Effect Of Zoledronic Acid On Bone Mineral Density And Bone Metabolism Markers In Osteoporosis Patients

Objectives:To investigate the effects of intravenous injection of zoledronic acid(ZOL)for 12 months,24 months,and 36 months on the lumbar spine bone mineral density(BMD)and bone metabolism marker levels in patients with different types of osteoporosis(OP)who recieved daily oral administration of vitamin D and calcium carbonate.Methods:This study retrospectively analyzed 164 patients with OP who were treated with ZOL in the Endocrinology Department of the First Affiliated Hospital of Kunming Medical University from 2012 to 2020.According to the different types of OP,study subjects were divided into primary OP group and secondary OP group.All study subjects received intravenous injection of ZOL once a year on the basis of oral vitamin D and calcium carbonate supplement.0 month is baseline value;12 months,24 months,and 36 months are the state of twelfth mouth after the first,second,and third time received ZOL treatment respectively.Patients with primary OP were included in group A(n=86),patients with secondary OP were included in group B(n=78).Group A1(n=86)and group B1(n=78)were included all subjects of group A and B,observed the therapeutic effect of ZOL treatment at first year.Group A2(n=46)and group B2(n=35)were included all subjects received the second treatment of group A and B,observed the therapeutic effect of ZOL treatment at first,second year.Group A3(n=9)and group B3(n=13)were included all subjects received the third treatment of group A and B,observed the therapeutic effect of ZOL treatment at first,second and third year.The changes in lumbar spine BMD and bone metabolic marker levels before and after treatment with ZOL in each group were compared,and new-onset bone fractures were recorded.Results:1.General data such as age,height,weight,and BMI of the subjects in each group are similar.2.The lumbar spine BMD increased significantly after treatment in the group A1 and B1 for 12 months(P<0.05);the lumbar spine BMD increased significantly after the treatment in the group A2 and B2 for 24 months(P<0.05),and compared with12 months,the lumbar spine BMD further increased,but the difference was not statistically significant(P>0.05);the lumbar spine BMD increased significantly after treatment in the group A3 for 36 months(P<0.05);and compared with 24 months,the lumbar spine BMD further increased,but the difference was not statistically significant(P>0.05);L3,L4,L1-4 increased significantly after treatment in the group B3 for 36 months(P<0.05),while L1,L2 was not statistically significant(P>0.05),and compared with 24 months,the lumbar spine BMD further increased,but the difference was not statistically significant(P>0.05).The lumbar spine BMD between A1 and B1 group,A2 and B2 group,A3 and B3 group are not statistically significant(P>0.05).3.The blood calcium,blood phosphorus,and parathyroid hormone(PTH)levels were not significantly different after treatment for 12,24 and 36 months compared with baseline(P>0.05).In group A1 and B1,the levels of 25-hydroxy vitamin D(25(OH)D)increased significantly and the level of alkaline phosphatase(ALP)decreased significantly after treatment for 12 months(P<0.05);in groups A2 and B2,the level of 25(OH)D increased significantly and the level of ALPdecreased significantly after treatment for 24 months(P<0.05);in groups A3 and B3,the levels of 25(OH)D and ALPwere not significantly different after treatment for 36 months(P>0.05).Conclusions:1.On the basis of oral calcium carbonate and vitamin D supplement,intravenous injection of ZOL can significantly increase the the lumbar spine BMD in patients with primary OP and secondary OP.2.Zoledronic acid can improve the lumbar BMD in patients with primary OP and secondary OP,and there is no difference in this improvement effect between the two groups.3.Intravenous injection of ZOL for 36 months incline to has a greater increase in bone density than 24-months-therapy or 12-months-therapy.