骨质疏松症治疗药物的研究进展

随着对骨质疏松症发病机制、病理学特征等进一步认识,治疗药物的研究也不断深入。临床治疗骨质疏松症的药物可分为促进骨形成药物如甲状旁腺激素、他汀类等,抑制骨吸收药物如雌激素、选择性雌激素受体调节剂、双膦酸盐类、狄诺塞麦等,既能抑制骨吸收又能促进骨形成的药物如锶盐,钙剂和维生素D及衍生物以及中医药等。文章对以上目前国内外治疗骨质疏松的药物研究进展做一综述。     

雌激素与双膦酸盐影响绝经后骨质疏松症作用机制的比较

绝经后骨质疏松症(postmenopausa losteopomsis,PMO)发生的主要机制是雌激素缺乏后骨转换加快,同时骨吸收多于骨形成,导致骨量下降.雌激素(e-strogen,E)和双膦酸盐(bisphosphonates,BPs)以其抗骨吸收作用.成为临床抗骨质疏松症的主要药物.     

骨质疏松症的药物预防和治疗

介绍治疗和预防骨质疏松症的几类药物的作用，疗程和不良反应及选药方案，按药物作用阶段可分为抗骨吸收剂，促骨增加病人的峰值骨量和增加骨质中骨的分布与质量，对于中青年患者应强调补钙和维生素D；对于绝经期后妇女 要加大补钙及增加相应药物；在高转模型骨质疏松时建议使用抗骨吸收剂，在低转换型为主时，建议使用骨形成刺激剂。     

骨质疏松症的药物治疗进展

骨质疏松症是一种常见的老年性疾病,成为目前越来越被关注的公众健康问题.近年来,随着对该病的病因及致病机制的深入研究,出现了多种抗骨质疏松症药物,通过查阅有关医学文献,结合临床实际,主要对抑制骨吸收,促进骨形成和骨矿化物3类药物进行探讨,分析它们的药理作用与特点、不良反应与注意事项,以指导临床选择针对性药物及联合用药,避免出现严重的不良反应.     

序贯使用降钙素和甲状腺激素对骨重建过程的作用

骨质疏松症的治疗是临床尚未解决的难题之一,随着老龄化社会的到来,这一问题日臻突出。按照药物作用于骨重建过程的时相来分类,骨质疏松症的治疗方法包括: (1)抑制破骨吸收:该类药物包括雌激素、降钙素、二磷酸盐和钙。由于在骨重建过程中骨形成与骨吸收在时间和空间上是耦联的,因而抑制骨吸收的同时也可能抑制骨形成,故可能不增加骨量。降钙素的主要作用是抑制破骨吸收,研究结果显示,降钙     

福美加+钙尔奇D对绝经后骨质疏松患者骨密度、β-CTx、P1NP的影响

<正>骨质疏松症(ostooporosis,OP)是一种以骨量减少、骨微结构破坏,导致骨强度降低、骨脆性增加、易发生骨折的全身代谢性骨病~([1])。骨转换率增高,骨形成低于骨吸收是导致绝经后OP的主要机制~([2])。福美加是一种能抑制骨吸收、降低骨转换率抗OP药物,     

骨质疏松症的药物治疗

治疗骨质疏松症的药物按照其作用阶段分为三类,即: ①抗骨重吸收药物。包括雌激素、降钙素和二磷盐。②促骨 形成药物。以氟化物为主。③骨矿化药物。主要有钙剂、维 生素D及其衍生物。 1 雌激素类 对绝经后骨质疏松症使用雌激素类替代疗法的治疗效果 已被公认。对减少绝经后的快速骨丢失,降低骨折发生率, 缓解骨质疏松造成的疼痛,改善更年期的症状均有肯定效 果。但应选用天然、短效、口服的雌激素,并限用最低有效 剂量,以防止乳腺和子宫内膜的异常增生。目前国外常用的 天然雌激素主要为戊酸雌二醇和雌三醇。国内由于药源困难     

骨质疏松症药物研究进展

骨质疏松症是以骨量降低,骨组织的显微结构破坏为特征,导致骨的脆性增高,易于骨折的一种全身代谢性骨病。在临床上表现为腰背疼和病理性骨折,主要发生在中老年人,尤其是绝经后妇女中,发生率高达60%以上。一些最新提供的药物已证实能够降低骨质疏松症椎体和非椎体骨折的风险。然而,在现代工业化国家的人口老龄化进程中,现在仍然有越来越多的骨折发生,骨质疏松症的治疗需要新的治疗药物和理念。新的骨形成促进剂和骨吸收抑制剂,如组织蛋白酶K抑制剂,通过维持破骨细胞-成骨细胞的平衡,从而维持骨形成。基于对骨质疏松症在病理生理学上更深入的理解,这些新药物的出现,将对防治骨质疏松性骨折有很大的改善,有助于大大降低目前骨质疏松症并发骨折在发生率,该研究就此作一综述。     

