Lanza Frank L
Section of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA.
Treat Endocrinol. 2002;1(1):37-43. doi: 10.2165/00024677-200201010-00004.
The bisphosphonate class of drugs are now utilized extensively in the treatment of patients with osteoporosis and Paget's disease. Gastrointestinal (GI) adverse effects, especially those associated with esophageal injury, have been of increasing concern to clinicians. Studies in humans and animals have shown that the mucosal erosion and ulceration seen with bisphosphonates is a result of direct contact with these agents. Numerous endoscopic studies in healthy volunteers and postmenopausal women have also demonstrated the potential of bisphosphonates to cause stomach and duodenal ulcers. However, serious GI adverse events have not been noted in several large efficacy trials. Esophageal injury has for the most part been avoided by appropriate administration instructions, and gastroduodenal injury appears to be an acute phenomenon not associated with significant complications, except in certain high-risk situations, for example in the presence of existing distal esophageal disease or motility disorders, or with concurrent use of nonsteroidal anti-inflammatory drugs or anticoagulants. From the standpoint of GI safety, the bisphosphonates are well tolerated and not associated with serious adverse events.
双膦酸盐类药物目前广泛应用于骨质疏松症和佩吉特病患者的治疗。胃肠道（GI）不良反应，尤其是与食管损伤相关的不良反应，越来越受到临床医生的关注。人和动物研究表明，双膦酸盐类药物导致的黏膜糜烂和溃疡是与这些药物直接接触的结果。对健康志愿者和绝经后女性进行的大量内镜研究也证实了双膦酸盐类药物有导致胃和十二指肠溃疡的可能性。然而，在几项大型疗效试验中并未发现严重的胃肠道不良事件。通过适当的给药说明，食管损伤在很大程度上已得以避免，胃十二指肠损伤似乎是一种急性现象，除了在某些高危情况下，例如存在远端食管疾病或动力障碍，或同时使用非甾体抗炎药或抗凝剂时，一般不会伴有严重并发症。从胃肠道安全性的角度来看，双膦酸盐类药物耐受性良好，且与严重不良事件无关。
