让我们来谈谈骨质疏松治疗药

Whether you have risk factors for developing osteoporosis or you’ve been diagnosed, you may wonder what the best avenues are for strengthening your bones. While there’s no cure for this bone-thinning condition, with the right meds, you can see improvement and slash your risk of fractures.

什么是骨质疏松症？我们来复习

骨质疏松means多孔骨头。In short: It’s a condition that occurs when you lose more bone mass than your body can make. Think of your bones as a bank account: You spend the first couple of decades of your life socking away bone (money) for retirement. When you reach age 30 or so, you’ll hit yourpeak bone mass—the highest bone mass you’ll have in your lifetime. When you’re a kid, a calcium-rich diet, exercise, and general good health yield healthy bone development.

If you skimped on any of the above (say, due to a childhood illness), your peak bone mass might be on the low side. Once you reach that retirement age (over 50), you’ll need to make some withdrawals; this is when you start losing bone mass naturally and bone formation slows.

如果你没有一个伟大的峰值骨量，开始时，你可能会遇到麻烦，留下骨头薄，脆，容易断裂。Certain risk factors—such as being a postmenopausal woman, having been on steroid medications such as prednisone, having an overactive thyroid condition, having undergone bariatric surgery or having a family history of osteoporosis —can also mean you’ll lose bone at a faster-than-normal rate.

What Is the Goal of Osteoporosis Treatment?

The end goal of all osteoporosis treatments is to stabilize yourbone density—meaning, prevent you from losing additional bone—rather than achieve a complete cure. These meds are designed to slow your bone loss, and in some cases, help make new bones, so yours areless vulnerable to断裂(breaking)。

That’s important because fractures aren’t just painful — they can be debilitating, leading to loss of mobility and independence, financial strain, and even death. The mortality rate a year after a hip fracture is about 22 percent. Yet, osteoporosis causes a staggering number of bone breaks a year: 1.5 million to be exact, according to research in theJournal of the American Medical Association。

Are Osteoporosis Drugs Given Preventatively?

要回答这个问题，让我们有什么实际上构成骨质疏松症开始。当你有一个条件是常被诊断bone density scan, a test that measures your骨矿物质密度（BMD）。

最常见的BMD测试是一个dual-energy X-ray absorptiometryorbone densitometry称为DXA或DEXA扫描。它会检查你的骨骼矿物质水平，比较你的水平，一个30岁的同性别的。我们的想法是，看看你的骨骼密度多远从那时起偏离。以下是如何看你的结果，被称为T-score：

• 1.0 and above is considered normal
• -1.0 to -2.4 is consideredlow bone density or osteopenia(meaning bone mass isn’t great, but it’s not yet osteoporosis)
• -2.5和以上被认为是骨质疏松

如果你遭遇了骨折，医生可能会做一次骨密度扫描，看是否骨质疏松症在作怪。扫描还经常给开始在65岁女性和男性（有风险的妇女可以在60开始）开始在70岁。

Your doctor will also determine how likely you are to fracture a major bone within the next 10 years via aFracture Risk Assessment Tool (FRAX)。如果你有骨质疏松和lowrisk of fracture, you probably won’t be treated with an osteoporosis drug. Instead, the recommendation is to make lifestyle changes to improve, or at least stabilize, your bone density. What kinds of tweaks are we talking about? These may include:

• 饮食改变（更钙，维生素d）
• Weight-bearing exercises (walking, dancing, resistance training, etc.)
• 限制饮酒
• 戒烟

However, if you’re diagnosed with osteopenia and have ahighrisk of fracture, your physician may start you on osteoporosis meds to slow down your bone loss before it becomes osteoporosis. Medications aren’t always a given though. A person who is diagnosed relatively young with no history of fractures and is otherwise healthy may not need meds just yet.

What Medications Are Prescribed For Osteoporosis?

