폐경기 여성에서 티볼론, 칼시토닌, 칼슘제제 주기적 병용 투여에 따른 골밀도 효과
Effect of Cyclic Therapy of Combined Tibolone, Calcitonin and Calcium on the Bone Mineral Density in Postmenopausal Women
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목적: 폐경 후 골다공증 여성에서 3개월 간격으로 티볼론, 칼시토닌, 칼슘을 병합 투여하는 것을 3개월 간격으로 두 번 반복 후 골밀도의 변화를 보고자 하였다. 방법: 2007년 1월부터 10월까지 골다공증으로 티볼론과 칼시토닌, 칼슘 병합요법을 시행한 269명 중 적어도 1년 이상 추적 관찰이 가능했던 101명이 분석대상이 되었으며 치료 전 후 골밀도와 혈액검사 상 칼슘, 인, 알칼라인 포스파타아제와 요 중 칼슘/크레아티닌 비를 비교하였다. 결과: 요추에서의 골밀도는 0.63g/cm2에서 0.66g/cm2로 증가하였으나 골반에서의 골밀도는 증가하지 않았으며(femur neck: 0.61g/cm2 to 0.61g/cm2, trochanter: 0.56g/cm2 to 0.49g/cm2, Ward's triangle: 0.38g/cm2 to 0.39g/cm2), 통계적으로 모두 유의하지 않았다. 혈액검사와 요 검사상 골대사와 관련된 지표들 역시 모두 통계적으로 유의한 변화를 보이지 않았다. 결론: 폐경 후 골다공증 여성에서 주기적인 티볼론과 칼시토닌, 칼슘 병합요법은 골밀도 상승효과를 가져오지 않는다.
Abstract
Objectives: Our study was designed to analyze the synergic effect after 2 times combined periodic therapy of tibolone, synthetic nasal spray type salmon calcitonin and calcium for 3 months each. Methods: This study was based on 101 patients among 269 patients treated osteoporotic drug(combination therapy of tibolone, synthetic salmon calcitonin, calcium agent) from January 2007 to October 2007, with a minimum follow up of 1 year. We compared initial bone mineral density(BMD) with post-treatment BMD and laboratory finding (ionized calcium, phosphate, alkaline phosphatase in serum and calcium/creatinine ratio in urine) which were statistically analyzed. Results: BMD was increased in spine(0.63g/cm² to 0.66g/cm²) and not increased in hip(femur neck: 0.61g/cm² to 0.61g/cm², trochanter: 0.56g/cm² to 0.49g/cm², Ward's triangle: 0.38g/cm² to 0.39g/cm²), but was not statistically significant(P>0.05). The laboratory finding was tendency of decreased bone metabolism(ionized calcium: 9.7mg/dL to 9.4mg/dL, phosphate: 4.3mg/dL to 3.8mg/dL, ALP: 100.0IU/L to 83.1IU/L in serum and calcium/creatinine ratio in urine: 11.0 to 9.2), but was not statistically significant(P>0.05). Conclusion: In the osteoporotic post-menopausal women, the periodic combined therapy of tibolone, calcitonin and oral calcium agent did not show the synergic effect in BMD and bone metabolism. This periodic combined therapy does not recommendable to osteoporotic post-menopausal women.
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