Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Alendronate use and Changes in Bone Mineral Density

알렌드로네이트의 복용 실태 및 투여 후 골밀도의 변화

  • Yoon, Sang-Hyup (Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University) ;
  • Kim, Shin-Yoon (Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University)
  • 윤상협 (경북대학교 의과대학 정형외과학교실) ;
  • 김신윤 (경북대학교 의과대학 정형외과학교실)
  • Published : 2009.03.31

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Abstract

Purpose: To evaluate the changes in bone mineral density (BMD) after alendronate intake and to determine the side effects and patient compliance. Materials and Methods: Two hundred twelve patients with osteoporosis were treated with alendronate. One hundred sixty-two patients were excluded because of early discontinuation. Thus, 50 patients were included in the analysis. Results: The annual increase in BMD in patients taking alendronate was 7.2% (1st year), 3.4%, 2.0%, and 0.9% (4th year) in the L-spine, and 2.2%, 1.5%, -0.9%, and 0.9% in the femur. The changes in BMD of patients < 60 years of age were 2.1% in the L-spine and 3.4% in the femur. The BMD of patients between 60 and 69 years of age increased 6.3% and 0.5% in the L-spine and femur, respectively, and the BMD of patients >70 of age were 2.9% and 1.2% in the L-spine and femur, respectively. The BMD changes in patients with a T-score < -4.0 were 7.0% (L-spine) and 1.2% (femur), the BMD changes in patients with a T-score between -3.0 and -3.9 were 5.3% and 0.2% for the Lspine and femur, respectively, and the BMD changes in patients with a T-score > -3.0 were 2.5% and 3.1% for the Lspine and femur, respectively. The reasons for early discontinuation of alendronate were difficulty in intake, economic reasons, and adverse events. Conclusion: The BMD changes were greater in the L-spine than the femu in alendronate users. At the first year, the changes in BMD was greatest. There was no significant difference in BMD change according to age. In the Lspine, however, BMD changes were greater in the group with lower T-scores. The early discontinuance rate was 74%, and the adverse events rate was 19.8%.

목적:알렌드로네이트 투여 후 골밀도 변화와 연령 및 최초 골밀도에 따른 치료 효과, 지속도 및 부작용을 알아보았다. 대상 및 방법: 총 212명 중, 1년 이상 복용이 지속되지 못한 162명을 제외한 50명을 연구 내용에 포함하였고, 제외된 162명에 대하여 조기 중단의 이유를 조사하였다. 결과: 요추에서 매해7.2%, 3.4%, 2.0%, 0.9%, 근위대퇴부에서는 각각2.2%, 1.5%, -0.9%, 0.9%의 증가를 보였다. 60세 미만에서는 2.1%(요추부), 3.4%(근위 대퇴부), 60세이상 70세 미만에서 6.3%, 0.5%, 70세 이상에서 2.9%, 1.2%의 골밀도 증가가 있었다. 최초 T점수가 -4.0 미만에서 요추부 및 근위 대퇴부 각각 7.0%, 1.2%, -4.0 이상 -3.0 미만에서5.3%, 0.2%, -3.0 이상에서 2.5%, 3.1%의 골밀도 증가를 보였다. 알렌드로네이트의 조기 중단 이유로는 복용의 번거로움, 경제적 이유, 부작용 등이 있었다. 결론: 요추부에서 더 큰 골밀도 증가가 있었고, 첫해의 골밀도 증가가 가장 컷다. 나이에 따른 골밀도 변화는 별다른 상관 관계가 없었으나, 요추부에서는 최초 골밀도가 낮을수록 골밀도는 더 증가하였다. 조기 치료 중단은 79.3%, 부작용 발현은 19.8%였다.

