Institute of Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia.
Oregon Osteoporosis Center, 2881 NW Cumberland Road, Portland, OR, 97210, USA.
Curr Osteoporos Rep. 2017 Aug;15(4):343-352. doi: 10.1007/s11914-017-0376-x.
The objective of this review is to update evidence regarding the use of osteoporosis drugs in sequence or in combination to optimize increases in bone mass and strength.
Simultaneous use of denosumab plus teriparatide produces larger increases in BMD than does monotherapy. The use of bisphosphonates or denosumab after teriparatide results in progressive gains in BMD. When switching from bisphosphonates and especially denosumab to teriparatide, an overlap of 6-12 months may prevent the transient loss of BMD in cortical sites. Phase 3 trials document fracture risk reduction with anabolic therapy for 12-18 months followed by an anti-remodeling drug. With the exception of adding teriparatide to ongoing denosumab therapy, there is little evidence to support the use of more than one osteoporosis drug at a time. In contrast, sequential therapy regimens of anabolic drugs followed by potent anti-remodeling agents will be the new standard for treating patients at imminent risk of fracture.
本文旨在更新关于骨质疏松症药物序贯或联合应用以优化骨量和骨强度增加的证据。
地舒单抗联合特立帕肽治疗比单药治疗能更显著增加骨密度。特立帕肽治疗后使用双膦酸盐或地舒单抗可使骨密度持续增加。从双膦酸盐特别是地舒单抗转换为特立帕肽时，重叠使用 6-12 个月可能会防止皮质部位骨密度的短暂丢失。3 期临床试验证明，使用合成代谢治疗 12-18 个月后，再使用抗再吸收药物可降低骨折风险。除了在持续使用地舒单抗的基础上添加特立帕肽外，目前几乎没有证据支持同时使用多种骨质疏松症药物。相比之下，合成代谢药物序贯治疗后再使用强效抗再吸收药物将成为治疗即将发生骨折风险患者的新标准。
