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Spine：绝经期后女性行硬膜外类固醇注射 须警惕骨折

2012-12-07 程蓓 编译 Spine

绝经期硬膜外类固醇注射骨折
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　　美国一项前瞻观察性研究显示，对于绝经后女性，单一硬膜外类固醇注射（ESI）可致其髋关节骨密度（BMD）下降。对于有神经根病变者，在选择治疗方案时应考虑这一点；有骨折风险者，应慎用ESI。论文12月1日发表于《脊柱》[Spine 2012，37（25）：E1567]杂志。 　　研究纳入接受ESI治疗神经根病变的绝经后女性28例，但有50%的病例由于无法满足研究需求而中途退出。分别于注

　　美国一项前瞻观察性研究显示，对于绝经后女性，单一硬膜外类固醇注射（ESI）可致其髋关节骨密度（BMD）下降。对于有神经根病变者，在选择治疗方案时应考虑这一点；有骨折风险者，应慎用ESI。论文12月1日发表于《脊柱》[Spine 2012，37（25）：E1567]杂志。

　　研究纳入接受ESI治疗神经根病变的绝经后女性28例，但有50%的病例由于无法满足研究需求而中途退出。分别于注射前（定为基线水平）、注射后3和6个月，对髋关节、股骨颈和脊柱的BMD，以及骨转换的标志物[骨特异性碱性磷酸酶和血清Ⅰ型胶原C端肽（CTX）]进行评估。

　　结果显示，与注射前相比，注射后6个月髋关节的BMD显著下降（P=0.002），且下降程度显著高于年龄相匹配的正常对照人群（P=0.007）。从注射后3个月至6个月间，骨特异性碱性磷酸酶显著增加（P=0.012），而CTX水平未显著增加。


Study Design
A prospective, observational study.
Objective
To evaluate the effect of epidural steroid injection (ESI) on bone mineral density (BMD) in postmenopausal women.
Summary of Background Data
ESIs are used to treat the pain associated with radiculopathy. Although it is known that exogenous steroid use can disrupt skeletal architecture, it is less clear whether ESIs result in a decrease of BMD.
Methods
Twenty-eight postmenopausal women experiencing radiculopathy elected L4–L5 ESI treatment. We had a 50% dropout rate due to noncompliance with study requirements. BMD of the hip, femoral neck, and spine along with markers of bone turnover, bone specific-alkaline phosphatase and serum C-telopeptide of collagen I (CTX), was evaluated at baseline preinjection and 3 and 6 months postinjection.
Results
There was a significant decline in the hip BMD of 0.018 g/cm2 (0.028 ± 0.007, P = 0.002) at 6 months compared with baseline. We compared this decline with an age-matched control population that exhibited a decline of 0.003 g/cm2, significantly less than our study population (P = 0.007). Bone-specific alkaline phosphatase increased significantly by 2.33 U/L from 3 to 6 months (P = 0.012), but the rise of CTX was not significant.
Conclusion
A single ESI in postmenopausal women adversely affects BMD of the hip. This is in conjunction with a rise in bone remodeling activity, as evidenced by an increase in bone-specific alkaline phosphatase and CTX. In addition, when compared with an age-matched control population, our study population exhibited a greater decline in BMD. Our findings show that epidural administration of corticosteroids has a deleterious effect on bone, which should be considered when contemplating treatment options for radiculopathy. The resulting decrease in BMD, while slight, suggests that ESIs should be used with caution in those at a risk for fracture.

    

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    2013-04-18 12498ebem19暂无昵称

    #硬膜外#

    0

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    2013-08-06 mgqwxj

    #Spine#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1937120, encodeId=4b66193e12025, content=<a href='/topic/show?id=c06ae363256' target=_blank style='color:#2F92EE;'>#硬膜外#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73632, encryptionId=c06ae363256, topicName=硬膜外)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3b172500206, createdName=12498ebem19暂无昵称, createdTime=Thu Apr 18 09:37:00 CST 2013, time=2013-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1699238, encodeId=30511699238f9, content=<a href='/topic/show?id=f5821661e14' target=_blank style='color:#2F92EE;'>#Spine#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16617, encryptionId=f5821661e14, topicName=Spine)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ba5829925263, createdName=mgqwxj, createdTime=Tue Aug 06 18:37:00 CST 2013, time=2013-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=5321, encodeId=4fce532144, content=I raelly couldn't ask for more from this article., beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=Kitty, createdTime=Mon Jan 07 18:28:00 CST 2013, time=2013-01-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256976, encodeId=179512569e676, content=<a href='/topic/show?id=cdfce8879b1' target=_blank style='color:#2F92EE;'>#绝经#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78879, encryptionId=cdfce8879b1, topicName=绝经)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Sun Dec 09 01:37:00 CST 2012, time=2012-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304817, encodeId=e8bd130481e91, content=<a href='/topic/show?id=9b09e89052f' target=_blank style='color:#2F92EE;'>#绝经期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78905, encryptionId=9b09e89052f, topicName=绝经期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3289320, createdName=海豹, createdTime=Sun Dec 09 01:37:00 CST 2012, time=2012-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1313347, encodeId=cd65131334e8a, content=<a href='/topic/show?id=d59be61251d' target=_blank style='color:#2F92EE;'>#类固醇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76125, encryptionId=d59be61251d, topicName=类固醇)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a691420, createdName=30397604, createdTime=Sun Dec 09 01:37:00 CST 2012, time=2012-12-09, status=1, ipAttribution=)]
    2013-01-07 Kitty

    I raelly couldn't ask for more from this article.

    0

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    2012-12-09 yeye5224612

    #绝经#

    0

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    2012-12-09 海豹

    #绝经期#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1937120, encodeId=4b66193e12025, content=<a href='/topic/show?id=c06ae363256' target=_blank style='color:#2F92EE;'>#硬膜外#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73632, encryptionId=c06ae363256, topicName=硬膜外)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3b172500206, createdName=12498ebem19暂无昵称, createdTime=Thu Apr 18 09:37:00 CST 2013, time=2013-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1699238, encodeId=30511699238f9, content=<a href='/topic/show?id=f5821661e14' target=_blank style='color:#2F92EE;'>#Spine#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16617, encryptionId=f5821661e14, topicName=Spine)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ba5829925263, createdName=mgqwxj, createdTime=Tue Aug 06 18:37:00 CST 2013, time=2013-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=5321, encodeId=4fce532144, content=I raelly couldn't ask for more from this article., beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=Kitty, createdTime=Mon Jan 07 18:28:00 CST 2013, time=2013-01-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256976, encodeId=179512569e676, content=<a href='/topic/show?id=cdfce8879b1' target=_blank style='color:#2F92EE;'>#绝经#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78879, encryptionId=cdfce8879b1, topicName=绝经)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Sun Dec 09 01:37:00 CST 2012, time=2012-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304817, encodeId=e8bd130481e91, content=<a href='/topic/show?id=9b09e89052f' target=_blank style='color:#2F92EE;'>#绝经期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78905, encryptionId=9b09e89052f, topicName=绝经期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3289320, createdName=海豹, createdTime=Sun Dec 09 01:37:00 CST 2012, time=2012-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1313347, encodeId=cd65131334e8a, content=<a href='/topic/show?id=d59be61251d' target=_blank style='color:#2F92EE;'>#类固醇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76125, encryptionId=d59be61251d, topicName=类固醇)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a691420, createdName=30397604, createdTime=Sun Dec 09 01:37:00 CST 2012, time=2012-12-09, status=1, ipAttribution=)]
    2012-12-09 30397604

    #类固醇#

    0