Adler Robert A
Endocrinology and Metabolism Section, McGuire Veterans Affairs Medical Center, Division of Endocrinology,Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Eur J Endocrinol. 2018 Mar;178(3):R81-R87. doi: 10.1530/EJE-17-1002. Epub 2018 Jan 16.
Modern osteoporosis treatment began in the mid-1990s with the approval of amino-bisphosphonates, anti-resorptive agents that have been shown to decrease osteoporotic fracture risk by about half. In 2005, the first cases of atypical femoral fractures (AFF), occurring in the shaft of the femur, were reported. Since then, more cases have been found, leading to great concern among patients and a dramatic decrease in bisphosphonate prescribing. The pathogenesis and incidence of AFF are reviewed herein. Management and an approach to prevention or early detection of AFF are also provided. Denosumab, a more recently approved anti-resorptive medication has also been associated with AFF. Long-term management of osteoporosis and prevention of fracture are challenging in light of this serious but uncommon side effect, yet with an aging population osteoporotic fracture is destined to increase in frequency.
现代骨质疏松症治疗始于20世纪90年代中期,当时氨基双膦酸盐获批,这是一类抗吸收药物,已被证明可将骨质疏松性骨折风险降低约一半。2005年,首次报告了非典型股骨骨折(AFF)病例,这些骨折发生在股骨干。从那时起,发现了更多病例,引起了患者的极大关注,并导致双膦酸盐处方量急剧下降。本文综述了AFF的发病机制和发病率。还提供了AFF的管理以及预防或早期检测方法。地诺单抗是一种最近获批的抗吸收药物,也与AFF有关。鉴于这种严重但不常见的副作用,骨质疏松症的长期管理和骨折预防具有挑战性,但随着人口老龄化,骨质疏松性骨折的发生率注定会增加。