Alendronate可能預防發生骨關節炎及降低膝蓋疼痛


  Nov. 4, 2004 - 一份刊載於11月號關節炎與風濕病期刊上的研究結果指出,alendronate可能降低骨關節炎(OA)發生率與膝蓋疼痛。
  
  來自田納西大學位於孟裴斯的健康科學中心,同時也是來自健康、老化與身體組成(ABC)試驗的Laura D. Carbone醫師指出,因為最近被核准治療骨質疏鬆症的抑制骨質溶離藥物引進(包括含氮的雙磷酸鹽與選擇性雌性激素受體調控藥物),但是這些藥物對於膝蓋骨關節炎結構或是臨床表現的作用仍不清楚。
  
  這項橫切試驗的目的是要檢驗健康ABC試驗族群中,老年女性抗骨質溶離療法的使用與膝蓋疼痛症狀的嚴重度與存在與否、膝蓋骨關節炎放射線學上的變化、與膝蓋骨關節炎相關的核磁共振(MRI)變化。
  
  818位因為骨關節炎症狀而進行膝蓋核磁共振的停經後婦女中,有214位(26.2%)使用抗骨質溶離藥物;抗骨質溶離藥物的使用與膝蓋疼痛或是膝蓋骨關節炎,在放射學上的改變沒有顯著的關係;根據西方安大略與麥克麥斯特大學骨關節炎指標(WOMAC)分數,alendronate的使用,但是不是使用雌性激素,與膝蓋疼痛的嚴重度降低有關。
  
  相較於沒有接受這些藥物的婦女,使用alendronate或是雌性激素的婦女,發生軟骨下骨骼磨損,與在膝蓋MRI上表現類似骨髓水腫異常的機會,顯著地較低。
  
  該項試驗的限制,包括使用雙磷酸鹽與其他抗骨質溶離藥物,造成骨密度降低與骨質疏鬆症可能性增加,可能受到適應症、非裔美國婦女比較少使用抗骨質溶離藥物、缺乏膠原蛋白指標、以及沒有使用除了alendronate以外的雙磷酸鹽藥物。
  
  Carbone醫師在新聞中表示,我們的試驗暗示,alendronate與雌性激素可能預防與膝蓋骨關節炎有關的骨骼異常,這可能對於這種疾病的整體表現有好處;不過,仍有待進一步縱向分析數據及隨機分派試驗研究,來評估使用alendonate、雌性激素、與其他骨骼抗骨質溶離藥物用來預防或是治療膝蓋骨關節炎的效果。
  
  國家老化機構贊助這項試驗,Carbone醫師是禮來、寶僑、安萬特、惠氏、與默克藥廠的諮詢顧問;其他研究者有接受Negma-Lerads、默克、先靈葆雅以及/或是安萬特的財務安排。

Alendronate May Protect Agains

By Laurie Barclay, MD
Medscape Medical News

Nov. 4, 2004 — Alendronate may protect against osteoarthritis (OA) and reduce knee pain, according to the results of a study published in the November issue of Arthritis & Rheumatism.

"Due to the rather recent introduction of antiresorptive agents approved for the treatment of osteoporosis (including nitrogen-containing bisphosphonates and selective estrogen receptor modulators), little is known about their effects on any structural or clinical findings of knee OA," write Laura D. Carbone, MD, from the University of Tennessee Health Sciences Center in Memphis, and colleagues from the Health, Aging and Body Composition (ABC) Study. "The purpose of this cross-sectional study was to examine the association of use of antiresorptive therapy with the presence and severity of symptoms of knee pain, knee OA radiographic changes, and knee OA–related magnetic resonance imaging (MRI) changes in elderly women in the Health ABC study cohort."

Of 818 postmenopausal women who had MRI of the knee performed for symptoms of knee OA, 214 women (26.2%) were receiving antiresorptive drugs. Overall use of antiresorptive drugs was not significantly associated with the presence of knee pain or with radiographic changes of knee OA. Based on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, use of alendronate, but not estrogen, was associated with less severity of knee pain.

Compared with women who had not received these medications, women who received alendronate or estrogen had significantly less subchondral bone attrition and bone marrow edema–like abnormalities in the knee on MRI.

Study limitations include greater probability of low bone mineral density and osteoporosis in users of bisphosphonates and other antiresorptive drugs, possible confounding by indication, few African-American women who reported use of antiresorptive agents, lack of collagen markers, and lack of use of bisphosphonates other than alendronate.

"Our study suggests that alendronate and estrogen may protect against the development of bone abnormalities associated with knee OA, which may have a beneficial effect on the overall course of the disease," Dr. Carbone says in a news release. "Further studies with longitudinal data and randomized trials are needed to evaluate the potential of using alendronate, estrogen, and other bone antiresorptive agents for the prevention or treatment of knee OA."

The National Institutes of Aging supported this study. Dr. Carbone has served as a consultant to Eli Lilly, Procter and Gamble, Aventis, Wyeth-Ayerst, and Merck. Other authors report various financial arrangements with Negma-Lerads, Merck, Shering-Plough, and/or Aventis.

Arthritis Rheum. 2004;50:3516-3525

Reviewed by Gary D. Vogin, MD

    
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