甲状旁腺激素(1-34)和阿仑膦酸钠治疗骨质疏松症合并类风湿关节炎疗效的对比研究
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摘要
目的比较甲状旁腺激素(parathyroid hormone,PTH)(1-34)和阿仑膦酸钠(alendronate,ALN)治疗骨质疏松症合并类风湿关节炎(rheumatoid arthritis,RA)女性患者的疗效。方法选取98例于2017年2月至2017年11月在我院就诊诊断为骨质疏松症合并RA的绝经后女性患者。按照治疗方案将患者分为PTH组和ALN组,两组患者分别接受特立帕肽或阿仑膦酸钠治疗,观察治疗6个月后两组患者骨密度和骨代谢指标的改变。结果在两组治疗6个月后,腰椎的骨密度较治疗前均有显著增加(P<0.05)。与ALN组相比,PTH组治疗6个月腰椎骨密度的平均变化百分比显然更高;而股骨颈骨密度仅在PTH组显著增加。结论甲状旁腺激素(1-34)在短期治疗骨质疏松症合并类风湿女性患者时,效果较阿仑膦酸钠更佳。
Objective To compare the efficacy of parathyroid hormone 1-34(PTH) and alendronate(ALN) in the treatment of osteoporosis combined with rheumatoid arthritis(RA) in women. Methods 98 female patients diagnosed with osteoporosis and RA after menopause were enrolled in our hospital from February 2017 to November 2017. Patients were divided into PTH group and ALN group according to the treatment plan. The two groups were treated with teriparatide or alendronate, respectively. The changes of bone mineral density and bone metabolism were observed after 6 months of treatment. Results After 6 months of treatment, the bone mineral density of lumbar spine increased significantly(P<0.05). Compared with the ALN group, the mean percentage change of lumbar spine BMD in the PTH group was significantly higher at 6 months of treatment; while the femoral neck BMD was only significantly increased in the PTH group. Conclusion Parathyroid hormone(1-34) is more effective than alendronate in the short-term treatment of osteoporosis combined with rheumatoid arthritis in women.
Objective To compare the efficacy of parathyroid hormone 1-34(PTH) and alendronate(ALN) in the treatment of osteoporosis combined with rheumatoid arthritis(RA) in women. Methods 98 female patients diagnosed with osteoporosis and RA after menopause were enrolled in our hospital from February 2017 to November 2017. Patients were divided into PTH group and ALN group according to the treatment plan. The two groups were treated with teriparatide or alendronate, respectively. The changes of bone mineral density and bone metabolism were observed after 6 months of treatment. Results After 6 months of treatment, the bone mineral density of lumbar spine increased significantly(P<0.05). Compared with the ALN group, the mean percentage change of lumbar spine BMD in the PTH group was significantly higher at 6 months of treatment; while the femoral neck BMD was only significantly increased in the PTH group. Conclusion Parathyroid hormone(1-34) is more effective than alendronate in the short-term treatment of osteoporosis combined with rheumatoid arthritis in women.
引文
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[11] Losada BR,Zanchetta JR,Zerbini C,et al.Active comparator trial of teriparatide vs alendronate for treating glucocorticoid-induced osteoporosis:results from the Hispanic and non-Hispanic cohorts[J].J Clin Densitom,2009,12(1):63-70.
[12] Wijbrandts CA,Klaasen R,Dijkgraaf MGW,et al.Bone mineral density in rheumatoid arthritis patients 1 year after adalimumab therapy:arrest of bone loss [J].Ann Rheum Dis,2009,68(3):373.
[13] van Staa TP,Leufkens HG,Cooper C.The epidemiology of corticosteroid-induced osteoporosis:a meta-analysis[J].Osteoporos Int,2002,13(10):777-787.
[14] Glüer C,Marin F,Ringe JD,et al.Comparative effects of teriparatide and risedronate in glucocorticoid-induced osteoporosis in men:18-month results of the Euro GIOPs trial[J].J Bone Miner Metab,2013,28(6):1355-1368.
[15] Manabe T,Mori S,Mashiba T,et al.Human parathyroid hormone (1-34) accelerates natural fracture healing process in the femoral osteotomy model of cynomolgus monkeys[J].Bone,2007,40(6):1475-1482.
