骨质疏松症药物治疗进展

骨质疏松症是一个严峻的公共健康问题,其主要特征是骨强度下降和骨折风险增高。目前,治疗骨质疏松症的药物分为两类:抑制骨吸收药物和促进骨形成药物。抑制骨吸收药物通过减少破骨细胞数量和/或抑制破骨细胞活性到达抑制骨吸收的目的。目前,上市的骨吸收药物包括:二磷酸盐制剂、雌激素和选择性雌激素受体调节剂、降钙素和Denosumab。其中,Denosumab是在2010年刚被美国食品药品管理局和欧洲议会批准而上市的。重组人类甲状旁腺激素是唯一的上市的促进骨形成药物。雷尼酸锶是唯一已上市的具有双重作用机制的新型抗骨质疏松症药物,其在刺激新骨形成的同时抑制骨吸收。在对骨代谢途径的深刻认识上,涌现了一批新型的制剂比如胰高血糖素样肽2、组织蛋白酶K阻滞剂、钙离子受体拮抗剂、抗-Sclerostin单克隆抗体等等。随着这些制剂逐步通过临床试验的检验,将会给骨质疏松症的治疗带来新的希望。     

骨质疏松症的药物治疗进展

骨质疏松症是一种以骨量降低、骨微结构破坏、骨脆性增加、骨强度下降、骨折风险性增大为特征的全身性、代谢性骨骼系统疾病。由于骨质疏松症是一种全身性的疾病,骨质疏松症的原始治疗、骨质疏松性骨折术后及术后再骨折过程中抗骨质疏松药物的治疗非常重要,临床应用的抗骨质疏松药物主要包括两大类：骨吸收抑制类及促进骨形成类。随着骨代谢途径认识的不断加深,不断升级目前已有药物、已有药物的合理配伍使用、研发新型的改变细胞功能和基因表达的药物、继承和发展祖国传统中医药等都是值得探索的方向。随着这些新进展、新方案逐步通过临床试验的检验,将会给骨质疏松症的治疗带来新的希望。     

骨质疏松症药物治疗进展

骨质疏松症药物治疗进展浙江丽水市人民医院（３２３０００）王济纬，史炜镔骨质疏松症是常见的骨代谢疾病，其合并的骨折，严重危害人们的健康，被称为无声的流行病（ｓｉｌｅｎｔｅｐｉｄｅｍｉｃ），许多机理尚未明了，这给该病的诊断及防治带来不少困难，国内外学者，...     

骨质疏松症的药物治疗进展

骨质疏松症 (Ｏｓｔｅｏｐｏｒｏｓｉｓ ,ＯＰ)系由多种原因引起的一组骨病 ,其特点是单位体积内骨量减少 ,骨皮质变薄 ,骨小梁数目及大小均减少 ,髓腔增宽 ,骨荷载功能减弱 ,从而产生腰背、四肢疼痛 ,脊柱畸形 ,骨脆性增加 ,最终可导致骨折[1 ] ,多见于中、老年人。目前世界上骨质疏松患者约达 2亿人 ,骨质疏松症已成为世界性关注的严重社会问题 ,在我国也已将它列为 3大重点攻关研究的老年疾病之一。对骨质疏松症病因、病理机制及分子生物学的深入研究给骨质疏松症的药物治疗提供了很多途径。现在一般将骨质疏松症药物分为两大类 :以抑制…     

骨质疏松症治疗药物研究进展

骨质疏松症是一种与增龄相关的代谢性骨病,主要是由成骨细胞介导的骨形成与破骨细胞介导的骨吸收之间的失衡所致.随着骨质疏松症患病率的逐年递增,如何防治骨质疏松已经成为我国重要公共健康问题.目前骨质疏松症治疗药物主要可分为促进骨形成剂和抑制骨吸收剂.本文主要就骨质疏松症治疗药物的研究进展作一综述,为临床治疗骨质疏松症提供理论...     

骨质疏松症的药物治疗进展

药物治疗是治疗骨质疏松症的重要手段之一,目前药物治疗可分为三类:抗骨重吸收、促骨形成和骨矿化药物,每类药物治疗都各有其优缺点,笔者就几类常见骨质疏松治疗药物近年的研究进展作一概述.     

