McClung Michael R
Founding and Emeritus Director, Oregon Osteoporosis Center, Portland, OR, United States of America.
Curr Osteoporos Rep. 2025 Mar 22;23(1):15. doi: 10.1007/s11914-025-00909-2.
Osteoporosis requires life-long management. This involves the use of different drugs in various sequences followed by long-term maintenance therapy. This review highlights the important transitions among osteoporosis therapies and outlines a strategy of intermittent bisphosphonate therapy for long-term maintenance.
Over the past few years, the effects and limitations of long-term treatment with bisphosphonates and denosumab have become apparent as have several key factors in the sequential use of anti-remodeling drugs and osteoanabolic agents. Strategies for transitions from estrogen, bisphosphonates, denosumab and the bone-forming drugs will be discussed, based on extant evidence, clinical experience and expert opinion. By appropriate selection of both the initial and subsequent drugs for the prevention and treatment of osteoporosis, therapeutic benefits can be optimized and safety issues minimized. Developing a strategy for long-term maintenance of the benefits of the initial therapies can provide a life plan for managing patients with osteoporosis.
骨质疏松症需要终身管理。这涉及按不同顺序使用不同药物，随后进行长期维持治疗。本综述强调了骨质疏松症治疗之间的重要转变，并概述了一种间歇性双膦酸盐治疗的长期维持策略。
在过去几年中，双膦酸盐和地诺单抗长期治疗的效果和局限性已变得明显，抗重塑药物和骨合成代谢药物序贯使用中的几个关键因素也是如此。将基于现有证据、临床经验和专家意见，讨论从雌激素、双膦酸盐、地诺单抗和骨形成药物过渡的策略。通过为骨质疏松症的预防和治疗适当选择初始药物和后续药物，可以优化治疗益处并将安全问题降至最低。制定一项长期维持初始治疗益处的策略可为骨质疏松症患者的管理提供一个终身计划。
