BACKGROUND & AIMS:
:The therapy of osteoporosis is mostly based upon the use of drugs which inhibit bone resorption. Among these, the bisphosphonate family is the best known and mostly used by clinicians. Both second and third generation bisphosphonates, like alendronate and risedronate, are now available as weekly tablets which have facilitated the patient compliance to treatment together with a decreased occurrence of gastrointestinal side effects. These compounds are used efficiently to treat postmenopausal osteoporosis and osteoporosis of men as well. Their use did provide good evidence of increased bone mineral density (BMD) and a reduction in fracture rates. The use of intravenous bisphosphonates such as Zoledronate, Ibandronate and Pamidronate remains in most of the cases limited to special indications such as intolerance to the oral formulations and treatment of patients with bone metastases. The selective estrogen modulators (SERM's) family is limited to a single product on the market as of now, Raloxifene, which does inhibit bone resorption and is well documented by postmenopausal women to increase BMD and reduce vertebral fractures. In addition, a large range of positive nonosseous effects have been documented such as the reduction of the incidence of breast cancer. Other substances do have a strong anabolic effect such as Teriparatide, a recombinant human formulation of PTH 1-34. This compound has demonstrated good efficacy in postmenopausal women, increasing vertebral and hip BMD and reducing the incidence of fractures at both sites. The exact role of Teriparatide in the clinical setting is still open but its overall impact in the therapy of osteoporosis could be major due to its major efficiency over shorter periods of time. Strontium ranelate, a new divalent Strontium salt taken orally, acts both as an anti-catabolic and anabolic agent. The first results provided with strontium ranelate are very promising due to its major effect on the increase in BMD both at the vertebral and hip sites and its ability to reduce the incidence of fractures at both locations. Additional data are awaited to confirm these initial positive results.
背景与目标:
: 骨质疏松症的治疗主要基于使用抑制骨吸收的药物。其中,双膦酸盐家族是最著名的,并且大多数被临床医生使用。第二代和第三代双膦酸盐,如阿仑膦酸盐和利塞膦酸盐,现在都可以作为每周片剂获得,这有助于患者对治疗的依从性以及减少胃肠道副作用的发生。这些化合物可有效地用于治疗绝经后骨质疏松症和男性骨质疏松症。它们的使用确实为骨矿物质密度 (BMD) 增加和骨折率降低提供了良好的证据。在大多数情况下,静脉内使用双膦酸盐 (如唑来膦酸盐,伊班膦酸盐和帕米膦酸盐) 仍然仅限于特殊适应症,例如对口服制剂的不耐受和骨转移患者的治疗。到目前为止,选择性雌激素调节剂 (SERM's) 家族仅限于市场上的单一产品雷洛昔芬 (Raloxifene),它确实抑制骨吸收,并且绝经后妇女已充分证明可以增加BMD并减少椎骨骨折。此外,已经记录了许多积极的非骨效应,例如降低了乳腺癌的发病率。其他物质确实具有很强的合成代谢作用,例如Teriparatide,PTH 1-34的重组人制剂。该化合物已在绝经后妇女中显示出良好的疗效,可增加椎骨和髋骨BMD并减少两个部位的骨折发生率。Teriparatide在临床环境中的确切作用仍然是开放的,但由于其在较短时间内的主要效率,其在骨质疏松症治疗中的总体影响可能是主要的。雷奈酸锶是一种新的口服二价锶盐,同时充当抗分解代谢和合成代谢剂。雷奈酸锶提供的第一个结果非常有希望,因为它对椎骨和髋关节部位的BMD增加有重要影响,并且能够减少两个部位的骨折发生率。等待其他数据来确认这些初步的积极结果。