Ebina Kosuke, Etani Yuki, Noguchi Takaaki, Nakata Ken, Okada Seiji
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
J Bone Miner Metab. 2025 Jan;43(1):3-9. doi: 10.1007/s00774-024-01536-0. Epub 2024 Jul 15.
In the management of osteoporosis, anti-resorptive agents serve as a primary therapeutic approach. However, in cases where individuals exhibit an increased susceptibility to fractures, such as those characterized by severe low bone mass or a history of vertebral or hip fractures that markedly diminish life expectancy, the immediate reduction of fracture risk through the administration of osteoanabolic agents could be beneficial. Teriparatide, available in daily, once-weekly, or twice-weekly dosages, along with abaloparatide and romosozumab, constitutes a trio of such agents. Each of these medications is defined by unique characteristics, distinct efficacy profiles, and specific adverse effects. There is growing evidence to suggest that these agents have a superior effect on enhancing bone mineral density and reducing fracture incidence when compared to traditional bisphosphonate therapies. Nonetheless, their employment demands thorough consideration of clinical indications, which includes evaluating economic factors, the frequency of injections required, and the potential for adverse effects. The objective of this review is to consolidate the current evidence focusing primarily on the efficacy of these agents, with the goal of enhancing understanding and aiding in making more informed treatment decisions, particularly for those individuals who are at an elevated risk of fractures.
在骨质疏松症的管理中,抗吸收药物是主要的治疗方法。然而,对于那些骨折易感性增加的个体,例如以严重低骨量为特征或有脊椎或髋部骨折病史且明显缩短预期寿命的个体,通过使用骨合成代谢药物立即降低骨折风险可能有益。特立帕肽有每日、每周一次或每周两次的剂量,与阿巴洛帕肽和罗莫佐单抗一起,构成了这类药物的三种。这些药物中的每一种都有独特的特性、不同的疗效和特定的不良反应。越来越多的证据表明,与传统双膦酸盐疗法相比,这些药物在提高骨矿物质密度和降低骨折发生率方面具有更好的效果。尽管如此,它们的使用需要全面考虑临床适应症,这包括评估经济因素、所需注射频率以及不良反应的可能性。本综述的目的是整合当前主要关注这些药物疗效的证据,以增强理解并有助于做出更明智的治疗决策,特别是对于那些骨折风险较高的个体。