僥骨DXAによる骨粗鬆症の縦的検討(第2報)-治療方法, 服用状況による治療効果判定に関する研究-

type:Article

骨塩量の測定が重要視される中で同時に治療効果に対する骨塩量の評価に関する必要性も言及されるようになってきた。前回本誌において, 我々は500症例の骨塩量の測定から男女での年間の骨塩量減少率(男性1%, 女性1.02%)を報告したが, 今回我々は骨粗鬆症と臨床診断された113名の女性患者に対し, 活性型ビタミンDの経口投与, カルシトニン筋肉注射, 運動療法の単独あるいは併用療法を試み, 8ヵ月以上の経過観察を実施し治療効果の判定を検討した結果, 治療方法での差は認められなかったものの治療有効例では4ヵ月以降に骨塩量の上昇が認められ, ある程度長期にわたる持続した治療が必要であること, また高齢者より60歳以下の症例に骨塩量の上昇率がやや高いという事実が確かめられ, 骨粗鬆症の早期治療の重要性が示唆された。

Toward 113 female outpatients to whom the remedy against osteoporosis was applied at Nishi Orthopedic, an investigation was made by measuring the bone mineral content at the distal position of their forearm every four months to a total of three times on the bone mineral measurement system (DCS-600) for a doctor's reference in judgment of the single or combinedacted therapeutic effects of oral administration of 1α-hydroxyvitamineD3, intramuscular injection of tyrocalcitonin as well as therapeutic exercise. As the result of investigation revealed tha following matters. (1) In all of the No.1, No.2 and No.3 measurements which were performed respectively in the first, second and third places, a decrease in measured value of bone mineral content was seen with the patients' again. (2) For the difference between each measurement of bone mineral, an increase in bone mineral content was seen between No.3 and No.2 and between No.3 and No.1 but that was not necessarily so between No.2 and No.1. In case of the patients of under sixty, however a therapeutic effect was seen clearly form the time of No.2 measurement (after four months of medical treatment). (3)In judgment of therapeutic effects based on the classification by differences in measurement of bone mineral content, the cases which were therapeutically effective reached to 14 persons of 113 examines (29.2%), as against the cases where the bone mineral content decreased by more than 10% and they were limited to 14 persons of 113 examines (29.2%) in number of patients. (4) In case of examination of only the group where a therapeutic effect was seen clearly, the increase in bone mineral content, there was seen a tendency to slightly reduce the increase in bone mineral content with the patients' again. (5) In judgement of therapeutic effects based on the classification by differences in relative value to the average value of the same age group, the cases which were decided as therapeutically effective reached to 45 persons of 113 examines (29.2%). As against this, the cases where a therapeutic effect was not seen were limited to 3 persons of 123 examines (2.6%) in number of patients. This shows that evidently the former is higher in frequency which a therapeutic effect was seen. (6) In case of examination of therapeutic effects based on the difference in remedy, the result indicated no difference in judgment of the effect besed on the remedy. (7) When the remedy is applied, the necessity for continuance of the medication and the therapeutic exercise is referred certainly at the same time. In the cases which followed the instructions to the extent over 1/2, there was seen a tendency toward increased measurements of bone mineral content. As above, though there were seen no difference in remedy, there was a rise of bone mineral content since the time after four months had passed, and the remedy extending for a somewhat long time (over eight months) was required in the cases which were therapeutically effective. Also in case of the patients of under sixty, it seems that a therapeutic effect is more clearly than the case of patients of more advanced age. In accordance with the medicated condition, it resulted in a high rate of rise in bone mineral content in the cases of more than 1/2 of the whole.