Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America; Department of Biomedical Engineering, Indiana University-Purdue University, Indianapolis, Indianapolis, IN 46202, United States of America.
Bone. 2020 Sep;138:115518. doi: 10.1016/j.bone.2020.115518. Epub 2020 Jul 3.
After fifty years of experience with several generations of bisphosphonates (BPs), and 25 years after these drugs were approved for use in humans, their mechanical effects on bone are still not fully understood. Certainly, these drugs have transformed the treatment of osteoporosis in both men and women. There is no question that they do prevent fractures related to low bone mass, and there is widespread agreement that they increase strength and stiffness of the vertebrae. There is less consensus, however, about their effects on cortical bone, or on bone tissue properties in either trabecular or cortical bone, or their effects with longer periods of treatment. The consensus of most studies, both those based on ovariectomized and intact animal models and on testing of human bone, is that long-term treatment and/or high doses with certain BPs make the bone tissue more brittle and less tough. This translates into reduced energy to fracture and potentially a shorter bone fatigue life. Many studies have been done, but Interpretation of the results of these studies is complicated by variations in which BP is used, the animal model used, dose, duration, and methods of testing. Duration effects and effects on impact properties of bone are gaps that should be filled with additional testing.
经过五十年几代双膦酸盐（BPs）的经验，以及这些药物在人类中使用 25 年后，它们对骨骼的机械作用仍不完全了解。当然，这些药物改变了男性和女性骨质疏松症的治疗方法。毫无疑问，它们确实可以预防与低骨量相关的骨折，并且广泛认为它们可以增加椎体的强度和刚度。然而，关于它们对皮质骨的影响，或者对小梁骨或皮质骨中骨组织特性的影响，或者对更长时间治疗的影响，共识较少。大多数研究的共识，包括基于去卵巢和完整动物模型以及人体骨骼测试的研究，都认为长期治疗和/或某些 BP 的高剂量会使骨组织更加脆弱和韧性降低。这转化为骨折能量降低和潜在的骨疲劳寿命缩短。已经进行了许多研究，但由于使用的 BP、使用的动物模型、剂量、持续时间和测试方法的不同，这些研究结果的解释变得复杂。应通过额外的测试来填补持续时间效应和对骨骼冲击性能的影响的空白。
