Quản lý Dược lý của Loãng xương Nặng sau Mãn kinh

Springer Science and Business Media LLC - Tập 22 - Trang 405-417 - 2012
Agostino Gaudio1, Nancy Morabito1
1Department of Internal Medicine, University of Messina, Messina, Italy

Tóm tắt

Hệ quả tàn khốc nhất của bệnh loãng xương là gãy xương, đặc biệt ở cấp độ đốt sống hoặc xương đùi. Như được định nghĩa bởi WHO, bệnh nhân mắc bệnh loãng xương đã từng trải qua một hoặc nhiều lần gãy xương do giòn nhẹ đã thuộc vào nhóm loãng xương nặng. Những người bị gãy đốt sống là một nhóm đặc biệt dễ bị tổn thương, có nguy cơ bị gãy đốt sống khác trong năm tiếp theo tăng lên gấp 3–5 lần. Ngoài ra, sự hiện diện của gãy đốt sống còn liên quan đến nguy cơ gãy xương hông tăng cao. Dựa trên những dữ liệu này, việc điều trị loãng xương đã được thiết lập là cực kỳ quan trọng để ngăn ngừa các gãy xương do giòn tiếp theo. Bài tổng quan này xem xét các liệu pháp đã được FDA Hoa Kỳ phê duyệt cho điều trị loãng xương, đã được chứng minh là làm giảm tỉ lệ gãy xương mới ở bệnh nhân đã có loãng xương. Chúng tôi đánh giá cơ chế hoạt động, các dạng bào chế có sẵn, hiệu quả trong việc ngăn ngừa gãy xương và tăng mật độ khoáng xương (BMD), thời gian điều trị, tác dụng phụ và chống chỉ định với việc sử dụng axit alendronic (alendronate), axit risedronic (risedronate), calcitonin, raloxifene và teriparatide. Tất cả các loại thuốc này đều có khả năng ngăn ngừa gãy đốt sống mới ở bệnh nhân mắc loãng xương đã được thiết lập. Chỉ có axit alendronic và axit risedronic cũng đã được chứng minh là làm giảm nguy cơ gãy xương ở cấp độ xương đùi, nhưng chúng bị chống chỉ định ở bệnh nhân mắc bệnh tiêu hóa trên. Calcitonin là một lựa chọn tốt cho những bệnh nhân có cơn đau lưng vì tác dụng giảm đau của nó. Raloxifene có ích khi bệnh nhân có mức lipid trong máu cao hoặc có tiền sử gia đình mắc ung thư vú. Teriparatide được chỉ định cho những bệnh nhân có BMD rất thấp và nhiều lần gãy đốt sống. Các đặc điểm của bệnh nhân nên xác định lựa chọn liệu pháp nhưng quyết định luôn khó khăn và đầy bất định.

Từ khóa

#loãng xương #gãy xương #điều trị loãng xương #thuốc điều trị #mật độ khoáng xương #axit alendronic #axit risedronic #calcitonin #raloxifene #teriparatide

