Faculty of Medicine of Geneva, Division of Bone Diseases, Department of Rehabilitation and Geriatrics, University Hospitals, CH_1211 Geneva 14, Switzerland.
QJM. 2011 Apr;104(4):281-300. doi: 10.1093/qjmed/hcq259. Epub 2011 Jan 21.
The primary goal of treatment for post-menopausal osteoporosis (PMO) is reduction in fracture risk. Therefore, clinicians must recommend therapies that are safe and have proven anti-fracture efficacy. Bisphosphonates have long been established as first-line therapy for osteoporosis and several of these drugs significantly reduce osteoporotic fracture risk. However, choosing among different bisphosphonates can represent a difficult clinical decision. This review outlines the pharmacology of various bisphosphonates, discusses how their pharmacological characteristics affect their efficacy, and summarizes clinical safety and efficacy data. Clinical trial data and the opinions of expert bodies suggest that alendronate, risedronate, ibandronate and zoledronic acid all provide fracture protection for patients with PMO. However, there are differences among these agents. For example, all four agents have demonstrated efficacy in preventing vertebral fractures, but only zoledronic acid and risedronate significantly reduce non-vertebral fracture risk in pivotal trials. Moreover, reduction in hip fracture risk has only been established for alendronate, risedronate and zoledronic acid. Current data suggest that ibandronate and zoledronic acid have the most persistent antifracture effect. Bisphosphonates have been associated with a number of side effects, the evidence for which is summarized in this review. The most pertinent of these when choosing a bisphosphonate for a particular patient are the well-documented associations between gastrointestinal adverse events and oral administration, and between acute phase reactions and intravenous administration. Ultimately, selection of a specific bisphosphonate for treatment of PMO should be based on efficacy, risk profile, cost-effectiveness and patient preference.
治疗绝经后骨质疏松症（PMO）的主要目标是降低骨折风险。因此，临床医生必须推荐安全且具有抗骨折疗效的治疗方法。双膦酸盐长期以来一直被确立为骨质疏松症的一线治疗药物，其中几种药物可显著降低骨质疏松性骨折风险。然而，在不同的双膦酸盐之间进行选择可能是一个困难的临床决策。本综述概述了各种双膦酸盐的药理学特性，讨论了它们的药理学特征如何影响其疗效，并总结了临床安全性和疗效数据。临床试验数据和专家机构的意见表明，阿仑膦酸钠、利塞膦酸钠、伊班膦酸钠和唑来膦酸均可为 PMO 患者提供骨折保护。然而，这些药物之间存在差异。例如，所有四种药物均已证明可有效预防椎体骨折，但只有唑来膦酸和利塞膦酸钠在关键性试验中显著降低了非椎体骨折风险。此外，只有阿仑膦酸钠、利塞膦酸钠和唑来膦酸降低了髋部骨折风险。目前的数据表明，伊班膦酸钠和唑来膦酸具有最持久的抗骨折效果。双膦酸盐与许多副作用有关，本综述总结了相关证据。在为特定患者选择双膦酸盐时，最相关的是口服给药与胃肠道不良反应以及静脉给药与急性期反应之间的明确关联。最终，选择特定的双膦酸盐治疗 PMO 应基于疗效、风险状况、成本效益和患者偏好。
