Soen Satoshi
Department of Orthopaedic Surgery and Rheumatology, Nara Hospital, Kinki University School of Medicine, Japan.
Clin Calcium. 2012 Jun;22(6):919-22.
Recent studies indicating a relationship between duration of bisphosphonate therapy and risk of atypical femoral fractures, together with epidemiological data demonstrating divergent trends in hip versus subtrochanteric fracture incidence, support the contention that there is an association between bisphosphonate therapy and atypical femoral fractures. However, although there are biologically plausible mechanisms by which bisphosphonates may impair bone strength, a direct causal association has yet to be established. The vast majority of patients treated with bisphosphonates do not develop atypical femoral fractures despite suppressed bone turnover, and, moreover, there is no evidence that suppression is greater in those with than without atypical fractures. Current evidence suggests that bisphosphonates, whilst not a prerequisite for the development of atypical femoral fractures, may contribute to their development in some cases. Identification of the factors that predispose individuals to develop these rare fractures may hold the key to uncovering their pathophysiology. The benefits of bisphosphonates use outweigh the risks.
近期研究表明双膦酸盐治疗的持续时间与非典型股骨骨折风险之间存在关联，同时流行病学数据显示髋部骨折与转子下骨折的发生率呈现不同趋势，这些都支持了双膦酸盐治疗与非典型股骨骨折之间存在关联这一观点。然而，尽管有生物学上合理的机制表明双膦酸盐可能损害骨强度，但尚未确立直接的因果关系。绝大多数接受双膦酸盐治疗的患者尽管骨转换受到抑制，但并未发生非典型股骨骨折，此外，没有证据表明发生非典型骨折的患者的骨转换抑制程度比未发生骨折的患者更大。目前的证据表明，双膦酸盐虽然不是非典型股骨骨折发生的先决条件，但在某些情况下可能促使其发生。识别使个体易发生这些罕见骨折的因素可能是揭示其病理生理学的关键。使用双膦酸盐的益处大于风险。
