Metabolic Bone Disease Service, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
Osteoporos Int. 2013 Feb;24(2):423-32. doi: 10.1007/s00198-012-2113-8. Epub 2012 Sep 7.
The purpose of this systematic review is to evaluate the effects of methotrexate (MTX) and tumor necrosis factor-alpha (TNF-α) inhibitors on bone mineral properties in the clinical literature. A systematic review of the literature identifying relevant case reports, population-based studies, cohort studies, case control studies, and randomized controlled trials in Pubmed and Web of Science databases from inception to December 31, 2011 was conducted. The following keywords were used: "bone turnover," "bone mineral density," "TNF-α inhibitors," "infliximab," "adalimumab," "etanercept," and "MTX." The bibliographies of all retrieved studies were also reviewed to identify additional articles. Based on these results, a rational drug therapy strategy was suggested for treating osteoporosis in patients with inflammatory disease. MTX and TNF-α inhibitors do not appear to have an adverse effect on BMD in patients with inflammatory disease. Their negative effects on BMD and bone turnover in pre-clinical models appear to be outweighed by their anti-disease effects in clinical studies. Treatment with MTX or TNF-α inhibitors has no adverse effect on BMD in patients with inflammatory disease. Future studies will focus on developing optimal drug strategies when combining DMARDs with anti-osteoporotic agents in this patient population.
本系统评价的目的是评估在临床文献中，甲氨蝶呤（MTX）和肿瘤坏死因子-α（TNF-α）抑制剂对骨矿物质特性的影响。通过在 Pubmed 和 Web of Science 数据库中对从起始时间到 2011 年 12 月 31 日的相关病例报告、基于人群的研究、队列研究、病例对照研究和随机对照试验进行系统的文献回顾，使用了以下关键字：“骨转换”、“骨矿物质密度”、“TNF-α 抑制剂”、“英夫利昔单抗”、“阿达木单抗”、“依那西普”和“MTX”。还对所有检索到的研究的参考文献进行了审查，以确定其他文章。基于这些结果，为治疗炎症性疾病患者的骨质疏松症提出了合理的药物治疗策略。MTX 和 TNF-α 抑制剂似乎不会对炎症性疾病患者的 BMD 产生不利影响。在临床研究中，它们对 BMD 和骨转换的负面影响似乎超过了其抗疾病的效果。在炎症性疾病患者中，MTX 或 TNF-α 抑制剂的治疗对 BMD 没有不良影响。未来的研究将集中于在这一患者人群中，当联合 DMARDs 和抗骨质疏松药物时，制定最佳药物治疗策略。
