Hochberg M
Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, USA.
Drugs Aging. 2000 Oct;17(4):317-30. doi: 10.2165/00002512-200017040-00007.
The evidence from randomised, controlled trials of the ability of antiresorptive treatments to reduce the risk of fractures in postmenopausal women with osteoporosis is reviewed and summarised. The aminobisphosphonates, alendronic acid and risedronic acid, and the selective estrogen receptor modulator raloxifene have all been shown to reduce the incidence of radiographic vertebral fractures. Only alendronic acid and risedronic acid have been shown to reduce the incidence of non-spine fractures in women with postmenopausal osteoporosis. There is evidence of antifracture efficacy for calcium plus vitamin D, primarily in a nursing home setting or in people with low intakes of these nutrients. Furthermore, since both the placebo and active treatment groups received calcium and vitamin D in most controlled trials of antiresorptive agents, it appears that the other agents provide benefits beyond those of calcium and vitamin D alone. There is insufficient published evidence from randomised controlled trials to convincingly support the antifracture efficacy of other agents, including calcitonin, estrogen and etidronic acid, at this time. Data from observational studies suggest, however, that estrogen and etidronic acid may have antifracture efficacy in this population.
本文回顾并总结了随机对照试验的证据，这些证据涉及抗吸收治疗降低绝经后骨质疏松症女性骨折风险的能力。氨基双膦酸盐、阿仑膦酸和利塞膦酸，以及选择性雌激素受体调节剂雷洛昔芬，均已显示可降低影像学椎体骨折的发生率。仅阿仑膦酸和利塞膦酸已显示可降低绝经后骨质疏松症女性非脊柱骨折的发生率。有证据表明钙加维生素D具有抗骨折疗效，主要是在疗养院环境中或这些营养素摄入量低的人群中。此外，由于在大多数抗吸收药物的对照试验中，安慰剂组和活性治疗组均接受了钙和维生素D，因此其他药物似乎提供了超出单独钙和维生素D的益处。目前，随机对照试验中发表的证据不足，无法令人信服地支持其他药物（包括降钙素、雌激素和依替膦酸）的抗骨折疗效。然而，观察性研究的数据表明，雌激素和依替膦酸在该人群中可能具有抗骨折疗效。
