DOI QR코드

DOI QR Code

비스포스포네이트의 치료 기간

Duration of Bisphosphonate Treatment

  • 김경민 (서울대학교 의과대학 분당서울대학교병원 내과) ;
  • 이유미 (연세대학교 의과대학 내과학교실)
  • Kim, Kyoung Min (Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Rhee, Yumie (Department of Internal Medicine, Yonsei University Colleage of Medicine)
  • 발행 : 2014.08.01

초록

Large, randomized, controlled trials have demonstrated the efficacy of bisphosphonates (BP) in terms of improving bone mineral density (BMD) and reducing fracture risk. Consequently, bisphosphonates are used widely in the treatment of osteoporosis. Recently, however, several safety issues regarding the long-term use of BP, especially BP-related osteonecrosis of the jaws and atypical fractures, have been noted and have emerged as a limitation of their clinical use. Although the absolute risk is very small, the risks could increase with the long-term use of BP. The anti-fracture efficacy of BP is not sustained after treatment for 5-10 years. Therefore, recommendations suggest that a drug holiday be considered after 5 years of treatment for patients at low risk of fracture. However, as the individual fracture risk varies, the treatment duration should be based on individual clinical risk factors and bone metabolism status. Moreover, recommendations regarding monitoring after discontinuing and reinitiating BP await further studies.

키워드

참고문헌

  1. Van Staa TP, Dennison EM, Leufkens HG, Cooper C. Epidemiology of fractures in England and Wales. Bone 2001;29:517-522. https://doi.org/10.1016/S8756-3282(01)00614-7
  2. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 2009;301:513-521. https://doi.org/10.1001/jama.2009.50
  3. Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 1999;353:878-882. https://doi.org/10.1016/S0140-6736(98)09075-8
  4. Lee YK, Jang S, Jang S, et al. Mortality after vertebral fracture in Korea: analysis of the National Claim Registry. Osteoporos Int 2012;23:1859-1865. https://doi.org/10.1007/s00198-011-1833-5
  5. Choi YJ, Oh HJ, Kim DJ, Lee Y, Chung YS. The prevalence of osteoporosis in Korean adults aged 50 years or older and the higher diagnosis rates in women who were beneficiaries of a national screening program: the Korea National Health and Nutrition Examination Survey 2008-2009. J Bone Miner Res 2012;27:1879-1886. https://doi.org/10.1002/jbmr.1635
  6. Russell RG. Bisphosphonates: the first 40 years. Bone 2011;49:2-19. https://doi.org/10.1016/j.bone.2011.04.022
  7. Chen JS, Sambrook PN. Antiresorptive therapies for osteoporosis: a clinical overview. Nat Rev Endocrinol 2011;8:81-91. https://doi.org/10.1038/nrendo.2011.146
  8. Reginster JY. Antifracture efficacy of currently available therapies for postmenopausal osteoporosis. Drugs 2011;71:65-78. https://doi.org/10.2165/11587570-000000000-00000
  9. Wright NC, Saag KG, Curtis JR, et al. Recent trends in hip fracture rates by race/ethnicity among older US adults. J Bone Miner Res 2012;27:2325-2332. https://doi.org/10.1002/jbmr.1684
  10. Watanabe A, Yoneyama S, Nakajima M, et al. Osteosarcoma in Sprague-Dawley rats after long-term treatment with teriparatide (human parathyroid hormone (1-34)). J Toxicol Sci 2012;37:617-629. https://doi.org/10.2131/jts.37.617
  11. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws: 2009 update. J Oral Maxillofac Surg 2009;67(5 Suppl):2-12. https://doi.org/10.1016/S0278-2391(08)01667-4
  12. Khosla S, Burr D, Cauley J, et al. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2007;22:1479-1491. https://doi.org/10.1359/jbmr.0707onj
  13. Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the american society for bone and mineral research. J Bone Miner Res 2014;29:1-23. https://doi.org/10.1002/jbmr.1998
  14. Mellstrom DD, Sorensen OH, Goemaere S, Roux C, Johnson TD, Chines AA. Seven years of treatment with risedronate in women with postmenopausal osteoporosis. Calcif Tissue Int 2004;75:462-468. https://doi.org/10.1007/s00223-004-0286-7
  15. Black DM, Schwartz AV, Ensrud KE, et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 2006;296:2927-2938. https://doi.org/10.1001/jama.296.24.2927
  16. Black DM, Reid IR, Boonen S, et al. The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res 2012;27:243-254. https://doi.org/10.1002/jbmr.1494
  17. Whitaker M, Guo J, Kehoe T, Benson G. Bisphosphonates for osteoporosis: where do we go from here? N Engl J Med 2012;366:2048-2051. https://doi.org/10.1056/NEJMp1202619
  18. Black DM, Bauer DC, Schwartz AV, Cummings SR, Rosen CJ. Continuing bisphosphonate treatment for osteoporosis: for whom and for how long? N Engl J Med 2012;366:2051-2053. https://doi.org/10.1056/NEJMp1202623
  19. Watts NB, Chines A, Olszynski WP, et al. Fracture risk remains reduced one year after discontinuation of risedronate. Osteoporos Int 2008;19:365-372. https://doi.org/10.1007/s00198-007-0460-7
  20. McNabb BL, Vittinghoff E, Schwartz AV, et al. BMD changes and predictors of increased bone loss in postmenopausal women after a 5-year course of alendronate. J Bone Miner Res 2013;28:1319-1327. https://doi.org/10.1002/jbmr.1864
  21. Watts NB, Diab DL. Long-term use of bisphosphonates in osteoporosis. J Clin Endocrinol Metab 2010;95:1555-1565. https://doi.org/10.1210/jc.2009-1947