目的 评估应用唑来膦酸治疗原发性骨质疏松的长期疗效。方法 回顾性分析从 2011 年 1 月至 2021 年 12 月因确诊原发性骨质疏松于中国人民解放军南部战区总医院就诊的且注射唑来膦 酸 3 年以上的 88 例患者病例资料，收集所有患者基线资料及用药 1~6 年内各时期腰椎 L1⁃4、左股骨颈和左 股骨颈上端骨密度（bone mineral density，BMD），N 端骨钙素（N⁃osteocalcin，N⁃OC）、β⁃Ⅰ型胶原交联 C⁃末 端肽（β⁃isomerized carboxy⁃telopeptide of typeⅠcollagen，β⁃CTX）、甲状旁腺素（parathyroid hormone，PTH）以 及血清Ⅰ型原胶原 N⁃端前肽（procollagen type 1 N⁃peptide，P1NP）四项标志物水平，用药期间新发骨折和不 良反应发生情况，观察各项指标变化趋势，评估其用药 6 年内的疗效变化。结果 研究对象年龄（64.94 ± 10.02）岁；唑来膦酸注射液的使用年限（4.65 ± 1.07）年，最长的使用年限长达 6 年。腰椎 BMD 在用药第 6 年相较治疗前增加了 24.18%，总体增幅最大；左股骨颈 BMD 在用药第 5 年较基线有最大增幅，增加了 11.03%，左股骨颈上端 BMD 在第 6 年较基线增加了 11.01%。3 个部位 BMD 水平在用药前 5 年达到疗效 高峰，在用药第 6 年均开始呈现下降趋势（P < 0.001）。N⁃OC、P1NP 等骨转换标志物指标均在用药 1 年内 均有较大幅度下降，但在用药 3 年后均呈现一定程度回升趋势，P1NP 在用药第 6 年时比基线水平高 4.87%。共发现 5 例用药期间新发骨折，未发现下颌骨坏死等严重不良反应。结论 唑来膦酸在用药 3 ~ 5年内疗效最为显著，若继续用药BMD 值将不再持续升高，可考虑进入停药期。 

Objective To evaluate the long⁃term efficacy of Zoledronic acid in the treatment of primary osteoporosis. Methods The medical records of 88 patients with primary osteoporosis，who had been injected with Zoledronic acid for more than 3 years at the General Hospital of the Southern Theater Command of the People′s Liberation Army from January 2011 to December 2021 were retrospectively analyzed.The data were collected and analyzed concerning bone mineral density（BMD）of lumbar spine L1⁃4，left femoral neck and left femoral neck upper end and bone turnover markers such as N⁃osteocalcin（N⁃OC），β⁃isomerized carboxy⁃telopeptide of type I collagen（β⁃CTX），parathyroid hormone（PTH）and procollagen type 1 N⁃peptide（P1NP）level at the baseline and medication within 1 ~ 6 years，new fractures during medication and adverse events. The efficacy of 6⁃year medica⁃ tion was evaluated. Results The average age of the patients was（64.94 ± 10.02）years，and the average duration of medication was（4.65 ± 1.07）years，the longest 6 years. The BMD of lumbar spine L1⁃4 and left femoral neck upper end was increased by 24.18% and 11.01% respectively compared with the baseline in the 6th year of treat⁃ ment. The BMD of the left femoral neck was increased to a largest extent against the baseline in the 5th year of treatment（+11.03%）. The BMD reached the peak of efficacy in the first 5 years of the medication，and then began to show a downward trend in the sixth year of medication（P < 0.001）. N ⁃OC，P1NP and other bone turnover markers all were declined significantly within 1 year of medication，but showed an upward trend after 3 years of medication. P1NP was 4.87% higher than the baseline at the 6th year of medication. A total of 5 cases of new frac⁃ tures during medication were found. No serious adverse reactions such as osteonecrosis of the mandible were found. Conclusion Zoledronic acid has the most significant effectiveness within 3 to 5 years of medication，and continued medication does no more good to the rise of BMD，indicating that suspension of the Zoledronic acid use can be considered after 5 years medication.