骨质疏松症骨微结构的病变与药物治疗  

Drug therapy and pathological changes of bone microarchitecture in osteoporosis

作　　者：林华[1] Lin Hua(The Center of Research for Metabolic Bone Disease,Department of Orthopaedics,the Affiliated Drum Tower Hospital of Medical School,Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院骨科骨病中心,南京210008

出　　处：《中华骨科杂志》2022年第22期1531-1538,共8页Chinese Journal of Orthopaedics

摘　　要：骨微结构的破坏是骨质疏松症最主要的病理性改变之一。骨微结构损伤会导致骨强度下降,骨折风险增加。骨重建失衡是骨质疏松症患者骨微结构损伤的主要原因。抗骨质疏松药物可以调节骨重建,从而改善骨微结构。目前抗骨质疏松药物主要包括抗骨吸收药、促骨形成药两大类。抗骨吸收药物[包括双膦酸盐、核因子κB受体活化因子配体(receptor activator of nuclear factor kappa-B ligand,RANKL)抑制剂等]一方面抑制骨吸收,防止骨小梁体积、数目及连接性的进一步损失;另一方面抑制骨重建,给骨重建单元提供更多时间来提高骨矿化程度。促骨形成药物(包括特立帕肽和阿巴洛肽)通过刺激骨重建及一定程度的骨塑建促使骨代谢正平衡(骨形成大于骨吸收);从而增加骨小梁数目,改善骨小梁结构。除以上两类药物之外,硬骨抑素抗体(如Romosozumab)可以中和硬骨抑素,具有双向作用,既可刺激骨形成,又可抑制骨吸收,对松质骨及皮质骨微结构的改善均有一定效果。既往有众多研究证实了各类抗骨质疏松药物在改善骨微结构、提升骨质量方面的疗效,但RANKL抑制剂促进骨塑建的具体作用机制、双膦酸盐对皮质骨孔隙度的影响等方面仍需要进一步研究。Destruction of bone microarchitecture is one of the most important pathological changes of osteoporosis;it will result in the decrease of bone strength and the increase of fracture risk.Imbalance occurring in bone remodeling is the main cause of microarchitecture destruction.Anti-osteoporosis drugs are able to regulate bone remodeling and therefore improve declined bone microarchitecture.So far,there are mainly two types of anti-osteoporosis drugs:antiresorptive agents and anabolic agents.The antiresorptive agents,including bisphosphonates and receptor activator of nuclear factor kappa-B ligand(RANKL)inhibitors,can improve microarchitecture in two ways:(1)preventing further loss of trabecular bone volume,trabecula number and connectivity;and(2)suppressing activation of remodeling,giving the remodeling unit more time to improve bone mineralization.The anabolic agents include teriparatide and abaloparatide,which can stimulate bone remodeling and some extent of bone modeling thus lead to a positive bone metabolism balance.Therefore,anabolic agents can increase the number of trabecula and improve trabecular bone structure.Except for the two types of agents,sclerostin antibodies,a new type of anti-osteoporosis drug,can neutralize sclerostin to bilaterally promote bone formation and inhibit bone resorption,leading to an improvement in microarchitecture in both cortical bone and trabecular bone.Although many studies have proved the efficacy of anti-osteoporosis drugs in the improvement of bone microarchitecture and quality,further research is still needed for specific topics,such as the mechanism of RANKL inhibitor to improve bone modeling and the effect of bisphosphonate on porosity of cortical bone.

关 键 词：抗骨质疏松药物 骨微结构 病理性改变 骨小梁结构 骨质疏松症 抑素 骨重建 骨吸收 

分 类 号：R681[医药卫生—骨科学]