Drug therapy for osteoporosis in older adults

被引:624
作者
Reid, Ian R. [1 ,2 ]
Billington, Emma O. [3 ]
机构
[1] Univ Auckland, Dept Med, Fac Med & Hlth Sci, Auckland, New Zealand
[2] Auckland Dist Hlth Board, Auckland, New Zealand
[3] Univ Calgary, Cumming Sch Med, Div Endocrinol & Metab, Calgary, AB, Canada
关键词
VITAMIN-D SUPPLEMENTATION; BONE-MINERAL DENSITY; ZOLEDRONIC ACID TREATMENT; POSTMENOPAUSAL WOMEN; FRACTURE RISK; VERTEBRAL FRACTURES; HORMONE-THERAPY; TERIPARATIDE; PREVENTION; DENOSUMAB;
D O I
10.1016/S0140-6736(21)02646-5
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
The goal of osteoporosis management is to prevent fractures. Several pharmacological agents are available to lower fracture risk, either by reducing bone resorption or by stimulating bone formation. Bisphosphonates are the most widely used anti-resorptives, reducing bone turnover markers to low premenopausal concentrations and reducing fracture rates (vertebral by 50-70%, non-vertebral by 20-30%, and hip by similar to 40%). Bisphosphonates bind avidly to bone mineral and have an offset of effect measured in months to years. Long term, continuous use of oral bisphosphonates is usually interspersed with drug holidays of 1-2 years, to minimise the risk of atypical femoral fractures. Denosumab is a monoclonal antibody against RANKL that potently inhibits osteoclast development and activity. Denosumab is administered by subcutaneous injection every 6 months. Anti-fracture effects of denosumab are similar to those of the bisphosphonates, but there is a pronounced loss of anti-resorptive effect from 7 months after the last injection, which can result in clusters of rebound vertebral fractures. Two classes of anabolic drugs are now available to stimulate bone formation. Teriparatide and abaloparatide both target the parathyroid hormone-1 receptor, and are given by daily subcutaneous injection for up to 2 years. Romosozumab is an anti-sclerostin monoclonal antibody that stimulates bone formation and inhibits resorption. Romosozumab is given as monthly subcutaneous injections for 1 year. Head-to-head studies suggest that anabolic agents have greater anti-fracture efficacy and produce larger increases in bone density than anti-resorptive drugs. The effects of anabolic agents are transient, so transition to anti-resorptive drugs is required. The optimal strategy for cycling anabolics, anti-resorptives, and off-treatment periods remains to be determined.
引用
收藏
页码:1080 / 1092
页数:13
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