双膦酸盐与骨折愈合和非典型性骨折

The effect of bisphosphonates on fracture healing and atypical fracture

典型的骨折愈合过程包括血肿和炎症反应、原始软骨痂形成、成熟板层骨形成以及骨板重建和塑形等四个时期。骨重建包括骨吸收和骨形成两个方面。软骨痂和硬骨痂重建对骨折愈合具有重要意义。双膦酸盐类药理基础在于抑制破骨细胞活性和骨转化水平,通过干预骨重建对骨折愈合产生影响。长期使用双膦酸盐不利于骨折愈合,有引起股骨非典型性骨折发生的危险。

Fracture healing is typically characterized by iour overlapping stages, including the hematoma and inflammatory response, initial fibroeartilage callus formation, hard callus formation, and bone remodeling. The remodeling process is driven by a coupled process of orderly bone resorption followed by bone formation. The soft callus remodeling and hard callus remodeling are of great importance to fracture healing. Bisphosphonates act to affect fracture healing by intervening callus remodelling, based on its pharmacological action on inhibiting osteoclast activity and bone turnover levels. The long-term use of bisphosphonates seems to be turning against fracture healing, and has been associated with the possibility of atypical fractures of the femur.