骨质疏松症的药物治疗进展

骨质疏松症现已成为中老年人的一种多发病和常见病,治疗主要以药物治疗为主,临床上主要有骨吸收抑制剂、骨形成促进剂和骨矿化药物。本文就近年来常见治疗骨质疏松症药物的研究进展作一概述。     

骨质疏松症的药物治疗进展

以国内发表的文献为依据，介绍骨质疏松症治疗药物的不同作用机制及代表药物。骨质疏松症治疗药物从作用机制上可分为两大类：骨吸收抑制剂和骨形成促进剂，此外中药在治疗骨质疏松症上有独特地位。该类药物的研究对临床合理用药具有指导意义。     

骨质疏松症药物治疗进展

近年来骨质疏松症的药物治疗研究有了很大进展，主要分为骨吸收抑制剂和骨形成促进剂两大类。在此主要介绍原发性骨质疏松症的药物治疗进展。     

骨质疏松症药物治疗进展

当今与年龄和绝经有关的骨质疏松症的发病率已位居全球常见病的第7位。近年来骨质疏松症的治疗药物研究有了很大进展，主要为骨吸收抑制剂和骨形成促进剂二大类。目前大部分药物为骨吸收抑制剂，对骨形成促进剂的研究将是未来骨质疏松症治疗的重点。本文主要阐述原发性骨质疏松症的药物治疗进展。     

中西药治疗骨质疏松症的研究进展

［摘要］以国内外发表的文献为依据,从中西医角度出发阐述治疗骨质疏松症的药物,包括促进骨形成、抑制骨吸收的药物及其他类.中药在治疗骨质疏松症上有独特优势,该类药物的研究具有很好的前景.     

治疗骨质疏松症药物研究进展（一）

骨质疏松症（Osteoporosis，OP）分为两类：（1）原发性骨质疏松痛包括Ⅰ型绝经后骨质疏松症和Ⅱ型老年性骨质疏松症：（2）继发性骨质疏松症由其他疾病或由药物等一些因素诱发。治疗骨质疏松症的药物主要有两大类：抑制骨吸收药物和促进骨形成药物。现对治疗骨质疏松症的药物作用机制及研究进展综述如下。     

特立帕肽治疗骨质疏松症的研究进展

骨质疏松症是一种骨代谢失衡导致的全身退行性骨病,其治疗药物主要有骨吸收抑制剂、骨形成促进剂和中药等。近年来国内外骨质疏松症患者日益增多,如何提高其治疗效果且减少药物不良反应成为当前研究重点。特立帕肽是目前多个国家获准治疗骨质疏松症的唯一促骨形成类药物,对骨质疏松症的治疗效果较为显著,逐渐成为增加骨密度、预防骨质疏松性骨折的研究热点。该文就特立帕肽对绝经后骨质疏松症、老年骨质疏松症及男性骨质疏松症的临床疗效,对糖皮质激素性骨质疏松症的动物实验结果及临床疗效,对糖尿病性骨质疏松症动物实验等方面的研究进展进行综述,以期为临床治疗各类原发性及继发性骨质疏松症提供理论依据。     

英语加油站

本期英语加油站我们学习骨质疏松症的治疗药物如何用英语表达。通过上期CE课堂的学习,我们已经知道抗骨质疏松症的药物可分为三类：促骨矿化剂、骨吸收抑制剂和骨形成促进剂,     

他汀类药物与骨质疏松症的研究进展

随着社会人口的老龄化,骨质疏松症已成为日益严重的危害广大中老年人(尤其是中老年女性)健康的医学和社会问题。目前骨质疏松症的防治药物主要有骨吸收抑制剂及骨形成促进剂两大剂。骨吸收抑制剂难以使已发生的骨质疏松组织恢复正常,而骨形成刺激剂如氟化物虽然可以促进新骨形成,但是可以导致骨质强度降低,仍然不能降低骨折风险。因此,防治骨质疏松症的新药不断地被开发出来。近期研究发现80年代后期应用于临床的降血脂药物——他汀类药物具有促进骨形成的作用,从而成为骨质疏松症药物治疗研究的热点。     

