Postmenapozal osteoporozlu hastalarda oral ve parenteral bifosfonatların etkinliğinin Karşılaştırılması: Tek merkezli retrospektif klinik çalışma

Abstract

Amaç: Çalışmamız postmenopozal osteoporoz (OP) tedavisinde kullanılan oral ve parenteral bifosfanatların etkinliklerini karşılaştırmayı amaçlamaktadır. Gereç ve Yöntemler: 2016-2019 yılları arasında postmenopozal OP tanısı konularak, oral ya da parenteral bifosfonat ile tedavi edilen 50 yaş üstü hastalar çalışmaya dahil edildi. Tedaviye göre oral bifosfonat alan 80 hasta grup ‘O’ ve parenteral bifosfonat alan 80 hasta grup ‘P’ olarak iki gruba ayrıldı. Tedavilerini düzenli alan ve en az 2 yıl takibi yapılabilen 160 hastanın tedavinin 2. yıldaki sonuçları değerlendirilerek karşılaştırıldı. Bulgular: Her iki grupta tedavi öncesine göre; vertebra ve femur kemik mineral yoğunluğu (BMD) ve T-skorlarında anlamlı düzelme olduğu görüldü. Vertebra ve femur T-skorundaki ve femur BMD değerindeki ortalama düzelme bakımından grup ‘P’ daha iyiydi ve istatistiksel olarak anlamlı fark vardı. Oral bifosfonat grubunda femur T-skorunda alendronat lehine gruplar arasında istatistiksel anlamlı fark olduğu ve parenteral bifosfonat grubunda ise vertebra ve femur T-skorundaki düzelme zoledronat alt grubunda daha iyiydi ve istatistiksel olarak anlamlıydı. Sonuç: Çalışmamızın sonuçları; postmenopozal OP’nin tedavisinde oral ve parenteral bifosfonatların etkili olduğunu göstermektedir. Bununla birlikte vertebra ve femur T-skorlarında ve femur KMY ortalama düzelme bakımından parenteral bifosfonatlar daha etkili bulundu.

Keywords

• DEXA
• bifosfonat
• Postmenopozal osteoporoz
• zolendronik asit

Comparison of the efficacy of oral and parenteral bisphosphonates in patients with postmenopausal osteoporosis: A single-center, retrospective clinical study

Abstract

Aim: The aim of the study is to compare the efficacy of oral and parenteral bisphosphonates used in the treatment of postmenopausal osteoporosis. Material and Methods: Patients older than 50 years who were diagnosed with postmenopausal OP and treated with oral or parenteral bisphosphonate between 2016 and 2019 were included in the study. The patients were grouped by treatment; 80 patients receiving oral bisphosphonate and 80 patients receiving parenteral bisphosphonate were divided into two groups as group ‘O’ and group ‘P’, respectively. The results of the second-year treatment of 160 patients, who were treated regularly and could be followed-up for at least 2 years, were evaluated and compared. Results: According to the pre-treatment state in both groups; vertebral and femoral bone mineral density (BMD) and T-scores showed significant improvement. The mean improvement in vertebral and femoral T-scores and femoral BMD values was better in group ‘P’ with a statistically significant difference. In the oral bisphosphonate group, there was a statistically significant difference between the groups in favor of alendronate in the femoral T-score, while, in the parenteral bisphosphonate group, the improvement in the vertebral and femoral T-score was better in the zoledronate subgroup and statistically significant. Conclusion: This study concluded that oral and parenteral bisphosphonates are effective in the treatment of postmenopausal OP. Nevertheless, parenteral bisphosphonates were found to be more effective in terms of mean improvement in vertebral and femoral T-scores and femoral BMD.

