Osteoporosis is a systemic metabolic disease, characterized by decreased bone mass and damaged bone microstructure, which leads to increased bone brittleness and prone to fracture. With the aging of the population becoming more and more serious, the population suffering from osteoporosis is expanding. Pain, spinal deformation and brittle fracture are the most typical clinical manifestations of osteoporosis. Many patients with osteoporosis have no obvious symptoms in the early stage, and it is often found that osteoporosis already exists after fracture. Therefore, it is very important to popularize the knowledge of osteoporosis, make early diagnosis, predict the fracture risk in time and adopt standardized long-term management [1].
The occurrence of osteoporosis is related to calcium, vitamin D, age, sex hormone (estrogen), parathyroid hormone (PTH), vitamin K, pituitary function and other factors. Among them, calcium is an important part of bone, which plays an important role in maintaining the integrity and rigidity of bone structure and supporting human body. 99% calcium combines with phosphoric acid and hydroxyl to form hydroxyapatite crystals, which are stored in bones and teeth. Bone is also the largest calcium storage place in human body and an important organ for regulating calcium and phosphorus metabolism in the body.
Based on the biology of calcium, at the peak of bone formation in adolescents, taking enough calcium can increase the peak of bone controlled by heredity, which is very important to prevent and delay the occurrence of osteoporosis in the future. People with calcium deficiency have accelerated bone loss and are more prone to osteoporosis. For people with calcium and vitamin D deficiency, supplementing adequate doses of calcium and vitamin D may alleviate osteoporosis to some extent. However, calcium supplementation alone cannot treat osteoporosis. From the data of multivariate meta-analysis, there is no significant difference in the incidence of osteoporotic fractures before and after calcium supplementation. This also shows that simply supplementing calcium is the biggest misunderstanding in the treatment of osteoporosis at present.
Osteoporosis is a chronic progressive disease, which takes a long time and needs comprehensive treatment. At present, there is no medicine that can cure the disease quickly, so it is very important to make an individualized medication plan for patients in clinical work and manage it for a long time. The prevention and treatment goals of osteoporosis include improving bone growth and development, promoting the ideal peak bone mass in adulthood, maintaining bone mass and quality, preventing bone loss with age, and avoiding falls and fractures [3]. Like diabetes, coronary atherosclerosis and other chronic diseases, establishing a standardized long-term management model is the focus of its prevention and treatment. In recent years, some foreign scholars have put forward corresponding health education management models. For example, Japanese scholars have proposed to establish evidence-based medical guidelines for osteoporosis and fracture prevention based on community health centers. However, at present, the diagnosis and treatment of osteoporosis in China is not optimistic, mainly manifested in the low awareness rate of the disease, the lack of diagnosis and treatment methods, and the lack of compliance of patients with long-term treatment [4]. The improvement of bone health needs a long-term management process, and its prevention and treatment strategies mainly include basic measures, drug intervention and rehabilitation treatment. In clinical work, various strategies should be combined to promote patients to form good health beliefs and behaviors, thereby increasing bone density, reducing the incidence of fractures and improving the quality of life [5].
Drug therapy is the most effective means to deal with osteoporosis. At present, the drugs used to treat osteoporosis in clinical work mainly include drugs to promote bone formation, drugs to inhibit bone absorption and drugs with the above two effects. In traditional treatment, bisphosphonates are the first choice for elderly patients with osteoporosis. They have high affinity for hydroxyapatite, an inorganic component of bone, and strong binding force with the bone surface with active bone metabolism. The main mechanism of bisphosphonates is to inhibit bone resorption by inhibiting the activities of farnesyl pyrophosphate synthase and osteoclasts. However, the side effects of these drugs are particularly obvious. Oral bisphosphonate has a great stimulating effect on the mucosa of the upper digestive tract, which will lead to adverse reactions of the upper digestive tract such as nausea, vomiting, upper abdominal pain and indigestion. At the same time, bisphosphonates also have certain nephrotoxicity, so osteoporosis patients with renal insufficiency should be used with caution [6]. In addition, bisphosphonates will enter a plateau after more than 5 years of treatment, which will reduce the clinical benefit and increase the risk of jaw necrosis and atypical fracture, thus increasing the management difficulty of osteoporosis patients.
