Bilezikian John P
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Int J Fertil Womens Med. 2005 Mar-Apr;50(2):53-60.
Until recently, calcium supplementation with vitamin D and hormone replacement therapy were the mainstays of treating osteoporosis associated with the menopause. Hormone replacement therapy, indeed, was (and is) effective in preventing fracture, but is no longer to be considered to be a primary indication for this purpose. Thus, while continuing with calcium and vitamin D, drug therapy now consists of the antiresorptive agents: raloxifene, calcitonin, and the bisphosphonates. These drugs reduce bone turnover, and do prevent fractures, but are limited to halting further deterioration of skeletal microarchitecture. The newest agent against osteoporosis is teriparatide, an amino terminal fragment parathyroid hormone containing 34 amino acids. PTH(1-34), or teriparatide, exhibits many of the classical actions of the whole molecule. It is anabolic with respect to bone when used according to well-defined protocols. Bone microarchitecture is restored with increases in cortical thickness and in connectivity. This paper describes the activities as known at present of the bisphosphonates and of teriparatide and reviews studies of their use alone and in combination with each other.
直到最近，补充钙与维生素D以及激素替代疗法一直是治疗绝经相关骨质疏松症的主要方法。事实上，激素替代疗法过去（现在依然）对预防骨折有效，但不再被视为用于此目的的主要指征。因此，在继续补充钙和维生素D的同时，药物治疗现在包括抗吸收剂：雷洛昔芬、降钙素和双膦酸盐类药物。这些药物可降低骨转换，确实能预防骨折，但仅限于阻止骨骼微结构的进一步恶化。最新的抗骨质疏松药物是特立帕肽，一种含34个氨基酸的甲状旁腺激素氨基末端片段。PTH(1-34)，即特立帕肽，具有全分子的许多经典作用。按照明确的方案使用时，它对骨骼具有合成代谢作用。随着皮质厚度和连通性的增加，骨微结构得以恢复。本文描述了目前已知的双膦酸盐类药物和特立帕肽的作用，并综述了它们单独使用以及联合使用的研究情况。
