Oregon Osteoporosis Center, Portland, OR 97213, USA.
Am J Med. 2013 Jan;126(1):13-20. doi: 10.1016/j.amjmed.2012.06.023. Epub 2012 Nov 20.
The amino-bisphosphonates are first-line therapy for the treatment of most patients with osteoporosis, with proven efficacy to reduce fracture risk at the spine, hip, and other nonvertebral skeletal sites. Further, bisphosphonates have been associated with a significant decrease in morbidity and increase in survival. Following the use of bisphosphonates in millions of patients in clinical practice, some unexpected possible adverse effects have been reported, including osteonecrosis of the jaw, atypical femur fractures, atrial fibrillation, and esophageal cancer. Because bisphosphonates are incorporated into the skeleton and continue to exert an antiresorptive effect for a period of time after dosing is discontinued, the concept of a drug holiday has emerged, whereby the risk of adverse effects might be decreased while the patient still benefits from antifracture efficacy. Patients receiving bisphosphonates who are not at high risk for fracture are potential candidates for a drug holiday, while for those with bone mineral density in the osteoporosis range or previous history of fragility fracture, the benefits of continuing therapy probably far outweigh the risk of harm.
氨基双膦酸盐是治疗大多数骨质疏松症患者的一线药物，已被证明可降低脊柱、髋部和其他非脊柱部位骨折的风险。此外，双膦酸盐还可显著降低发病率和提高生存率。在临床实践中，在数百万患者中使用双膦酸盐后，已报告了一些意想不到的可能的不良反应，包括颌骨坏死、非典型股骨骨折、心房颤动和食管癌。由于双膦酸盐被整合到骨骼中，并在停药后一段时间内继续发挥抗吸收作用，因此出现了药物假期的概念，即患者仍可受益于抗骨折疗效，同时降低不良反应的风险。对于没有骨折高风险的接受双膦酸盐治疗的患者，可能适合进行药物假期，而对于骨密度处于骨质疏松范围或有脆性骨折病史的患者，继续治疗的益处可能远远超过危害的风险。
