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ChapterDrugsusedforthetreatmentofosteoporosisDepartmentofpharmacologyLimingzhou2015.9ContentsOsteoporosis
Antiresorptivedrugs
Bone-formingdrugs
MineralizationdrugsOsteoporosis
Osteoporosisisadiseasecharacterizedbylowbonemass(bonethinning)thatleadstofragilebonesandanincreasedriskoffracturesofthehip,spine,andwrist.Normal
OsteoporosisSevereosteoporosisOsteoporosis
—symptomsCommonsymptoms:BackpainStoopedpostureFracturesOsteoporosis—types
PrimaryosteoporosisSecondaryosteoporosisIdiopathicosteoporosisPostmenopausalosteoporosisSenileosteoporosis[Osteoporosis—riskfactors
FactorsyoucannotchangeGenderAge;Bodysize;Ethnicity;FamilyhistoryFactorsyoucanchangeSexhormones;Anorexianervosa;(神经性厌食症)CalciumandvitaminDintake;Medicationuse;Lifestyle;Cigarettesmoking;AlcoholintakeOsteoporosis—diagnosis
TheBoneMineralDensityTest(BDT)DetectlowbonedensitybeforeafractureoccursConfirmanosteoporosis
diagnosisifyoualreadyhaveoneormorefracturesPredictyourchancesofhavingfracturesinthefutureDetermineyourrateofbonelossandmonitortheeffectsoftreatmentOsteoporosis—diagnosisBoneMassDensityTheNationalOsteoporosisFoundationRecommendsaBDTif:YouusemedicationsthatcauseosteoporosisYouhavetypeIdiabetes,liverdisease,kidneydiseaseorafamilyhistoryYouexperienceearlymenopauseYouarepostmenopauseover50andhaveatleastoneriskfactorYouarepostmenopauseover65andneverhadatestOsteoporosis—treatmentComprehensivetreatmentfor
osteoporosisdealswith:
PropernutritionExerciseSafetyissuestopreventfallsMedicationsOsteoporosis—medicationsAntiresorptivedrugs:Bisphosphonates,calcitonin,estrogenBone-formingdrugs:Parathyroidhormone,androgenMineralizationdrugs:CalciumandvitaminDBisphosphonates(双磷酸盐）—PharmacologicalSlowbonelossIncreasebonedensityReducetheriskfracturesAntiresorptivedrugsBisphosphonate—clinicalapplicationOsteoporosisinmenandpostmenopausalwomenPreventingandtreatingosteoporosisduetoglucocorticoidsteroidmedicationsTreatinghighblood
calcium
levelsduetocancer
Treating
multiplemyeloma
orsolidtumorcancersthathavespreadtotheboneBisphosphonate—sideeffects
Nausea,abdominalpainandindigestion
Rashanditchyskin
Atemporaryincreaseinparathyroidhormone
andserumtransaminase（血转氨酶）
CalcitoninCalcitoninanalogues(whicharemanufacturedversionsofcalcitonin)canbeusefulfortreatingosteoporosisbyslowingthebreakdownofbone.Calcitoninisadelicatemoleculethatwouldbedestroyedbythedigestivetract,itmustbetakenbynasalsprayorbyinjectionWithsideeffectsofnausea,vomitingandallergic
rashetal.EstrogenTherapy—application
Estrogentherapy(ET)reduceboneloss,increase
bonedensity
inboththespineandhip,andreducetheriskofhipandspinefracturesinpostmenopausalwomen.
ETis
approvedforpreventingpostmenopausalosteoporosis
andaremostcommonlyadministeredintheformofatabletorskinpatch（经皮吸收）.
EstrogenTherapy—sideeffectsTakingestrogenaloneincreasesawoman'sriskofdevelopingcanceroftheuterinelining(endometrialcancer).Toreducethisrisk,womenwhostillhaveauterus(whohavenothadahysterectomy（子宫切除）)shouldusuallytakeaprogestinincombinationwithestrogenSelectiveestrogenreceptormodulators(SERMS)aredrugsthatactlikeestrogenatsomereceptorsItactslikeestrogenforpreventingbonelossandimprovingcholesterol.Currently,onlyraloxifene（雷洛昔芬）thatisapprovedtopreventandtreatosteoporosis.SelectiveEstrogenReceptorModulatorsBone-formingdrugsParathyroidhormone(PTH)—mechanismWithbothcatabolicandanabolicactions
Lowdose:PTHstimulateboneturnoverandisassociatedwithboneformation（成骨作用）
Highdose:PTHincreasetherateofboneresorptionfollowedbyslowerrateofboneformation（破骨作用）Parathyroidhormone(PTH)—application
OsteoporosisPrimaryparathyroidfunctiondecline
(Intake
vitaminsDandcalciumtogether)
GenerallyappliesonlytofirstaidAndrogenandanabolichormone—mechaismAndrogencanpromotethesynthesisofproteinandcollagen,stimulateboneformationandretentionofcalcium,phosphorus,andpotassium.Androgenandanabolichormone—applicationmaleosteoporosisSideeffectisbigger,thedoseoftreatmentandtheprosandconsofrelationshipisstillinthefurtherresearchMineralizationdrugsCalciumAddingbonemineralandpromotingbonemineralizationvitaminD3
Increasetheabsorptionofdietarycalciumandphosphorus,maintainthebalanceofcalciumandphosphorusandincreasetheactivityofosteoblastsCalcium—applicationAcuteorchronichypocalcemia;Tetanydisease（手足抽搐）Rickets（佝偻病）;Osteomalacia（软骨病）,osteoporosis,parathyroidfunctionimpairmentMagnesiumpoisoningcounterpoison（镁中毒解救）(Onekeypieceofadviceistotakeyourcalciuminseveralsmalldosesthroughouttheday).vitaminD3—applicationOsteoporosisChronicrenalfailureFortreatmentandpreventionofvitaminDdeficiencyPsoriasis（银屑癣）Osteoporosisisadiseaseofbonethatcommonlyoccursinelderlypeople,andischaracterizedbythedegenerationofbonesuperstructure,adecreaseofbonestrength,anincreaseofbonefragilityandthusanincreasedriskoffracture.Drugsava
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