内分泌
词汇介绍
拓展阅读
解析
Bisphosphonates
释 义 双磷酸盐
例 句 She picked the drugs because of studies in humans that suggest bisphosphonates may help prevent cancer from spreading to the bone.她之所以选择这些药物是因为在人类研究中表明双磷酸盐可以帮助阻止癌症扩散到骨骼。
概述
概述
双膦酸盐是一类防止骨密度降低的药物，用于治疗骨质疏松症和类似疾病。它们是用于治疗骨质疏松症的最常用处方药。双膦酸盐的用途包括预防和治疗骨质疏松症，骨转移（有或没有高钙血症），多发性骨髓瘤，原发性甲状旁腺功能亢进，成骨不全症，纤维异常增生以及其他表现出骨脆性的疾病。
临床应用
双膦酸盐用于治疗骨质疏松症，变形性骨炎（骨骼的佩吉特氏病），骨转移（伴或不伴高钙血症），多发性骨髓瘤和其他涉及脆弱，易碎的骨骼的疾病。
在骨质疏松症和佩吉特氏症中，最常使用的一线双膦酸盐药物是阿仑膦酸盐和利塞膦酸盐。如果这些方法无效或患者出现消化道问题，可以使用静脉注射帕米膦酸。雷奈酸锶或特立帕肽用于难治性疾病，雷奈酸锶的使用受到限制，因为增加了静脉血栓栓塞，肺栓塞和严重的心血管疾病（包括心肌梗塞）的风险。在绝经后妇女中，选择性雌激素受体调节剂 雷洛昔芬偶尔使用双膦酸盐代替，在激素引起的骨质疏松症中，双膦酸酯有助于降低椎体骨折的风险。
建议将双膦酸盐类药物作为绝经后骨质疏松症的一线治疗方法。长期使用双膦酸酯治疗会产生抗骨折和骨矿物质密度的影响，双膦酸盐阿仑膦酸盐可将髋部，椎骨和腕部骨折的风险降低35-39%，唑来膦酸盐可将髋部骨折的风险降低38%，将椎骨骨折的风险降低62%。利升膦酸也被证明可以降低髋部骨折的风险。在低危人群中，经五年口服药物或三年静脉药物治疗后，可以停止双膦酸盐治疗。在高危人群中，可以使用十年的口服药物治疗或六年的静脉内治疗。
癌症
双膦酸盐可降低乳腺癌，肺癌，和其他转移性癌症以及多发性骨髓瘤患者的骨折和骨痛风险，在乳腺癌中，有关双膦酸盐是否能改善生存率的证据不一。2017年的Cochrane评论发现，对于患有早期乳腺癌的人，双膦酸盐治疗可以降低癌症扩散到人骨的风险，但是对于患有晚期乳腺癌的双膦酸盐治疗的人治疗似乎并未降低癌症扩散到骨骼的风险。双膦酸盐治疗对乳腺癌患者的副作用轻微且罕见。双膦酸盐还可以降低多发性骨髓瘤和前列腺癌患者的死亡率。
不良反应
口服双膦酸盐可引起恶心、炎症和糜烂食道，服药后保持直立坐立30至60分钟可以防止这种情况。初次输注后，静脉注射双膦酸盐会产生发烧和流感样症状，这被认为是由于其激活人γδT细胞的潜力而发生的。当静脉内注射双膦酸盐治疗癌症时，与颌骨骨坏死（ONJ）有关，下颌骨受累的频率是上颌骨的两倍，大多数情况下发生于某些癌症患者的大剂量静脉内给药后。
复制标题补充维生素d对paget病双膦酸盐输注后急性期反应的预防作用
发表时间：2019-10-22
影响指数：5.6
作者： Daniela Merlotti
期刊：J Clin Endocrinol Metab
Paget’s disease of bone (PDB) is a chronic skeletal disorder affecting up to 1-5% of elderly population in certain European countries, which typically results in enlarged and deformed bones in one or more regions of the skeleton. Specific therapy for PDB is aimed at decreasing the abnormal bone remodelling and bisphosphonates (BPs) are currently considered the treatment of choice. These compounds are associated with a reduction in bone turnover markers and an improvement in radiological and scintigraphic appearance as well as with a reduction in bone pain, whereas the effects of treatment on the development or progression of PDB complications remain poorly understood. To date, different BPs have been successfully used for the treatment of PDB. In particular, the development of newer, more potent nitrogen-containing BPs (N-BPs) has remarkably improved treatment outcomes. These compounds have a high binding affinity to hydroxyapatite as well as increased potency in terms of inhibition of bone resorption, and can be given as either oral (alendronate and risedronate) or intravenous (zoledronate and neridronate) regimens. All N-BPs administered intravenously can induce an acute phase reaction (APR), essentially characterized by pyrexia, musculoskeletal pain and other flu-like symptoms, which may require intervention with analgesics and antipyretics. These symptoms are transient and occur predominantly on first exposure to the drug in most N-BP “naïve” patients (up to 40-70% of cases) and rarely with subsequent doses. However, despite its higher prevalence, preventative strategies against APR are not well established, so that APR remains the main reason leading to treatment discontinuation in N-BP users.
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