Rubin Mishaela R, Bilezikian John P
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Drugs. 2005;65(17):2481-98. doi: 10.2165/00003495-200565170-00005.
The quest for effective treatment for osteoporosis merits great attention because of the widespread prevalence of this disease, which is not only associated with fragility fractures, but also with significant morbidity and mortality. The efficacy of the antiresorptive drugs in this disease is achieved by reducing bone turnover, increasing bone density and improving other aspects of bone quality. This article concentrates on another approach to the treatment of osteoporosis, namely the use of anabolic therapy, which has even greater prospects for improving bone quality. Parathyroid hormone (PTH) is currently available only as the recombinant amino-terminal fragment, PTH(1-34), known as teriparatide. The full-length molecule, human PTH(1-84), is currently being investigated, as are other PTH molecules. Teriparatide improves bone quality through actions on bone turnover, bone density, bone size and bone microarchitecture. In postmenopausal women with osteoporosis, teriparatide reduces the incidence of vertebral and nonvertebral fractures. In individuals who have previously been treated with an antiresorptive agent, the subsequent actions of teriparatide on bone density are transiently delayed if bone turnover has been markedly suppressed. Combination therapy with teriparatide or PTH(1-84) and an antiresorptive agent does not appear, at this time, to offer advantages over the use of PTH or an antiresorptive agent alone. However, in order to maintain the densitometric gains in bone density obtained with PTH, it is important to follow its use with that of an antiresorptive agent.
由于骨质疏松症的广泛流行，对其有效治疗方法的探索值得高度关注。这种疾病不仅与脆性骨折相关，还与显著的发病率和死亡率有关。抗吸收药物在该疾病中的疗效是通过降低骨转换、增加骨密度和改善骨质量的其他方面来实现的。本文着重探讨治疗骨质疏松症的另一种方法，即使用合成代谢疗法，这种方法在改善骨质量方面具有更大的前景。甲状旁腺激素（PTH）目前仅以重组氨基末端片段PTH(1 - 34)的形式存在，即特立帕肽。全长分子人PTH(1 - 84)以及其他PTH分子目前正在研究中。特立帕肽通过对骨转换、骨密度、骨大小和骨微结构的作用来改善骨质量。在患有骨质疏松症的绝经后女性中，特立帕肽可降低椎体和非椎体骨折的发生率。在先前接受过抗吸收剂治疗的个体中，如果骨转换已被显著抑制，特立帕肽随后对骨密度的作用会暂时延迟。目前，特立帕肽或PTH(1 - 84)与抗吸收剂的联合治疗似乎并不比单独使用PTH或抗吸收剂更具优势。然而，为了维持使用PTH所获得的骨密度增加，在使用PTH后使用抗吸收剂很重要。
