a Department of Oncology and Metabolism , University of Sheffield Medical School , Sheffield , UK.
b Sheffield Teaching Hospitals NHS Foundation Trust , Northern General Hospital , Sheffield , UK.
Expert Opin Pharmacother. 2019 Jun;20(9):1123-1134. doi: 10.1080/14656566.2019.1594772. Epub 2019 Apr 8.
Pharmacological options to address the imbalance between bone resorption and accrual in osteoporosis include anti-resorptive and osteoanabolic agents. Unique biologic pathways such as the Wnt/β-catenin pathway have been targeted in the quest for new emerging therapeutic strategies.
This review provides an overview of existing pharmacotherapy for osteoporosis in women and explore state-of-the-art and emerging therapies to prevent bone loss, with an emphasis on the mechanism of action, indications and side effects.
Bisphosphonates appear to be a reliable and cost-effective option, whereas denosumab has introduced a simpler dosing regimen and may achieve a linear increase in bone mineral density (BMD) with no plateau being observed, along with continuous anti-fracture efficacy. Abaloparatide, a parathyroid-hormone-related peptide (PTHrP)-analogue, approved by the FDA in April 2017, constitutes the first new anabolic osteoporosis drug in the US for nearly 15 years and has also proven its anti-fracture efficacy. Romosozumab, a sclerostin inhibitor, which induces bone formation and suppresses bone resorption, has also been developed and shown a significant reduction in fracture incidence; however, concerns have arisen with regard to increased cardiovascular risk.
为解决骨质疏松症中骨吸收和骨形成之间的失衡问题，可选择使用抗吸收和促合成代谢药物。在寻找新的治疗策略时，人们已经将独特的生物学途径（如 Wnt/β-连环蛋白途径）作为靶向目标。
本文综述了女性骨质疏松症的现有药物治疗方法，并探讨了预防骨丢失的最新和新兴疗法，重点介绍了作用机制、适应证和副作用。
双膦酸盐似乎是一种可靠且具有成本效益的选择，而地舒单抗则引入了更简单的给药方案，并且可能会实现骨密度（BMD）的线性增加，而不会出现平台期，同时保持持续的抗骨折疗效。甲状旁腺激素相关肽（PTHrP）类似物abaloparatide 于 2017 年 4 月获得 FDA 批准，是美国近 15 年来首个新的促合成代谢骨质疏松症药物，也已证明其具有抗骨折疗效。骨硬化蛋白抑制剂 romosozumab 可促进骨形成和抑制骨吸收，也已被开发出来，并显示出骨折发生率的显著降低；但是，人们对心血管风险增加表示担忧。
