Department of Endocrinology, 424 General Military Hospital, Thessaloniki, Greece.
First Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Expert Opin Pharmacother. 2020 Mar;21(4):477-490. doi: 10.1080/14656566.2020.1717468. Epub 2020 Jan 28.
: Since postmenopausal osteoporosis is a chronic, potentially disabling condition requiring long-term treatment, the physician is expected to decide the optimal treatment strategy, e.g. how to use the available osteoanabolic and antiresorptive agents, sequentially or in combination, in the most effective and safe way, based on personalized patient care.: Herein, the authors outline clinical data regarding the efficacy and safety of various sequential treatment strategies. More specifically, they compare the efficacy of osteoanabolic agents when they precede or follow antiresorptive treatment, as well as the efficacy of antiresorptives following other antiresorptives. Finally, the authors quote and discuss available evidence regarding the efficacy and safety of the co-administration of osteoanabolics and antiresorptives in comparison with monotherapies.: Initiation with an osteoanabolic agent followed by an antiresorptive seems to be the optimal treatment sequence, at least in patients with severe osteoporosis. Osteoanabolic treatment following antiresorptives seems to lead in more modest responses in bone mineral density (BMD) and bone turnover markers. Combination therapy with teriparatide and denosumab or zoledronate has achieved higher BMD gains compared to each agent alone; however, due to the high cost, combination therapy is rarely compensated. On the contrary, the combination of teriparatide with alendronate results in smaller BMD increases than TPTD monotherapy.
: 由于绝经后骨质疏松症是一种慢性、潜在致残的疾病，需要长期治疗，因此医生需要根据个性化的患者护理，决定最佳的治疗策略，例如如何以最有效和安全的方式序贯或联合使用现有的骨合成代谢和抗吸收药物。: 在此，作者概述了关于各种序贯治疗策略的疗效和安全性的临床数据。更具体地说，他们比较了骨合成代谢药物在前或在后抗吸收治疗时的疗效，以及在其他抗吸收药物之后使用抗吸收药物的疗效。最后，作者引用并讨论了关于骨合成代谢药物和抗吸收药物联合应用与单药治疗相比的疗效和安全性的现有证据。: 起始使用骨合成代谢药物，然后使用抗吸收药物似乎是最佳的治疗顺序，至少在严重骨质疏松症患者中是如此。抗吸收药物之后使用骨合成代谢药物似乎会导致骨密度（BMD）和骨转换标志物的反应较为温和。特立帕肽和地舒单抗或唑来膦酸联合治疗与每种药物单独治疗相比，可获得更高的 BMD 增益；然而，由于成本较高，联合治疗很少得到补偿。相反，特立帕肽与阿仑膦酸钠联合治疗的 BMD 增加幅度小于 TPTD 单药治疗。
