From the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York..
Endocr Pract. 2020 Jul;26(7):777-786. doi: 10.4158/EP-2019-0596. Epub 2020 Nov 24.
Provide an update regarding anabolic medications for osteoporosis, which are often considered to be the last resort for patients with osteoporosis, after multiple fractures have already occurred and other medications have already been administered.
Literature review and discussion.
Recent pivotal trial data for anabolic agents and randomized trials comparing anabolic and antiresorptive medications suggest that three anabolic agents (teriparatide, abaloparatide, and romosozumab) reduce nonvertebral and vertebral fractures faster and to a greater extent than potent antiresorptive treatments. Furthermore, bone density accrual is maximized when patients are given anabolic agents first, followed by potent antiresorptive therapy. Since total hip bone density during or after osteoporosis treatment has emerged as an excellent surrogate for future fracture risk, attaining a greater hip bone mineral density is a treatment goal for high-risk osteoporosis patients.
This review defines the highest-risk patients and summarizes the rationale for the evolving role of anabolic therapy in the management of postmenopausal women at high risk for fracture.
ACTIVE = Abaloparatide Comparator Trial in Vertebral Endpoints; ARCH = Active Controlled Fracture Study in Postmenopausal Women with Osteoporosis at High Risk; BMD = bone mineral density; FRAME = Fracture Study in Postmenopausal Women with Osteoporosis; FRAX = Fracture Risk Assessment Tool; PTH = parathyroid hormone; TBS = trabecular bone score.
提供关于骨质疏松症合成代谢药物的最新信息，这些药物通常被认为是已经发生多次骨折和已经使用其他药物的骨质疏松症患者的最后手段。
文献回顾和讨论。
最近关于合成代谢药物的关键试验数据和比较合成代谢药物与抗吸收药物的随机试验表明，三种合成代谢药物（特立帕肽、abaloparatide 和 romosozumab）能更快、更大程度地减少非椎体和椎体骨折。此外，当患者首先接受合成代谢药物治疗，然后再接受强效抗吸收治疗时，骨密度的积累达到最大化。由于骨质疏松症治疗过程中或之后的全髋关节骨密度已成为未来骨折风险的极佳替代指标，因此获得更高的髋关节骨矿物质密度是高风险骨质疏松症患者的治疗目标。
本文定义了最高风险患者，并总结了合成代谢治疗在管理高骨折风险绝经后妇女中的作用不断发展的基本原理。
ACTIVE = Abaloparatide Comparator Trial in Vertebral Endpoints；ARCH = Active Controlled Fracture Study in Postmenopausal Women with Osteoporosis at High Risk；BMD = 骨矿物质密度；FRAME = 骨质疏松症绝经后妇女骨折研究；FRAX = 骨折风险评估工具；PTH = 甲状旁腺激素；TBS = 小梁骨评分。
