Management of osteoporosis and Paget's disease. An appraisal of the risks and benefits of drug treatment.
Management of osteoporosis and Paget's disease. An appraisal of the risks and benefits of drug treatment.
复制标题
骨质疏松症和佩吉特氏病的治疗。
作者：
C. Gennari;R. Nuti;D. Agnusdei;A. Camporeale;G. Martini
骨质疏松症是一个主要的公共卫生问题，主要发生在绝经后人群中。骨质疏松症是一种可预防的疾病，但尽管在预防方面取得了一些进展，但迄今为止，对已确诊疾病的治疗仍然是初级保健医生面临的主要挑战。在任何治疗方案中，稳定骨量和预防福尔斯是对已确诊椎体骨折的骨质疏松患者最重要的。骨质疏松症的药物治疗可分为两大类：抑制骨吸收，从而减少骨转换的药物，以及刺激骨形成，发挥合成代谢作用的药物。抑制骨重建的治疗药物似乎最适合于高转换性骨质疏松症患者（约30%）。这一类别包括钙、维生素D及其代谢物、性腺类固醇、降钙素、依普黄酮和双膦酸盐。尽管雌激素替代疗法已被证明对老年女性有效，但降钙素似乎是该人群的首选治疗，因为它稳定或增加骨量，并且还具有镇痛特性。刺激骨重建或骨形成的药物最适合低转换骨质疏松症患者（约70%）。在这类试剂中，广泛使用的是氟化钠。新的治疗方法包括间歇性注射合成甲状旁腺激素和环状二膦酸盐，以激活然后抑制吸收和形成。用任何药物方案稳定骨骼的任何尝试都必须伴随着足够的钙供应，即1200至1500 mg/天）。针对骨质疏松症的组织学治疗的理论基础尚未得到充分证实，但越来越多的实验支持这种方法。抑制骨转换的药物，如降钙素，似乎可以有效地增加骨量1.5至2年，大约需要时间来补充高转换骨质疏松症患者的重塑空间。相比之下，虽然在使用氟化钠治疗的患者中，骨量似乎增加了长达5年，但椎骨或髋部骨折的发生率并没有持续降低。骨的佩吉特病是一种骨骼的局灶性疾病，其特征在于过度的再吸收和随后的骨的无序形成。这种疾病的病因尚不清楚。佩吉特病可能是单骨或多骨的;由于骨骼节段增大而引起的疼痛和骨畸形是主要的临床表现。然而，在许多患者中，该疾病可能无症状。（400字处截断摘要）
Osteoporosis is a major public health problem occurring primarily among the postmenopausal population. Osteoporosis is a preventable disease, but despite several advances in its prevention, treatment of the established disease to date remains a major challenge to be managed by primary care physicians. Stabilisation of bone mass and prevention of falls are of paramount importance in any therapeutic programme for osteoporotic patients with established vertebral fractures. Drug therapy for osteoporosis can be divided operationally into 2 main categories: those that inhibit bone resorption, and thus reduce bone turnover, and those that stimulate bone formation, exerting an anabolic effect. Therapeutic agents that inhibit bone remodeling would appear to be best suited to those patients with high turnover osteoporosis (about 30%). Included in this category are calcium, vitamin D and its metabolites, gonadal steroids, calcitonin, ipriflavone and bisphosphonates. Although estrogen replacement therapy has been proven to be effective in older females, calcitonin appears to be the treatment of choice for this population since it stabilises or increases bone mass and also has reported analgesic properties. Drugs that stimulate bone remodeling or bone formation would be best suited to patients with low turnover osteoporosis (about 70%). The agent in this class that is widely used is sodium fluoride. New therapies include intermittent injections of synthetic parathyroid hormone, and cyclic bisphosphonates to activate then depress resorption and formation. Any attempts to stabilise the skeleton with any drug regimen must be accompanied by an adequate calcium supply, i.e. 1200 to 1500 mg/day). The theoretical basis of tailoring treatment for osteoporosis to the underlying histology has not yet been fully proven, but there is increasing experimental support to this approach. Drugs that inhibit bone turnover, such as calcitonin, appear to be effective in increasing bone mass for 1.5 to 2 years, about the time it would take to replenish the remodeling space in a patient with high turnover osteoporosis. In contrast, although bone mass appears to increase for as long as 5 years in patients treated with sodium fluoride, there has been no consistent reduction in occurrence of vertebral or hip fractures. Paget' disease of bone is a focal disorder of the skeleton characterised by excessive resorption and subsequently disorganised formation of bone. The aetiology of the disease is unknown. Paget's disease may be mono-ostotic or polyostotic; pain and bone deformities due to enlargement of skeletal segments represent the main clinical aspects. However, in many patients the disease may be asymptomatic.(ABSTRACT TRUNCATED AT 400 WORDS)