Keywords

• DEXA
• bisphosphonate
• Postmenopausal osteoporosis
• zolendronic acid

References

1. 1. Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY, et al. European guidance for the diagnosis and management of osteoporosis in postmenop ausal women. Osteoporos Int 2013; 24:23-57.
2. 2. Aslan A, Konya MN, Yağcı Ş, Karakoyun Ö. FRAX® Türkiye modeli yeterli mi? Türk Toplumunda FRAX® ile osteoporotik kırık riski analizi. Turk J Osteoporos 2014; 20:21-5.
3. 3. Aslan A, Karakoyun Ö, Güler E, Aydın S, Gök MV, Akkurt S. Evaluation of bone mineral density, osteoporosis prevalence and regional risk factors in Turkish women living in Kastamonu: KASTÜRKOS study. Eklem Hastalık Cerrahisi 2012; 23:62-7.
4. 4. Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, Johansson H, et al. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int 2012; 23:949-55.
5. 5. Aslan A, Uysal E, Karakoyun Ö. Kastamonu ve yöresi Türk Toplumu Kadınlarında kemik mineral yoğunluğu değerleri. Journal of Clinical and Analytical Medicine 2013; 4:209-12.
6. 6. Aslan A, Sargın S, Özmeriç A, Yağcı Ş. Treatments of patients with postmenopausal osteoporosis: a comparative study. OA Musculoskeletal Medicine 2014; 2:4.
7. 7. Aslan A, Özmeriç A, Bilal Ö, Doğar F, Özkaya Z, Uysal E. Comparative evaluation of clinical effectivity and side effects of two different parenteral agents used in the treatment of osteoporosis. J Rheumatol Orthop 2014; 1:1-6.
8. 8. Sindel D. Günümüzde ve Gelecekte Osteoporoz Tedavisi. Turk J Phys Med Rehab 2013; 59:330-7.

9. 9. Inderjeeth CA, Inderjeeth AJ, Raymond WD. Medication selection and patient compliance in the clinical management of osteoporosis. Aust Fam Physician 2016; 45:814-7.
10. 10. Lakatos P, Takács I, Marton I, Tóth E, Zoltan C, Lang Z, et al. A Retrospective Longitudinal Database Study of Persistence and Compliance with Treatment of Osteoporosis in Hungary. Calcif Tissue Int 2016; 98:215-25.
11. 11. Ishtiaq S, Fogelman I, Hampson G. Treatment of post-menopausal osteoporosis: beyond bisphosphonates. J Endocrinol Invest 2015; 38:13-29.
12. 12. Albert SG, Reddy S. Clinical evaluatıon of cost efficacy of drugs for treatment of osteoporosis: a meta-analyss. Endocr Pract 2017; 23:841-56.
13. 13. Zhou J, Ma X, Wang T, Zhai S. Comparative efficacy of bisphosphonates in short-term fracture prevention for primary osteoporosis: a systematic review with network meta-analyses. Osteoporos Int 2016; 27:3289-300.
14. 14. Genant HK, Grampp S, Glüer CC, Faulkner KG, Jergas M, Engelke K, et al. Universal standardization for dual x-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res 1994; 9:1503-14.
15. 15. Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, et al. Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference. J Clin Densitom 2008; 11:75-91.
16. 16. Erselcan T, Özen A, Yüksel D, Altun GD, Öztürk E, Balcı TA, et al. Kemik mineral yoğunluğu ölçümü uygulama klavuzu. Turk J Nucl Med 2009; 18:31-40.
17. 17. No authors listed. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 1994; 843:1- 129.
18. 18. Demirel AÇ, Umay E, Öztürk Karaahmet ÖZ, Çelik Avluk Ö, Çakcı A. Osteoporozlu Hastalarda Bifosfonatların Devamlı veya Aralıklı Kullanımının Kırık, Kemik Yoğunluğu ve Biyokimyasal Parametrelere Etkisi. Turk J Osteoporos 2010; 16:1-8.
19. 19. Sarıdoğan M. Postmenopozal Osteoporoz Tedavisi: Bifosfonatlar. Turkiye Klinikleri J Gynecol Obst-Special Topics 2009; 2:62-8.
20. 20. Harris ST, Reginster JY, Harley C, Blumentals WA, Poston SA, Barr CE, et al. Risk of fracture in women treated with monthly oral ibandronate or weekly bisphosphonates: the eValuation of IBandronate Efficacy (VIBE) database fracture study. Bone 2009; 44:758-65.
21. 21. Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC, et al. Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. J Clin Endocrinol Metab 2000; 85:4118-24.
22. 22. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996; 348:1535-41.
23. 23. Cummings SR, Black DM, Thompson DE, Applegate WB, BarrettConnor E, Musliner TA, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998; 280:2077-82.
24. 24. John Camm A. Review of the cardiovascular safety of zoledronic acid and other bisphosphonates for the treatment of osteoporosis. Clin Ther 2010; 32:426-36.