骨质疏松治疗中的抑制骨吸收药物

骨质疏松症的治疗药物种类繁多,作用特点也各不相同,临床治疗选择与应用较为复杂.大部分骨质疏松的治疗药物是抑制骨吸收药,本文主要对骨质疏松治疗中的抑制骨吸收药物双膦酸盐、性激素替代疗法、选择性雌激素受体调节剂和降钙素等四类骨吸收抑制剂进行概要说明.     

骨质疏松症的药物治疗研究进展

骨质疏松症是一种涉及内分泌系统及骨骼系统的代谢性骨病,以因骨量降低与骨微结构破坏导致骨脆性增加及骨折风险增大为临床特征。针对骨质疏松,临床上药物治疗主要为抗骨吸收药物、促进骨吸收药物及双重作用药物联合治疗,随着对骨质疏松药物治疗的不断深入研究,为对临床工作者更有针对性选择药物治疗骨质疏松症,本文对骨质疏松症的各类治疗药物进行阐述。     

Management of steroid-induced osteoporosis

Purpose To review the pathogenesis, clinical presentation, diagnostic assessment and treatment regimens of steroid-induced bone loss. Data sources An English-language literature search (MEDLINE 1966-1999) and bibliographic reviews of textbooks and review articles. Study selection Cross-sectional and prospective studies with BMD measurements or fracture rate. Results The greatest rate of bone loss occur during the first 6 to 12 months of steroid therapy, affecting trabecular more than cortical bone. High steroid dosage for a prolonged period, prevalent fracture, hypogonadism, older age, low calcium intake and family history of osteoporosis are risk factors for steroid-induced bone loss. Based on bone density results, patients with osteoporosis or osteopenia with a T-score below -1.5 should receive antiresorptive treatment during steroid therapy. Among the various antiresorptive agents, bisphosphonates have the strongest evidence of preventing steroid-induced bone loss. Conclusion The most important step in the management of steroid-induced osteoporosis is the proper assessment of the individual patient’s risk of bone loss, and the selection of appropriate anti-resorptive agent for each patient.     

Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 4. Calcium nutrition and osteoporosis.

OBJECTIVE: To recommend appropriate levels of calcium intake in light of the most recent studies. OPTIONS: Dietary calcium intake, calcium supplementation, calcium and vitamin D supplementation; ovarian hormone therapy in postmenopausal women. OUTCOMES: Fracture and loss of bone mineral density in osteoporosis; increased bone mass, prevention of fractures and improved quality of life associated with osteoporosis prevention. EVIDENCE: Relevant clinical studies and reports were examined, in particular those published since the 1988 Osteoporosis Society of Canada position paper on calcium nutrition. Only studies in humans were considered, including controlled, randomized trials and prospective studies, using bone mass and fractures as end-points. Studies in early and later phases of skeletal growth were noted. The analysis was designed to eliminate menopause as a confounding variable. VALUES: Preventing osteoporosis and maximizing quality of life were given a high value. BENEFITS, HARMS AND COSTS: Adequate calcium nutrition increases bone mineral density during skeletal growth and prevents bone loss and osteoporotic fractures in the elderly. Risks associated with high dietary calcium intake are low, and a recent study extends this conclusion to the risk of kidney stones. Lactase-deficient patients may substitute yogurt and lactase-treated milk for cow's milk. True milk allergy is probably rare; its promotion of diabetes mellitus in susceptible people is being studied. RECOMMENDATIONS: Current recommended intakes of calcium are too low. Revised intake guidelines designed to reduce bone loss and protect against osteoporotic fractures are suggested. Canadians should attempt to meet their calcium requirements principally through food sources. Pharmaceutical calcium supplements and a dietician's advice should be considered where dietary preferences or lactase deficiency restrict consumption of dairy foods. Further research is necessary before recommending the general use of calcium supplements by adolescents. Calcium supplementation cannot substitute for hormone therapy in the prevention of postmenopausal bone loss and fractures. Adequate amounts of vitamin D are necessary for optimal calcium absorption and bone health. Elderly people and those who use heavy sun screens should have a dietary intake of 400 to 800 IU of vitamin D per day.     

