Carmona Raj, Adachi Rick
Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Patient Prefer Adherence. 2009 Nov 3;3:189-93. doi: 10.2147/ppa.s3494.
Oral bisphosphonates are of proven efficacy in preventing fractures in postmenopausal osteoporosis. However, poor adherence limits their real-world efficacy and clinical utility. Zoledronic acid (ZOL) is a potent bisphosphonate administered by annual intravenous infusion, effectively ensuring adherence to therapy over the following year. According to available data, 66% to 79% of patients have expressed a preference for ZOL over oral bisphosphonates. This is likely to lead to enhanced clinical outcomes, although long-term (repeat annual) adherence is currently unknown. ZOL is of proven efficacy, with hip fracture reduction of 41% and morphometric vertebral fracture reduction of 70% over 3 years in the HORIZON PFT trial. It has demonstrated a good side-effect profile with postinfusion flu-like symptoms being the most common. Additionally, it has been associated with decreased mortality in patients following surgery for hip fracture. There is no clear association between exposure and the rate of serious or nonserious atrial fibrillation. We review adherence to oral bisphosphonates, and the pharmacokinetics, efficacy, safety, and patient preference for ZOL.
口服双膦酸盐在预防绝经后骨质疏松症骨折方面已被证实具有疗效。然而，依从性差限制了它们在实际应用中的疗效和临床效用。唑来膦酸（ZOL）是一种强效双膦酸盐，通过每年静脉输注给药，有效地确保了患者在接下来的一年中坚持治疗。根据现有数据，66%至79%的患者表示相较于口服双膦酸盐，他们更倾向于使用ZOL。这可能会带来更好的临床效果，尽管目前尚不清楚长期（每年重复）使用的依从性情况。在HORIZON PFT试验中，ZOL已被证实具有疗效，在3年内可使髋部骨折减少41%，形态计量学椎体骨折减少70%。它已显示出良好的副作用特征，输注后流感样症状最为常见。此外，它与髋部骨折手术后患者的死亡率降低有关。暴露与严重或非严重心房颤动的发生率之间没有明确关联。我们综述了口服双膦酸盐的依从性，以及ZOL的药代动力学、疗效、安全性和患者偏好。
