Journal of Diagnostics Concepts & Practice ›› 2020, Vol. 19 ›› Issue (03): 219-224.doi: 10.16150/j.1671-2870.2020.03.003
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Received:2020-02-28
Online:2020-06-25
Published:2020-06-25
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| 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 |
| [1] | 中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南(2017)[J]. 中华内分泌代谢杂志, 2017, 33(10):890-913. |
| [2] | Hanley DA, McClung MR, Davison KS, et al. Western Osteoporosis Alliance Clinical Practice Series: Evaluating the balance of benefits and risks of long-term osteoporosis therapies[J]. Am J Med, 2017, 130(7):862,e1-e7. |
| [3] | Sims NA, Martin TJ. Coupling signals between the osteoclast and osteoblast: How are messages transmitted between these temporary visitors to the bone surface?[J]. Front Endocrinol (Lausanne), 2015, 6:41. |
| [4] |
Kim BJ, Koh JM. Coupling factors involved in preserving bone balance[J]. Cell Mol Life Sci, 2019, 76(7):1243-1253.
doi: 10.1007/s00018-018-2981-y URL |
| [5] |
Pogada P, Priemel M, Rueger JM, et al. Bone remodeling: New aspects of a key process that controls skeletal maintenance and repair[J]. Osteoporos Int, 2005, 16(Suppl 2):S18-S24.
doi: 10.1007/s00198-004-1787-y URL |
| [6] |
Vahle JL, Long GG, Sandusky G, et al. Bone neoplasms in F344 rats given teriparatide [rhPTH(1-34)] are dependent on duration of treatment and dose[J]. Toxicol Pathol, 2004, 32(4):426-438.
pmid: 15204966 |
| [7] |
Andrews EB, Gilsenan AW, Midkiff K, et al. The US Postmarketing Surveillance Study of adult osteosarcoma and teriparatide: Study design and findings from the first 7 years[J]. J Bone Miner Res, 2012, 27(12):2429-2437.
doi: 10.1002/jbmr.1768 URL |
| [8] |
Black DM, Bilezikian JP, Ensrud KE, et al. One year of alendronate after one year of parathyroid hormone (1-84) for osteoporosis[J]. N Engl J Med, 2005, 353(6):555-565.
doi: 10.1056/NEJMoa050336 URL |
| [9] |
Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mine-ral density in postmenopausal women with osteoporosis[J]. N Engl J Med, 2001, 344(19):1434-1441.
doi: 10.1056/NEJM200105103441904 URL |
| [10] |
Dempster DW, Lambing CL, Kostenuik PJ, et al. Role of RANK ligand and denosumab, a targeted RANK ligand inhibitor, in bone health and osteoporosis: A review of preclinical and clinical data[J]. Clin Ther, 2012, 34(3):521-536.
doi: 10.1016/j.clinthera.2012.02.002 pmid: 22440513 |
| [11] |
Lindsay R, Scheele WH, Neer R, et al. Sustained vertebral fracture risk reduction after withdrawal of teriparatide in postmenopausal women with osteoporosis[J]. Arch Intern Med, 2004, 164(18):2024-2030.
pmid: 15477438 |
| [12] |
Bone HG, Cosman F, Miller PD, et al. ACTIVExtend: 24 months of alendronate after 18 months of abaloparatide or placebo for postmenopausal osteoporosis[J]. J Clin Endocrinol Metab, 2018, 103(8):2949-2957.
doi: 10.1210/jc.2018-00163 URL |
| [13] |
McClung MR, Brown JP, Diez-Perez A, et al. Effects of 24 months of treatment with romosozumab followed by 12 months of denosumab or placebo in postmenopausal women with low bone mineral density: A randomized, double-blind, phase 2, parallel group study[J]. J Bone Miner Res, 2018, 33(8):1397-1406.
doi: 10.1002/jbmr.3452 URL |
| [14] |
Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Mana-ging osteoporosis in patients on long-term bisphosphonate treatment: report of a task force of the American Society for bone and mineral research[J]. J Bone Miner Res, 2016, 31(10):1910.
doi: 10.1002/jbmr.2918 URL |
| [15] |
Khan M, Cheung AM, Khan AA. Drug-related adverse events of osteoporosis therapy[J]. Endocrinol Metab Clin North Am, 2017, 46(1):181-192.
doi: 10.1016/j.ecl.2016.09.009 URL |
| [16] |
Dempster DW, Zhou H, Recker RR, et al. A longitudinal study of skeletal histomorphometry at 6 and 24 months across four bone envelopes in postmenopausal women with osteoporosis receiving teriparatide or zoledronic acid in the SHOTZ trial[J]. J Bone Miner Res, 2016, 31(7):1429-1439.
doi: 10.1002/jbmr.2804 pmid: 26841258 |
| [17] | Rittmaster RS, Bolognese M, Ettinger MP, et al. Enhancement of bone mass in osteoporotic women with parathyroid hormone followed by alendronate[J]. J Clin Endocrinol Metab, 2000, 85(6):2129-2134. |
| [18] |
Kurland ES, Heller SL, Diamond B, et al. The importance of bisphosphonate therapy in maintaining bone mass in men after therapy with teriparatide [human parathyroid hormone(1-34)][J]. Osteoporos Int, 2004, 15(12):992-997.
pmid: 15175844 |
| [19] |
Cosman F, Miller PD, Williams GC, et al. Eighteen months of treatment with subcutaneous abaloparatide followed by 6 months of treatment with alendronate in postmenopausal women with osteoporosis: results of the ACTIVExtend trial[J]. Mayo Clin Proc, 2017, 92(2):200-210.