A few drug classes for osteoporosis that work in different ways to prevent fracture and a treatment plan may include one of the following types of drugs:

Antiresorptives

This family of meds give your natural bone production a chance to play catch-up by slowing or stopping吸收, when bones break down and release minerals such as calcium into your blood. They home in on and inhibitosteoclasts细胞,分解。Antiresorptive drugs include:

Bisphosphonates

你可能听说过福善美或Boniva（或Boniva通用伊班膦酸钠）的。他们这种药物类的一部分 - 最常用的骨质疏松症。双膦酸盐通过减缓那些破骨细胞，使你的工作osteoblasts(the bone-building cells) a chance to get ahead. Examples include:

• Boniva (ibandronate), an oral tablet approved for women that’s taken monthly or via IV every three months.
• Fosamax/Fosmax D Plus (alendronate), an oral tablet approved for women and men that’s taken daily or weekly.
• Binosto（阿仑膦酸钠），批准用于女性和男性每周泡腾片在液体中溶解。
• Actonel (risedronate), an oral tablet approved for women and men that’s taken daily, weekly, twice monthly, or monthly.
• Atelvia (risedronate), an oral tablet approved for women that’s taken weekly.
• 密固达（唑来膦酸），静脉滴注批准给予一年一次的男女。

大多数药物都具有副作用一定的风险，二膦酸盐也不例外。双膦酸盐的最常见的副作用是：

• nausea
• heartburn
• 胃溃疡
• 骨关节疼痛
• muscle pain

There is a side effect from Fosamax calledosteonecrosis of the jaw（血液供应丧失该骨）。这是一个危险allbisphosphonates, but it’s rare and usually seen in people receiving high doses of the meds during cancer treatments. Another less common side effect isatypical femoral fracture; (yes, an osteoporosis med can actually cause a bone break). Long-term use is linked to breaks in the upper thigh area. Zoledronic acid side effects can also include flu-like symptoms, but they’re temporary.

To reduce the risk of the more serious side effects, current osteoporosis treatment guidelines for bisphosphonates call for reassessing a patient’s fracture risk after three to five years. If your risk of fracture is low-to-moderate after treatment, you may be able to take a break from the drugs; those who are still high risk can remain on bisphosphonates for up to 10 years.

RANK配体（RANKL）抑制剂

这些注射中和工作RANKL, a protein that’s necessary for osteoclasts to do their job breaking down bone. They’re given via injection every six months, depending on the brand, for up to 10 years. Example include:

• Prolia, an injection approved for men and women, given every six months. Side effects include: constipation, muscle and back pain, weakness, rash, swelling, bloody, cloudy or painful urination.
• Xgeva, an injection approved for men and women, given every four weeks. Side effects include: diarrhea, nausea, fatigue, joint and muscle pain.

RANKL injections can also lead to atypical fractures, and that risk is even greater if you suddenly stop treatment. A study in the journal国际骨质疏松症found a five percent increase in multiple vertebral fractures after halting the osteoporosis treatment injection.

Hormone Replacement Therapy (HRT)

HRT cuts down on fragility fractures by 20 to 35 percent, studies have shown, but because of its potential health risks (pulmonary embolism, cardiovascular issues, and breast cancer are just a few), it’s considered a last resort treatment for osteoporosis alone and is reserved for women who are experiencing both menopause symptomsandosteoporosis. Side effects can include:

• Breast tenderness
• 腿脚肿胀
• Weight gain

HRT is approved for women in the form of daily oral tablets and transdermal patches that are applied daily or weekly.

Selective Estrogen Receptor Modulators (SERMs)

SERM的不是激素，所以他们不携带相同的风险，因为传统的HRT，但这类药物确实起到减少更年期系统和强化骨骼和预防骨折，特别是在脊柱类似雌激素在体内。

It’s a good option for women who are dealing with both menopause symptoms and osteoporosis, but have a high risk of breast cancer that eliminates HRT as an option. SERMs are taken as a daily tablet. One example is Evista (raloxifene), a daily oral tablet approved for women. Evita’s most common side effects are:

• 潮热
• 腿抽筋
• 血块

Tissue-Specific Estrogen Complex (TSEC)

This type of drug, like Duavee (conjugated estrogens/bazedoxifene) combines estrogen with a SERM to help with severe menopause symptoms such as hot flashes and boost bone mineral density. Research has shown it can increase both spine and hip density after 12 months. It’s a daily tablet that’s taken orally. Side effects can include:

• Nausea
• Dizziness
• Pain
• 肌肉痉挛

Because TSEC contains estrogen, it carries some of the risks of HRT.

