骨质疏松治疗方案应用评价.pptVIP

问题4：骨折后多久可以应用双膦酸盐？ Is fracture healing affected by bisphosphonates? 阿仑膦酸钠促进老年女性低创伤髋部骨折后愈合——1年随机前瞻性临床试验 手术后被随机分组 预选417人 钙-维生素D3 (500 MG/D +400 IU/DAY n=125 阿仑膦酸钠 (70 MG/W) + 钙-维生素D3 (500 MG/D + 400 IU/D) n=114 治疗均在患者能够保持直立坐位或立位后立即开始——通常为术后2至4 天且均在出院前 主要终点事件：全髋骨密度变化 Adapted from Cecilia et al.Osteoporos Int (2009) 20:903-910 阿仑膦酸钠促进老年女性低创伤髋部骨折后愈合 10 8 6 4 2 0 -2 -4 -6 TH TC IT FN LS Change in BMD (%; 95% CI) Patients treated with alendronate+calcium+vitamin D3 vs. patients treated with calcium +vitamin D3. Bone mineral density (BMD; g/cm2) TH:totalhip, TC:trochanteric, IT:inter-trochanteric, FN:femoral neck, LS:lumbar spine Adapted from Cecilia et al.Osteoporos Int (2009) 20:903-910 年龄大于65岁绝经后骨质疏松妇女，转子间骨折患者共16人 阿伦膦酸钠治疗或安慰剂治疗3月 给予内固定治疗（经转子固定器和羟磷灰石涂层的固定钉） 术后3月后拔钉 治疗组与对照组固定钉转入力矩与转出力矩 小梁骨 皮质骨 P0.0005 小结 老年人腰背酸痛须警惕存在椎体压缩性骨折 一次发生骨质疏松性骨折后短期内再发骨折可能性大 严重骨质疏松伴多发性骨折须注意排除多发性骨髓瘤、恶性肿瘤骨转移等病变 骨折急性期应及时采用疗效可靠药物防止制动期的快速骨丢失 Thank you! * Effect of Prior Vertebral Fracture on Risk of Subsequent Vertebral Fracture This figure shows the incidence of vertebral fracture during the first year of study according to the number of vertebral fractures present at baseline. These results are from an analysis of 2725 women randomly assigned to a placebo group in 3 global osteoporosis treatment trials of the bisphosphonate, risedronate [Vertebral Efficacy with Risedronate Therapy (VERT) study – Multinational and North American, and the Hip Intervention Program (HIP) study]. Having one vertebral fracture at baseline resulted in a 2.6-fold increase in the risk of having a subsequent fracture during the first year of the trial; having 1 or more or 2 or more baseline vertebral fractures increased this risk by 5-fold and 7-fold, respectively. Among women with a confirmed incident (new) fracture, almost 20% experienced a subsequent vertebral fracture within 1 year of the initial fracture. Thus, the presence of a vertebral fracture is a potent risk factor for the oc