臨 Therapeutics of Clinical Drugs OC) (osteoblast OB) 1 表 一 WHO 骨 質 密 度 診 斷 標 準 T ( ) +1~-1.0-1~ ,4 表 二 影 響 造 骨 細 胞 與 蝕 骨 細 胞 的 因 子 (stromal c

Transcription

1 骨 質 疏 鬆 症 的 臨 台 北 榮 民 總 醫 院 新 竹 分 院 劑 科 師 蔡 麗 雲 王 茂 富 摘 要 (osteopenia) (osteoporosis) () RANKL (denosumab) osteoporosis fracture bisphosphonates 壹 流 行 病 % 12.5% % 22% 10 貳 骨 質 疏 鬆 症 簡 介 一 定 義 2000 (National Institutes of Health, NIH) (WHO) (BMD) ( ) 二 成 因 (osteoclast 30 2 Jun 雜 誌

2 臨 Therapeutics of Clinical Drugs OC) (osteoblast OB) 1 表 一 WHO 骨 質 密 度 診 斷 標 準 T ( ) +1~-1.0-1~ ,4 表 二 影 響 造 骨 細 胞 與 蝕 骨 細 胞 的 因 子 (stromal cell) (osteocalcin) ( ) Osteoblast OB PTH*( ) 1.25 (OH) 2 D 3 PGE 2 (Glucocorticoid) T 3 T 4 TGF**- hgh IGF -1 Osteoclast OC PTH ( ) IL -2 IL-6 TGF- TNF*** Calcitonin Estrogen TGF- PGE 2 IFN *PTH parathyroid hormone, **TGFtransforming growth factor, ***TNF tumor necrosis factor, IGF insulin-like growth factor, IL interleukin 三 分 類 ( 一 ) 原 發 性 骨 質 疏 鬆 症 次 分 為 1. ( ) 2. ( ) D ( 0.5-1%) ( 二 ) 次 發 性 骨 質 疏 鬆 症 10% (glucocorticoid) (1) (2) (3) (4) 3. 參 2008 (NOF) 70 THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.2 Jun

3 表 三 停 經 後 婦 女 及 五 十 歲 以 上 男 性 的 骨 質 疏 1,5 鬆 介 入 準 則 1. 髖 2. 髖 DXA T 髖 DXA T T T (FRAX Tool) 10 20% 髖 3% 一 抗 溶 蝕 品 (antiresorptive agents) ( 一 ) 雙 磷 酸 塩 類 (bisphosphonates) (turnover rate) ml ( ) (upright) (osteonecrosis of the jaw ONJ) (flu like symptoms) ( ) 1.alendronte (Fosamax)70 mg 6 2.risedronate (Actonel) 150 mg 3.ibandronate (Bonviva) 3 mg zoledronic acid (Aclasta ) 5 mg ( 二 ) 選 擇 性 雌 激 素 受 體 調 節 劑 (selective estrogen respose modulators,serms) ( agonist) (antagonist) (BMD) 1. Raloxifene (Evista ) 60 mg 7 (LDL) (venous thromboembolism VTE) 2. Bazedoxifene (Viviant ) SERM estrogen receptor raloxifene 8 ( 三 )Calcitonin 抑 鈣 激 素 臨 30 2 Jun 雜 誌

4 臨 Therapeutics of Clinical Drugs 9 (tachyphylaxis) (rhinitis)200 IU (European Medicines Agency EMA) % EMA 10 ( 四 )RANKL 單 株 抗 體 (human monoclonal antibody for RANKL)- Denosumab (Prolia, 保 骨 麗 ) B (receptor activator of nuclear factor- B RANK) RANKL Denosumab RANKL denosumab denosumab 6 60 mg 11 二 同 化 作 用 的 品 (anabolic agents) ( 一 ) 副 甲 狀 腺 (teriparatide, Forteo 骨 穩 ) (FDA) ( ) 20 g teriparatide 3 ml 750 g 20 g 18 teriparatide 三 兼 具 抗 溶 蝕 及 同 化 作 用 的 品 ( 一 ) 鍶 化 合 (strontium ranelate,protos 補 骨 挺 疏 ) 2 (ranelic acid) ranelic acid Protos 2 2 gm DRESS ( drug rashes with eosinophilia and systemic symptoms) 72 THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.2 Jun

5 SJS ( - Stevens-Johnson syndrome) TEN (toxic epidermal necrolysis) VTE VTE strontium ranelate 四 研 發 中 的 新 cathepsin K cathepsin K cathepsin K odanacatib 13 肆 飲 食 及 生 活 型 態 的 建 議 D mg ( elemental calcium ) D IU 25 (OH) D3 30 ng/ml ( ) 14 表 四 各 類 含 鈣 製 劑 含 鈣 量 伍 總 結 Calcium acetate 25% 667 mg = 169 mg Calcium carbonate 40% 500 mg = 200 mg Calcium citrate 21% 950 mg = 200 mg Calcium glubionate 6.5% 1.8 g = 115 mg Calcium gluconate 9% 500 mg = 45 mg Calcium lactate 13% 650 mg = 84.5 mg Calcium phosphate 39% mg = 600 mg raloxifene alendronte teriparatide teriparatide 臨 30 2 Jun 雜 誌

6 臨 Therapeutics of Clinical Drugs Management of Osteoporosis Li-Yun Tsai, Mao-Fu Wang Department of Pharmacy, Hsinchu Branch, Taipei Veterans General Hospital Abstract Osteoporosis is a progressive, and sometimes an asymptomatic systemic skeletal disease characterized by low bone density and architectural deterioration of bone tissue. It disturbs the elderly in Taiwan deeply, especially the postmenopausal women. Prevention and treatment of osteoporopsis consist of non-drug and drug or hormonal therapy. There are three components to the nondrug therapy of osteoporopsis: diet, exercise, and cessation of smoking.the drugs for therapy of osteoporopsis includes bisphosphonates, selective estrogen receptor modulators, calcitonin, denosumab, parathyroid hormone, strontium ranelate...etc. The article attempts to look into the drug treatment of osteoporopsis including the medicine still under research. For the purpose to manage osteoporopsis, the modification of life style is as important as drug treatment. 參 考 資 料 : 1.!2011; 1747, 1749, 1748: Teriparatide (4) William F: Review of Medical Physiology, 20th ed, 2001: Overview of the management of osteoporosis in postmenopausal women from UpToDate 6. Wells GA, Granney A,Peterson J, et al: Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrone Database Syst Rev. 2008; 23: CD Delmas PD, Ensrud KE,Adachi JD, et al: Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis four-year results from a randomized clinical trial. J Clin Endocrinol Metab. 2002; 87: Medical Journal of South Taiwan 2013;9: Knopp-Sihota JA, Newburn-Cook CV, Homik J, et al: Calcitonin for treating acute and chronic pain of recent and remote osteoporotic vertebral compression fractures:a systematic review and meta-analysis. Osteoporos Int. 2012; 23: ;1780: Denosumab 2013; 29(1): Saag G, Shane E, et al:teriparatide or Alendronate in Glucocorticoid-Induced Osteoporosis, The New Engl Journal of Medicine 2007; 357: Perez-Castrillon JL, Pinacho F, De Luis D,et al. Odanacatib, a new drug for the treatment of osteoporosis: review of the results in postmenopausal women. J Osteoporos.2010; 2010, pii: Osteoporosis management from Lexicomp Online. 74 THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.2 Jun