The treatment of osteoporosis is the treatment of drugs to be achieved through drug treatment to prevent fractures. Osteoporosis treatment drugs are divided into three categories: bone resorption inhibitors, bone formation promoters, and bone metabolism regulators. According to the characteristics of the drugs currently used, the recommended grades for the bone mineral density, vertebral fractures, non-vertebral fractures, and proximal thigh bone fractures are recommended for reference.
I. Bone resorption inhibitor
Key Point: Bisphosphonates are the first choice for the treatment of osteoporosis.
Pharmacodynamics • Mechanism of action: According to the structure of the side chain, it is divided into the first generation to the third generation; according to the presence or absence of nitrogen atoms in the side chain, the mechanism of bone resorption inhibiting activity and pharmacological action is different; only the sodium etidronate is not The exact inhibitory effect of non-vertebral fractures.
Usage • Dosage: Formulations with intermittent intermittent administration, daily administration, once-a-week administration or even once a month.
In particular, the use of the preparation once a week and once a month reduces the medicinal compliance of the patient who is required to be fasted. See the table below for details.
The amount of bone formation and osteoinhibition of etidronate disodium is not much different, and in order to prevent bone calcification, a periodic intermittent administration method is employed. Other drugs (alendronate, risedronate, minodronate hydrate) have a large difference in the amount of bone formation inhibition and bone resorption inhibition, and patients can adjust and select the dosage form according to lifestyle.
Adverse reactions: prodromal symptoms of atypical fractures, usually pain in the thigh and groin; for patients with oral bisphosphonate medication for more than three years or at risk of osteonecrosis of the jaw, invasive dental treatment is recommended. It is best to stop the drug for 3 months; it is time to resume the medication, it is recommended to wait until the wound is healed.
(basic structure of bisphosphonate)
Key Point: Using the appropriate choice and use of the drug by the patient can reduce the occurrence of adverse events and maximize the therapeutic effect of the drug.
The characteristics of estrogen drugs for the treatment of osteoporosis, percutaneous and oral characteristics, see the table below.
Mechanism of action: Estrogen drugs can inhibit the bone resorption of parathyroid hormone. At the same time, it can promote the absorption of calcium in the intestine, the reabsorption of calcium by the kidney, and promote the production of active vitamin D3.
Adverse reactions: If you have a surgical plan and consider taking a long time to stay in bed, it is recommended to stop the drug for a period of time, but the time to stop the drug is still inconclusive.
3. Selective estrogen receptor modulator (SERM)
Key Point: Due to the safety and convenience of taking drugs, SERM is currently recommended as the first choice for early postmenopausal women with low fracture risk.
Selective estrogen receptor modulator (SERM) exhibits an estrogen-like effect on bone and lipid metabolism, exhibits an anti-estrogen-like effect on the mammary gland and uterus, and avoids the most important female hormone drugs. The problem point can also exert the bone absorption inhibition effect. The preventive effects of SERM drug fractures are shown in the table below.
Effectiveness • Safety:
1 The preventive effect of non-vertebral fractures, raloxifene hydrochloride has certain advantages compared with bazedoxifene acetate.
Both raloxifene hydrochloride and bazedoxifene acetate increased the risk of deep venous thrombosis, and the incidence of both drugs was comparable.
Both raloxifene hydrochloride and bazedoxifene acetate caused a slight increase in low estrogen symptoms such as vasodilation (hypotion) and calf pain, and the incidence was not significantly different.
Adverse reactions: Expected long-term immobility (surgery, long-distance bus, long-distance flight overseas) It is recommended to stop the drug for a while.
Key Point: 1 A case of bone pain caused by osteoporosis accompanied by osteolysis and/or osteopenia. 2 The pain improvement effect takes about 2 to 6 weeks.
Calcitonin, we expect it to relieve pain and improve quality of life, is the first choice for patients with osteoporotic fractures and skeletal deformities associated with vertebral bodies. The mechanism of action of calcitonin is to exert an analgesic effect by regulating the level of serotonin in the central nervous system, and at the same time, it can directly inhibit the receptor of osteoclasts, thereby exerting an effect of inhibiting bone resorption. Adverse reactions occasionally allergic symptoms, erythema, pimples, etc., severe shock has also been reported.
Key Point: female estrogen-like effect, play a role in bone resorption and bone formation; peptic ulcer and patients with this past history should be used with caution.
There has been no report on the effectiveness of the drug since 2001, and evidence of doubts about the effects of fracture inhibition continues to emerge. At present, the frequency of treatment of osteoporosis with ipriflavone is lower than other therapeutic drugs.
Adverse reactions: Allergies, gastrointestinal symptoms, and neurological symptoms occur frequently. In particular, patients with a history of peptic ulcer may induce ulcers or worsen symptoms and require special attention. Cases of male breast development have also been reported occasionally.
II. Bone formation promoter
1. Parathyroid hormone (PTH)
Key Point: Parathyroid hormone is mainly targeted at patients with osteoporosis at high risk of fracture; it is currently used as a secondary treatment for osteoporosis treatment.
Mechanism of action: Persistent PTH excess causes bone metabolism to decrease and causes bone mass to decrease. On the other hand, intermittent subcutaneous injection once a day or once a week induces osteoblast differentiation and inhibits apoptosis, and promotes bone mass increase, but the mechanism of action is not clear.
Combination therapy: The combination of teriparatide and alendronate will weaken the effect of promoting bone formation. At present, there is no clear evidence that the advantages of the combination of this drug and bone resorption inhibitor are not recommended for use with bone resorption inhibitors.
Adverse reactions: nausea and vomiting caused by PTH drugs, antiemetics support treatment; PTH drugs should not be given to patients with cancer.
2. Protein anabolic hormone
The clinical research evidence for the treatment of osteoporosis is rare and the frequency of use is relatively low. The frequency of liver function damage in adverse reactions is about 50%, and it will improve after stopping the drug. Occasionally, masculine symptoms such as hairiness and vocalization occur, and are relieved after stopping the drug.
3. Vitamin K2
Key Point: For patients with vitamin K2 deficiency; determine whether the patient has vitamin K2 deficiency by measuring the concentration of carboxylate incomplete calcium in the blood.
In vivo dynamics • Drug interactions: The drug relies on bile absorption and should be taken after meals; warfarin inhibits coagulation factors by antagonizing vitamin K, so patients who are using warfarin should not use this drug.
III. Bone Metabolism Regulators
Key Point: Pay attention to the different calcium content of different preparations when administering; it is recommended to choose a better absorption of organic salt calcium.
Adverse reactions: constipation occurs as a sign of drug reduction; calcium intake is associated with an increased risk of cardiovascular disease, and it is recommended that the intake of calcium should not exceed 500 mg per time.
2. Active vitamin D3
Key Point: Alfacalculated alcohol and calcitriol reduce the risk of falls, especially for elderly patients; compared with other drugs, Alcohol has an advantage in bone mineral density increase and fracture prevention.
Adverse reactions: severe adverse reactions may occur due to renal insufficiency caused by hypercalcemia, it is necessary to regularly monitor blood calcium levels; pay attention to observation and monitoring of nausea, vomiting, thirst, polyuria, muscle weakness and other early stages of hypercalcemia Symptoms; digitalis drugs combined, serum calcium concentration increased, enhance the role of digitalis drugs, easily lead to arrhythmia.