수술적 치료를 받은 고관절 주위 골절 환자에서의 정주용 Bisphosphonate : 단기 안전성에 대한 전향적 코호트 연구
Intravenous Zolendronic Acid for the Patients Treated Operatively after Hip Fracture: A Short-Term Safety Prospective Cohort Study
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목적: 고관절 부위 골절 이후의 유병율과 사망률은 이후 새로이 발생하는 골다공증성 골절과 관련이 있어, 이의 예방이 중요하 다. 본 연구에서는 골다공증성 골절의 예방을 위해 고관절 주위 골절 후 수술적 치료를 받은 환자에서 정주용 bisphosphonate 의 사용에 있어서 단기간의 안전성을 알아보고자 한다. 대상 및 방법: 2008년 5월부터 2008년 8월까지 고관절 부위 골절에 대해 수술적 치료를 받은 환자 36명을 대상으로 정주용 bisphosphonate 투여 하였고 이후 발생하는 단기 안정성에 대하여 전향적 연구를 시행하였다. 결과: 고관절 골절 수술 후 평균 5일 (2~11일)에 약물이 투여되었으며, 약물 투여 후 총 14명(38.9%)에서 부작용이 관찰되었 으며, 생명을 위협할 정도의 심각한 부작용은 관찰되지 않았다. 가장 흔한 부작용은 고열과 감기유사증상이 각각 6명 (16.7%) 에서 관찰되었으며, 다음으로 두통 및 섬망, 전신근육통과 관절통 순이었다. 결론: 고관절 주위 골절에 대해 수술을 받은 환자에게 수술 후 입원 기간 동안에 정주용 bisphosphonate를 주사하여도 합병증 의 빈도와 정도는 이전 연구에서 알려진 결과와 비슷하였다. 다만 기존에 보고된 일시적 정주 후 증후군 이외에 섬망에 대한 고 려가 있어야 하며, 정주용 bisphosphonate 의 투여 시기 또한 수술 후 환자의 상태에 따라 결정해야 할 것으로 생각된다.
Abstract
Purpose: Hip fractures in senile osteoporotic patients are associated with high rates of morbidity and mortality. Accordingly, it is important to prevent further fracture by treating the osteoporosis in these patients. In this study, we evaluated the complications and safety of intravenous bisphosphonate, which was injected shortly after the operation. Materials and Methods: We prospectively studied the complications of administering intravenous bisphosphonate in 36 senile patients who were operated due to hip fracture between May 2008 and August 2008 at the authors’ hospital. Results: Bisphosphonate was injected at a mean of 5 days (range, 2~ 11 days) after the operation for hip fracture. Fourteen patients (38.9%) experienced complications: pyrexia in 6, flu-like symptoms in 6, headache in 3, delirium in 3, myalgia in 2 and arthralgia in 2. However, no life-threatening complications were observed. Conclusion: The incidence and severity of complications in our patients were comparable with those of the previous studies in patients who received intravenous bisphosphonate treatment weeks or months after the hip fracture operation. We recommend physicians be alert for patients to exhibit delirium in addition to the wellestablished post-infusion symptoms and to decide the correct time of infusion according to status of the patients after the operation.
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