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骨质疏松症药物对骨折愈合的影响:一项基于证据的综述。

Effect of Osteoporosis Medication on Fracture Healing: An Evidence Based Review.

作者信息

Shin Young Ho, Shin Won Chul, Kim Ji Wan

机构信息

Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, Korea.

出版信息

J Bone Metab. 2020 Feb;27(1):15-26. doi: 10.11005/jbm.2020.27.1.15. Epub 2020 Feb 29.

Abstract

A systematic search was conducted and relevant studies that evaluated the influence of osteoporosis medications (bisphosphonates [BPs], denosumab, selective estrogen receptor modulators [SERMs], recombinant human parathyroid hormone teriparatide [TPTD], and strontium ranelate [SrR]) on wrist, hip, and spine fracture healing, were selected. BPs administration did not influence fracture healing and clinical outcomes after distal radius fracture (DRF). Similar results were observed in hip fracture, but evidence is lacking for spine fracture. Denosumab did not delay the non-vertebral fractures healing in one well-designed study. No studies evaluated the effect of SERMs on fracture healing in humans. One study reported shorter fracture healing times in TPTD treated DRF patients, which was not clinically meaningful. In hip fracture, recent studies reported better pain and functional outcomes in TPTD treated patients. However, in spine fracture, recent studies found no significant differences in fracture stability between TPTD treated patients and controls. Evidence is lacking for SrR, but it did not influence wrist fracture healing in one study. In comparisons between TPTD and BPs, fracture healing and physical scores were not significantly different in hip fracture by 1 study. In spine fracture, controversy exists for the role of each medication to the fracture stability, but several studies reported that fracture site pain was better in TPTD treated patients than BPs treated patients. Considering no clinical data of negative fracture healing of the antiresorptive medication and the danger of subsequent fracture after initial osteoporotic fracture, there is no evidence to delay initiation of osteoporosis medications after fracture.

摘要

进行了系统检索,选取了评估骨质疏松症药物(双膦酸盐[BPs]、地诺单抗、选择性雌激素受体调节剂[SERMs]、重组人甲状旁腺激素特立帕肽[TPTD]和雷奈酸锶[SrR])对腕部、髋部和脊柱骨折愈合影响的相关研究。给予BPs对桡骨远端骨折(DRF)后的骨折愈合和临床结局无影响。在髋部骨折中观察到类似结果,但脊柱骨折方面缺乏证据。在一项设计良好的研究中,地诺单抗未延迟非椎体骨折的愈合。尚无研究评估SERMs对人类骨折愈合的影响。一项研究报告称,接受TPTD治疗的DRF患者骨折愈合时间较短,但在临床上无意义。在髋部骨折方面,近期研究报告称接受TPTD治疗的患者疼痛和功能结局更好。然而,在脊柱骨折方面,近期研究发现接受TPTD治疗的患者与对照组在骨折稳定性上无显著差异。关于SrR缺乏证据,但在一项研究中其未影响腕部骨折愈合。在TPTD与BPs的比较中,一项研究表明髋部骨折的骨折愈合和身体评分无显著差异。在脊柱骨折方面,每种药物对骨折稳定性的作用存在争议,但多项研究报告称,接受TPTD治疗的患者骨折部位疼痛比接受BPs治疗的患者更好。考虑到抗吸收药物无骨折愈合不良的临床数据以及初次骨质疏松性骨折后后续骨折的风险,没有证据表明骨折后应延迟启动骨质疏松症药物治疗。

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