Papapoulos Socrates E, Makras Polyzois
Center for Bone Quality, Department of Internal Medicine, Section Endocrinology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, 11525 Athens, Greece.
Pharmaceuticals (Basel). 2025 Jul 20;18(7):1068. doi: 10.3390/ph18071068.
Osteoporosis is a chronic disease associated with significant morbidity and mortality and requires long-term therapy. Efficacious and well-tolerated treatments are available, but their effect is either short-lived or lost following their discontinuation. The exception is bisphosphonates that reduce bone resorption and turnover, can be administered in regimens ranging from once-daily to once-yearly, and have been shown in randomized clinical trials to reduce the incidence of all osteoporotic fractures, but their effect persists following their discontinuation. This is due to their property of being taken-up selectively by the skeleton and being slowly released following treatment arrest. This property allows the discontinuation of bisphosphonate treatment for different periods of time, the so-called drug holiday, which reduces the risk of rare adverse events while maintaining the effect; an action particularly important for patients at very high risk of fractures for whom sequential therapy with different agents is currently advised. Thus, bisphosphonates, apart from being the treatment of choice for certain groups of patients, are also indispensable for the consolidation and maintenance of the gains of all other treatments, providing, in addition, the opportunity of temporary treatment arrest. Most patients with postmenopausal osteoporosis will, therefore, receive bisphosphonate at some stage during therapy of their disease, regardless of their initial fracture risk.
骨质疏松症是一种与高发病率和死亡率相关的慢性疾病，需要长期治疗。目前有有效且耐受性良好的治疗方法，但这些治疗方法的效果要么是短期的，要么在停药后就会消失。双膦酸盐是个例外，它能减少骨吸收和骨转换，可以每天服用一次，也可以每年服用一次，随机临床试验表明，双膦酸盐能降低所有骨质疏松性骨折的发生率，而且在停药后其效果仍然存在。这是因为它们具有被骨骼选择性摄取并在治疗停止后缓慢释放的特性。这种特性使得双膦酸盐治疗可以中断不同的时间，即所谓的药物假期，这在维持疗效的同时降低了罕见不良事件的风险；对于骨折风险非常高的患者来说，这一作用尤为重要，目前建议这类患者采用不同药物的序贯治疗。因此，双膦酸盐除了是某些患者群体的首选治疗方法外，对于巩固和维持所有其他治疗的效果也是不可或缺的，此外，它还提供了暂时停药的机会。因此，大多数绝经后骨质疏松症患者在疾病治疗的某个阶段都会接受双膦酸盐治疗，无论其初始骨折风险如何。
