icon fsr

文献詳細

雑誌文献

臨床婦人科産科61巻7号

2007年07月発行

今月の臨床 中高年女性のトータルヘルスケア

骨粗鬆症

2.骨粗鬆症治療薬の選択基準は

著者: 岩本潤1 市村正一1

所属機関: 1慶應義塾大学医学部スポーツクリニック

ページ範囲:P.910 - P.915

文献概要

はじめに

 骨粗鬆症と診断された患者に対して薬物治療は必須である.本邦では閉経後の骨粗鬆症患者に対する治療薬として,アレンドロネート,リセドロネート,エチドロネートなどのビスフォスフォネートやラロキシフェン,活性型ビタミンD3,ビタミンK2,カルシトニン,女性ホルモンなどが使用されている.本稿では閉経後の骨粗鬆症患者におけるevidence─based medicine(EBM)に基づいた薬物治療と治療薬の選択基準について概説する.

参考文献

1) Cranney A, Guyatt G, Griffith L, et al : Meta-analyses of therapies for postmenopausal osteoporosis. IX ; Summary of meta-analyses of therapies for postmenopausal osteoporosis. Endocr Rev 23 : 570-578, 2002
2) Boonen S, Laan RF, Barton IP, et al : Effect of osteoporosis treatments on risk of non-vertebral fractures ; review and meta-analysis of intention-to-treat studies. Osteoporos Int 16 : 1291-1298, 2005
3) Papapoulos SE, Quandt SA, Liberman UA, et al : Meta-analysis of the efficacy of alendronate for the prevention of hip fractures in postmenopausal women. Osteoporos Int 16 : 468-474, 2005
4) Liberman UA, Hochberg MC, Geusens P, et al : Hip and non-spine fracture risk reductions differ among antiresorptive agents ; Evidence from randomised controlled trials. Int J Clin Pract 60 : 1394-1400, 2006
5) The WHO Scientific Group : Prevention and management of osteoporosis. World Health Organ Tech Rep Ser 921 : 86-109, 2003
6) Bone HG, Hosking D, Devogelaer JP, et al : Alendronate Phase III Osteoporosis Treatment Study Group. Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 350 : 1189-1199, 2004
7) Mellstrom DD, Sorensen OH, Goemaere S, et al : Seven years of treatment with risedronate in women with postmenopausal osteoporosis. Calcif Tissue Int 75 : 462-468, 2004
8) Miller PD, Watts NB, Licata AA, et al : Cyclical etidronate in the treatment of postmenopausal osteoporosis ; efficacy and safety after seven years of treatment. Am J Med 103 : 468-476, 1997
9) Siris ES, Harris ST, Eastell R, et al : Continuing Outcomes Relevant to Evista(CORE)Investigators. Skeletal effects of raloxifene after 8 years ; results from the continuing outcomes relevant to Evista(CORE)study. J Bone Miner Res 20 : 1514-1524, 2005
10) 骨粗鬆症の予防と治療のガイドライン(2006年版)(折茂 肇).ライフサイエンス出版,東京,2006
11) Shiraki M, Kushida K, Fukunaga M, et al : A double-masked multicenter comparative study between alendronate and alfacalcidol in Japanese patients with osteoporosis. Osteoporos Int 10 : 183-192, 1999
12) Shiraishi A, Takeda S, Masaki T, et al : Alfacalcidol inhibits bone resorption and stimulates formation in an ovariectomized rat model of osteoporosis : distinct actions from estrogen. J Bone Miner Res 15 : 770-779, 2000
13) Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al : Effect of vitamin D on falls ; a meta-analysis. JAMA 291 : 1999-2006, 2004
14) Chapuy MC, Arlot ME, Duboeuf F, et al : Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327 : 1637-1642, 1992
15) Hauschka PV, Lian JB, Cole DEC, et al : Osteocalcin and matrix Gla protein ; vitamin K-dependent proteins in bone. Physiol Rev 69 : 990-1047, 1989
16) Koshihara Y, Hoshi K : Vitamin K2 enhances osteocalcin accumulation in the extracellular matrix of human osteoblasts in vitro. J Bone Miner Res 12 : 431-438, 1997
17) Shearer MJ : Vitamin K. Lancet 345 : 229-234, 1995
18) Vermeer C, Jie KSG, Knapen MHJ : Role of vitamin K in bone metabolism. Annu Rev Nutr 15 : 1-22, 1995
19) Tabb MM, Sun A, Zhou C, et al : Vitamin K2 regulation of bone homeostasis is mediated by the steroid and xenobiotic receptor SXR. J Biol Chem 278 : 43919-43927, 2003
20) Shibata K, Takeda M, Ito A, et al : Ovariectomy-induced hyperalgesia and antinociceptive effect of elcatonin, a synthetic eel calcitonin. Pharmacol Biochem Behav 60 : 371-376, 1998
