Dunn Rebecca L, Bird Matthew L, Conway Susan E, Stratton Mark A
Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, Oklahoma 73117, USA.
Consult Pharm. 2013 Jan;28(1):39-57. doi: 10.4140/TCP.n.2013.39.
To assess the benefits and risks of long-term bisphosphonates for treatment of osteoporosis in older adults.
A MEDLINE search was performed using PubMed from 1966 through 2011 to identify relevant publications. Key words searched included: adverse effects (AEs), aged, alendronate, atrial fibrillation, atypical fractures, bisphosphonate-associated osteonecrosis of the jaw, bisphosphonates, diaphyseal fractures, gastrointestinal cancer, ibandronate, musculoskeletal pain, osteoporosis, risedronate, subtrochanteric fractures, and zoledronic acid. Additional sources were obtained through bibliographic review of selected articles.
Relevant studies that examined efficacy and safety of bisphosphonates in the treatment of osteoporosis were included. Focus was given to data involving older adults. Stronger levels of evidence (prospective trials) were given preference as the predominant body of literature, when available.
Osteoporosis affects millions of elderly patients. Bisphosphonates represent first-line therapy. Recent literature has heightened concerns regarding AEs associated with long-term use, leading to the proposition of a "drug holiday." Additionally, there is a lack of literature concerning management of bisphosphonates in older adults.
Evidence indicates that bisphosphonates maintain their efficacy and safety in older adults. Consideration must be given on a case-by-case basis to potential AEs associated with long-term use, as well as the derived benefit. Drug holidays may be appropriate given consideration of certain patient characteristics. Well-designed, prospective studies are needed to evaluate long-term use and AEs in older adults; therefore, clinical judgment combined with available evidence will have to suffice as the current practice.
评估长期使用双膦酸盐类药物治疗老年人骨质疏松症的获益与风险。
利用PubMed对1966年至2011年期间的文献进行检索，以识别相关出版物。检索关键词包括：不良反应（AEs）、老年人、阿仑膦酸盐、心房颤动、非典型骨折、双膦酸盐相关颌骨坏死、双膦酸盐类药物、骨干骨折、胃肠道癌、伊班膦酸盐、肌肉骨骼疼痛、骨质疏松症、利塞膦酸盐、转子下骨折和唑来膦酸。通过对所选文章的文献综述获取其他资料来源。
纳入了考察双膦酸盐类药物治疗骨质疏松症疗效和安全性的相关研究。重点关注涉及老年人的数据。如有可能，优先选择证据强度更高的（前瞻性试验）作为主要文献主体。
骨质疏松症影响着数百万老年患者。双膦酸盐类药物是一线治疗药物。近期文献加剧了对长期使用相关不良反应的担忧，从而提出了“药物假期”的建议。此外，关于老年人双膦酸盐类药物管理的文献较少。
证据表明双膦酸盐类药物在老年人中保持其疗效和安全性。必须根据具体情况考虑与长期使用相关的潜在不良反应以及所获得的益处。鉴于某些患者特征，药物假期可能是合适的。需要设计良好的前瞻性研究来评估老年人的长期使用情况和不良反应；因此，目前的实践中必须将临床判断与现有证据相结合。
