골다공증성 고관절 골절 환자의 수술적 치료 후 정주용 Bisphosphonate의 효과
Effect of Intravenous Administration of Bisphosphonate for Patients Operatively Treated for Osteoporotic Hip Fracture
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 고관절 골절 후 수술적 치료를 받은 환자에서 골 교체율을 감소시키고 골밀도를 증진시키는 정주용 zoledronic acid의 효과로써 골밀도 및 생화학적 골 대사 표지자 변화에 대하여 알아보고자 하였다. 대상 및 방법: 2009년 1월부터 2010년 6월까지 고관절 주위 골절에 대해 수술적 치료를 받고 zoledronic acid를 정주한 환자중 1년 이상의 추시가 가능하였던 34명을 대상으로 후향적 연구를 시행하였다. 수술 전, 수술 1년 후 DXA의 T 점수 및 생화학적 골 대사 표지자를 비교 평가 하였다. 결과: 수술 전 T 점수는 평균 -4.2, 1년 뒤 -3.3으로 호전되었으며 통계학적 유의성을 보였다(P<0.05). 두가지 생화학적 골 대사 표지자는 대부분의 환자에서 감소하는 소견을 보였다. 약물 투여 후 3일 이내에 총 7명(20.6%)에서 경미한 부작용이 관찰되었으나, 심방세동 등의 심각한 합병증은 발생하지 않았다. 결론: 고관절 골절 후 수술적 치료를 받은 환자에서 골다공증성 골절의 예방을 위해 정주한 zoledronic acid의 효과는 경미한 부작용 이외에 심각한 부작용은 발견되지 않았다고, 골 밀도 및 생화학적 골 대사 표지자 변화 등 긍정적인 효과를 1년 추시로 확인할 수 있었다.
Abstract
Purpose: We evaluated changes in bone mineral density and biochemical bone turn over markers resulting from intravenous administration of zoledronic acid for the purpose of increasing bone mineral density and decreasing bone turnover rate in patients who had received operative treatment after hip fracture. Materials and Methods: We carried out a retrospective study of 34 patients who had received injections of zoledronic acid after surgical treatment for hip fracture from January 2009 to June 2010, with a follow up period of more than one year. We evaluated pre and post T-scores of DXA in spine, proximal femur and femoral neck along with biochemical bone metabolic markers, and we then analyzed each factor. Results: T score was enhanced in all cases with pre T-score -4.2 and post T-score -3.3 revealing statistical significance (P<0.05). In addition, two biochemical bone turnover markers were observed to decrease in most patients. Three days after drug administration, 7 patients(20.6%) had minor adverse effects. There were no serious complications such as atrial fibrillation. Conclusion: No major adverse effects were observed, only minor ones in patients who had been injected with zoledronic acid for the prevention of osteoporotic fracture after surgical treatment for hip fracture. We confirmed the affirmative effects on changes in bone mineral density and biochemical bone turn over markers associated with the use of this drug.
