非典型骨折作为长期双酸盐治疗的潜在并发症
1Johns Hopkins School of Medicine, 5200 Eastern Ave, Mason F. Lord Center Tower, Ste 4300, Baltimore, MD 21224, USA. dsellme1@jhmi.edu
JAMA
|October 7, 2010
概括
双酸盐疗法有效治疗骨质疏松症,但长期使用可能会损害骨的修复,导致不典型的骨折. 管理涉及风险评估,治疗中断,并考虑替代方案,如 teriparatide.
科学领域:
- 骨生物学和药理学 骨生物学和药理学
- 整形外科手术 整形外科手术
- 老年医学 老年医学
背景情况:
- 双酸盐对于治疗50岁以上的人的低骨质量和骨质疏松症至关重要.
- 目前的双酸盐有效地减少了脊椎,非脊椎和部骨折.
- 骨质疏松症影响超过一半的50岁以上的人.
研究的目的:
- 审查与长期双酸盐治疗相关的非典型骨折的潜在风险和管理.
- 突出这些骨折的特征和关于这些骨折的患病率和风险因素的有限数据.
主要方法:
- 对非典型骨折的病例报告和临床系列的审查.
- 对与双酸盐有关的骨折的当前管理策略的分析.
主要成果:
- 长时间的双酸盐治疗可能会抑制骨重塑,导致骨修复功能受损.
- 不典型的骨折呈现独特的特征,包括部下部关节的参与,前端大腿疼痛和最小的创伤.
- 关于这些骨折的患病率和风险因素的数据仍然有限.
结论:
- 目前的管理包括仔细评估骨折风险和适当的双酸盐向.
- 在稳定的患者中,建议在治疗5年后考虑12个月的药物假期.
- 在双酸盐治疗期间出现异常骨折的患者,特里巴拉提德可能是治疗的选择.
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