骨质疏松症的联合治疗与序贯治疗

The combination and sequential therapy in osteoporosis management

联合和序贯治疗骨质疏松症是为了追求更大疗效的一种选择,本文检索分析近45年来发表的此类临床研究结果。目前尚无证据表明两种抗骨吸收联合治疗有降低骨折发生率的叠加作用(如双膦酸盐加ERT或雷洛昔芬,雌激素加降钙素),仅观察到联合治疗可以降低骨转换和增加骨密度的结果。联合甲状腺激素(PTH)同抗骨吸收药物,随着药物的不同对骨密度的效果各异。在停止使用促进骨形成剂PTH后序贯使用双膦酸盐、雷洛昔芬或锶盐,可以防止因停用PTH后的骨丢失,可能成为未来治疗严重的绝经后骨质疏松症的重要选择。

To get more efficacy, combination and sequential therapies were applied in management of osteoporosis. The clinical trial on this issue in PebMed from 1965 to 2011were collected and analysed in this paper. There is insufficient evidence show that the combined use of two antiresorptive agents （ for example, bisphosphonates plus ERT or raloxirene; estrogen plus calcitonin） has an additive effect on fracture reduction. Additive effects on bone mass and bone turnover have been observed. The combination of an antiresorptive agent with teriparatide or parathyroid hormone may alter the BMD and bone turnover response, depending on the antiresorptive agent. The use of an inhibitor of bone resorption after completion of PTH treatment seems an appropriate way to maintain the skeletal benefits gained during therapy. This sequential therapy may be considered in patients with severe or refractory postmenopausal osteoporosis.