Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain.
Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research, IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain.
Expert Rev Hematol. 2022 Aug;15(8):697-710. doi: 10.1080/17474086.2022.2108783. Epub 2022 Aug 19.
The relationship between severe hemophilia and osteoporosis has been well established in the literature. However, although the importance of its prevention in order to reduce the risk of bone fractures has been reported, the importance of its treatment in clinical practice has not been well analyzed.
In this paper, a review of the available clinical and experimental information on osteoporosis in hemophilia has been performed, to better understand the relationship between hemophilia and osteoporosis. Prevention of osteoporosis in hemophilia should include primary hematological prophylaxis; a diet appropriate in calcium and vitamin D; a regular exercise program that includes aerobics, strength training and balance and flexibility activities; restriction of tobacco and alcohol use; and limitation of the duration of immobilization.
Prevention of osteoporosis in hemophilic patients is paramount. However, it is noteworthy that there is only one publication on the treatment of osteoporosis in patients with hemophilia. Until further research is done on this topic, the existing recommendations for non-hemophilic patients should be followed. They include the use of antiresorptives (estrogens, selective estrogen receptor modulators, bisphosphonates, denosumab) and anabolic agents (teriparatide, abaloparatide, romosozumab). Further studies on the management of osteoporosis in patients with hemophilia are required.
严重血友病与骨质疏松症之间的关系在文献中已有充分的记载。然而，尽管预防骨质疏松症以降低骨折风险的重要性已被报道，但在临床实践中，其治疗的重要性尚未得到很好的分析。
本文对血友病患者骨质疏松症的现有临床和实验信息进行了综述，以更好地理解血友病与骨质疏松症之间的关系。血友病患者的骨质疏松症预防应包括初级血液学预防；适当摄入钙和维生素 D 的饮食；包括有氧运动、力量训练、平衡和灵活性活动的定期运动计划；限制吸烟和饮酒；以及限制固定时间。
预防血友病患者的骨质疏松症至关重要。然而，值得注意的是，只有一篇关于血友病患者骨质疏松症治疗的出版物。在对该主题进行进一步研究之前，应遵循针对非血友病患者的现有建议。这些建议包括使用抗吸收剂（雌激素、选择性雌激素受体调节剂、双磷酸盐、地诺单抗）和合成代谢剂（特立帕肽、abaloparatide、romosozumab）。需要进一步研究血友病患者骨质疏松症的管理。