骨质疏松症的药物治疗

骨质疏松症是一种无声的流行病（silect epidemic disease），常易致骨折而严重危害人们的健康，对该病的防治是医疗界普遍关注的问题。目前，治疗骨质疏松症的药物可分为骨吸收抑制剂、骨形成刺激剂和骨矿化促进剂等三类。现就国内外有关该病的常用的药物治疗作一综述。     

抗骨质疏松药物的研究进展

骨质疏松(osteoporosis)是一种最为常见的代谢性骨病,主要表现为骨量减少、骨组织微结构破坏从而导致骨痛、骨脆性及骨折危险性增加。目前临床常用抗骨质疏松药物可分为骨吸收抑制剂、骨形成剌激剂及骨矿化药物。选择性雌激素受体调节剂（SERMs)作为一种新型骨吸收抑制剂,于骨骼系统表现为雌激素激动剂作用,于乳腺等组织表现为雌激素拮抗剂作用,从而不增加致癌风险。骨保护素（OPG)及抗RANKL单克隆抗体可与核因子KB受体活化因子（RANK)竞争结合其配体 (RANKL),从而抑制破骨细胞骨重吸收作用。C-src激酶抑制剂可阻断破骨细胞的细胞内信号转导通路从而不能形成完整的细胞骨架,氯离子通道阻滞剂可破坏破骨细胞骨吸收酸性微环境,αVβ3整合素抗体及其受体拮抗剂可减弱破骨细胞与骨组织粘附,组织蛋白酶K抑制剂可减少骨胶原裂解,从而均有待于成为新一代骨吸收抑制剂。新型骨形成剌激剂主要包括PTH 片段制剂、钙离子敏感受体激动剂、骨硬化蛋白中和抗体、他汀类药物等。其中钙离子敏感受体激动剂于成骨细胞可通过促分裂原活化蛋白激酶(MAPK)通路来促进成骨细胞的骨形成作用,于破骨细胞可能通过RANKL信号通路以诱导破骨细胞凋亡。骨硬化蛋白中和抗体可抑制骨硬化蛋白与低密度脂蛋白受体相关蛋白（LRP)5/6结合,从而保证Wnt信号通路在骨形成及重建中发挥作用。他汀类药物则通过增强机体内骨形态发生蛋白-2基因表达以增加骨强度,减少骨折发生。本文就目前新型骨吸收抑制剂及新型骨形成剌激剂的研究进展作一综述。     

治疗骨质疏松症靶向药物研究进展

骨质疏松症(Osteoporosis,OP)是世界性高发生率的、易于引发骨折为特征的代谢性疾病。其治疗药物主要有促骨合成药和抑制骨吸收药。随着对其发病机制研究的不断深入,多肽、激素、细胞因子等靶向药物成为研究的热点。本文阐述的促骨合成药有:PTH、钙敏感受体负向调节剂calcilytics、雷尼酸锶、PYK2抑制剂;抑制骨吸收药有OPG、Denosumab;抑制骨基质降解的组织蛋白K等新型药物。它们有的已经上市,有的处于临床研究中。     

祖国传统医学对骨质疏松症的治疗进展

骨质疏松症是以骨量减少和骨组织的纤维结构退化为特征的代谢性骨病。随着21世纪我国老龄化社会的到来，骨质疏松发病率明显增高，已逐渐成为世界性广泛关注的问题。原发性骨质疏松分为I、Ⅱ两种类型。I型为高代谢型，主要是绝经后骨质疏松，由雌激素缺乏，而使骨代谢呈负平衡，骨吸收相对增强引起；Ⅱ型是低骨转换型，主要为老年性骨     

骨质疏松并发骨折的治疗新概念

骨质疏松合并骨折是一种常见而严重的疾患，本文总结了治疗方面的近期进展和新概念。骨折后由于制动治疗导致继发性骨质疏松，在原发性骨质疏松的基础上，骨丢失愈发严重，形成恶性循环，影响愈合。因此，治疗的关键是要阻断这一恶性循环，防止或减少骨丢失。尽早进行功能练习和负重活动，常规服用治疗骨质疏松的药物，两者是同等重要的。牢靠的内固定和假体置换应该是多数骨折治疗的首选方法。在药物治疗方面，降钙素、激素替代疗法（利维爱等）、双磷酸盐（福善美等）、维生素D2、维生素D3及钙剂都是适用的。     

镓治疗骨质疏松的研究进展

骨质疏松症是一类"以低密度和骨组织结构破坏为主要特点的全身骨骼性疾病",目前居全球常见病第六位,其危害日益严峻。尽管治疗骨质疏松的药物多种多样,但每种药品都有其自身的缺点,为达到个体化用药目的,开发新型骨质疏松药物仍是国内外关注的热点。镓(gallium,Ga)为硼族元素,国内外有很多实验表明其有很好的抗骨质疏松作用,使其有希望成为新一代抗骨质疏松药,本文就镓治疗骨质疏松的实验研究、作用机理、以及尚存在的问题等方面做一阐述。     

骨质疏松症的物理治疗研究进展

骨质疏松症是一种中老年人易患的骨骼性疾病,骨质疏松的治疗方法种类繁多,主要包括药物治疗和物理治疗。药物治疗效果确切,但存在治疗周期长,患者依从性差、费用较高及药物不良反应等问题。相比其他几种方法,物理疗法具有副作用小的优点。为了更全面阐释物理治疗方法的相关研究工作,本文主要从物理治疗的角度对脉冲电磁场(PEMFs)、高压氧、超声波、电针、体外冲击波、振动以及运动疗法对骨质疏松的治疗作用进行探讨,分析它们的作用机制、临床应用研究新进展,以指导临床更合理地选择治疗方法,找出各自的优势,扬长避短,以达到更好的治疗效果。     