doi: 10.1016/j.mayocp.2016.10.009 URL |
| [20] |
Eastell R, Nickelsen T, Marin F, et al. Sequential treatment of severe postmenopausal osteoporosis after teriparatide: final results of the randomized, controlled European Study of Forsteo(EUROFORS)[J]. J Bone Miner Res, 2009, 24(4):726-736.
doi: 10.1359/jbmr.081215 URL |
| [21] |
Ebina K, Hashimoto J, Kashii M, et al. The effects of switching daily teriparatide to oral bisphosphonates or denosumab in patients with primary osteoporosis[J]. J Bone Miner Metab, 2017, 35(1):91-98.
doi: 10.1007/s00774-015-0731-x URL |
| [22] |
Leder BZ, Tsai JN, Uihlein AV, et al. Denosumab and teriparatide transitions in postmenopausal osteoporosis (the data-switch study): extension of a randomised controlled trial[J]. Lancet, 2015, 386(9999):1147-1155.
doi: 10.1016/S0140-6736(15)61120-5 URL |
| [23] |
Bonafede MM, Shi N, Bower AG, et al. Teriparatide treatment patterns in osteoporosis and subsequent fracture events: A US claims analysis[J]. Osteoporos Int, 2015, 26(3):1203-1212.
doi: 10.1007/s00198-014-2971-3 pmid: 25567774 |
| [24] |
Nancollas GH, Tang R, Phipps RJ, et al. Novel insights into actions of bisphosphonates on bone: Differences in interactions with hydroxyapatite[J]. Bone, 2006, 38(5):617-627.
pmid: 16046206 |
| [25] |
Leder BZ. Optimizing sequential and combined anabolic and antiresorptive osteoporosis therapy[J]. JBMR Plus, 2018, 2(2):62-68.
doi: 10.1002/jbm4.10041 URL |
| [26] |
Ettinger B, San Martin J, Crans G, et al. Differential effects of teriparatide on BMD after treatment with raloxi-fene or alendronate[J]. J Bone Miner Res, 2004, 19(5):745-751.
pmid: 15068497 |
| [27] |
Obermayer-Pietsch BM, Marin F, McCloskey EV, et al. Effects of two years of daily teriparatide treatment on BMD in postmenopausal women with severe osteoporosis with and without prior antiresorptive treatment[J]. J Bone Miner Res, 2008, 23(10):1591-1600.
doi: 10.1359/jbmr.080506 pmid: 18505369 |
| [28] |
Boonen S, Marin F, Obermayer-Pietsch B, et al. Effects of previous antiresorptive therapy on the bone mineral density response to two years of teriparatide treatment in postmenopausal women with osteoporosis[J]. J Clin Endocrinol Metab, 2008, 93(3):852-860.
doi: 10.1210/jc.2007-0711 URL |
| [29] |
Cosman F, Keaveny TM, Kopperdahl D, et al. Hip and spine strength effects of adding versus switching to teriparatide in postmenopausal women with osteoporosis treated with prior alendronate or raloxifene[J]. J Bone Miner Res, 2013, 28(6):1328-1336.
doi: 10.1002/jbmr.1853 URL |
| [30] |
Eiken P, Vestergaard P. Treatment of osteoporosis after alendronate or risedronate[J]. Osteoporos Int, 2016, 27(1):1-12.
doi: 10.1007/s00198-015-3334-4 pmid: 26438307 |
| [31] |
Cosman F. Anabolic and antiresorptive therapy for osteoporosis: combination and sequential approaches[J]. Curr Osteoporos Rep, 2014, 12(4):385-395.
doi: 10.1007/s11914-014-0237-9 URL |
| [32] |
Miller PD, Delmtas PD, Lindsay R, et al. Early responsiveness of women with osteoporosis to teriparatide after therapy with alendronate or risedronate[J]. J Clin Endocrinol Metab, 2008, 93(10):3785-3793.
doi: 10.1210/jc.2008-0353 URL |
| [33] |
Cosman F, Nieves JW, Zion M, et al. Effect of prior and ongoing raloxifene therapy on response to PTH and maintenance of BMD after PTH therapy[J]. Osteoporos Int, 2008, 19(4):529-535.
doi: 10.1007/s00198-007-0475-0 pmid: 17929072 |
| [34] |
Cosman F, Wermers RA, Recknor C, et al. Effects of teriparatide in postmenopausal women with osteoporosis on prior alendronate or raloxifene: Differences between stopping and continuing the antiresorptive agent[J]. J Clin Endocrinol Metab, 2009, 94(10):3772-3780.
doi: 10.1210/jc.2008-2719 URL |
| [35] |
Geusens P, Marin F, Kendler DL, et al. Effects of teriparatide compared with risedronate on the risk of fractures in subgroups of postmenopausal women with severe osteoporosis: the VERO trial[J]. J Bone Miner Res, 2018, 33(5):783-794.
doi: 10.1002/jbmr.3384 pmid: 29329484 |
| [36] |
Black DM, Greenspan SL, Ensrud KE, et al. The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis[J]. N Engl J Med, 2003, 349(13):1207-1215.
doi: 10.1056/NEJMoa031975 URL |
| [37] |
Delmas PD, Munoz F, Black DM, et al. Effects of yearly zoledronic acid 5 mg on bone turnover markers and relation of PINP with fracture reduction in postmenopausal women with osteoporosis[J]. J Bone Miner Res, 2009, 24(9):1544-1551.
doi: 10.1359/jbmr.090310 URL |
| [38] |
Guañabens N, Moro-álvarez MJ, Casado E, et al. The next step after anti-osteoporotic drug discontinuation: an up-to-date review of sequential treatment[J]. Endocrine, 2019, 64(3):441-455.
doi: 10.1007/s12020-019-01919-8 pmid: 30963388 |
| [39] | Cosman F. Combination therapy for osteoporosis: a reappraisal[J]. Bonekey Rep, 2014, 3:518. |
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