In recent years, a lot of progress has been made in the research of new anti-osteoporosis drugs, and the continuous emergence of new anti-osteoporosis drugs provides clinicians with more choices. Different from traditional drugs, desuzumab, a monoclonal antibody drug, affects the activity of osteoclasts by mimicking the ligand of nuclear factor k-B receptor activator, thus playing a positive role in bone reconstruction and increasing BMD. Disuzumab is a nuclear factor κ-B receptor-activated ligand (RANKL) inhibitor, and it is a specific and fully humanized RANKL monoclonal antibody. By inhibiting the combination of RANKL and its receptor RANKL, the drug produces an OPG-like effect, which can inhibit the differentiation and activation of osteoclasts mediated by RANKL- RANKL -OPG signal pathway, reduce the formation of osteoclasts and their function and survival, thereby reducing bone resorption, increasing bone mass and improving cortical bone. Compared with traditional drugs for osteoporosis, dizuzumab has the following clinical advantages: 65,438+0. Drugs are mainly eliminated through the endothelial reticular system, not through renal metabolism, and patients with renal insufficiency do not need to adjust the dose; 2. Subcutaneous injection has little effect on gastrointestinal tract; 3. Targeted combination with RANKL has definite effect and low possibility of drug interaction; 4. The medication frequency is low, and the price is low and affordable, which improves the accessibility of patients to drugs.
In addition to the above advantages, unlike the long-term maintenance of bisphosphonates, dizuzumab will not be stored in combination with its receptor for a long time, so the risk of jaw necrosis and atypical fracture is low. At the same time, the current clinical research shows that there is no plateau of curative effect of desuzumab. After using 10 years, the bone mineral density of the whole hip joint gradually increases, which means that its long-term application can bring more bone health benefits to patients [7].
Cardiovascular disease determines the length of life, and bone health determines the width of life. As a systemic metabolic disease that is easily overlooked, osteoporosis is one of the important public health problems facing the world. The disease seriously affects the quality of life of patients and causes a heavy disease burden, so it is very important to strengthen prevention and treatment. Disuzumab has a good therapeutic effect and can be used as a new treatment for osteoporosis, bringing clinical benefits to more patients. Only the health of bones can improve the quality of life and enrich the color of life.
Brief introduction of the author
Cheng qun
Huadong Hospital Affiliated to Fudan University
Director, Department of Metabolic Osteopathy, Huadong Hospital, Fudan University
Doctor of medicine, chief physician, professor, doctoral supervisor
Director, Bone Metabolism Research Office, Shanghai Institute of Geriatrics
Chairman-designate of Osteoporosis Branch of Shanghai Medical Association
Member of osteoporosis and bone mineral salt disease branch of Chinese medical association
Deputy Head of Bone Metabolism Group of Geriatrics Branch of Chinese Medical Association
Standing Committee of Osteoporosis Branch of China Geriatric Health Care Medical Research Association
Chief researcher, National Geriatrics Clinical Medicine Research Center.
Editorial Board of China Journal of Osteoporosis and Bone Mineral Salt Diseases
Editorial Committee of Journal of Shanghai Jiaotong University (Medical Edition)
20/2/2013 went to the Bone and Joint Research Center of the University of Rochester Medical Center for postdoctoral work. His research direction was the mechanism of nonunion or delayed union of fracture in the elderly and its intervention targets. At present, the epidemiological investigation of osteoporosis and sarcopenia is also carried out in the community.
He presided over the National Natural Science Foundation, the key projects of Shanghai Science and Technology Commission and the major scientific research projects of Shanghai Health Planning Commission, and published more than 80 papers by the first author and correspondent.
References:
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