Factors affecting fracture location in atypical femoral fractures: A cross-sectional study with 147 patients

IntroductionMany studies have tried to determine the characteristics of atypical femoral fractures (AFFs) through age-, sex-, and ethnicity-matched comparison with non-AFFs. However, we hypothesized that diaphyseal AFFs would have characteristics different from those of subtrochanteric AFFs. The aim of this study was to evaluate the clinical features of diaphyseal/subtrochanteric AFFs and determine the factors related to fracture location.Patients and methodsOne hundred forty-seven patients with AFF were enrolled, 114 patients (78%) had a history of bisphosphonate use. Forty-nine patients (33%) had bilateral lesion, and 35% of patients had thigh pain. Patients were divided into two groups according to fracture location: 52 patients (35.4%) with subtrochanteric AFF and 95 patients (64.6%) with diaphyseal AFF. The patient demographics and fracture characteristics of the two groups were compared. Multivariate logistic regression analysis was used to adjust for variables related to fracture location.ResultsThe patients in the diaphyseal AFFs group were older and had lower BMI, lower BMD, and larger lateral and anterior bowing. Multivariate analysis revealed that age greater than 65 years and low BMD were related with diaphyseal location. With greater lateral bowing angle, the AFF location was moved from the subtrochanteric area to the diaphyseal area.ConclusionThis study demonstrated that patients with diaphyseal AFFs had different characteristics compared with those with subtrochanteric AFFs.     

Lower extremity stress fractures during intermittent cyclical etidronate treatment for osteoporosis

During intermittent cyclical etidronate treatment, a lower extremity pain syndrome associated with stress fractures was observed in three osteoporotic patients. This report describes the development of stress fractures during initial cycles of treatment, with recurrence of symptoms in two patients when etidronate therapy was resumed. Further studies are needed to confirm whether stress fractures are associated with cyclic etidronate treatment and if so, the incidence and pathophysiology need to be determined.     

Racial disparity in treatment of osteoporosis after diagnosis

Introduction Racial disparities have been identified in a number of areas in clinical medicine. Patients diagnosed with osteoporosis should be treated similarly regardless of race. However, limited data are available on the relative frequency of treatment by race after diagnosis of osteoporosis.Methods We analyzed all 739 dual-energy X-ray absorptiometry (DXA) results obtained of women 50 years old and older between 1998 and 2002 at our medical center. Our study sample was 82% Caucasian and 15% African American. Of 353 women who had low bone mineral density on first DXA, we abstracted the electronic and paper medical records to compare treatment rates by race.Results Of the women diagnosed with osteoporosis or osteopenia, 80.0% and 68.3%, respectively, were started on antiresorptive medications. Of the African American women, 61.9% diagnosed with osteoporosis were started on antiresorptive treatment compared with 83.3% of Caucasian women (p<0.05). African American women with low bone mass were less likely than Caucasian women to be smokers (p<0.05) and use alcohol (p<0.01) but were more likely to be on corticosteroids (p<0.05). No other significant differences were found among treated and nontreated groups that might explain the disparity in treatment.Conclusion A smaller proportion of African American than Caucasian women with osteoporosis received antiresorptive medications after a DXA diagnosis. This significant disparity requires further study in a larger population.     

Osteonecrosis of the jaw and bisphosphonate treatment for osteoporosis

A potential side effect associated with bisphosphonates, a class of drugs used in the treatment of osteoporosis, Paget's disease and metastatic bone disease, is osteonecrosis of the jaw (ONJ). The incidence of ONJ in the general population is unknown; this rare condition also may occur in patients not receiving bisphosphonates. Case reports have discussed ONJ development in patients with multiple myeloma or metastatic breast cancer receiving bisphosphonates as palliation for bone metastases. These patients are also receiving chemotherapeutic agents that might impair the immune system and affect angiogenesis. The incidence or prevalence of ONJ in patients taking bisphosphonates for osteoporosis seems to be very rare. No causative relationship has been unequivocally demonstrated between ONJ and bisphosphonate therapy. A majority of ONJ occurs after tooth extraction. Furthermore, the underlying risk of developing ONJ may be increased in osteoporotic patients by comorbid diseases. Treatment for ONJ is generally conservative.     

金乌骨通胶囊治疗骨质疏松67例临床观察

目的 评价金乌骨通胶囊用于骨质疏松治疗的有效性和安全性.方法 收集67例临床骨质疏松患者,进行为期3个月的用药疗效观察,通过对治疗前后的症状分级量化评分进行疾病疗效判定.结果 金乌骨通胶囊具有较好的改善患者临床症状治疗骨质疏松的作用,能有效地减轻患者腰背、关节疼痛,有效率达92.5%以上.治疗后腰椎骨密度测定略有增加,但差异无显著性差异.结论 金乌骨通胶囊用于骨质疏松治疗效果确切,安全性良好.