Giusti Andrea
Department of Gerontology and Musculoskeletal Sciences, Galliera Hospital, ASL3, Genoa, Italy,
J Bone Miner Metab. 2014 Nov;32(6):606-15. doi: 10.1007/s00774-014-0584-8. Epub 2014 Apr 21.
Bisphosphonates are potent inhibitors of bone resorption, widely used for the management of osteoporosis and fracture prevention. Recent evidence suggests that bisphosphonates may have beneficial effects in the treatment of thalassemia-associated osteoporosis, a complex and multifactorial condition. Here we summarise available data about the efficacy and tolerability of bisphosphonates in beta--thalassemic patients. Randomised controlled trials (RCTs) of bisphosphonates in beta-thalassemia were identified searching PubMed. Studies were reviewed to retrieve relevant clinical information. The following variables were considered to assess the safety and efficacy of bisphosphonates-bone mineral density (BMD), markers of bone turnover, incidence of fragility fracture, bone pain, back pain, and clinical adverse events. Five RCTs were identified, investigating alendronate, clodronate, zoledronic acid and neridronate. All bisphosphonates produced a significant decrease of the markers of bone turnover. Alendronate, neridronate, and zoledronic acid significantly improved BMD at the lumbar spine, femoral neck and total hip. Zoledronic acid and neridronate were also shown to reduce bone and back pain. Probably due to the small sample sizes and to the short duration of the trials, it was not possible to establish the anti-fracture efficacy of bisphosphonates; however, they were well tolerated and adverse events were rare but expected on the basis of previous studies. Sufficient evidence exists to support the use of bisphosphonates in the management of thalassemia-associated osteoporosis (to prevent bone loss and improve the BMD). Further research is warranted to establish their anti-fracture efficacy and long-term safety.
双膦酸盐是强效的骨吸收抑制剂，广泛用于治疗骨质疏松症和预防骨折。最近的证据表明，双膦酸盐可能对治疗地中海贫血相关的骨质疏松症有益，这是一种复杂的多因素疾病。在此，我们总结了关于双膦酸盐在β地中海贫血患者中的疗效和耐受性的现有数据。通过检索PubMed确定了双膦酸盐治疗β地中海贫血的随机对照试验（RCT）。对研究进行了综述以检索相关临床信息。考虑以下变量来评估双膦酸盐的安全性和疗效——骨矿物质密度（BMD）、骨转换标志物、脆性骨折发生率、骨痛、背痛和临床不良事件。确定了五项RCT，研究对象为阿仑膦酸盐、氯膦酸盐、唑来膦酸和奈立膦酸。所有双膦酸盐均使骨转换标志物显著降低。阿仑膦酸盐、奈立膦酸和唑来膦酸显著改善了腰椎、股骨颈和全髋的骨矿物质密度。唑来膦酸和奈立膦酸还显示可减轻骨痛和背痛。可能由于样本量小和试验持续时间短，无法确定双膦酸盐的抗骨折疗效；然而，它们耐受性良好，不良事件很少见，但根据先前研究是可以预期的。有充分的证据支持使用双膦酸盐治疗地中海贫血相关的骨质疏松症（以防止骨质流失并改善骨矿物质密度）。有必要进行进一步研究以确定其抗骨折疗效和长期安全性。