合成代谢代理

These are your bone builders. This osteoporosis drug class is designed to stimulate osteoblasts, the cells that beef up bone formation. They’re typically reserved for more severe cases of osteoporosis where the risk of fracture is very high. Anabolics include:

• 每月一次给予一年Evenity（romosozumab-aqqg）
• Forteo (teriparatide) injection is given daily and is limited to two years of use
• Tymlos (abaloparatide) is a daily injection also with a two-year cap

The most common side effects of these osteoporosis treatment injections are:

• Headaches
• Nausea
• Fatigue
• Joint pain

新est bone maker on the block, romosozumab-aqq, is an anti-sclerosin monoclonal antibody approved for postmenopausal women with high risk of fracture. It comes with a risk of cardiovascular issues, so if you’ve had a heart attack or a stroke within the past year, this is not an ideal drug. Teriparatide and abaloparatide are synthetic versions of parathyroid hormone, which regulates calcium, essential for strong bones.

While worries about side effects may give you pause about filling your prescription for osteoporosis meds, it’s important to remember this: The benefits of preventing a fracture (and all that comes with it) win out over the risks of taking these meds, according to guidelines from the Endocrine Society published in该杂志内分泌与代谢的。

Can You Combine Meds?

它没有被广泛完成，但有证据表明，配对的骨吸收与合成代谢剂可以产生更好的效果比单独给予一种药物。在一项研究中国骨与矿物质研究的showed combining the bisphosphonate zoledronic acid with the anabolic teriparatide boosted bone mineral density in the spine and hip more than either drug alone.

在七项研究的分析，research in theBMJ Openfound that a combo of the two drug classes greatly improved bone mineral density of the hip and spine more quickly than an anabolic agent alone. Some doctors will also give an anabolic first (in severe cases) and prescribe a bisphosphonate to maintain your newly formed bone mass.

What Other Drugs May Help Bones?

While bisphosphonates and anabolic agents are the most common osteoporosis medications, some drugs that are used to treat other conditions that can also have a positive effect on bone density.

Anabolic Steroids

You’ve probably heard steroids are bad for bones. It’s true; long-term use ofcorticosteroids(synthetic drugs that are similar to cortisol, a hormone your body produces) deteriorates bone mineral density, causing osteoporosis. But low doses of合成代谢类固醇(synthetic versions of the male hormone androgen) may have the opposite effect, stimulating bone growth and reducing osteoporosis pain from fractures, according to research inClinical Calcium。However, there’s limited data to know the long-term side effects of anabolic steroids.

Plaquenil (Hydroxychloroquine)

这曾经是一个疟疾药物。怎么能这possibly help your bones? Hydroxychloroquine is antirheumatic, meaning it’s used to treat rheumatoid arthritis (RA), lupus, Sjögen syndrome, etc. Researchers discovered those treated with Plaquenil had higher bone mineral density than those who weren’t. It’s not FDA approved for osteoporosis and comes with a rare, but serious risk of eye damage in high doses. More common side effects include:

• Rashes
• 模糊的视野
• 减肥
• Diarrhea
• Hair loss

阿可达（帕米膦酸二钠）

This is another type of bisphosphonate given via IV infusion that slows down bone loss, but it’s primarily used to treat bone damage from佩吉特氏病（一种慢性疾病，导致骨组织的劣化）和某些类型的癌症，以及hypercalcemia(high levels of calcium in blood caused by calcium). It’s an option for osteoporosis patients, but zoledronic acid has proved better for fracture prevention.

What About Natural Supplements for Osteoporosis?

Right now, there are no natural supplements that experts recommend in lieu of FDA-approved osteoporosis drugs. If you’ve been searching the internet for that, you’ve probably come across info on strontium, a trace element, for osteoporosis.

There is some scientific basis on this one. A study found that postmenopausal women who took two grams of strontium ranelate every day for three years suffered 37 percent fewer spinal fractures compared to women taking a daily placebo pill.

There’s also a strontium ranelate-based drug (Protelos) approved in Europe, but not here in the US. (It’s associated with some serious side effects such as pulmonary embolism and heart attacks.) So, should you take an over-the-counter version of the mineral, such as strontium citrate or strontium chloride, to strengthen your bones? Not so fast. These are not the same as strontium ranelate, and there’s no evidence they work.

What about OTC estrogen pills? Phytoestrogens, plant-based versions of the hormone such as soy and flaxseed, have some limited data behind them to show that they may help slow bone loss. But physicians say not enough to replace your prescribed medication. Phytoestrogens in your diet may be better at preventing low bone density than treating osteoporosis.