Monitoring And Preventin Gucocorticoid-associated Osteoporosis In Patients With Connective Tissue Disease

Objective:Monitoring the change of bonephosphorus metabolism related indicators and bone mineral density of patients taking glucocorticoids to treat connective tissue disease and observing the effect of Fosamax and calcium carbonate to improve patients’ bone mineral density in order to guide the clinical practice.Methods:Collect the basic information of the change of bonephosphorus metabolism related indicators and bone mineral density of93patients taking glucocorticoids to treat connective tissue disease followed-up in Sir Run Run Shaw Hospital. In the total33patients undertaking blood25-hydroxyvitamin-D test, Comparing24cases of patients’blood25-hydroxyvitamin-D levels with normal lumbar spine bone mineral density(BMD) and9cases with abnormal BMD by T test;25cases of patients’blood25-hydroxyvitamin-D levels with normal femoral bone mineral density and8cases with abnormal BMD by T test.15cases of patients’blood25-hydroxyvitamin-D levels without using glucocorticoids and18cases having been using glucocorticoids by T test. In the total28patients undertaking blood specific alkaline phosphatase (Ostase) test, Comparing21cases of patients’blood Ostase levels with normal lumbar spine bone mineral density(BMD) and7cases with abnormal BMD by T test;20cases of patients’blood Ostase levels with normal femoral bone mineral density and8cases with abnormal BMD by T test.13cases of patients’blood Ostase levels without using glucocorticoids and15cases having been using glucocorticoids by T test.Divide33cases of patients without taking glucocorticoids and60cases of patients taking glucocorticoids to treat connective tissue into5groups by age, research the relationship between age and lumbar spine/femur bone BMD respectively in two group.Among the total93patients,54cases have never been used alendronate or calcitriol and have measured their lumbar spine BMD, Comparing the lumbar spine BMD of30cases of patients using glucocorticoids with and24cases of patients not using glucocorticoisd by T test.41cases have never been used alendronate or calcitriol and have measured their femoral BMD, Comparing the femoral BMD of21cases of patients using glucocorticoids with and20cases of patients not using glucocorticoisd by T test. Examine the significance of taking calcitriol or alendronate, with calcium carbonate D3Tablets to prevent osteoporosis of patients’ long-term use of glucocorticoids by comparing lumbar spine BMD by self-controlled T-test.Results:Among the93patients,43cases of patients have abnormal lumbar spine BMD,14cases of patients have abnormal femoral BMD. Among33cases of patients who have been measured25(OH) vitamin D3,24cases of patients have normal range of25(OH) vitamin D3;9cases of patients have abnormal25(OH) vitamin D3. Among28cases of patients who have been measured bone-specific alkaline phosphatase(Ostase),21cases of patients have normal range of blood Ostase;7cases of patients have abnormal blood Ostase. In the total33patients undertaking blood25-hydroxyvitamin-D test, Comparing24cases of patients’blood25-hydroxyvitamin-D levels with normal lumbar spine bone mineral density(BMD) and9cases with abnormal BMD by T test, there is no significant correlation between2groups (P>0.5). Comparing25cases of patients’blood25-hydroxyvitamin-D levels with normal femoral bone mineral density and8cases with abnormal femoral BMD by T test, there is no significant correlation between2groups (P>0.5). Compareing15cases of patients’blood25-hydroxyvitamin-D levels without using glucocorticoids and18cases having been using glucocorticoids by T test, there is no significant correlation between2groups (P>0.5). In the total28patients undertaking blood specific alkaline phosphatase (Ostase) test, Comparing21cases of patients’blood Ostase levels with normal lumbar spine bone mineral density(BMD) and7cases with abnormal BMD by T test, there is no significant correlation between2groups (P>0.5). Comparing20cases of patients’blood Ostase levels with normal femoral bone mineral density and8cases with abnormal BMD by T test., there is no significant correlation between2groups (P>0.5).13cases of patients’blood Ostase levels without using glucocorticoids and15cases having been using glucocorticoids by T test, there is no significant correlation between2groups (P>0.5).In patients without using glucocorticoids, the lumbar spine BMD increased gradually before40-year-old patients, reach highest in the age between40to50years old, and show a downward trend after the age of50,the group of patients elder than60year-old has relatively less sample thus affect the result. In patients having been using glucocorticoids, the lumbar spine BMD increased gradually before30-year-old patients, reach highest in the age between30to40years old, and show a downward trend after the age of40. In patients without using glucocorticoids, the femoral BMD increased gradually before40-year-old patients, reach highest in the age between40to50years old, and show a downward trend after the age of50,the group of patients elder than60year-old has relatively less sample and some patients have high femoral BMD thus makes the average BMD higher than other groups. In patients having been using glucocorticoids, the lumbar spine BMD increased gradually before30-year-old patients, reach highest in the age between30to40years old, and show a downward trend after the age of40.Among the total93patients,54cases have never been used alendronate or calcitriol and have measured their lumbar spine BMD, the lumbar spine BMD of30cases of patients having been using glucocorticoids is significantly decreased compared by24cases of patients without using glucocorticoids (T test,P<0.05).41cases have never been used alendronate or calcitriol and have measured their femoral BMD, the femoral BMD of21cases of patients using glucocorticoids have no significant difference with20cases of patients not using glucocorticoisd (T test,P>0.05). In patients with reduced bone mass or orosteoporosis caused by long-term use of glucocorticoids, alendronate sodium and calcium carbonate can increase the patients’ lumbar spine BMD(T test,P<0.05)..Discussion and Conclusions:The results suggest that, there is no significant difference in blood25dihydroxyvitamin D3and Ostase level between the group with or without the use of glucocorticoids, one possible explanation is that the changes of bonemetabolic markers may significantly earlier than changes in bone mineral density,or on the other hand, the calcium and vitamin D supplement treatment after using of glucocorticoids may weaken the influence on bone metabolism.After40years-old, no matter the use of glucocorticoids or not, the lumbar spine and femur bone density begin to decline, thus calcium and vitamin D t supplement treatment to prevent osteoporosis is very important.In patients who have never been used alendronate or calcitriol, the lumbar spine BMD of patients having been using glucocorticoids is significantly decreased compared with patients without using glucocorticoids, which indicates the use of glucocorticoids can reduce the the lumbar spine BMD,and calcium carbonate can not completely reverse the process. In patients who have never been used alendronate or calcitriol, the femoral BMD of patients having been using glucocorticoids has no significant difference with patients without using glucocorticoids, which indicates the effect of glucocorticoids to reduce the the femoral BMD is not obvious,or calcium carbonate can reverse the process better.The use of alendronate, and calcium carbonate,D3Tablets in patients with Long-term use of glucocorticoids to prevent osteoporosis is important, Lumbar spine BMD increased after use of alendronate in patients using glucocorticoid, alendronate is effective for the treatment of osteoporosis.