骨质疏松症使用甲状旁腺激素类似物和双膦酸盐序贯治疗的机制及策略

doi:10.16150/j.1671-2870.2020.03.003

摘要/Abstract

关键词: 骨质疏松症, 甲状旁腺激素类似物, 双膦酸盐, 序贯治疗

中图分类号:

R589.5

杜艳萍, 程群. 骨质疏松症使用甲状旁腺激素类似物和双膦酸盐序贯治疗的机制及策略[J]. 诊断学理论与实践, 2020, 19(03): 219-224.

图/表 1

表1

常用抗骨质疏松药物的分类、机制和效果

药物分类	具体药物	作用机制	对BMD作用	对骨折作用	禁忌证	不良反应
抗骨吸收药物
双膦酸盐	包括阿仑膦酸钠、利塞膦酸钠、依替膦酸二钠、唑来膦酸钠、伊班膦酸钠	抑制法尼基焦磷酸的合成,从而抑制破骨细胞活性,减少破骨细胞数目,骨吸收减少	腰椎BMD↑,髋部BMD↑,骨代谢↓	椎体骨折↓,非椎体骨折↓,髋部骨折↓（除依替膦酸二钠和伊班膦酸钠）	肌酐清除率不应﹤35 mL/min;胃食管反流（口服）	过度骨抑制;胃肠道反应（口服）
选择性雌激素受体调节剂	雷洛昔芬	选择性在骨组织中与雌激素受体结合,发挥类雌激素作用,减少破骨细胞的生成和活性	腰椎BMD↑,骨代谢↓	椎体骨折↓	静脉栓塞;肌酐清除率﹤35 mL/min（仅用于绝经后女性）	潮热;下肢痉挛;静脉栓塞
降钙素	包括鲑鱼降钙素、鳗鱼降钙素	为钙调节激素,抑制破骨细胞活性,减少破骨细胞数目	腰椎BMD↑,髋部BMD↑	椎体骨折↓,非椎体骨折（鲑鱼降钙素）↓	降钙素过敏	面部潮红、恶心
RANKL抑制剂	迪诺塞麦（国内已完成Ⅲ期临床试验）	为特异性RANKL完全人源化单抗,抑制RANKL与其受体RANK结合,减少破骨细胞形成、功能和存活	腰椎BMD↑,髋部BMD↑,骨代谢↓	椎体骨折↓,非椎体骨折↓,髋部骨折↓	低钙血症	低血钙、炎症感染;过度骨抑制;停药后BMD“断崖式”下降
促骨形成药物	包括PTHa、特立帕肽	rhPTH 1-34,刺激成骨细胞活性	腰椎BMD↑,髋部BMD↑,骨代谢↑	椎体骨折↓,非椎体骨折↓	畸形性骨炎;骨骼疾病放射治疗史;肿瘤骨转移;高钙血症;小于18岁的青少年;肌酐清除率﹤35 mL/min	高血钙;肌肉酸痛;高尿酸血症;头痛;终身治疗时间不超过2年;停药后,骨丢失加快

表1

参考文献 39

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骨质疏松症使用甲状旁腺激素类似物和双膦酸盐序贯治疗的机制及策略

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