Osteoporosis - a current view of pharmacological prevention and treatment.
Osteoporosis - a current view of pharmacological prevention and treatment.
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DOI：
10.2147/dddt.s31504
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Crockett JC
中科院分区：
文献类型：
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作者：
Das S;Crockett JC
绝经后骨质疏松症是最常见的骨疾病，与低骨矿物质密度（BMD）和病理性骨折相关，导致显著的发病率。临床上将其定义为BMD低于年轻女性成年平均值2.5个标准差或更多（T评分=-2.5）。骨质疏松症是一个巨大的全球性社会和经济问题-仅在英国，2011年每天花费600万英镑用于治疗和社会护理230，000例骨质疏松性骨折患者-因此，可行的预防和治疗方法是管理当今老龄化人口中这一问题的关键。围绕骨质疏松症管理潜力的主要问题之一是在患者发生骨折之前诊断出患者的风险。我们讨论了目前和未来的可能性，确定易感患者，从骨折风险评估的形状建模和骨质疏松症的高遗传性，现在过多的基因已与低BMD和骨质疏松性骨折。本综述重点介绍了目前临床使用的治疗药物（包括双膦酸盐、抗RANKL [NF-κB配体的受体激活剂]、间歇性低剂量甲状旁腺激素和雷奈酸锶）以及一些正在开发的治疗药物（抗硬化蛋白抗体和组织蛋白酶K抑制剂）。通过突出骨形成（成骨细胞）和骨吸收（破骨细胞）细胞的活动之间的密切关系，我们包括在每种疗法中利用的分子机制的概述和比较。
Postmenopausal osteoporosis is the most common bone disease, associated with low bone mineral density (BMD) and pathological fractures which lead to significant morbidity. It is defined clinically by a BMD of 2.5 standard deviations or more below the young female adult mean (T-score =−2.5). Osteoporosis was a huge global problem both socially and economically – in the UK alone, in 2011 £6 million per day was spent on treatment and social care of the 230,000 osteoporotic fracture patients – and therefore viable preventative and therapeutic approaches are key to managing this problem within the aging population of today. One of the main issues surrounding the potential of osteoporosis management is diagnosing patients at risk before they develop a fracture. We discuss the current and future possibilities for identifying susceptible patients, from fracture risk assessment to shape modeling and in relation to the high heritability of osteoporosis now that a plethora of genes have been associated with low BMD and osteoporotic fracture. This review highlights the current therapeutics in clinical use (including bisphosphonates, anti-RANKL [receptor activator of NF-κB ligand], intermittent low dose parathyroid hormone, and strontium ranelate) and some of those in development (anti-sclerostin antibodies and cathepsin K inhibitors). By highlighting the intimate relationship between the activities of bone forming (osteoblasts) and bone-resorbing (osteoclasts) cells, we include an overview and comparison of the molecular mechanisms exploited in each therapy.