and 20.7 +/- 6.2 vs. 13. 7 +/- 1.3%, respectively). Osteoid surface was significantly lower than baseline values (9.5 +/- 5.2 vs. 18.8 +/- 5.3%, p < 0.05). These data suggest that etidronate given to young male CSF patients presenting with hypercalciuria and osteopenia led to a significant amelioration of BMD, evident only in the lumbar spine after 1 year of treatment. There was no histological evidence of long-term improvement in bone remodeling.
骨质疏松症在伴有高钙尿症的含钙结石形成（CSF）患者中很常见。我们研究了骨保护剂依替膦酸二钠为期2年的治疗疗程对7名年轻男性CSF患者的影响。治疗包括每74天循环间歇给予磷酸盐，随后给予依替膦酸钠和钙剂补充。每隔12个月测量骨矿物质密度（BMD），并在基线和2年后进行骨活检，作为主要疗效参数。第1年后，腰椎平均BMD显著增加2.6±1.0%（平均值±标准误，p<0.05），第2年后非显著增加5.6±2.6%。第1年或第2年后，股骨颈平均BMD均未出现显著变化（分别下降2.0±1.0%和2.0±3.0%）。平均组织形态计量学参数显示，骨体积、类骨质体积和侵蚀面与基线无差异（分别为13.9±2.2%对12.2±1.1%、1.2±0.7%对2.6±0.7%、20.7±6.2%对13.7±1.3%）。类骨质表面显著低于基线值（9.5±5.2%对18.8±5.3%，p<0.05）。这些数据表明，给予患有高钙尿症和骨质疏松症的年轻男性CSF患者依替膦酸二钠可使BMD显著改善，仅在治疗1年后腰椎表现明显。没有组织学证据表明骨重塑有长期改善。