Nutrition and aging--practical advice for healthy eating

This article provides practical advice about foods and dietary supplements that are beneficial for the health of older people. Overweight and obesity are among the most common nutrition-related disorders in older people. A plant-based diet is associated with reduced risk of chronic diseases such as obesity, cardiovascular disease, cancer, and diabetes. Vitamin B12 deficiency is prevalent in older adults, but there are misconceptions about the causes, consequences, and treatments. Diminished synthesis of vitamin D in the skin that occurs with aging and poor dietary intake contribute to the high prevalence of poor vitamin D status in older adults. Vitamin D deficiency is associated with chronic disorders beyond poor bone health. Supplements containing vitamin B12 and vitamin D will help older adults meet their needs for these key nutrients.     

Sequential non-traumatic femoral shaft fractures in a patient on long-term alendronate.

Fractures associated with osteoporosis are common among elderly people and postmenopausal women. Bisphosphonate is an effective anti-resorptive drug commonly used for the prevention and treatment of osteoporosis. There are, however, concerns about potential side-effects during long-term treatment with alendronate. We report a case where an 82-year-old woman who had been taking alendronate for 10 years presented with two episodes of non-traumatic femoral shaft fracture. An iliac bone biopsy showed severely suppressed bone turnover, suggestive of adynamic bone disease. We suspect the bone turnover suppression was related to the prolonged use of alendronate.     

Postnatal evaluation of vitamin D and bone health in women who were vitamin D-deficient in pregnancy, and in their infants

OBJECTIVE: To determine the postnatal vitamin D status and bone health of women identified as vitamin D-deficient in pregnancy, and of their infants. DESIGN AND PARTICIPANTS: Retrospective audit conducted between 27 August and 5 November 2003. The study included women delivering between August and October 2002 at the Royal Women's Hospital, Melbourne, who had had a 25-hydroxyvitamin D (25-[OH]D) level < 30 nmol/L in pregnancy, and their infants at age 4-10 months. SETTING: The outpatient clinic at the Royal Children's Hospital, Melbourne. MAIN OUTCOME MEASURES: Maternal and infant serum levels of vitamin D, total alkaline phosphatase (tALP), parathyroid hormone (PTH), calcium and phosphorus; x-ray results in children with clinical or laboratory findings suggestive of rickets. RESULTS: Of 69 mother-infant pairs invited to participate, 47 (68%) attended. All 47 women had 25-(OH)D levels < 50 nmol/L, and 39 (83%) had levels < 30 nmol/L. Vitamin D supplements had been prescribed in pregnancy for 35 women (74%), and 19/35 reported having taken them as prescribed. None had continued to take supplements postnatally, but one had recently started taking them again. Among 45 infants from whom blood samples were successfully obtained, 18 (40%) had 25-(OH)D levels < 50 nmol/L, and 14 (31%) had levels < 30 nmol/L. Twelve of 16 breastfed infants had 25-(OH)D levels < 30 nmol/L, compared with 2/29 fed formula milk (P = 0.001). CONCLUSIONS: Most mothers who had been vitamin D-deficient in pregnancy were also deficient postnatally, indicating that treatment offered, counselling and/or treatment compliance were inadequate. Their infants, especially if breastfed, were at high risk of vitamin D deficiency and increased bone formation. Breastfed infants of mothers at high risk of vitamin D deficiency should receive vitamin D supplements.     

新型放射性核素骨显像剂的应用和进展

全身放射性核素骨显像在早期发现骨骼系统疾病中起着非常重要的作用,而现有的骨显像剂由于自身的缺陷,已不能满足骨骼疾病诊断和治疗的需要。因此,大量新型骨显像剂不断涌现以期填补其不足。99Tcm-乙二胺四甲撑膦酸、153Sm乙-二胺四甲撑膦酸和99Tcm-亚甲基氨基二膦酸具有很好的亲骨性,而177Lu乙-二胺四甲撑膦酸、99Tcm(Ⅴ)-二巯基丁二酸、99Tcm-唑来膦酸、99Tcm-毫微胶体和18F氟-化钠在单独骨病上效果明显。传统改进的膦酸盐、亲和性强的生物制剂蛋白和胆碱,以及性质稳定的化学物质氟和甲缩醛等新型骨显像剂都从不同角度上提升力骨骼成像的作用和价值。     

Policy for prevention of Asian rickets in Britain: a preliminary assessment of the Glasgow rickets campaign

Evidence of continuing hospital admissions of patients with Asian rickets and osteomalacia led to a further attempt to provide more effective preventive measures for the Glasgow Asian community. Dose-response studies showed that the equivalent of 10 microgram of vitamin D daily would provide effective prophylaxis, and a general practice survey showed that self-administered vitamin D supplements would reduce the prevalence and severity of Asian rickets. A multidisciplinary working group devised a preventive campaign based on the free issue of vitamin D supplements on demand to children who required them. Supported by a health education programme for community health personnel and the Asian community, the first 16 months of the campaign produced an eight-fold rise in the issue of supplements to older Asian children and a 33% increase in their issue to infants of all ethnic groups. Because more children are receiving vitamin D supplementation the campaign seems likely to reduce the prevalence of Asian rickets in Glasgow.     

