骨質疏鬆症之藥物治療簡介 國軍高雄總醫院左營分院臨床藥劑科藥師陳立材 施嘉慶 魏春生 摘要 osteoporosisfractured 臨床藥Therapeutics of Clinical Drugs 物治療學壹 前言 (osteoporosis) 1 15% 22% 1-2 10 1-2 貳 骨質疏鬆症定義 診斷與病理生理學 88 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.2 Jun. 30 2015 T T ( ) T -1 T -1-2.5 (osteopenia)
藥學雜誌 123 89 (low bone mass)t -2.5 T -2.5 3 (osteoblast) (osteoclast) 參 骨質疏鬆症之流行病學 21% 16% 3 ( ) ( ) 臨床 藥物治療 學肆 骨質疏鬆症之預防與藥物治療指引 D D 3-4 伍 骨質疏鬆的藥物簡介一 雙磷酸鹽 (bisphosphonates) () (osteonecrosis of the jaws) 312 Jun. 30 2015
( ) 3-8 6-8 表一雙磷酸鹽類藥物資訊整理 N ( etidronate ) alendronate (plus D3) Fosamax 100-1000 10 ibandronate Boniva / 1000-10000 10-60 risedronate Actonel 1000-10000 480 zoledronic acid Zometa 10000 146 臨床藥Therapeutics of Clinical Drugs 物治療學二 選擇性雌激素受體調節物 (selective estrogen receptor modulators,serm) Raloxifene IDL 3-8 三 荷爾蒙替代療法 (estrogen/ progestin therapy) 3-8 四 副甲狀腺素 (parathyroid hormone) teriparatide 90 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.2 Jun. 30 2015 2 18 3-8 五 抑鈣激素 (calcitonin) 3-5 六 鍶 2 (strontium) ranelic acid ranelic acid 3-8 七 Denosumab ( 細胞核 Kb 受體活化因子配體抑制劑, RANKL Inhibitor) kb
藥學雜誌 123 91 臨床 藥物治療學 (Receptor Activator of NFkB; 八 鈣製劑 (calcium) 和維生素 D RANK) kb D (RANK Ligand; RANKL) RANKL Inhibitor 1000 RANKL RANKL 1500D Denosumab 60 mg 3-8 3-8 () 表二常見鈣片的種類與比較 (%) (mg) C 40 500 20 meq 27% C 39 362-487 19.3 meq 25% C 21 262 10.6 meq 35% C 13 162 6.5 meq 29% C 9 112 4.5 meq 27% 1250 mg 312 Jun. 30 2015 陸 如何選擇骨質疏鬆症的治療藥物 ( ) ( ) 3-4 柒 結論
Drugs for the Treatment of Osteoporosis Li-Chai Chen, Jia-Qing Shi, Chun-Sheng Wei Department of Pharmacy, Zuoying Branch of Kaohsiung Armed Forces General Hospital Therapeutics of Clinical Drugs 臨床藥物治療學92 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.2 Jun. 30 2015 Abstract Osteoporosis is a common problem that causes bones to become abnormally thin, weakened, and easily broken (fractured). Currently estimated to be a major public health threat. Osteoporosis occurs mostly in postmenopausal women and patients taking long-term corticosteroids. Fortunately, preventive treatments are available that can help to maintain or increase bone density. For those already affected by osteoporosis, prompt diagnosis of bone loss and assessment of fracture risk are essential because therapies are available that can slow further loss of bone or increase bone density. The main aim of treatment is to prevent fractures and to reduce the both morbidity and mortality. This topic review discusses the therapies available for the prevention and treatment of osteoporosis. 參考資料 : 1. http://www.toa1997.org.tw/index.php?page_id=9bf31c7ff 062936a96d3c8bd1f8f2ff3&mod=bulletin_edit&id=34: 2. 2010 3. 2012 4. http://www.uptodate.com/contents/osteoporosis-prevention-and-treatment-beyond-the-basics?view: Rosen HN:Patient information: Osteoporosis prevention and treatment (Beyond the Basics) 5. O'Connell MB, Vondracek SF: Osteoporosis and other metabolic bone diseases. In: Dipiro JT, Talbert RL, Yee GC et al: eds. Pharmacotherapy-A pathophysiologic approach, 7th ed. New York. McGraw-Hill, 2008:1489-1491. 6. Woo SB, Hellstein JW, Kalmar JR: Systematic review: Bisphosphonates and osteonecrosis of the jaws. Ann intern med 2006; 144: 753-761. 7. Licata, AA: Discovery, Clinical development, and therapeutic uses of bisphosphonates. Ann pharmacother 2005; 39: 668-677. 8. Khajuria DK, Razdan R, Mahapatra DR: Drugs for the management of osteoporosis: a review. Rev Bras Reumatol 2011; 51(4): 365-382.