Osteoporosis treatment: bisphosphonates reign to continue for a few more years, at least?
Osteoporosis treatment: bisphosphonates reign to continue for a few more years, at least?
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DOI：
10.1111/nyas.13166
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发表时间：
2016-01-01
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影响因子：
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通讯作者：
Abrahamsen, Bo
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文献类型：
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作者：
Pazianas, Michael;Abrahamsen, Bo
2002年妇女健康倡议研究的结果使激素替代疗法的使用边缘化，并将双膦酸盐确定为骨质疏松症的一线治疗。狄诺塞单抗可用于选定患者。尽管双膦酸盐仅维持骨结构完整，但其具有任何累积的结构或材料缺陷，但其骨选择性和降低骨折风险的有效性以及其低成本几乎没有为新的抗再吸收剂留下改进的空间。骨合成代谢特立帕替尼可增加新骨形成，但其施用时间最长仅为2年，并且成本仍然是一个考虑因素。类似的限制预计将适用于抗sclerostin抗体，美国食品和药物管理局可能会在不久的将来对其进行评估。如果批准，组织蛋白酶K抑制抗体可能是一种替代品;尽管是一种抗吸收剂，但与双膦酸盐相比，它可以维持骨形成，并且可能用于长期治疗。双膦酸盐的罕见不良反应，即颌骨骨坏死和非典型股骨骨折，相对于其受益/危害比，已被谨慎强调。骨质疏松症的治疗是一个漫长的过程，许多患者在其一生中需要使用多种药物进行治疗。
The findings of the Women's Health Initiative study in 2002 marginalized the use of hormone replacement therapy and established bisphosphonates as the first line of treatment for osteoporosis. Denosumab could be used in selected patients. Although bisphosphonates only maintain the structure of bone complete with any accumulated structural or material faults, their bone selectivity and effectiveness in reducing the risk of fractures, together with their low cost, have left little room for improvement for new antiresorptives. The osteoanabolic teriparatide increases new bone formation, but it is administered for up to 2 years only and the cost remains a consideration. Similar restrictions are expected to apply to an anti-sclerostin antibody, which could be evaluated by the U.S. Food and Drug Administration in the near future. Cathepsin K-inhibiting antibody could be an alternative if approved; although an antiresorptive, it maintains bone formation, in contrast with bisphosphonates, and can be probably used for long-termtreatment. Rare adverse effects of bisphosphonates, namely osteonecrosis of the jaws and atypical femoral fractures, have been disproportionally emphasized relative to their benefits/harmratio. Treatment of osteoporosis is a long process, and many patients will require treatment with more than one type of drug over their lifetime.