从药物假期谈双膦酸盐在老年骨质疏松症患者中的合理应用

摘要

Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue,which leads to increased bone fragility and consequent increased risk of fracture.Bisphosphonates (BPs),the most widely used anti-osteoporosis drugs,can reduce the risk for vertebral,non-vertebral and hip fractures effectively.Following the long-term use of BPs,their effectiveness decreases,while serious complications,for example,atypical femur fractures and osteonecrosis of the jaw increase.In general,the recommended course of treatment using BPs is 3-5 years,followed by drug holiday.During the drug holiday,attention should be paid to detect the changes in bone mineral density (BMD) and bone turnover markers (BTMs) regularly,in order to determine the subsequent treatment.In general,for patients who have low BTMs levels and stable BMD,drug holiday should continue,for patients who have increased BTMs and decreased BMD,antiresorptive drugs should be given,and for those who have low BTMs and decreased BMD,osteoanabolic treatment should be considered.%骨质疏松症(osteoporosis,OP)是一种以骨量低下、骨微结构破坏,导致骨脆性增加、易发生骨折为特征的全身性疾病.双膦酸盐是目前最常用的抗OP药物,它能有效降低OP患者椎体、非椎体和髋部骨折的风险.但是长期使用双膦酸盐类药物会出现疗效下降,并诱发不典型骨折和下颌骨坏死等严重并发症.目前一般建议连续使用双膦酸盐药物3～5年后,就进入药物假期.在药物假期期间,应注意定期检测骨密度(bone mineral density,BMD)和骨转换标志物(bone turnover markers, BTMs),并根据两者的变化,来决定下一步治疗方案.一般来说,如BTMs水平较低、BMD稳定,则药物假期继续;如BTMs水平增高、BMD下降,应重新接受抗骨吸收治疗;如BTMs水平较低、BMD下降,则应考虑改用特立帕肽成骨治疗.