Combination anabolic and antiresorptive therapy for osteoporosis: opening the anabolic window.
Combination anabolic and antiresorptive therapy for osteoporosis: opening the anabolic window.
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DOI：
10.1007/s11914-008-0005-9
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发表时间：
2008-03-01
影响因子：
4.3
通讯作者：
Bilezikian, John P
中科院分区：
文献类型：
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作者：
Bilezikian, John P
抗骨质吸收药物是治疗骨质疏松症的基石，但合成代谢药物最近增加了我们的选择。通过刺激骨形成，合成代谢剂除了增加骨量外，还通过改善骨质量来减少骨折发生率。目前唯一被美国食品和药物管理局批准用于治疗骨质疏松症的合成代谢药物teriparatide（重组人甲状旁腺激素）已成为骨质疏松症患者的主要治疗方法。重组人甲状旁腺激素（1-84）在欧洲也可以买到。特立帕肽增加骨密度和骨更新，改善微结构，改变骨大小。降低了椎体和非椎体骨折的发生率。目前关于特立帕肽作用机制的一个概念是，它在刺激与骨吸收相关的过程之前，先刺激与骨形成相关的过程。这一系列事件导致了合成代谢窗口的概念，即特立帕肽最大合成代谢的时间段。使用特立帕肽单独和联合抗吸收药物的新方法已经导致了合成代谢窗口可以扩大的方法。
Antiresorptive agents for osteoporosis are a cornerstone of therapy, but anabolic drugs have recently increased our options. By stimulating bone formation, anabolic agents reduce fracture incidence by improving bone qualities in addition to increasing bone mass. The only anabolic agent currently approved for osteoporosis by the US Food and Drug Administration, teriparatide (recombinant human parathyroid hormone ), has emerged as a major approach to selected patients with osteoporosis. Recombinant human parathyroid hormone (1-84) is also available in Europe. Teriparatide increases bone density and bone turnover, improves microarchitecture, and changes bone size. The incidence of vertebral and nonvertebral fractures is reduced. A current concept in the mechanism of teriparatide action is related to its effect to stimulate processes associated with bone formation before it stimulates processes associated with bone resorption. This sequence of events has led to the concept of the anabolic window, the period of time when teriparatide is maximally anabolic. Newer approaches to the use of teriparatide alone and in combination with antiresorptive agents have led to ways in which the anabolic window can be expanded.