骨质疏松症的药物治疗进展

骨质疏松症已成为严重危害人类健康的多发性疾病，目前临床用于治疗的药物主要分为骨吸收抑制剂和骨形成促进剂两种，本文概述其作用机制、用法、副作用及临床应用。     

骨髓间充质干细胞复合I型胶原修饰的聚乳酸聚乙醇酸对骨质疏松大鼠骨缺损的影响

目的 通过将骨髓间充质干细胞复合I型胶原修饰的聚乳酸聚乙醇酸(PLGA)微球支架注入骨质疏松大鼠股骨转子间,探讨其对骨缺损后骨质量的局部改善情况.方法 通过切除30只SD雌性大鼠双侧卵巢建立骨质疏松动物模型,并用电钻在股骨转子间人为制作骨缺损;实验动物按随机数字表法均分为给药组、模型组和假手术组.给药组大鼠骨缺损部位注入骨髓间充质干细胞复合I型胶原修饰的PLGA微球,模型组大鼠骨缺损部位注入PBS缓冲液,假手术组大鼠行假手术.分别考察术后1、3个月骨缺损部位的骨矿含量、骨密度、骨小梁厚度、骨小梁面积百分比及分离度.结果 骨髓间充质干细胞与I型胶原修饰的PLGA微球支架体外培养7 d,发现细胞在支架表面黏附、生长良好.与模型组比较,给药组动物术后1个月的骨密度、骨小梁厚度、骨小梁面积百分比均显著增大,骨小梁分离度显著减小,均差异有统计学意义(P<0.05),骨矿含量变化不明显(P>0.05);给药组动物术后3个月的骨矿含量、骨密度、骨小梁厚度、骨小梁面积百分比均显著大于模型组,骨小梁分离度显著小于模型组,均差异有统计学意义(P<0.05).结论 骨髓间充质干细胞复合I型胶原修饰的PLGA微球可修复大鼠骨质疏松部位骨缺损,改建骨小梁结构,提高骨质量.     

An update on biomarkers of bone turnover and their utility in biomedical research and clinical practice

Background: Maintenance of the structural and functional integrity of the skeleton is a critical function of a continuous remodeling driven by highly associated processes of bone resorption and synthetic activities driven by osteoclasts and osteoblasts, respectively. Acceleration of bone turnover, accompanied with a disruption of the coupling between these cellular activities, plays an established role in the pathogenesis of metabolic bone diseases, such as osteoporosis. During the past decades, major efforts have been dedicated to the development and clinical assessment of biochemical markers that can reflect the rate of bone turnover. Numerous studies have provided evidence that serum levels or urinary excretion of these biomarkers correlate with the rate of bone loss and fracture risk, proving them as useful tools for improving identification of high-risk patients.Objective: The aim of the present review is to give an update on biomarkers of bone turnover and give an overview of their applications in epidemiological and clinical research.Discussion: Special attention is given to their utility in clinical trials testing the efficacy of drugs for the treatment of osteoporosis and how they supplement bone mass measurements. Recent evidence suggests that biochemical markers may provide information on bone age that may have indirectly relates to bone quality; the latter is receiving increasing attention. A more targeted use of biomarkers could further optimize identification of high-risk patients, the process of drug discovery, and monitoring of the efficacy of osteoporosis treatment in clinical settings.     

脑卒中偏瘫后康复训练联合药物预防继发性骨质疏松

目的通过对脑卒中后偏瘫患者进行康复训练,并使联合使用降钙素和碳酸钙D3抗骨质疏松治疗,分析对预防骨质疏松的疗效。方法选择脑卒中后偏瘫患者132例,实验组72例,对照组60例,按Brunnstrom分期治疗,两组均进行正规康复训练,实验组采用降钙素联合碳酸钙D3抗骨质疏松治疗,对照组未进行任何抗骨质疏松药物治疗,测定患侧股骨Ward三角、桡骨远端、第1腰椎三部位骨密度并进行分析比较。结果 Brunnstrom I～Ⅱ期两组三部位均相当(P>0.05),Ⅲ～IV期、VI～V期实验组三部位骨密度均高于对照组(P<0.05),说明中晚期预防骨质疏松疗效显著。结论脑卒中后偏瘫极易继发骨质疏松,在正规康复训练的基础上,使用联合抗骨质疏松药物治疗,可明确预防继发性骨质疏松。     

药物干预治疗老年性低骨量或骨质疏松症的观察研究

目的：研究早期干预骨质疏松症的临床疗效。方法：将120例低骨量或骨质疏松症患者随机分为4组,各组30例,给药方案分别是,A组唑来膦酸钠（密固达）5mg静脉滴注,每年1次;B组降钙素（密钙息）100IU隔日肌注,连用7d;C组降钙素100IU隔日肌注,连用7d＋维生素D200IU,连用14d;D组运动锻炼,无药物干预。干预前后采用HK-1骨密度仪镅一吸收法（SPA）检测右侧跟骨密度及骨量。结果：3种药物干预均能有效维持骨密度,效果优于运动锻炼。结论：早期采用药物干预（唑来膦酸钠、降钙素）可以安全有效地预防老年性的骨量丢失,从而降低骨质疏松性骨折的发生率。     

右归丸加减治疗肾虚型骨质疏松症的临床研究

目的探讨右归丸加减治疗肾虚型骨质疏松症的临床治疗效果。方法将我院60例肾虚型骨质疏松症患者分为治疗组30例应用右归丸加减法治疗,对照组30例应用骨化三醇胶丸治疗;观察两组患者治疗前、后的临床症状积分变化,并对两组的治疗效果进行比较。结果两组患者经治疗后在平均积分、骨密度与治疗前对比差异均具有统计学意义(P<0.05);治疗组治疗后骨密度升高情况与对照组对比,差异具有统计学意义(P<0.05);治疗有效率及总有效率方面治疗组均明显优于对照组,具有统计学意义(P<0.05)。结论右归丸加减治疗肾虚型骨质疏松症,可提高骨质疏松患者骨矿含量,改善其生命质量,显示良好的防治骨质疏松的效应,为一种安全、无毒副作用、治疗效果确切的临床用药。     

