Brar K S
Classified Specialist (Medicine & Endocrinology), Command Hospital (EC), Kolkata-27.
Med J Armed Forces India. 2010 Jul;66(3):249-54. doi: 10.1016/S0377-1237(10)80050-4. Epub 2011 Jul 21.
Osteoporosis and fractures associated with it constitute a real and serious socio-medical problem, which only recently has come to the forefront of social consciousness. With increasing number of exservicemen and their dependents, osteoporosis management has become very important in our setup. Currently available pharmacological therapies for prevention of fragility fractures are limited in scope, efficacy and acceptability to patients. Oral bisphosphonates are the standard treatment for osteoporosis which are associated with significant gastrointestinal side effects and thus poor patient compliance. Newer regimens, including intravenous (IV) formulations of bisphosphonates, have successfully come in vogue with greater patient compliance and equal or better benefits. The real need in osteoporosis treatment is for additional anabolic drugs. The only currently approved anabolic agent for treating osteoporosis is teriparatide (recombinant human parathyroid hormone 1-34), which stimulates new bone formation. Considerable efforts are being made to develop new, more effective treatment for osteoporosis. These novel drugs under trial include those primarily inhibiting osteoclastic bone resorption (like bisphosphonates) such as inhibitors of receptor activator of nuclear factor-kappa B ligand (RANKL) signalling, cathepsin K inhibitors, c-Src kinase inhibitors, integrin inhibitors, chloride channel inhibitors and the drugs with osteo-anabolic actions such as orally active parathyroid hormone (PTH) analogues, calcium sensing receptor antagonists, PTH-related peptide analogues and agents that induce osteoblast anabolism via pathways involving key, recently identified, molecular targets (wnt low-density lipoprotein receptor-related protein-5 signalling; sclerostin antibodies).
骨质疏松症及其相关骨折构成了一个现实且严重的社会医学问题，直到最近才成为社会关注的焦点。随着退役军人及其家属数量的增加，骨质疏松症的管理在我们的医疗体系中变得非常重要。目前用于预防脆性骨折的药物治疗在范围、疗效和患者可接受性方面都存在局限性。口服双膦酸盐是治疗骨质疏松症的标准方法，但会产生明显的胃肠道副作用，因此患者依从性较差。包括双膦酸盐静脉制剂在内的新治疗方案已成功流行起来，患者依从性更高，且疗效相同或更好。骨质疏松症治疗真正需要的是更多的促合成代谢药物。目前唯一被批准用于治疗骨质疏松症的促合成代谢药物是特立帕肽（重组人甲状旁腺激素1-34），它能刺激新骨形成。人们正在付出巨大努力来开发新的、更有效的骨质疏松症治疗方法。这些正在试验的新型药物包括主要抑制破骨细胞骨吸收的药物（如双膦酸盐），如核因子-κB受体活化因子配体（RANKL）信号抑制剂、组织蛋白酶K抑制剂、c-Src激酶抑制剂、整合素抑制剂、氯离子通道抑制剂，以及具有骨促合成代谢作用的药物，如口服活性甲状旁腺激素（PTH）类似物、钙敏感受体拮抗剂、PTH相关肽类似物，以及通过涉及关键的、最近发现的分子靶点（wnt低密度脂蛋白受体相关蛋白-5信号；硬化蛋白抗体）的途径诱导成骨细胞合成代谢的药物。
