Lewiecki E Michael
New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM 87106, USA.
Curr Med Res Opin. 2007 Nov;23(11):2617-25. doi: 10.1185/030079907x233278.
Osteoporosis is a common disease associated with diminished bone strength and increased risk of fracture. With the aging of the population, the number of people with osteoporosis, particularly postmenopausal women, is expected to increase. There are excellent tools for diagnosing osteoporosis and widely available treatments that are safe and effective. Nevertheless, osteoporosis is underdiagnosed and undertreated. Even among those who are diagnosed and treated, widespread nonadherence with treatment regimens undermines the efficacy of osteoporosis therapy.
To examine the pharmacological options for the treatment of postmenopausal osteoporosis and the influence of extended dosing intervals upon outcomes, medication adherence, and patient preference.
A Medline and Cochrane Review database search was conducted for appropriate clinical trials, meta-analyses, and systematic reviews published between 1987 and 2007.
The causes of nonadherence include poor understanding of the consequences of a silent disease, concern regarding potential side-effects of medications, the inconvenience associated with administration of some osteoporosis medications, and medication costs. The recent development of effective oral and injectable osteoporosis medications that can be given with long dosing intervals may improve patient adherence. Less frequent dosing lessens the inconvenience of administration, and dosing by injection assures that the medication is 100% bioavailable. Osteoporosis patients have shown a preference for monthly bisphosphonate dosing compared with weekly dosing.
Enhanced adherence with new dosing regimens can be expected to improve treatment efficacy, reduce fracture risk, and lessen the burden of osteoporosis on patients and society. Further study is required to fully elucidate the relationship between extended dosing, adherence, and positive outcomes.
骨质疏松症是一种常见疾病，与骨强度降低及骨折风险增加相关。随着人口老龄化，骨质疏松症患者数量，尤其是绝经后女性患者数量预计将会增加。目前有用于诊断骨质疏松症的优良工具以及广泛可得的安全有效的治疗方法。然而，骨质疏松症仍存在诊断不足和治疗不足的情况。即便在那些已被诊断并接受治疗的患者中，普遍存在的不依从治疗方案的情况也会削弱骨质疏松症治疗的效果。
探讨绝经后骨质疏松症的药物治疗选择以及延长给药间隔对治疗效果、药物依从性和患者偏好的影响。
对1987年至2007年间发表的相关临床试验、荟萃分析和系统评价进行了Medline和Cochrane综述数据库检索。
不依从的原因包括对这种隐匿性疾病后果的认识不足、对药物潜在副作用的担忧、某些骨质疏松症药物给药带来的不便以及药物费用。近期开发出的可延长给药间隔的有效口服和注射用骨质疏松症药物可能会提高患者的依从性。给药频率降低可减少给药的不便，而注射给药可确保药物100%生物利用度。与每周给药相比，骨质疏松症患者表现出对每月一次双膦酸盐给药的偏好。
有望通过提高对新给药方案的依从性来提高治疗效果、降低骨折风险并减轻骨质疏松症对患者及社会的负担。需要进一步研究以充分阐明延长给药、依从性和积极治疗效果之间的关系。
