成骨药物对骨质疏松疾病促成骨代谢治疗的研究进展

Advances in the Treatment of Bone-Forming Drugs Contribute to Osteoporosis Diseases

骨质疏松是一种老年慢性疾病。当前国内临床治疗使用较多的是抗骨吸收药物(双膦酸盐、雌激素受体调节剂、降钙素等)。但随着甲状旁腺素(parathyroid hormone, PTH)为代表的成骨药物的出现,为临床治疗骨质疏松带来新的选择,但国内成骨药物的使用报道还并不多。在国际的骨质疏松疾病的治疗中,目前已经开发了一些新的靶点治疗药物来丰富治疗手段。目前可用的骨合成代谢疗法的成骨药物主要是甲状旁腺激素和甲状旁腺激素合成类似物(PTHrP)如特立帕肽(teriparatide)和阿巴拉帕肽(abaloparatide)。有研究证明每日给药剂量为20和80微克的实验组,与只有连续的PTH分泌的空白组相比,实验组的成骨增加,并且椎体和非椎体骨折的风险降低。在增加骨密度、改善骨结构和降低骨折风险方面,特立帕肽(Teriparatide)比双膦酸盐(阿仑膦酸盐(Alendronate),利索膦酸钠(Risedronate)更有效。与特立帕肽(Teriparatide)相比,阿巴拉帕肽(Abaloparatide)骨密度的增加作用更加显著,对骨质疏松性的骨折(上臂、手腕、髋部或临床脊柱)具有很显著的效果,并有较低的高钙血症风险。罗莫索珠单抗(Romosozumab)是一种硬化蛋白抑制剂,既能诱导骨形成,又能抑制骨吸收,它能减少椎体,非椎体和髋部骨折的风险。

Osteoporosis is a chronic disease in the elderly. At present, more anti-osteogenesis drugs (bisphosphonates, estrogen receptor modulators, calcitonin, etc.) are used in clinical treatment in China. However, with the advent of osteogenic drugs represented by parathyroid hormone (PTH), it has brought new choices for clinical treatment of osteoporosis, but there are not many reports on the use of domestic osteogenic drugs. In the treatment of international osteoporosis, some new target therapeutic drugs have been developed to enrich treatment. Currently available bone anabolic therapies for osteogenic drugs are mainly parathyroid hormone and parathyroid hormone synthetic analogues (PTHrP) such as teriparatide and apalaparatide. Studies have shown that in the experimental group administered daily at doses of 20 and 80 micrograms, the osteogenesis of the experimental group increased and the risk of vertebral and non-vertebral fractures decreased compared with the blank group with only continuous PTH secretion. Teriparatide is more effective than bisphosphonates (Alendronate, Risedronate) in increasing bone density, improving bone structure and reducing fracture risk. Compared with teriparatide, the increase in bone mineral density of abaloparatide is more pronounced and has a significant effect on osteoporotic fractures (upper arm, wrist, hip or clinical spine) and have a lower risk of hypercalcemia. Romosozumab is a sclerostin inhibitor that induces both bone formation and bone resorption, reducing the risk of vertebral, non-vertebral and hip fractures.