Alendronate有助於預防肝臟移植的骨質流失


  July 26, 2005 - 肝臟移植期刊八月份刊載,一項先期性、單臨床中心的研究結果顯示,Alendronate可以預防肝臟移植(LT)引起的骨質流失。
  
  奧地利Innsbruck醫學大學的Gunda Millonig醫師表示,骨質流失是肝臟移植前後常見的併發症;器官移植引發的骨質流失必須予以治療,但是目前尚無醫療準則是根據多數的肝臟受贈者所進行對照式臨床試驗。
  
  本研究的目的在於確定bisphosphonate對於肝臟移植後的療效,視其對於骨質流失的治療效果,患者為末期肝病,等待肝臟移植者;肝移植之前,及4、12、24、36與48個月之後,所有的136位患者皆以雙重X光吸收掃描作骨質密度及骨新陳代謝的測量;所有的患者皆接受維生素D與鈣質補充,移植前患有骨質減少及骨質疏鬆症的患者,在移植之後同時接受alendronate治療。
  
  移植之前,48.5%的患者患有骨質減少症,23.5%患有骨質疏鬆;移植前的骨質密度皆無關於性別,潛藏的肝病,或Child-Turcotte-Pugh等級;但是,身體質量指數在移植之前會明顯關連到骨折的風險。
  
  對於骨質減少與骨質疏鬆的患者,Alendronate可以預防移植之後骨質的持續流失;肝臟移植後24個月內,Alendronate可以增加骨質疏鬆患者的身體質量指數。
  
  研究的限制因素,為即使同一位患者,骨質轉換標記有著高度的變化,試驗亦無隨機分配。
  
  Millonig醫師表示,根續研究結果,Alendronate可以有效的預防肝臟移植所產生的自然骨質流失;但是,這些結果目前只能視為理論性的,必須進行更進一步的隨機分配試驗。
  
  本研究的贊助單位,含Verein zur Forderung Wissenschaftlicher Arbeit in Gastroenterologie und Hepatologie der Universitat Innsbruck。

Alendronate May Help Prevent B

By Laurie Barclay, MD
Medscape Medical News

July 26, 2005 — Alendronate can prevent the bone loss associated with liver transplantation (LT), according to the results of a prospective, single center study reported in the August issue of Liver Transplantation.

"Bone loss is a common complication in patients before and after LT," write Gunda Millonig, MD, from Innsbruck Medical University in Austria, and colleagues. "The need for therapy of transplantation-related bone loss has been recognized, but no guidelines based on controlled clinical trials dealing with larger cohorts of LT recipients are yet available."

The study objective was to determine the efficacy of bisphosphonates after LT in preventing progressive bone loss in patients with end-stage liver diseases awaiting LT. All 136 patients had measurement of bone mineral density (BMD) by dual x-ray absorptiometry and markers of bone metabolism before and 4, 12, 24, 36, and 48 months after LT. Before and after LT, all patients received vitamin D and calcium supplementation, and those with osteopenia or osteoporosis before LT also received alendronate after LT.

Before LT, 48.5% of patients had osteopenia, and 23.5% had osteoporosis. Decreased BMD before LT was not associated with sex, underlying liver disease, or Child-Turcotte-Pugh classification. However, body mass index before LT was significantly correlated with fracture risk.

In patients with osteoporosis and osteopenia, alendronate prevented the consistently observed bone loss after LT. Within 24 months after LT, alendronate was also associated with increased BMD in patients with osteoporosis.

Study limitations include lack of randomization and high variability of bone turnover markers within the same individual.

"Our study suggests that alendronate is efficacious in preventing the natural course of bone loss associated with LT," the authors write. "However, these results can only be interpreted as hypothesis-generating for the present time, and further randomized studies are needed."

Verein zur Förderung Wissenschaftlicher Arbeit in Gastroenterologie und Hepatologie der Universität Innsbruck supported this study.

Liver Transpl. 2005;11:960-966

Reviewed by Gary D. Vogin, MD

    
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