참고문헌 (30)
- Boonen S, "Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study", Osteoporosis Int, 15, pp.87~94 (2004)
- Davidson CW, "Hip fracture mortality and morbidity--can we do better?", N Z Med J, 114, pp.329~332 (2001)
- 이성락, "고관절 주위골절로 인한 사망률 및 활동성 -전향적 연구-", 대한정형외과학회지, 40(4), pp.423~427 (2005), 대한정형외과학회
- Magaziner J, "Excess mortality attributable to hip fracture in white women aged 70 years and older", Am J Public Health, 87, pp.1630~1636 (1997)
- 문은수, "The Incidence of New Vertebral Compression Fractures in Women after Kyphoplasty and Factors Involved", Yonsei Medical Journal, 48(4), pp.645~652 (2007), 연세대학교의과대학
- 윤형구, "고령에서 시간을 달리한 양측 고관절 주위 골절의 임상 형태", 대한골절학회지, 18(4), pp.375~378 (2005), 대한골절학회
- Gardner MJ, "Improvement in the undertreatment of osteoporosis following hip fracture", J Bone Joint Surg Am, 84-A, pp.1342~1348 (2002)
- 하용찬, "제주도 지역 고관절 주위골절에 대한 역학연구", 대한정형외과학회지, 39(2), pp.131~136 (2004), 대한정형외과학회
- Lyles KW, "Zoledronic acid and clinical fractures and mortality after hip fracture", N Engl J Med, 357, pp.1799~1809 (2007)
- Black DM, "Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group", Lancet, 348, pp.1535~1541 (1996)
- Miller PD, "Monthly oral ibandronate therapy in postmenopausal osteoporosis: 1- year results from the MOBILE study", J Bone Miner Res, 20, pp.1315~1322 (2005)
- Reginster JY, "Efficacy and tolerability of once-monthly oral ibandronate in postmenopausal osteoporosis: 2 year results from the MOBILE study", Ann Rheum Dis, 65, pp.654~661 (2006)
- Cramer JA, "Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis", Curr Med Res Opin, 21, pp.1453~1460 (2005)
- Downey TW, "Adherence and persistence associated with the pharmacologic treatment of osteoporosis in a managed care setting", South Med J, 99, pp.570~575 (2006)
- Cooper A, "Treatment persistence with once-monthly ibandronate and patient support vs. once-weekly alendronate: results from the PERSIST study", Int J Clin Pract, 60, pp.896~905 (2006)
- Black DM, "Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis", N Engl J Med, 356, pp.1809~1822 (2007)
- Chesnut CH 3rd, "Hormone replacement therapy in postmenopausal women: urinary N-telopeptide of type I collagen monitors therapeutic effect and predicts response of bone mineral density", Am J Med, 102, pp.29~37 (1997)
- el-Hajj Fuleihan G, "Effect of sequential and daily continuous hormone replacement therapy on indexes of mineral metabolism", Arch Intern Med, 152, pp.1904~1909 (1992)
- Rosen LS, "Long-term efficacy and safety of zoledronic acid in the treatment of skeletal metastases in patients with nonsmall cell lung carcinoma and other solid tumors: a randomized, Phase III, double-blind, placebo-controlled trial", Cancer, 100, pp.2613~2621 (2004)
- Bobyn JD, "Zoledronic acid causes enhancement of bone growth into porous implants", J Bone Joint Surg Br, 87, pp.416~420 (2005)
- Bragdon CR, "Effect of oral alendronate on net bone ingrowth into canine cementless total hips", J Arthroplasty, 20, pp.258~263 (2005)
- Zou X, "Effect of alendronate on bone ingrowth into porous tantalum and carbon fiber interbody devices: an experimental study on spinal fusion in pigs", Acta Orthop Scand, 74, pp.596~603 (2003)
- 이영균, "수술적 치료를 받은 고관절 주위 골절 환자에서의 정주용 Bisphosphonate : 단기 안전성에 대한 전향적 코호트 연구", Hip and Pelvis, 20(4), pp.305~310 (2008), 대한고관절학회
- Diel IJ, "Adverse effects of bisphosphonates: current issues", J Support Oncol, 5, pp.475~482 (2007)
- Novince CM, "Osteonecrosis of the jaw: an update and review of recommendations", Cells Tissues Organs, 189, pp.275~283 (2009)
- Sarin J, "Updates on bisphosphonates and potential pathobiology of bisphosphonate-induced jaw osteonecrosis", Oral Dis, 14, pp.277~285 (2008)
- Allen MR, "Alendronate reduces bone toughness of ribs without significantly increasing microdamage accumulation in dogs following 3 years of daily treatment", Calcif Tissue Int, 82, pp.354~360 (2008)
- Goh SK, "Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution", J Bone Joint Surg Br, 89, pp.349~353 (2007)
- Neviaser AS, "Low-energy femoral shaft fractures associated with alendronate use", J Orthop Trauma, 22, pp.346~350 (2008)
- Black DM, "The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal Fracture Trial (PFT)", J Bone Miner Res, 27, pp.243~254 (2012)