【病例学习第8期】Osteoporosis（骨质疏松症）

From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)

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Osteoporosis

MK is a 76-year-old woman who was recently seen at an outpatient clinic following a fall on icy ground. She was given a bone mineral density scan and was found to have a T-score at the spine of –1.8 and at the hip of –2.6. The physician at the clinic gives her a prescription for alendronate 70 mg by mouth weekly, and she brings the prescription to the pharmacy. The pharmacist reviews MK’s profile and sees that she is also taking simvastatin 40 mg daily, lisinopril 20 mg daily, lansoprazole 30 mg daily, and calcium carbonate 500 mg plus 400 IU of vitamin D, 3 times daily. MK tells the pharmacist that she feels fine and does not understand why she should take this medication. She also asks if it is true that she has to stand up for 2 hours after she takes “bone drugs.”

What should the pharmacist tell the patient?



ANSWER

Osteoporosis is due to an imbalance of bone formation and resorption and may lead to complications such as fractures. Diagnosis is typically made by measuring the T-score, which compares a patient’s bone mineral density with that of a young healthy person of the same sex. A T-score <–2.5 is diagnostic for having osteoporosis. Based on MK’s T-score at the hip (–2.6), she is considered to have osteoporosis and should receive treatment to prevent fractures. The pharmacist should tell the patient that her alendronate will help to keep her bones strong so that she would be less likely to get a fracture if she were to fall again. Alendronate prevents bone loss and should be taken in addition to calcium and vitamin D. MK should take alendronate in the morning with a full glass of water (~8 ounces) at least 30 minutes before eating, taking other medications, or drinking anything besides water. The patient should remain upright (either sitting or standing) for 30 minutes, not 2 hours. This is to prevent any esophageal irritation that might result from direct contact of alendronate on the esophagus. MK also is taking lansoprazole, which may have a drug interaction with her calcium. Calcium is better absorbed in an acidic stomach environment, but MK likely has reduced calcium absorption due to her acid suppression. She might benefit from switching to a calcium citrate form (plus vitamin D), which does not require as much acidity in the stomach for absorption.


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MK是一位76岁的老年妇女，由于在结冰的地上摔倒而被送到门诊诊所。医生给她进行了骨密度扫描：脊柱和臀部的T score分别为-1.8和-2.6.诊所医生给她开了处方：口服阿伦磷酸钠70 mg每周一次。当MK拿着处方到药房时，药师查看了MK的病史档案后发现MK每天的服药情况如下：辛伐他汀40mg,qd；赖诺普利20mg,qd；兰索拉唑30mg,qd；碳酸钙500mg,tid；维生素D400 IU，tid。MK告诉药师她感觉很好，不明白医生为什么给她开这种药，如果确实要服这种药，服药后她是否要站立2小时？药师应如何解释？

答案

骨质疏松是由于骨形成与骨吸收不平衡而导致的，易引发骨折。其可根据T-score的数值大小来诊断。T-score为受试者的骨密度数值与年轻健康同性别的成人的骨密度平均值的标准差。T-score <–2.5为骨质疏松。基于MK臀部的T-score（-2.6），药师应建议其服用阿伦磷酸钠来治疗骨质疏松症，使其骨更加健康强壮以免其再摔倒后发生骨折。阿伦磷酸钠可预防骨流失，可与钙和维生素D服用。在早晨吃东西或服用其他药物或喝其他饮料（水除外）前至少30分钟服用阿伦磷酸钠，同时确保服用足够的水送服（约8盎司）。服药后应保持兴奋状态（或坐或站）30分钟，而不是2小时。这是为了预防阿伦磷酸钠与食道直接接触而刺激食道。MK同时服用胃酸抑制剂—兰索拉唑可减少该钙的吸收，钙离子在酸性环境里更易被吸收。她可选择柠檬酸钙（加维生素D），胃酸对柠檬酸钙的吸收影响较小。

不足之处，敬请请各位老师指教
MK是一位76岁的老年妇女，由于在结冰的地上摔倒而被送到门诊诊所。医生给她进行了骨密度扫描：脊柱和臀部的T score分别为-1.8和-2.6.诊所医生给她开了处方：口服阿伦磷酸钠70 mg每周一次。当MK拿着处方到药房时，药师查看了MK的病史档案后发现MK每天的服药情况如下：辛伐他汀40mg,qd；赖诺普利20mg,qd；兰索拉唑30mg,qd；碳酸钙500mg,tid；维生素D400 IU，tid。MK告诉药师她感觉很好，不明白医生为什么给她开这种药，如果确实要服这种药，服药后她是否要站立2小时？药师应如何解释？
答案
骨质疏松是由于骨形成与骨吸收不平衡而导致的，易引发骨折。其可根据T-score的数值大小来诊断。T-score为受试者的骨密度数值与年轻健康同性别的成人的骨密度平均值的标准差。T-score <–2.5为骨质疏松。基于MK臀部的T-score（-2.6），药师应建议其服用阿伦磷酸钠来治疗骨质疏松症，使其骨更加健康强壮以免其再摔倒后发生骨折。阿伦磷酸钠可预防骨流失，可与钙和维生素D服用。在早晨吃东西或服用其他药物或喝其他饮料（水除外）前至少30分钟服用阿伦磷酸钠，同时确保服用足够的水送服（约8盎司）。服药后应保持兴奋状态（或坐或站）30分钟，而不是2小时。这是为了预防阿伦磷酸钠与食道直接接触而刺激食道。MK同时服用胃酸抑制剂—兰索拉唑可减少该钙的吸收，钙离子在酸性环境里更易被吸收。她可选择柠檬酸钙（加维生素D），胃酸对柠檬酸钙的吸收影响较小。

骨质疏松症
　　
　　一位76岁的女人是可在最近看过之后门诊落在冰冷的地上。她是一个骨密度检查,发现在脊柱的T-score -1.8和髋骨的-2.6。临床医生在给了她一个处方阿仑70毫克,她每周用嘴带来的处方去药房。药剂师评论可的概况和看到她也服用他汀40毫克/天,赖诺普利20毫克/天,lansoprazole 30毫克/天,和碳酸钙500毫克加上400国际单位维生素D,3次。可告诉那个药剂师,她感到美好,不明白为什么她要采取这种药物。她还问如果这是真的,她站起来为2小时后,她以“骨的药物。”
　　
　　应该告诉病人的药剂师呢?
　　
　　
　　
　　答案
　　
　　骨质疏松症是由于一个不平衡的骨形成和吸收,并可能导致并发症,如骨折。诊断是典型的T-score由测量,与病人的骨密度一个年轻健康的人的性别相同的。一个T-score < -2.5诊断为是骨质疏松。基于可的T-score髋骨(-2.6),她被认为患有骨质疏松和应该接受治疗预防骨折。药剂师应该告诉病人说她将帮助她阿仑骨头强壮,这样她就会更容易得到裂缝她如果想再次下跌。阿仑预防骨质疏松和应该采取除钙和维生素d可应该采取阿仑早晨用开水(~ 8盎司)至少30分钟前吃,以其他药物治疗,或喝东西除了水。这个病人应该保持直立(或坐或站)为30分钟,而不是2小时。这是为了避免任何可能造成的食道刺激的直接接触的食管阿仑膦酸。可也正在lansoprazole,这可能是药物的作用与她的钙。更好的吸收钙是酸性胃的环境,但可有可能减少钙吸收由于她抑酸。她可能会受益于对钙柠檬酸形式(包括维生素D),而不需要太多的酸性胃内的吸收。

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