Cesareo R, Iozzino M, Alva D, Napolitano C, De Rosa B, Contini S, Mallardo L, Lauria A, Reda G, Orsini A
Unit of Internal Medicine, S. Maria Goretti Public Hospital, Latina, Italy.
Minerva Endocrinol. 2007 Dec;32(4):275-95.
Osteoporosis and fractures associated with it constitute a real and serious socio-medical problem, which only recently has come to the forefront of social consciousness. The authors are carrying out a critical re-examination of the medical literature of osteoporosis pharmacological treatment. Particular attention has been paid to studies which show a clear reduction of the primary endpoint that, in the case of this pathology, consists of a reduction of the fracturing event. According to the examination of the clinical studies introduced, antiresorptive bone agents, such as alendronate and risenderonate, turn out to be molecules with higher levels of evidence implicated on the reduction of the main osteoporotic fractures, in particular the reduction of vertebral and femoral fractures. The 10 years long-term extension studies, in particular those that have seen the employment of alendronate, found a positive outcome regarding densitometry data and a favorable trend in antifracture effectiveness. Ibandronate is another amino-bisphosphonate which was recently validated as an effective drug for the treatment of osteoporosis with its documented ability to meaningfully reduce vertebral fractures. Also ranelate of strontium, a drug that seems to explain its own result in a different way from the other antiresorptive bone agents, constitutes another valid alternative in the treatment of this pathology. Both of these molecules however, need further studies in order to estimate their antifracture effectiveness in the long term, particularly those related to femoral fractures. Teriparatide and the entire molecule paratohormone are usually not prescribed for its high cost in treatment and because, typically, patients with high-risk level fractures that are already affected, produce more vertebral fractures from moderate to severe intensity.
骨质疏松症及其相关骨折构成了一个现实且严重的社会医学问题，直到最近才成为社会意识的焦点。作者正在对骨质疏松症药物治疗的医学文献进行批判性重新审视。特别关注那些显示主要终点明显降低的研究，在这种疾病中，主要终点是骨折事件的减少。根据对所引入的临床研究的审查，抗吸收骨药物，如阿仑膦酸盐和利塞膦酸盐，被证明是对减少主要骨质疏松性骨折，特别是减少椎体和股骨骨折有更高证据水平的分子。长达10年的长期扩展研究，特别是那些使用阿仑膦酸盐的研究，在骨密度测量数据方面取得了积极成果，并且在抗骨折有效性方面呈现出有利趋势。伊班膦酸盐是另一种氨基双膦酸盐，最近被确认为治疗骨质疏松症的有效药物，其有记录的显著降低椎体骨折的能力。锶盐雷奈酸，一种似乎以与其他抗吸收骨药物不同的方式解释其效果的药物，也是治疗这种疾病的另一种有效选择。然而，这两种分子都需要进一步研究，以评估它们长期的抗骨折有效性，特别是与股骨骨折相关的有效性。特立帕肽和整个甲状旁腺激素分子通常因其治疗成本高而不被处方，而且通常已经受影响的高风险骨折患者会产生更多中度至重度强度的椎体骨折。