21) Nishizawa Y, Nakamura T, Ohta H, et al : Committee on the Guidelines for the Use of Biochemical Markers of Bone Turnover in Osteoporosis Japan Osteoporosis Society. Guidelines for the use of biochemical markers of bone turnover in osteoporosis(2004).J Bone Miner Metab 23 : 97-104, 2005
22) Cummings SR, Karpf DB, Harris F, et al : Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med 112 : 281-289, 2002
23) Hochberg MC, Greenspan S, Wasnich RD, et al : Changes in bone density and turnover explain the reductions in incidence of nonvertebral fractures that occur during treatment with antiresorptive agents. J Clin Endocrinol Metab 87 : 1586-1592, 2002
24) Epstein S : The roles of bone mineral density, bone turnover, and other properties in reducing fracture risk during antiresorptive therapy. Mayo Clin Proc 80 : 379-388, 2005
25) McClung MR, Geusens P, Miller PD, et al(Hip Intervention Program Study Group): Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344 : 333-340, 2001
26) Harris ST, Watts NB, Genant HK, et al(Vertebral Efficacy With Risedronate Therapy(VERT)Study Group): Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis : a randomized controlled trial. JAMA 282 : 1344-1352, 1999
27) Reginster J, Minne HW, Sorensen OH, et al(Vertebral Efficacy with Risedronate Therapy(VERT)Study Group) : Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Osteoporos Int 11 : 83-91, 2000
28) Cummings SR, Black DM, Thompson DE, et al : Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures ; results from the Fracture Intervention Trial. JAMA 280 : 2077-2082, 1998
29) Black DM, Cummings SR, Karpf DB, et al : Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 348 : 1535-1541, 1996
30) Storm T, Thamsborg G, Steiniche T, et al : Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. N Engl J Med 322 : 1265-1271, 1990
31) Watts NB, Harris ST, Genant HK, et al : Intermittent cyclical etidronate treatment of postmenopausal osteoporosis. N Engl J Med 323 : 73-79, 1990
32) Ettinger B, Black DM, Mitlak BH, et al : Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene : results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation(MORE)Investigators. JAMA 282 : 637-645, 1999
33) Kung AW, Chao HT, Huang KE, et al : Efficacy and safety of raloxifene 60 mg/day in postmenopausal Asian women. J Clin Endocrinol Metab 88 : 3130-3136, 2003
34) 東佐由美 : 骨粗鬆症治療薬としてもカルシムとビタミンD. Clinical Calcium 13 : 920-929, 2003
35) Sahota O : Osteoporosis and the role of vitamin D and calcium-vitamin D deficiency, vitamin D insufficiency and vitamin D sufficiency. Age Ageing 29 : 301-304, 2000
36) Chapuy MC, Arlot ME, Duboeuf F, et al : Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327 : 1637-1642, 1992
37) Vergnaud P, Garnero P, Meunier PJ, et al : Undercarboxylated osteocalcin measured with a specific immunoassay predicts hip fracture in elderly women ; the EPIDOS Study. J Clin Endocrinol Metab 82 : 719-724, 1997
38) Wells G, Tugwell P, Shea B, et al(Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group): Meta-analyses of therapies for postmenopausal osteoporosis. V. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women. Endocr Rev 23 : 529-539, 2002
39) Anderson GL, Limacher M, Assaf AR, et al(Women's Health Initiative Steering Committee): Effects of conjugated equine estrogen in postmenopausal women with hysterectomy ; the Women's Health Initiative randomized controlled trial. JAMA 291 : 1701-1712, 2004
40) 太田博明 : 女性ホルモン補充療法の効能と問題点-Women's Health Initiativeの成績を基に.日本内科学会雑誌94 : 1183-1191,2005

掲載誌情報

出版社:株式会社医学書院

電子版ISSN:1882-1294

印刷版ISSN:0386-9865

雑誌購入ページに移動
icon up

本サービスは医療関係者に向けた情報提供を目的としております。
一般の方に対する情報提供を目的としたものではない事をご了承ください。
また,本サービスのご利用にあたっては,利用規約およびプライバシーポリシーへの同意が必要です。

※本サービスを使わずにご契約中の電子商品をご利用したい場合はこちら