[16] Aspenberg P,Genant HK,Johansson T,et al.Teriparatide for acceleration of fracture repair in humans:a prospective,randomized,double-blind study of 102 postmenopausal women with distal radial fractures[J].J Bone Miner Res,2010,25(2):404-414.
[17] Bultink IE,Vis M,Ie HB,et al.Inflammatory rheumatic disorders and bone[J].Curr Rheumatol Rep,2012,14(3):224-230.
[2] Rodan GA,Reszka AA.Bisphosphonate mechanism of action[J].Curr Rheumatol Rep,2003,5(1):65-74.
[3] Wells GA,Cranney A,Peterson J,et al.Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women[J].Cochrane Database Syst Rev,2008,119(1):CD001155.
[4] Hakala M,Kr?ger H,Valleala H,et al.Once-monthly oral ibandronate provides significant improvement in bone mineral density in postmenopausal women treated with glucocorticoids for inflammatory rheumatic diseases:a 12-month,randomized,double-blind,placebo-controlled trial[J].Scand J Rheumatol,2012,41(4):260-266.
[5] Gallacher SJ,Dixon T.Impact of treatments for postmenopausal osteoporosis (bisphosphonates,parathyroid hormone,strontium ranelate,and denosumab) on bone quality:a systematic review[J].Calcif Tissue Int,2010,87(6):469-484.
[6] Ebina K,Hashimoto J,Shi K,et al.Comparison of the effect of 18-month daily teriparatide administration on patients with rheumatoid arthritis and postmenopausal osteoporosis patients[J].Osteoporos Int,2014,25(12):2755-2765.
[7] Saleh A,Hegde VV,Potty AG,et al.Management strategy for symptomatic bisphosphonate-associated incomplete atypical femoral fractures[J].HSS J,2012,8(2):103-110.
[8] Ikeda K,Watanabe K,Hirai T,et al.Mizoribine synchronized methotrexate therapy should be considered when treating rheumatoid arthritis patients with an inadequate response to various combination therapies[J].Inter Med,2017,56(10):1147-1152.
[9] Aletaha D,Smolen J.The simplified disease activity Index (SDAI) and the clinical disease activity index (CDAI):a review of their usefulness and validity in rheumatoid arthritis[J].Clin Exp Rheumatol,2005,23(Suppl 39):S100.
[10] Nakatoh S.Effect of osteoporosis medication on changes in bone mineral density and bone turnover markers after 24-month administration of daily teriparatide:comparison among minodronate,raloxifene,and eldecalcitol[J].J Bone Miner Metab,2018,36(2):221-228.
[11] Losada BR,Zanchetta JR,Zerbini C,et al.Active comparator trial of teriparatide vs alendronate for treating glucocorticoid-induced osteoporosis:results from the Hispanic and non-Hispanic cohorts[J].J Clin Densitom,2009,12(1):63-70.
[12] Wijbrandts CA,Klaasen R,Dijkgraaf MGW,et al.Bone mineral density in rheumatoid arthritis patients 1 year after adalimumab therapy:arrest of bone loss [J].Ann Rheum Dis,2009,68(3):373.
[13] van Staa TP,Leufkens HG,Cooper C.The epidemiology of corticosteroid-induced osteoporosis:a meta-analysis[J].Osteoporos Int,2002,13(10):777-787.
[14] Glüer C,Marin F,Ringe JD,et al.Comparative effects of teriparatide and risedronate in glucocorticoid-induced osteoporosis in men:18-month results of the Euro GIOPs trial[J].J Bone Miner Metab,2013,28(6):1355-1368.
[15] Manabe T,Mori S,Mashiba T,et al.Human parathyroid hormone (1-34) accelerates natural fracture healing process in the femoral osteotomy model of cynomolgus monkeys[J].Bone,2007,40(6):1475-1482.
[16] Aspenberg P,Genant HK,Johansson T,et al.Teriparatide for acceleration of fracture repair in humans:a prospective,randomized,double-blind study of 102 postmenopausal women with distal radial fractures[J].J Bone Miner Res,2010,25(2):404-414.
[17] Bultink IE,Vis M,Ie HB,et al.Inflammatory rheumatic disorders and bone[J].Curr Rheumatol Rep,2012,14(3):224-230.