Tài liệu tham khảo

Cauley JA. Risk of mortality following clinical fractures. Osteoporos Int 2000; 11: 556–61 National Osteoporosis Foundation. America’s bone health: the state of osteoporosis and low bone mass [online]. Available from URL: http://www.nof.org/advocacy/prevalence/index.htm [Accessed 2004 Mar 25] Hodgson SF, Watts NB, Bilezikian JP, et al. American Association of Clinical Endocrinologists. 2001 medical guidelines for clinical practice for the prevention and management of postmenopausal osteoporosis. Endocr Pract. 2001; 7(4): 293–312 European Commission. Report on osteoporosis in the European Community: action on prevention. Luxembourg: Office for Official Publications of the European Communities, 2002: 2 National Institutes of Health (USA). Osteoporosis prevention, diagnosis and therapy. NIH Consensus Statements 2000; 17(1): 1–45 World Health Organization Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: WHO Technical Report Series. Geneva: WHO, 1994: 843 Zuckerman JD. Hip fracture. N Engl J Med 1996; 334: 1519–25 Center JR, Nguyen TV, Schneider D, et al. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 1999; 353: 878–82 Kado DM, Browner WS, Palermo L, et al. Vertebral fractures and mortality in older women. Arch Intern Med 1999; 159: 1215–20 Cooper C, Atkinson EJ, O’Fallon WM, et al. Incidence of clinically diagnosed vertebral fractures: a population based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 1992; 7: 221–7 Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA 2001; 285: 320–3 Klotzbuecher CM, Ross PD, Landsman PB, et al. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 2000; 4: 721–39 Black DM, Arden NK, Palmero L, et al. Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. J Bone Miner Res 1999; 14: 821–8 Davidson M, DeSimone ME. Confronting osteoporosis: what we know, where we’re headed. Clin Rev 2002; 12: 76–82 Kannus P, Parkkari J, Niemi S, et al. Prevention of hip fracture in elderly people with use of a hip protector. N Engl J Med 2000; 343: 1506–13 Reid IR, Ames RW, Evans MC, et al. Long-term effects of calcium supplementation on bone loss and fractures in postmenopausal women: a randomized controlled trial. Am J Med 1995; 98: 331–5 Cumming RG, Nevitt MC. Calcium for prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res 1997; 12: 1321–9 Dawson-Hughes B, Harris SS, Krall EA, et al. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997; 337: 670–6 Reid IR. The role of calcium and vitamin D in the prevention of osteoporosis. Endocrinol Metab Clin North Am 1998; 27: 389–98 Lips P, Graafmans WC, Ooms ME, et al. Vitamin D supplementation and fracture incidence in elderly persons. Ann Intern Med 1996; 124: 400–6 Fleisch HA. Bisphosphonates: preclinical aspects and use in osteoporosis. Ann Med 1997; 29: 55–62 Russell RG, Rogers MJ. Bisphosphonates: from the laboratory to the clinic and back again. Bone 1999; 25: 97–106 Cummings SR, Black DM, Thompson DE, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998; 280: 2077–82 Pols HA, Felsenberg D, Hanley DA, et al. Multinational, placebo-controlled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results of the FOSIT study. Fosamax International Trial Study Group. Osteoporos Int 1999; 9: 461–8 Harris ST, Watts NB, Genant HK, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 1999; 282: 1344–52 Chesnut III CH, McClung M, Ensrud KE, et al. Alendronate treatment of the postmenopausal osteoporotic woman: effect of multiple dosages on bone mass and bone remodeling. Am J Med 1995; 99: 144–52 Liberman UA, Weiss SR, Broil J, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med 1995; 333: 1437–43 Schneider PF, Fischer M, Allolio B, et al. Alendronate increases bone density and bone strength at the distal radius in postmenopausal women. J Bone Miner Res 1999; 14: 1387–93 Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures: Fracture Intervention Trial Research Group. Lancet 1996; 348: 1535–41 Schnitzer T, Bone HG, Crepaldi G, et al. Therapeutic equivalence of alendronate 70mg once-weekly and alendronate 10mg daily in the treatment of osteoporosis. Aging (Milano) 2000; 12: 1–12 Rizzoli R, Greenspan SL, Bone III G, et al. Alendronate Once-Weekly Study Group: two-year results of once-weekly administration of alendronate 70mg for the treatment of postmenopausal osteoporosis. J Bone Miner Res 2002; 17(11): 1988–96 Bone HG, Hosking D, Devogelaer JP, et al. Alendronate Phase III Osteoporosis Treatment Study Group: ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 2004; 350(12): 1189–99 Chavassieux PM, Arlot ME, Reda C, et al. Histomorphometric assessment of the long-term effects of alendronate on bone quality and remodeling in patients with osteoporosis. J Clin Invest 1997; 100: 1475–80 Boivin GY, Chavassieux PM, Santora AC, et al. Alendronate increases bone strength by increasing the mean degree of mineralization of bone tissue in osteoporotic women. Bone 2000; 27: 687–94 Boivin G, Meunier PJ. Changes in bone remodeling rate influence the degree of mineralization of bone. Connect Tissue Res 2002; 