Analysis Of Effects Three Years After The Treatment Of Patients With Postmenopausal Osteoporosis With Zoledronic Acid

Objective: To analysis the long-term efficacy,efficacy on anti fracture,efficacy on reducing pain and safety three years after the treatment of patients with postmenopausal osteoporosis with zoledronic acid(trade name: Aclasta)injected yearly.Methods: This is a retrospective clinical study,the medical records of patients with postmenopausal osteoporosis,who were treated in ward or outpatient in the Affiliated Hospital of Qingdao University from February 2011 to June 2016,were consulted,259 patients with average age of 63.4 years were enrolled in the study,according to the treatment,they were divided into 4 groups.65 patients in group Z0 were given calcium and calcitriol daily,meanwhile patients in group Z1?Z2?Z3 were given the same dose of calcium and calcitriol daily,and 65 patients in group Z0 were intravenous dripped with zoledronic acid(5mg)on the first day(the first injection was deemed to be the first day),64 patients in group Z2 received two injections of zoledronic acid at the first day and the twelfth months,group Z3 received three injections of zoledronic acid at the first day,the twelfth months and the twenty-fourth months,respectively.All the patients were observed to the thirty-sixth months.Through the changes of the bone mineral density(BMD)of the lumbar vertebrae 1-4,the femoral neck and the hip,the occurrence of new fractures,pain scores,biochemical indicators,adverse reactions and adverse events,evaluate the long-term efficacy,anti fracture effect,efficacy on reducing pain,the change of biochemical indexes and safety of zoledronic acid.Results: The age,bone mineral density,pain score,biochemical index of each group were similar.(1)The change of BMD: the BMD of each part in each stage increased in group Z3,at the thirty-sixth months,the density of L1-4,femoral neck and total hip were(0.104g/cm2,15.55%),(0.106g/cm2,15.78%),(0.114g/cm2,16.94%)higher than BMD before first injection respectively.BMD of group Z1 and Z2 increased after zoledronic acid treatment,and decreased after the termination of treatment.(2)New fractures:Z0(n=8,12.31%),Z1(n=5,7.69%),Z2(n=2,3.13%),Z3(n=1,1.5%),new fractures in four groups were statistically significant(P=0.048),group Z3 was significantly lower than that of group Z0(P=0.016).(3)Pain relief: The pain scores of group Z3 were decreased in each stage,and the pain scores of group Z1 and Z2 were decreased after treatment,but increased after the termination of treatment.(4)Biochemical indicators: the levels of serum calcium,phosphorus,parathyroid hormone,urea nitrogen and creatinine in each group were not significantly different from the previous period;Alkaline phosphatase(ALP)decreased continuously in group Z3;The levels of alkaline phosphatase in group Z1 and Z2 were decreased after administration of zoledronic acid,and increased after the termination of treatment.(5)Adverse reactions and adverse events: There are more adverse reactions after zoledronic acid injection,such as fever,flu like symptoms,myalgia,arthralgia,appeared in 3 days after each treatment.Adverse reactions in patients received the first injection was 43.6%,and 13.2% after the second injection,4.6% after the third injection,no serious adverse events occurred after each injection.Conclusion:(1)Zoledronic acid has significant effect on the increase of BMD.(2)Compared patients who terminated after infusion of zoledronic acid 1 or 2 times,BMD showed an increasing trend after 3 times of infusion.(3)Continuous infusion of zoledronic acid 3 times reduced the incidence of new fractures.(4)Continuous infusion of zoledronic acid can effectively relief pain.(5)Repeated infusion of zoledronic acid continued to decrease the level of alkaline phosphatase.(6)Infusion of zoledronic acid had more adverse effects,But after the second and the third treatment,the adverse reaction was less than the first time.