Columbia University College of Physicians and Surgeons, New York, NY, USA;
Int J Womens Health. 2010 Aug 9;1:1-9. doi: 10.2147/ijwh.s3789.
Bisphosphonates are the mainstay of treatment for postmenopausal women with osteoporosis. Despite numerous clinical trials documenting efficacy, tolerability, and safety of bisphosphonate therapy, long-term persistence and adherence to these agents remains low. This has serious consequences for patients with osteoporosis in that medication non-compliance is associated with significantly higher fracture risk. This review explores the unique physicochemical properties of bisphosphonates that allow more convenient intermittent dosing and whether less frequent dosing regimens improve compliance. Bisphosphonates are now available as oral drugs (taken daily, weekly, or monthly) or as intravenous preparations (given every 3 months or annually). The safety and efficacy of these various preparations are reviewed and compared, with particular emphasis on the newest agent to be approved, once-monthly risedronate. In contrast to monthly oral ibandronate, risedronate is the first and only monthly oral bisphosphonate to offer both vertebral and non-vertebral fracture reduction, based upon non-inferiority trials. Whether the greater convenience of this monthly oral bisphosphonate will translate into improved compliance and lower fracture risk is yet to be determined.
双膦酸盐是治疗绝经后骨质疏松症妇女的主要药物。尽管有许多临床试验记录了双膦酸盐治疗的疗效、耐受性和安全性，但长期坚持和使用这些药物的依从性仍然很低。这对骨质疏松症患者来说后果严重，因为药物不依从与更高的骨折风险显著相关。这篇综述探讨了双膦酸盐独特的物理化学性质，这些性质允许更方便的间歇性给药，以及更不频繁的给药方案是否能提高依从性。双膦酸盐现在有口服药物（每日、每周或每月服用）或静脉制剂（每 3 个月或每年给药一次）。本文综述并比较了这些不同制剂的安全性和疗效，特别强调了最近批准的新型药物，即每月一次的利塞膦酸钠。与每月口服伊班膦酸钠相比，利塞膦酸钠是第一个也是唯一一个基于非劣效性试验，既能减少椎体骨折又能减少非椎体骨折的每月口服双膦酸盐。这种每月口服双膦酸盐更方便是否会转化为更高的依从性和更低的骨折风险，还有待确定。
