【病例学习第18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. 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 into the pharmacy. The pharmacist reviews MK's profile and sees that she is also taking simvastatin, lisinopril, lansoprazole, and calcium carbonate plus vitamin D. 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 the alendronate.

What should the pharmacist tell the patient?

ANSWER
Osteoporosis
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 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 should 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 the 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, and should remain upright (either sitting or standing) for 30 minutes, not 2 hours. This is to prevent any esophageal damage that might result from direct contact of alendronate on the esophagus. MK also is taking lansoprazole, which may interact with the calcium. Calcium is better absorbed in an acidic stomach environment, but MK likely has reduced calcium absorption due to her lansoprazole-induced acid suppression. She might benefit by 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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骨质疏松症

MK是一位由于摔倒后近期来门诊看病的患者。她在接受了骨矿物质扫描后，得到了脊柱-1.8和髋关节-2.6的T分数。临床医师给她开具了“口服阿伦唑奈 一日一次，每次70mg×7天”的处方，她拿着这张处方来到药房取药。药师查阅了MK的既往史，发现她还经常服用HMG-CoA还原酶抑制剂、赖诺普利、兰索拉唑和碳酸钙维生素D几种药物。MK告诉药师她目前感觉很好，不明白为什么她还要服用这种药物。她还询问是否真的在服用阿伦唑奈后2小时内必须保持站立。
药师应该告诉患者一些什么东西？

回答
骨质疏松症是由于骨形成与再吸收失衡造成，而且有可能导致类似骨折这样的并发症。一般是靠测量T分数值，通过将患者的骨矿物质密度和同性别年轻健康人进行比较来诊断的。T分数值小于2.5一般被诊断为骨质疏松。基于MK髋关节的T分数（-2.6），她被诊断为患有骨质疏松症，应该接受防止骨折的治疗。药师应该告诉患者阿伦唑奈有助于保持她的骨骼强壮，以减少她如果再次摔倒而导致骨折的可能性。阿伦唑奈防止骨丢失，同时应该加服钙和维生素D。MK应该在早晨用一满杯水（8盎司）送服阿伦唑奈，而且必须至少在吃饭、服用其他药物或者饮用除水以外饮料前30分钟服用，同时保持直立状态（坐或站立）30分钟，而不是2小时。这样是为了避免任何因为阿伦唑奈接触食道而造成的食道损害。MK同时服用兰索拉唑，此药可以和钙发生反应。钙在胃部酸性环境下容易吸收，但是MK有可能由于服用兰索拉唑诱导酸的抑制而导致钙的吸收减少。她可以改服钙的柠檬酸盐制剂来达到想要的效果，这种制剂不需要太多胃部的酸来吸收。

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