[Clinical study on combination of multiple regimens in treatment of osteoporosis in perimenopause and postmenopausal women].

OBJECTIVE: To evaluate clinical efficacy of multiple regimen combination in treatment of osteoporosis of perimenopausal or postmenopausal women. METHODS: From Jul. 2008 to Dec. 2009, 109 women with low bone mineral density (BMD) or osteoporosis treated in Department of Obstetrics and Gynecology, Affiliated Second Hospital, Wenzhou Medical College were enrolled randomly into 3 group, including 36 women in Group A managed by osteoform 1000 mg/d + alfacalcidol 0.25 µg/bid orally, 40 women in group B managed by osteoform 1000 mg/d + alfacalcidol 0.25 µg/bid + tibolone 1.25 mg/d orally and 33 women in group C managed by osteoform 1000 mg/d + alfacalcidol 0.25 µg/bid + bisphosphonates 70 mg/w orally. After 48 weeks BMD on lumbar 1-4 (L1₋4) and left femur were detected by X-ray. Bone alkaline phosphatase(BALP), cross linked clelopeptide of type I collagen (CTX) and 25-hydroxychole calciferol [25(OH)D3] was measured by enzyme linked immunosorbent assay (ELISA). RESULT: Seven women (6.4%, 7/109) were withdrawed form this study, including 2 cases losing follow up in group A, 3 cases stopping treatment in group B, 2 cases giving up treatment due to severe adverse effect (burning in upper abdomen) in group C. (1) Pain relieve: after 48 weeks treatment, women in 3 groups improved symptom of pain significantly, the rates of pain relieve were 85% (29/34) in group A, 92% (34/37) in group B and 94% (29/31) in group C. (2) BMD: BMD was improved significantly in women in 3 groups after treatment. BMD of L1₋4 were (0.88 ± 0.15) g/cm² in group A, (0.89 ± 0.18) g/cm² in group B and (0.87 ± 0.10) g/cm² in group C before treatment, and converted to (0.90 ± 0.01) g/cm² in group A, (0.93 ± 0.09) g/cm² in group B and (0.91 ± 0.11) g/cm² in group C after treatment. BMD of left femur were (0.87 ± 0.07) g/cm² in group A, (0.87 ± 0.07) g/cm² in group B and (0.85 ± 0.12) g/cm² in group C before treatment and converted to (0.90 ± 0.03) g/cm² in group A, (0.91 ± 0.08) g/cm² in group B and (0.89 ± 0.12) g/cm² in group C after treatment. It was shown significantly different BMD between group B or C and group A (P < 0.01), however, there was no significant different BMD between group B and C (P > 0.05). (3) Index of bone metabolism: BALP were (26 ± 6) µg/L in group A, (26 ± 9) µg/L in group B and (28 ± 7) µg/L in group C before treatment and converted to (22 ± 5) µg/L in group A, (20 ± 9) µg/L in group B and (22 ± 8) µg/L in group C after treatment, which showed statistical difference (P < 0.05). CTX were (0.85 ± 0.20) ng/L in group A, (0.84 ± 0.47) ng/L in group B, and (0.88 ± 0.11) ng/L in group C before treatment and converted to (0.81 ± 0.19) ng/L in group A, (0.77 ± 0.33) ng/L in group B, and (0.82 ± 0.14) ng/L in group C after treatment, which showed statistical difference (P < 0.05). CONCLUSIONS: Those 3 regimens combination could be used in treatment of osteoporosis by decreasing bone conversion, increasing bone density, decreasing bone absorption. Regimen A was only suitable for basic therapy, the other two regimens could provide better treatment.

[Intermediate and long term clinical effects of uterine arterial embolization with sodium alginate microspheres in treatment of diffuse adenomyosis].

OBJECTIVE: To study intermediate and long term efficacy of uterine arterial embolization (UAE) with sodium alginate microspheres (KMG) at diameters 500-00 microm in treatment of diffuse adenomyosis. METHODS: Totally 40 patients with standard diffuse adenomyosis were enrolled and treated with UAE. KMG at diameters 500-700 microm for vascular embolization were used to embolize the arteries. The degree of dysmenorrhea, amount of menorrhea and uterine volume, as well as the level of serum CA125, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) were investigated before and after UAE. RESULTS: The follow up rates were 100% (40/40), 100% (40/40), 80% (32/40), 68% (27/40), 58% (23/40) after uterine arterial UAE 12, 24, 36, 48 and 60 months respectively. The early, intermediate and long-term effective rates were 90% (36/40), 88% (28/32), 83% (19/23). The degree of dysmenorrhea, the amount of menorrhea and the uterine volume, as well as serum CA125 all decreased significantly 3 months after UAE at varying degrees (P < 0.05). Compared with other follow-up time, the degree of dysmenorrhea and the amount of menorrhea declined to their lowest point at 6 month after UAE (P < 0.01). Paralleled with the decrease of volume of uterine, serum CA125 also decreased significantly and reached the lowest level 12 months later compared with other follow-up times (P < 0.01). Even at the 12th month after UAE serum CA125 was not normal and FSH, LH and E2 did not change all the times after UAE, (P > 0.05). No recurrence was found during the 60 months after UAE. CONCLUSION: KMG used in UAE at diameters 500-700 microm has good intermediate and long term effectiveness in treatment of diffuse adenomyosis with no side effects.