Department of Endocrinology, 424 Military General Hospital, Thessaloniki 564 29, Greece.
Endocrinology Unit, 1st Department of Propaedeutic and Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laikon University Hospital of Athens, Athens 115 27, Greece.
Eur J Endocrinol. 2024 Jul 2;191(1):R9-R21. doi: 10.1093/ejendo/lvae076.
Osteoanabolic agents are used as a first line treatment in patients at high fracture risk. The PTH receptor 1 (PTH1R) agonists teriparatide (TPTD) and abaloparatide (ABL) increase bone formation, bone mineral density (BMD), and bone strength by activating PTH receptors on osteoblasts. Romosozumab (ROMO), a humanized monoclonal antibody against sclerostin, dramatically but transiently stimulates bone formation and persistently reduces bone resorption. Osteoanabolic agents increase BMD and bone strength while being more effective than antiresorptives in reducing fracture risk in postmenopausal women. However, direct comparisons of the antifracture benefits of osteoanabolic therapies are limited. In a direct comparison of TPTD and ABL, the latter resulted in greater BMD increases at the hip. While no differences in vertebral or non-vertebral fracture risk were observed between the two drugs, ABL led to a greater reduction of major osteoporotic fractures. Adverse event profiles were similar between the two agents except for hypercalcemia, which occurred more often with TPTD. No direct comparisons of fracture risk reduction between ROMO and the PTH1R agonists exist. Individual studies have shown greater increases in BMD and bone strength with ROMO compared with TPTD in treatment-naive women and in women previously treated with bisphosphonates. Some safety aspects, such as a history of tumor precluding the use of PTH1R agonists, and a history of major cardiovascular events precluding the use of ROMO, should also be considered when choosing between these agents. Finally, convenience of administration, reimbursement by national health systems and length of clinical experience may influence patient choice.
骨合成代谢药物被用作高骨折风险患者的一线治疗药物。甲状旁腺素受体 1（PTH1R）激动剂特立帕肽（TPTD）和abaloparatide（ABL）通过激活成骨细胞上的 PTH 受体增加骨形成、骨矿物质密度（BMD）和骨强度。Romosozumab（ROMO）是一种针对硬化蛋白的人源化单克隆抗体，可显著但短暂地刺激骨形成，并持续减少骨吸收。与抗吸收剂相比，骨合成代谢药物在增加 BMD 和骨强度方面更有效，可降低绝经后妇女的骨折风险。然而，骨合成代谢治疗抗骨折益处的直接比较有限。在 TPTD 和 ABL 的直接比较中，后者导致髋关节 BMD 增加更大。虽然两种药物之间未观察到椎体或非椎体骨折风险的差异，但 ABL 导致主要骨质疏松性骨折的减少更大。两种药物的不良事件谱相似，除了 TPTD 更常发生高钙血症。ROMO 和 PTH1R 激动剂之间没有关于骨折风险降低的直接比较。个别研究表明，与 TPTD 相比，ROMO 在治疗初治女性和先前接受双膦酸盐治疗的女性中，BMD 和骨强度增加更大。在选择这些药物时，还应考虑一些安全性方面的因素，例如有肿瘤史排除使用 PTH1R 激动剂，有主要心血管事件史排除使用 ROMO。最后，给药方便性、国家卫生系统的报销和临床经验的长短可能会影响患者的选择。
