骨質(zhì)疏松用藥課件

ChapterDrugsusedforthetreatmentofosteoporosisDepartmentofpharmacologyLimingzhou2015.9ContentsOsteoporosis

Antiresorptivedrugs

Bone-formingdrugs

MineralizationdrugsOsteoporosis

Osteoporosisisadiseasecharacterizedbylowbonemass(bonethinning)thatleadstofragilebonesandanincreasedriskoffracturesofthehip,spine,andwrist.Normal

OsteoporosisSevereosteoporosisOsteoporosis

—symptomsCommonsymptoms:BackpainStoopedpostureFracturesOsteoporosis—types

PrimaryosteoporosisSecondaryosteoporosisIdiopathicosteoporosisPostmenopausalosteoporosisSenileosteoporosis[Osteoporosis—riskfactors

FactorsyoucannotchangeGenderAge;Bodysize;Ethnicity;FamilyhistoryFactorsyoucanchangeSexhormones;Anorexianervosa;(神經(jīng)性厭食癥)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(雙磷酸鹽）—PharmacologicalSlowbonelossIncreasebonedensityReducetheriskfracturesAntiresorptivedrugsBisphosphonate—clinicalapplicationOsteoporosisinmenandpostmenopausalwomenPreventingandtreatingosteoporosisduetoglucocorticoidsteroidmedicationsTreatinghighblood

calcium

levelsduetocancer

Treating

multiplemyeloma

orsolidtumorcancersthathavespreadtotheboneBisphosphonate—sideeffects

Nausea,abdominalpainandindigestion

Rashanditchyskin

Atemporaryincreaseinparathyroidhormone

andserumtransaminase（血轉(zhuǎn)氨酶）

CalcitoninCalcitoninanalogues(whicharemanufacturedversionsofcalcitonin)canbeusefulfortreatingosteoporosisbyslowingthebreakdownofbone.Calcitoninisadelicatemoleculethatwouldbedestroyedbythedigestivetract,itmustbetakenbynasalsprayorbyinjectionWithsideeffectsofnausea,vomitingandallergic

rashetal.EstrogenTherapy—application

Estrogentherapy(ET)reduceboneloss,increase

bonedensity

inboththespineandhip,andreducetheriskofhipandspinefracturesinpostmenopausalwomen.

ETis

approvedforpreventingpostmenopausalosteoporosis

andaremostcommonlyadministeredintheformofatabletorskinpatch（經(jīng)皮吸收）.

EstrogenTherapy—sideeffectsTakingestrogenaloneincreasesawoman'sriskofdevelopingcanceroftheuterinelining(endometrialcancer).Toreducethisrisk,womenwhostillhaveauterus(whohavenothadahysterectomy（子宮切除）)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（佝僂?。?Osteomalacia（軟骨?。?osteoporosis,parathyroidfunctionimpairmentMagnesiumpoisoningcounterpoison（鎂中毒解救）(Onekeypieceofadviceistotakeyourcalciuminseveralsmalldosesthroughouttheday).vitaminD3—applicationOsteoporosisChronicrenalfailureFortreatmentandpreventionofvitaminDdeficiencyPsoriasis（銀屑癬）Osteoporosisisadiseaseofbonethatcommonlyoccursinelderlypeople,andischaracterizedbythedegenerationofbonesuperstructure,adecreaseofbonestrength,anincreaseofbonefragilityandthusanincreasedriskoffracture.Drugsava