钙剂及维生素D治疗原发性骨质疏松症的有效性与安全性研究进展

骨质疏松症(osteoporosis,OP)是以骨强度下降以及骨折风险增加为特征的骨骼疾病。随着我国人口结构老龄化的加剧,骨质疏松症的发病率呈逐年上升的趋势。原发性骨质疏松症是一种老年人常见的全身性骨病,女性较男性多见,常见于绝经后妇女和老年人,主要包括Ⅰ型绝经后骨质疏松症和Ⅱ型老年性骨质疏松症。为提升国民生活质量,减轻医疗经济负担,促进资源合理分配,预防与治疗骨质疏松症成为了关键。而如何有效地治疗骨质疏松症成为了我国乃至全球不得不面对的难题。随着专家学者们的共同努力,如今有越来越多的方法可以用于治疗骨质疏松症。其中钙剂与维生素D作为骨质疏松患者治疗最常用的药物,在未引入循证医学之前就将钙剂与维生素D的补充治疗作为骨质疏松症治疗的基础。然而,口服钙剂与维生素D出现了消化道不适、肾结石、心血管不良事件等副反应,也开始有人质疑其治疗骨质疏松的有效性。引入循证医学后,国内外的众多专家学者开始着手对钙剂与维生素D进行研究,其实际的有效性与安全性值得关注。笔者根据相关文献,对近年来钙剂与维生素D治疗骨质疏松症的有效性和安全性研究进展进行综述。钙剂与维生素D对骨质疏松患者具有比较确切的作用,活性维生素D较单纯维生素D更佳。钙剂与维生素D两者联用效果比单药更佳,在控制其不良反应的条件下推荐用于治疗骨质疏松症。      

Determination of bisphosphonates anti-resorptive properties based on three forms of ceramic materials: Sorption and release process evaluation

There is a strong need to search for more effective compounds with bone anti-resorptive properties, which will cause fewer complications than commonly used bisphosphonates. To achieve this goal, it is necessary to search for new techniques to characterize the interactions between bone and drug. By studying their interaction with hydroxyapatite (HA), this study used three forms of ceramic materials, two of which are bone-stimulating materials, to assess the suitability of new active substances with anti-resorptive properties. In this study, three methods based on HA in loose form, polycaprolactone/HA (a polymer-ceramic materials containing HA), and polymer-ceramic monolithic in-needle extraction (MINE) device (a polymer inert skeleton), respectively, were used. The affinity of risedronate (a standard compound) and sixteen aminomethylenebisphosphonates (new compounds with potential antiresorptive properties) to HA was defined according to the above-mentioned methods. Ten monolithic materials based on 2-hydroxyethyl methacrylate/ethylene dimethacrylate are prepared and studied, of which one was selected for more-detailed further research. Simulated body fluids containing bisphosphonates were passed through the MINE device. In this way, sorption–desorption of bisphosphonates was evaluated using this MINE device. The paper presents the advantages and disadvantages of each technique and its suitability for assessing new active substances. All three methods allow for the selection of several compounds with potentially higher anti-resorptive properties than risedronate, in hope that it reflects their higher bone affinity and release ability.     

系统性红斑狼疮血液学异常及治疗后的变化

目的:探讨系统性红斑狼疮(SLE)病人血液学异常改变及临床特征。方法:对62例SLE患者血液学资料及应用糖皮质激素、免疫抑制剂治疗的效果进行回顾性分析。结果:血象异常者为53例,占82.5%,以二系以上减少为主,46例进行了骨髓象检查,发现骨髓增生活跃或明显活跃40例,增生减低6例,表现为增生性贫血或特发性血小板减少性骨髓象,47例诊断后做Coombs试验,9例阳性,血细胞减少者,用糖皮质激素及免疫抑制剂治疗,血象均有升高。结论:血液系统是SLE易损器官,SLE病人血液学异常较常见,其特点是血液学改变多样性,缺乏特异性,以二系以上减少常见,骨髓象表现增生活跃为主,对糖皮质激素及免疫抑制治疗有效。