Clinical use of serum and urine bone markers in the management of osteoporosis

ABSTRACT

Osteoporosis is a common disease characterized by decreased bone mass, increased bone turnover, and increased susceptibility to fracture. Almost 44 million Americans are estimated to have low bone mass, which puts them at increased risk of developing osteoporosis and fractures. Osteoporosis is diagnosed by a low bone density (BMD) measurement, because a low BMD is known to contribute to increased fracture risk, which is the main source of morbidity and mortality for osteoporosis. However, changes in bone mass and density in response to anti-resorptive therapy account for only a small portion of the predicted fracture risk reduction. Whereas dynamic changes in bone turnover, estimated by measurement of bone biochemical markers, such as breakdown products of type-I collagen and proteins secreted by osteoblasts and osteoclasts in blood and urine, can account for a major portion of anti-fracture efficacy of anti-resorptive agents. Most anti-resorptive agents act by rapidly reducing bone markers. This has led to advocacy for use of bone turnover markers, in complement to BMD measurement, in the management of osteoporosis. In general, higher bone turnover is associated with accelerated bone loss and potential deterioration in bone quality. Several clinical trials have established the potential utility of markers to identify patients with rapid bone loss, to aid in therapeutic decision-making, and to monitor therapeutic efficacy of various treatments. Elevated marker levels have been shown to be associated with increased risk of fracture in elderly women, but their utility in predicting fracture is not yet established. In this article, we provide a brief summary to primary practitioners about the role bone markers can play in the management of osteoporosis.     

Incadronate inhibits osteoporosis in ovariectomized rats

Incadronate is a highly effective inhibitor of stimulated bone resorption as demonstrated in a hypercalcemia model in rats, bone metastasis models in mice and rats, and an osteoporosis model in dogs. In this study, the effect of incadronate on osteoporosis in ovariectomized rats was examined. Incadronate dose-dependently inhibited decreases in second lumbar vertebrae bone mineral density (BMD) following oral administration for 4 or 12 weeks. Significant inhibition was observed at doses of more than 0.3 mg/kg. Incadronate dose-dependently inhibited the loss of distal femur metaphyseal compressive strength following 12 weeks of oral administration, and this was significant at a 3 mg/kg daily dose. Incadronate also dose-dependently inhibited the increases in urinary deoxypyridinoline levels after 4-or 12-week oral administrations. While incadronate had no effect on serum osteocalcin levels after 4 weeks of oral administration, it did dose-dependently reduce levels after 12 weeks of oral administration. These results suggested that incadronate may be a useful drug for osteoporosis due to stimulated bone resorption.     

甾体-双膦酸酯化合物的合成及防治骨质疏松作用研究

双膦酸盐有趋骨性并有抗骨质疏松症活性。甾体激素常用于骨质疏松症的防治。本文设计合成了7个甾体-双膦酸酯偶合物,希望新化合物既有趋骨性又有协同抗骨质疏松作用,能得到疗效好副作用小的骨靶向化合物的先导物。经骨细胞培养试验表明,化合物有促进骨形成作用。     

特乐定治疗雄性骨质疏松大鼠的实验研究

目的：探讨特乐定对男性骨质疏松骨代谢的影响。方法：采用15周龋雄性大鼠去睾后作为动物模型，随机分为正常对照组，模型组，特乐定治疗组，28周后行血尿生化，骨密度，骨生物力学及病理检查。结果：与正常组比较，模型组睾酮水平，碱性磷酸酶，全身及股骨中点骨密度，股骨最大受力负荷及股骨最大挠度，骨小梁体积，骨表面面积／体积比，平均骨小梁厚度均明显下降，24小时尿羟脯氨酸，尿钙与肌苷比值显著增高，应用特乐定治疗后，上述指标仅有一定限度好转。结论：雄性大鼠去睾28周后形成了骨质疏松，早期应用特乐定预防治疗可使部分指标好转，但不能完全逆转骨质疏松的发生。     

绝经后妇女骨密度与骨代谢标志物的关系

目的 研究绝经后妇女骨密度(Bone mineral density,BMD)与骨代谢标志物的关系.方法 应用双能X线骨密度仪测量绝经期妇女腰椎BMD值,参照WHO的骨质疏松诊断标准,将109例绝经后妇女分为无骨质疏松(NOP)组,骨量减少组(OPl)组和骨质疏松(OP2)组,测定各组受试者BMD和电化学发光法检测骨代谢标志物包括血清骨钙素(0C)、Ⅰ型原胶原N端肽(PINP)、Ⅰ型胶原交联C-末端肽(β-CTX)、25羟维生素D(VitD-T)和甲状旁腺素(PTH)的水平.结果 随着OP程度的加重,BMD值逐渐降低,而年龄逐渐增大;然而不同骨量组患者的OC、PINP、β-CTX和PTH等比较差异均无统计学意义(均P＞ 0.05).结论 绝经后骨质疏松患者血清骨代谢标志物水平未提示与骨密度存在联系;血清OC、PINP、β-CTX和PTH只反映绝经后妇女骨转换的高低,对绝经后骨质疏松的诊断无明显意义.