Keywords

References

  1. Kanis JA: Osteoporosis and osteopenia. J Bone Miner Res 5: 209-211, 1990. https://doi.org/10.1002/jbmr.5650050302
  2. Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N: The diagnosis of osteoporosis. J Bone Miner Res, 9: 1137-1141, 1994. https://doi.org/10.1002/jbmr.5650090802
  3. Sambrook P, Cooper C: Osteoporosis. Lancet, 367: 2010-2018, 2006. https://doi.org/10.1016/S0140-6736(06)68891-0
  4. Wasnich RD, Ross PD, Heilbrun LK, Vogel JM: Prediction of postmenopausal fracture risk with use of bone mineral measurements. Am J Obstet Gynecol, 153: 745-751, 1985.
  5. Hui SL, Slemenda CW, Johnston CC Jr.: Age and bone mass as predictors of fracture in a prospective study. J Clin Invest, 81: 1804-1809, 1988. https://doi.org/10.1172/JCI113523
  6. Cummings SR, Black DM, Nevitt MC, et al.: Appendicular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Research Group. JAMA, 263: 665-668, 1990. https://doi.org/10.1001/jama.263.5.665
  7. Gardsell P, Johnell O, Nilsson BE: Predicting fractures in women by using forearm bone densitometry. Calcif Tissue Int, 44: 235-242, 1989. https://doi.org/10.1007/BF02553757
  8. Cummings SR, Black DM, Nevitt MC, et al.: Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet, 341: 72-75, 1993. https://doi.org/10.1016/0140-6736(93)92555-8
  9. Wahner HW: Estimating the risk of osteoporosis. J Nucl Med, 1994;35: 1155-1158.
  10. Nevitt MC, Johnell O, Black DM, Ensrud K, Genant HK, Cummings SR: Bone mineral density predicts nonspine fractures in very elderly women. Study of Osteoporotic Fractures Research Group. Osteoporos Int, 4: 325-331, 1994. https://doi.org/10.1007/BF01622192
  11. Carano A, Teitelbaum SL, Konsek JD, Schlesinger PH, Blair HC: Bisphosphonates directly inhibit the bone resorption activity of isolated avian osteoclasts in vitro. J Clin Invest, 85: 456-461, 1990. https://doi.org/10.1172/JCI114459
  12. Reginster JY, Sarlet N: The treatment of severe postmenopausal osteoporosis: a review of current and emerging therapeutic options. Treat Endocrinol, 5(1): 15-23, 2006. https://doi.org/10.2165/00024677-200605010-00003
  13. Hochberg MC, Rizzoli R: Long-term experience with alendronate in the treatment of osteoporosis. Expert Opin Pharmacother, 7: 1201-1210, 2006. https://doi.org/10.1517/14656566.7.9.1201
  14. Madenci E, Yilmaz K, Yilmaz M, Coskun Y: Alendronate treatment in osteogenesis imperfecta. J Clin Rheumatol, 12: 53-56, 2006. https://doi.org/10.1097/01.rhu.0000208490.22492.09
  15. Sen C, Gunes T, Erdem M, Koseoglu RD, Filiz NO: Effects of calcitonin and alendronate on distraction osteogenesis. Int Orthop, 30: 272-277, 2006. https://doi.org/10.1007/s00264-005-0048-9
  16. Liel Y: Paget's disease and bisphosphonates. N Engl J Med, 15;353: 2616-2618, 2005. https://doi.org/10.1056/NEJMc052601
  17. Newman ED, Matzko CK, Olenginski TP, et al.: Glucocorticoid-Induced Osteoporosis Program (GIOP): a novel, comprehensive, and highly successful care program with improved outcomes at 1 year. Osteoporos Int, 17: 1428-1434, 2006. https://doi.org/10.1007/s00198-006-0149-3
  18. Curtis JR, Westfall AO, Allison JJ, Freeman A, Saag KG: Channeling and adherence with alendronate and risedronate among chronic glucocorticoid users. Osteoporos Int, 17: 1268-1274, 2006. https://doi.org/10.1007/s00198-006-0136-8
  19. Gass M, Dawson-Hughes B: Preventing osteoporosisrelated fractures: an overview. Am J Med, 119 (4 Suppl 1): S3-S11, 2006.
  20. Cramer JA, Silverman S: Persistence with bisphosphonate treatment for osteoporosis: finding the root of the problem. Am J Med, 119 (4 Suppl 1): S12-17, 2006.
  21. Emkey RD, Ettinger M: Improving compliance and persistence with bisphosphonate therapy for osteoporosis. Am J Med, 119 (4 Suppl 1): S18-24, 2006. https://doi.org/10.1016/j.amjmed.2005.12.019
  22. Penning-van Beest FJ, Erkens JA, Olson M, Herings RM: Loss of treatment benefit due to low compliance with bisphosphonate therapy. Osteoporos Int, 19: 511-517, 2008. https://doi.org/10.1007/s00198-007-0466-1
  23. Rabenda V, Mertens R, Fabri V, et al.: Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women. Osteoporos Int, 19: 811-818, 2008. https://doi.org/10.1007/s00198-007-0506-x
  24. Heaney RP, Yates AJ, Santora AC 2nd: Bisphosphonate effects and the bone remodeling transient. J Bone Miner Res, 12: 1143-1151, 1997. https://doi.org/10.1359/jbmr.1997.12.8.1143
  25. Ravn P, Weiss SR, Rodriguez-Portales JA, et al.: Alendronate in early postmenopausal women: effects on bone mass during long-term treatment and after withdrawal. Alendronate Osteoporosis Prevention Study Group. J Clin Endocrinol Metab, 85: 1492-1497, 2000. https://doi.org/10.1210/jc.85.4.1492
  26. Baker DE: Alendronate and risedronate: what you need to know about their upper gastrointestinal tract toxicity. Rev Gastroenterol Disord, 2: 20-33, 2002.
  27. Cramer JA, Amonkar MM, Hebborn A, Altman R: Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Curr Med Res Opin, 21: 1453-1460, 2005. https://doi.org/10.1185/030079905X61875
  28. Recker RR, Gallagher R, MacCosbe PE: Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women. Mayo Clin Proc, 80: 856-861, 2005. https://doi.org/10.4065/80.7.856
  29. Rizzoli R: Long-term outcome of weekly bisphosphonates. Clin Orthop Relat Res, 443: 61-65, 2006. https://doi.org/10.1097/01.blo.0000200249.12006.6e
  30. Cooper A, Drake J, Brankin E: the PERSIST Investigators.: Treatment persistence with once-monthly ibandronate and patient support vs. once-weekly alendronate: results from the PERSIST study. Int J Clin Pract, 60: 896-905, 2006. https://doi.org/10.1111/j.1742-1241.2006.01059.x