PDF(Pubmed)
Abstract：
Bone forming agents, also known as anabolic therapies, are essential in managing osteoporosis, particularly for patients at very high-risk of fractures. Identifying candidates who will benefit the most from these treatments is crucial. For example, this group might include individuals with severe osteoporosis, multiple vertebral fractures, a recent fragility fracture or those unresponsive to antiresorptive treatments. Definitions of patients with a very high fracture risk vary across nations, are often based on fracture history, bone mineral density (BMD), and/or fracture risk calculated by FRAX® or other algorithms. However, for very high-risk patients, anabolic agents such as teriparatide, abaloparatide, or romosozumab are commonly recommended as first-line therapies due to their ability to stimulate new bone formation and improve bone microarchitecture, offering significant benefits in rapid fracture reduction over antiresorptive therapies. The cost-effectiveness of these agents is a critical consideration for decision-makers. Despite their higher costs, their effectiveness in significantly reducing fracture risk and improving quality of life can justify the investment, especially when long-term savings from reduced fracture rates and associated healthcare costs are considered. Additionally, after completing a course of anabolic therapy, transitioning to antiresorptive agents like bisphosphonates or denosumab is crucial to maintain the gains in bone density and minimize subsequent fracture risks. This sequential treatment approach ensures sustained protection and optimal resource utilization. In summary, the effective use of bone forming agents in osteoporosis requires a comprehensive strategy that includes accurate patient identification, consideration of cost-effectiveness, and implementation of appropriate sequential treatments, ultimately maximizing patient outcomes and healthcare efficiency.
摘要：
骨形成剂,也被称为合成代谢疗法，对治疗骨质疏松症至关重要，特别是对于骨折风险很高的患者。确定将从这些治疗中受益最多的候选人至关重要。例如,这一组可能包括患有严重骨质疏松症的人，多发性椎骨骨折,最近的脆性骨折或对抗吸收治疗无反应的人。对骨折风险极高的患者的定义因国家而异，通常基于骨折史，骨矿物质密度（BMD），和/或通过FRAX®或其他算法计算的骨折风险。然而,对于高危患者，合成代谢药物如特立帕肽，abaloparatide,或romosozumab通常被推荐为一线治疗，因为它们能够刺激新骨形成和改善骨微结构，与抗吸收疗法相比，在快速骨折复位方面具有显着的益处。这些代理商的成本效益是决策者的关键考虑因素。尽管成本较高,它们在显著降低骨折风险和提高生活质量方面的有效性可以证明投资是合理的，特别是考虑到降低骨折率和相关医疗费用带来的长期节省。此外,完成一个疗程的合成代谢疗法后，过渡到抗再吸收药物如二膦酸盐或denosumab对于维持骨密度的增加和减少后续骨折风险至关重要。这种顺序处理方法确保了持续的保护和最佳的资源利用。总之,在骨质疏松症中有效使用骨形成剂需要一个全面的策略，包括准确的患者识别，考虑成本效益，并实施适当的序贯治疗，最终最大限度地提高患者的治疗效果和医疗效率。
