Bisphosphonates可以幫助膝骨關節炎及骨質疏鬆症


Sept. 24, 2003 ( 明尼阿波利斯 ) —根據一篇發表於美國骨骼和礦物質研究學會第25屆年會的研究報告,Bisphosphonates 對於骨關節炎(OA)的患者可以提供治療益處。
  
  來自人口研究健康、老化和身體組成研究的資料(健康-ABC)顯示,服用Bisphosphonates治療骨質疏鬆症的女性利用核磁共振成像 (MRI) 測量後,有較低的骨骼摩損和膝關節較少的骨贅及骨髓水腫評分。
  
  健康-ABC是一項長期研究,可以預測無能力的因素,這個部分的研究結果,由田納西州大學的Laura Carbone博士所發表。
  
  Carbone博士表示,我們認為bisphosphonate和阻止再吸收的藥物對於OA可能有效的原因在於,OA的早期病灶之一為軟骨下的再吸收,而阻止再吸收的藥物可以減少骨骼再吸收的作用。
  
  共有818名69到81歲的女性參與這項分析,一共898個膝蓋以MRI檢查,這些受試女性經過會見評估膝蓋的疼痛(使用Western Ontario and McMaster Universities骨關節炎索引[ WOMAC ])及活動,沒有膝關節疼痛的女性則隨機作為比較病例。
  
  之後根據受試女性所服用的阻止再吸收的藥物,將她們分組(雌性激素、bisphosphonate 或 raloxifene)並對應於非服用者。
  
  研究人員調整年齡、種族、身體質量指數、使用的非類固醇抗發炎的藥物、鈣補充劑,和其他會分散阻止再吸收的藥物藥物之效果的其他因素,這些是可以比較的女性組。
  
  X光並未靈敏到足以發現女性OA的差異,任何阻止再吸收的藥物對於OA的X光檢查都會造成影響,如果你只看X光檢查結果,雌激素、raloxifene 或alendronate都無法產生效果,但是結構的差異則可以藉由MRI觀察出來。
  
  其他組相較之下,bisphoshonates使用者的骨骼摩損和膝關節較少的骨贅及骨髓水腫評分顯著地較低,相較於非使用者,他們的WOMAC成績也較低,但是這個成績與雌激素組相似。
  
  幾項參數建議,這種藥物可能對於OA的MRI變化具有有益的效果,當研究完成時,bisphosphonate患者都服用alendronate,她警告,這項研究結果只是代表性的數據,還需要進一步完成研究。
  
  緬因州大學的營養學教授Clifford Rosen博士表示,醫師對於使用bisphosphonates治療骨關節炎的興趣越來越高,越來越多的研究建議bisphosphonates具有效果,這是有科學根據的,Bisphosphonates 可以減少發炎的細胞,因此降低病灶總數而阻止關節炎症狀的惡化。
  

Bisphosphonates May Help Knee<

By
Medscape Medical News

Pippa Wysong

Sept. 24, 2003 (Minneapolis) — Bisphosphonates may provide some benefit to patients with osteoarthritis (OA), according to a presentation at the 25th annual meeting of the American Society for Bone and Mineral Research.

Data from the population study Health, Aging and Body Composition (Health ABC) show that women using bisphosphonates for osteoporosis had lower bone attrition and lower osteophyte and bone marrow edema scores of the knee as measured by magnetic resonance imaging (MRI).

Health ABC is a long-term study investigating factors that may predict disability. Findings from this portion of the study were presented by Laura Carbone, MD, associate professor of medicine and director of the metabolic bone center at the University of Tennessee in Memphis.

"The reason we thought there might be an effect of the bisphosphonate and antiresorptive agents on OA is because, in one of the early lesions of OA, there is subchondral bone resorption. The antiresorptives act to decrease bone resorption," she said.

A total of 818 women ranging in age from 69 to 81 years were included in this analysis, and a total of 898 knees were imaged with MRI. The women underwent interviews to assess knee pain (using the Western Ontario and McMaster Universities Osteoarthritis Index function scale [WOMAC]) and activity. A random sample of women with no knee pain were included for comparison.

The women were then divided into groups according to the type of antiresorptive agent they used (estrogen, bisphosphonate, or raloxifene) and compared with non-users.

Researchers adjusted for age, race, body mass index, use of nonsteroidal anti-inflammatory drugs, calcium supplements, and other factors to try to isolate the effects from antiresorptive drugs. "These were comparable groups of women," Dr. Carbone said.

X-rays were not sensitive enough to detect any differences in knee OA in the women. "There is no effect of any antiresorptive agent on x-ray changes of OA. If you looked at just x-rays, neither estrogen, raloxifene, or alendronate had an effect on that," she said. However, structural differences could be seen on MRI.

Compared with the other groups, users of bisphoshonates had significantly lower values for bone attrition, osteophytes, and bone marrow edema. They also had a lower WOMAC score compared with nonusers, but this score was similar to that of the estrogen group.

"Several parameters suggested that...there might be a beneficial effect on MRI changes of OA of the knee," Dr. Carbone said. At the time the study was done, bisphosphonate users were all taking alendronate.

She cautioned that the finding is only from cross-sectional data and that additional studies need to be done.

There is a growing amount of interest in the possible use of bisphosphonates for treatment of osteoarthritis, said Clifford Rosen, MD, professor of nutrition at the University of Maine in Orono, who was not involved in the study. "There are more and more studies suggesting that some [bisphosphonates] have an effect, and there's some scientific rationale," he said.

Bisphosphonates may help prevent the worsening of arthritis symptoms by reducing the amount of damage that inflammatory cells may cause, he explained.

Dr. Carbone's research was funded by Health ABC, which is supported by the National Institutes of Health.

25th ASBMR: Abstract SU053. Presented Sept. 21, 2003.

Reviewed by Gary D. Vogin, MD

Pippa Wysong is a freelance writer for Medscape.

    
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