Leder Benjamin Z
Harvard Medical School, Endocrine Unit, Massachusetts General Hospital, Boston, USA.
Curr Osteoporos Rep. 2017 Apr;15(2):110-119. doi: 10.1007/s11914-017-0353-4.
The purpose is to review the efficacy and optimal use of parathyroid hormone and parathyroid hormone-related protein analogs in osteoporosis treatment.
The parathyroid hormone analog teriparatide, a potent stimulator of bone remodeling, increases hip and spine bone mineral density and reduces the risk of vertebral and non-vertebral fractures in postmenopausal osteoporotic women. The parathyroid hormone-related protein analog, abaloparatide, also reduces fracture incidence but has pharmacological effects that differ from teriparatide, particularly in cortical bone. These analogs provide maximal benefit when their use is followed by a potent antiresorptive medication. Moreover, studies have shown that the combination of teriparatide and the RANK-ligand inhibitor, denosumab, increase bone density and estimated strength more than monotherapy and more than any currently available regimen. Parathyroid hormone and parathyroid hormone-related protein analogs, whether as monotherapy, in combination with antiresorptive agents or in sequence with antiresorptive agents, will likely play an expanding role in osteoporosis management.
本文旨在综述甲状旁腺激素及甲状旁腺激素相关蛋白类似物在骨质疏松症治疗中的疗效及最佳应用。
甲状旁腺激素类似物特立帕肽是一种强大的骨重塑刺激剂，可增加绝经后骨质疏松症女性的髋部和脊柱骨密度，并降低椎体和非椎体骨折的风险。甲状旁腺激素相关蛋白类似物阿巴洛帕肽也可降低骨折发生率，但其药理作用与特立帕肽不同，尤其是在皮质骨方面。当这些类似物与强效抗吸收药物联合使用时，可提供最大益处。此外，研究表明，特立帕肽与RANK配体抑制剂地诺单抗联合使用，比单一疗法及任何现有治疗方案更能增加骨密度和估计强度。甲状旁腺激素及甲状旁腺激素相关蛋白类似物，无论是作为单一疗法、与抗吸收药物联合使用还是与抗吸收药物序贯使用，都可能在骨质疏松症管理中发挥越来越重要的作用。
