阿仑膦酸盐对骨质疏松性骨折愈合影响的研究进展

Research progress in effect of alendronate on healing of osteoporotic fracture

骨折愈合是由成骨细胞、破骨细胞的等多种细胞和分子参与的复杂生理过程。典型骨折愈合分为炎症反应、软骨痂形成、硬骨痂形成和骨重建四个阶段。破骨细胞在硬骨痂形成和骨重建过程中起主导作用。阿仑膦酸盐可抑制破骨细胞活性,抑制骨质疏松症患者骨质丢失,但也可能抑制骨折愈合,因此骨质疏松性骨折发生后能否使用阿仑膦酸盐存在一定争议。近年研究表明,骨质疏松性骨折发生后使用阿仑膦酸盐并不影响患者骨折愈合,还可降低患者发生二次骨折的风险,提高患者治疗预后。笔者就阿仑膦酸盐作用机制及其全身和局部使用对骨质疏松性骨折愈合的影响做综述,为临床选择治疗药物提供参考。

Fracture healing is a complex physiological process involving osteoblasts,osteoclasts and other cells and molecules.Typical fracture healing can be divided into four stages:inflammatory response,soft callus formation,hard callus formation,and bone remodeling.Osteoclasts play a leading role in hard callus formation and bone remodeling.Alendronate can inhibit osteoclast activity and bone loss in patients with osteoporosis,but it may also inhibit fracture healing.Therefore,whether alendronate can be used after osteoporotic fracture is controversial.In recent years,it has been found that alendronate can not affect the fracture healing,but also reduce the risk of secondary fracture and improve the prognosis of patients.In this article,the mechanism of alendronate and its effect on osteoporotic fracture healing by systemic and local use are reviewed,which can provide a reference for clinical selection of therapeutic drugs.