期刊
CURRENT OSTEOPOROSIS REPORTS
卷 19, 期 2, 页码 189-205出版社
SPRINGER
DOI: 10.1007/s11914-021-00663-1
关键词
Postmenopausal osteoporosis; Teriparatide; Abaloparatide; Romosozumab; Treatment sequence; Anabolic
There are three anabolic agents available for postmenopausal women at high risk for fracture, and studies show that they are more effective than antiresorptive agents. There is no definitive answer on how to choose which agent to use at different stages of a woman's life.
Purpose of Review There are now three anabolic agents available for the treatment of postmenopausal women at high risk for fracture. The purpose of this review is to supply a rationale to aid in determining which agent should be used in which clinical settings. Recent Findings Studies over the last decade have shown that anabolic agents produce faster and larger effects against fracture than antiresorptive agents. Furthermore, trials evaluating anabolic antiresorptive treatment sequences have shown that anabolic first treatment strategies produce the greatest benefits to bone density, particularly in the hip region. However, there are no head-to-head evaluations of the three anabolic therapies with fracture outcomes or bone density, and these studies are not likely to occur. How to decide which agent to use at which time in a woman's life is unknown. We review the most significant clinical trials of anabolic agents which have assessed fracture, areal or volumetric bone density, microarchitecture, and/or bone strength, as well as information gleaned from histomorphometry studies to provide a rationale for consideration of one agent vs another in various clinical settings. There is no definitive answer to this question; all three agents increase bone strength and reduce fracture risk rapidly. Since the postmenopausal lifespan could be as long as 40-50 years, it is likely that very high-risk women will utilize different anabolic agents at different points in their lives.
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