Borrelli Joseph, Lane Joseph, Bukata Susan, Egol Kenneth A, Takemoto Richelle, Slobogean Gerard, Morshed Saam
*Borrelli Department of Orthopedic Surgery, Texas Health Arlington Memorial Hospital, Arlington, TX; †Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY; ‡Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA; §Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY; ‖Lihue, Hawaii; ¶Division of Orthopaedic Trauma, University of British Columbia, Hamilton, Ontario, Canada; and **Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA.
J Orthop Trauma. 2014;28 Suppl 1:S36-42. doi: 10.1097/BOT.0000000000000073.
Osteoporosis (OP) results from an imbalance between bone production and absorption that results in decreased bone mass and microstructural deterioration of the bone trabeculae, leading to diminished bone quality and fragility fractures. It is synonymous with decreased bone strength and affects millions of people worldwide. The most commonly prescribed drugs for the treatment of OP are the bisphosphonates (BPs). Long-term BP use may be associated with stress fractures of the subtrochanteric and shaft regions of the femur known as atypical femur fractures (AFFs). Although AFFs can be devastating, BPs have decreased the number of low-energy hip fractures and the number of vertebral and nonvertebral fractures that occur each year. Many trials and population-based studies have assessed the association between AFF and BP, and several studies have attempted to establish AFF's true incidence. The authors will summarize a few of the major studies and discuss their strengths and limitations. The findings of an association between BPs and AFFs have been variable and may reflect sample selection and measurement bias. AFFs are uncommon; the increase in risk associated with BP use is very small and does not outweigh the benefit of fracture prevention in patients with OP. Evidence for the efficacy of BPs for the prevention of fractures in postmenopausal women with OP is very strong, and the current clinical practice of using BPs as first-line therapy for these patients should be continued. Further information is required to determine the appropriate duration and time of discontinuation of BP therapy.
骨质疏松症（OP）是由骨生成与骨吸收之间的失衡所致，这会导致骨量减少以及骨小梁的微观结构恶化，进而致使骨质量下降和脆性骨折。它等同于骨强度降低，影响着全球数百万人。治疗OP最常用的药物是双膦酸盐类（BPs）。长期使用BPs可能与股骨转子下和骨干区域的应力性骨折相关，这种骨折被称为非典型股骨骨折（AFFs）。尽管AFFs可能具有破坏性，但BPs已减少了每年发生的低能量髋部骨折以及椎体和非椎体骨折的数量。许多试验和基于人群的研究评估了AFF与BP之间的关联，并且有几项研究试图确定AFF的真实发病率。作者将总结一些主要研究，并讨论它们的优点和局限性。BPs与AFFs之间存在关联的研究结果各不相同，这可能反映了样本选择和测量偏差。AFFs并不常见；与使用BP相关的风险增加非常小，且不超过OP患者预防骨折的益处。BPs对预防绝经后OP女性骨折疗效的证据非常充分，目前将BPs作为这些患者一线治疗的临床实践应继续。需要更多信息来确定BP治疗的合适疗程和停药时间。
