Severely suppressed bone turnover: A potential complication of alendronate therapy
Severely suppressed bone turnover: A potential complication of alendronate therapy
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DOI：
10.1210/jc.2004-0952
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发表时间：
2005-03-01
影响因子：
5.8
通讯作者：
Pak, CYC
中科院分区：
文献类型：
--
作者：
Odvina, CV;Zerwekh, JE;Pak, CYC
阿仑膦酸钠是一种骨吸收抑制剂，广泛用于骨质疏松症的治疗。然而，人们担心长期使用过程中可能会过度抑制骨转换。我们报告了 9 名在阿仑膦酸钠治疗期间发生自发性非脊柱骨折的患者，其中 6 名患者在治疗期间 3 个月至 2 年内表现出骨折愈合延迟或不愈合。松质骨的组织形态计量学分析显示骨形成明显受到抑制，大多数患者成骨细胞表面减少或缺失。 8 名患者的破骨细胞表面较低或低于正常水平，4 名患者的侵蚀表面减少。所有患者的基质合成均显着减少，双四环素标记缺失，单四环素标记缺失或减少。在皮质内和皮质内表面也出现了相同的趋势。我们的研究结果提出了长期阿仑膦酸钠治疗期间可能出现骨转换严重抑制的可能性，导致非脊柱骨折的易感性增加和愈合延迟。虽然雌激素或糖皮质激素的共同给药似乎是一个诱发因素，但这种明显的并发症也可能发生在单一疗法中。我们的观察强调需要提高对长期阿仑膦酸钠治疗期间骨转换过度抑制的潜在发展的认识和监测。
Alendronate, an inhibitor of bone resorption, is widely used in osteoporosis treatment. However, concerns have been raised about potential oversuppression of bone turnover during long-term use. We report on nine patients who sustained spontaneous nonspinal fractures while on alendronate therapy, six of whom displayed either delayed or absent fracture healing for 3 months to 2 yr during therapy.Histomorphometric analysis of the cancellous bone showed markedly suppressed bone formation, with reduced or absent osteoblastic surface in most patients. Osteoclastic surface was low or low-normal in eight patients, and eroded surface was decreased in four. Matrix synthesis was markedly diminished, with absence of double-tetracycline label and absent or reduced single-tetracycline label in all patients. The same trend was seen in the intracortical and endocortical surfaces.Our findings raise the possibility that severe suppression of bone turnover may develop during long-term alendronate therapy, resulting in increased susceptibility to, and delayed healing of, nonspinal fractures. Although coadministration of estrogen or glucocorticoids appears to be a predisposing factor, this apparent complication can also occur with monotherapy. Our observations emphasize the need for increased awareness and monitoring for the potential development of excessive suppression of bone turnover during long-term alendronate therapy.