严重脊柱侧凸病例中骨质疏松症的诊断和治疗策略的确定难题

©. Timur, T. Tsoriev, I. Skripnikova, V. Ol’ga, Maria A Kosmatova, Kolchina
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引用次数: 0

摘要

一名女性患者因手术导致更年期提前和严重的 S 型脊柱侧弯,在居住地被诊断为骨质疏松症,并接受了双膦酸盐(唑来膦酸)治疗。尽管脊柱和胸部出现畸形,但患者直到最近才出现不适症状,而且生活方式也很活跃。在国家治疗和预防医学研究中心进行 X 射线骨密度测量时,尤其是在检查腰椎时,很难对患者进行定位,以正确扫描感兴趣的区域,因此也很难获得有关骨小梁组织真实状况的信息。股骨近端的骨矿物质密度(BMD)与骨质疏松症相符。其他实验室和仪器参数,如骨重塑的生化标志物(骨钙素和 C 端 1 型胶原端肽)和骨小梁评分(TBS),也无法精确判断骨折风险,也无法就是否有必要继续进行抗骨吸收治疗得出明确结论。考虑到腰椎的 BMD 值较低(T-score -4.8 SD),以及因轻微外伤导致椎体压缩性骨折的可能性,加上胸部畸形进一步发展和重要器官功能衰竭,决定继续使用唑来膦酸治疗。进一步的治疗策略将在一年后的下一次定期检查后决定。
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The difficulties of diagnosing and determining the tactics of treating osteoporosis in severe spinal scoliosis case
A female patient with early surgical menopause and severe S-shaped scoliosis was diagnosed with osteoporosis at the place of residence and treated with a bisphosphonate (zoledronic acid). Despite the deformity of the spine and chest, the patient had no complaints until recently and led an active lifestyle. During X-ray densitometry at the National Medical Research Center for Therapy and Preventive Medicine, in particular when examining the lumbar spine, there were difficulties with positioning the patient for correct scanning of the area of interest and, as a result, obtaining information about the true state of trabecular bone tissue. Bone mineral density (BMD) in the proximal femur was consistent with osteopenia. Additional laboratory and instrumental parameters, such as biochemical markers of bone remodelling (osteocalcin and C-terminal type 1 collagen telopeptide) and trabecular bone score (TBS), also did not allow to precise the risk of fractures and make an unambiguous conclusion about the necessity of continuing antiresorptive therapy. Given the low BMD values in lumbar spine (T-score -4.8 SD) and the possibility of developing vertebral compression fractures as a result of minimal trauma with further chest deformity progression and vital organs failure, it was decided to continue treatment with zoledronic acid. Further therapeutic tactics will be determined after the next scheduled examination in 1 year.
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