43: 535–7 Ensrud KE, Barrett-Connor EL, Schwartz A, et al. Randomized trial of effect of alendronate continuation versus discontinuation in women with low BMD: results from the Fracture Intervention Trial long-term extension. J Bone Miner Res 2004; 19: 1259–69 Donahue JG, Chan KA, Andrade SE, et al. Gastric and duodenal safety of daily alendronate. Arch Intern Med 2002 Apr 22; 162(8): 936–42 Fosamax® (alendronate sodium) package insert. Whitehouse Station NJ): Merck & Co., 2001 Jan McClung MR, Geusens P, Miller PD, et al. Effects of risedronate on the risk of hip fracture in elderly women. N Engl J Med 2001; 344: 333–40 Delmas PD, Balena R, Confravreux E, et al. Bisphosphonate risedronate prevents bone loss in women with artificial menopause due to chemotherapy of breast cancer: a double-blind, placebo-controlled study. J Clin Oncol 1997; 15: 955–62 Reginster JY, Minne HW, Sorensen OH, et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Osteoporos Int 2000; 11: 83–91 Watts NB, Josse RG, Hamdy RC, et al. Risedronate prevents new vertebral fractures in postmenopausal women at high risk. JCEM 2003; 88: 542–9 Roux C, Seeman E, Eastell R, et al. Efficacy of risedronate on clinical vertebral fractures within six months. Curr Med Res Opin 2004; 20(4): 433–9 Harrington JT, Ste-Marie LG, Brandi ML, et al. Risedronate rapidly reduces the risk for nonvertebral fractures in women with postmenopausal osteoporosis. Calcif Tissue Int 2004; 74(2): 129–35 Brown JP, Kendler DL, McClung MR, et al. The efficacy and tolerability of risedronate once a week for the treatment of postmenopausal osteoporosis. Calcif Tissue Int 2002; 71: 103–11 Sorensen OH, Crawford GM, Mulder H, et al. Long-term efficacy of risedronate: a 5-year placebo-controlled clinical experience. Bone 2003; 32(2): 120–6 Mellstrom DD, Sorensen OH, Goemaere S, et al. Seven years of treatment with risedronate in women with postmenopausal osteoporosis. Calcif Tissue Int 2004; 75(6): 462–8 Actonel® (risedronate sodium) package insert. Cincinatti OH): Procter & Gamble, 2002 May Kanis JA, McCloskey EV. Effect of calcitonin on vertebral and other fractures. QJM 1999; 92: 143–9 Chesnut III CH, Silverman S, Andriano K, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the Prevent Recurrence of Osteoporotic Fractures Study. Am J Med 2000; 109: 267–76 Silverman SL, Azria M. The analgesic role of calcitonin following osteoporotic fracture. Osteoporos Int 2002; 13: 858–67 Lyritis GP, Ioannidis GV, Karachalios T, et al. Analgesic effect of salmon calcitonin suppositories in patients with acute pain due to recent osteoporotic vertebral crush fractures: a prospective double-blind, randomized, placebo-controlled clinical study. Clin J Pain 1999; 15: 284–9 Repchinsky C. Compendium of Pharmaceuticals and specialities. 36th ed. Ottawa: Canadian Pharmacists Association, 2001: 236–7 Goldstein SR. Selective estrogen receptors modulators: a new category of therapeutic agents for extending the health of postmenopausal women. Am J Obstet Gynecol 1998; 179: 1479–8 Khovidhunkit W, Shoback DM. Clinical effects of raloxifene hydrochloride in women. Ann Intern Med 1999; 130: 431–9 Walsh BW, Kuller LH, Wild R, et al. Effects of raloxifene on serum lipids and coagulation factors in healthy postmenopausal women. JAMA 1998; 279: 1445–51 Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in post-menopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA 1999; 282: 637–45 Cummings SR, Eckert S, Krueger KA, et al. The effect of raloxifene on risk of breast cancer in postmenopausal women. JAMA 1999; 281: 2189–97 Walsh BW, Kuller LH, Wild RA, et al. Effects of raloxifene on serum lipids and coagulation factors in healthy postmenopausal women. JAMA 1998; 279: 1445–51 Draper MW, Flowers DE, Huster WJ, et al. A controlled trial of raloxifene (LY139481) HC1: impact on bone turnover and serum lipid profile in healthy postmenopausal women. J Bone Miner Res 1996; 11: 835–42 Delmas PD, Bjarnason NH, Mitlak BH, et al. Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med 1997; 337: 1641–7 Lilly Forteo. Osteoporosis indication approval recommended with restrictions: FDA Endocrinological and Metabolic Drugs Advisory Committee. Pink Sheet 2001 Jul 30; 63(31): 3 Jilka RL, Weinstein RS, Bellido T, et al. Increased bone formation by prevention of osteoblast apoptosis with parathyroid hormone. J Clin Invest 1999; 104: 439–46 Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1–34) on fracture and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344: 1434–41 Ettinger B, San Martin J, Crans G, et al. Differential effects of teriparatide on BMD after treatment with raloxifene or alendronate. J Bone Miner Res 2004; 19(5): 745–51 Reid IR, Brown JP, Burckhardt P, et al. Intravenous zoledronic acid in postmenopausal women with low bone mineral density. N Engl J Med 2002; 346: 653–61 Chesnut III CH, Skag A, Christiansen C, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 2004; 19: 1241–9 Meunier PJ, Roux C, Seeman E, et al. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 2004; 350(5): 459–68