Gennari Luigi, Bilezikian John P
a Department Medicine, Surgery and Neurosciences , University of Siena , Siena , Italy.
b Medicine and Pharmacology, International Education and Research, Division of Endocrinology, Emeritus, Metabolic Bone Diseases Unit, Department of Medicine, College of Physicians and Surgeons , Columbia University , New York , NY , USA.
Expert Opin Pharmacother. 2018 Feb;19(3):253-264. doi: 10.1080/14656566.2018.1428559. Epub 2018 Jan 19.
Osteoporosis represents a major health and societal burden in men, as well as in women. However, only a minority of men are screened and treated for osteoporosis and fracture prevention, even after first fracture.
This article provides a comprehensive summary of the currently available drugs for osteoporosis in men as well as insights into new and developing pharmacotherapy.
To date, therapeutic approaches to osteoporosis in men remain not as well defined as in women, since antifracture efficacy data are lacking for most approved pharmaceuticals. Based on the currently available evidence, bisphosphonates are generally recommended as first line pharmacotherapy in men. Conceptually, osteoanabolic agents, such as teriparatide could be more appropriate for men with primary osteoporosis and low bone turnover. However, osteoanabolic agents display a limited anabolic window during which their stimulatory effects on bone formation prevail over the increase in bone resorption and their use, for theoretical safety reasons, is limited to a cumulative duration of two years. Due to the recent advances in bone biology, future drugs for osteoporosis in men might include more selective antiresorptive compounds which do not markedly inhibit bone formation as well as newer osteoanabolic agents that appear to more selectively stimulate bone formation.
骨质疏松症是男性和女性面临的一项重大健康和社会负担。然而，即使在首次发生骨折后，也只有少数男性接受骨质疏松症筛查及骨折预防治疗。
本文全面总结了目前可用于男性骨质疏松症的药物，并深入探讨了新出现及正在研发的药物治疗方法。
迄今为止，男性骨质疏松症的治疗方法仍不如女性明确，因为大多数已获批药物缺乏抗骨折疗效数据。根据现有证据，双膦酸盐类药物通常被推荐为男性骨质疏松症的一线药物治疗。从概念上讲，骨合成代谢药物，如特立帕肽，可能更适合原发性骨质疏松症且骨转换率低的男性。然而，骨合成代谢药物的合成代谢窗口期有限，在此期间它们对骨形成的刺激作用超过骨吸收的增加，并且出于理论安全性考虑，其使用期限限制为累计两年。由于骨生物学的最新进展，未来用于男性骨质疏松症的药物可能包括更具选择性的抗吸收化合物，这些化合物不会明显抑制骨形成，以及似乎更具选择性地刺激骨形成的新型骨合成代谢药物。
