Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne, UK.
Maturitas. 2012 Jan;71(1):76-8. doi: 10.1016/j.maturitas.2011.10.005. Epub 2011 Nov 10.
In the past 15 years, oral bisphosphonate therapy has become the mainstay of pharmacological management in patients with osteoporosis. In the UK, alendronate is the drug of first choice, based on clinical efficacy data and cost. However, some patients are unable to take oral bisphosphonates for a number of reasons. In this article, we review the practical management of such cases, including strategies for monitoring adherence and switching to alternative oral agents (e.g. risedronate, strontium ranelate, raloxifene). In some cases, alternative parenteral agents may be considered, including intravenous bisphosphonates, parathyroid hormone therapies and denosumab. Specific concerns about safe prescribing are considered, when prescribing potent anti-resorptive medications, particularly relating to renal function and vitamin D deficiency. Finally, consideration is given to clinical risk factors, including aspects of lifestyle which may be modified to decrease fracture risk.
在过去的 15 年中，口服双膦酸盐疗法已成为骨质疏松症患者药物治疗的主要手段。在英国，根据临床疗效数据和成本，阿仑膦酸钠是首选药物。然而，由于多种原因，有些患者无法服用口服双膦酸盐。本文综述了此类病例的实际处理方法，包括监测依从性和改用其他口服药物（如利塞膦酸钠、雷奈酸锶、雷诺昔芬）的策略。在某些情况下，可能会考虑使用其他的注射用药物，包括静脉用双膦酸盐、甲状旁腺激素治疗和地舒单抗。在开具强效抗吸收药物时，特别是与肾功能和维生素 D 缺乏有关时，会考虑安全用药的具体问题。最后，还考虑了临床风险因素，包括可能降低骨折风险的生活方式方面。
