Murray T M, Ste-Marie L G
Division of Endocrinology and Medicine, University of Toronto, Ont.
CMAJ. 1996 Oct 1;155(7):949-54.
To present the latest findings on the use of fluoride in the treatment of osteoporosis.
Plain sodium fluoride (NaF), enteric-coated sodium fluoride (EC-NaF), sodium monofluorophosphate (Na2FPO4), slow-release sodium fluoride (SR-NaF); fluoride with a calcium supplement.
Fracture and loss of bone mineral density in osteoporosis; increased bone mass, prevention of fractures and improved quality of life associated with treatment.
Relevant clinical studies and reports were examined, with an emphasis on recent prospective, randomized, controlled trials. Clinical practices in European countries were also considered.
Reducing fractures, increasing bone mineral density and minimizing side effects of treatment were given a high value.
BENEFITS, HARMS AND COSTS: NaF therapy stimulates bone formation and may be effective in preventing osteoporotic fractures. It may be an acceptable alternative treatment to estrogen or bisphosphonate therapy and useful in premenopausal and corticosteroid-induced osteoporosis and in some patients with mild osteogenesis imperfecta. Toxic effects are dependent on formulation and dosage. They include a range of gastrointestinal and musculoskeletal conditions. EC-NaF is associated with less toxicity than plain NaF; its gastrointestinal toxicity is negligible. Na2FPO4 has no gastrointestinal toxicity, but can give rise to skeletal toxicity. SR-NaF appears to have no side effects when given intermittently. Carcinogenicity has not been found in vivo with fluoride therapy, despite in vitro results.
New data indicate that fluoride therapy should be re-evaluated as a potentially effective treatment of osteoporosis with minimal side effects. More studies are needed of slow-release fluoride formulations, intermittent treatment schedules and calcium supplementation of fluoride. Studies should be undertaken to see if it is advantageous to initiate treatment with antiresorptive agents before or in combination with fluoride. Conclusive data have not been presented regarding the benefit of any specific type of calcium supplement. Further studies on the basic mechanism of action of fluoride on the skeleton are necessary to evaluate fluoride's potential to stimulate bone formation therapeutically.
介绍氟化物用于治疗骨质疏松症的最新研究结果。
普通氟化钠（NaF）、肠溶包衣氟化钠（EC-NaF）、单氟磷酸钠（Na2FPO4）、缓释氟化钠（SR-NaF）；氟化物与钙补充剂联用。
骨质疏松症患者的骨折情况及骨矿物质密度丢失情况；骨量增加、预防骨折以及治疗相关的生活质量改善情况。
审查了相关临床研究和报告，重点关注近期的前瞻性、随机、对照试验。还考虑了欧洲国家的临床实践。
高度重视减少骨折、增加骨矿物质密度以及将治疗的副作用降至最低。
益处、危害和成本：氟化钠疗法可刺激骨形成，可能对预防骨质疏松性骨折有效。它可能是雌激素或双膦酸盐疗法的可接受替代治疗方法，对绝经前和皮质类固醇诱导的骨质疏松症以及一些轻度成骨不全患者有用。毒性作用取决于制剂和剂量。包括一系列胃肠道和肌肉骨骼疾病。EC-NaF的毒性低于普通NaF；其胃肠道毒性可忽略不计。Na2FPO4无胃肠道毒性，但可引起骨骼毒性。间歇性给予SR-NaF似乎没有副作用。尽管有体外实验结果，但在体内尚未发现氟化物疗法有致癌性。
新数据表明，应重新评估氟化物疗法作为一种潜在有效且副作用最小的骨质疏松症治疗方法。需要对缓释氟化物制剂、间歇性治疗方案以及氟化物的钙补充进行更多研究。应开展研究，以确定在使用氟化物之前或与氟化物联合使用抗吸收剂是否有益。关于任何特定类型钙补充剂的益处，尚未给出确凿数据。有必要对氟化物对骨骼作用的基本机制进行进一步研究，以评估氟化物在治疗上刺激骨形成的潜力。
