與雙磷酸鹽類藥物相關的非典型股骨骨折

雙磷酸鹽類藥物治療是骨質疏鬆症的常用藥物，在經過長期臨床使用後，逐漸出現頓骨壞死等數種併發症。第1171非典型股骨骨折在2005年發表於文獻後，這項併發症才逐漸受到重視。形成的原因目前還沒有明確結論，推測和抑制破骨細胞(osteoclast)有關。美國骨礦質研究學會(American Society for Boneand Mineral Research, ASBMR)的第2次專案小組在2013年重新定義非典型股骨骨折，修改為5個主要表現中至少須符合4個，才是非典型股骨骨折，但次要表現則非必需。專家建議「藥物假期(drug holiday)」的觀念，可停藥來減少長期使用雙磷酸鹽所引起的非典型股骨骨折副作用，也有專家訂定雙磷酸鹽的使用期間指引原則。由於發生非典型股骨骨折之後才施行手術時，併發症發生率高，專家建議在發生移位骨折前，先進行預防性的手術固定。由於延遲骨折癒合或是不癒合是非典型股骨骨折的另一個問題，有人嘗試使用teriparatide或strontium ranelate等藥物加速骨合成和骨折癒合，但其效果目前仍無定論。

關鍵字

骨質疏鬆症；雙磷酸鹽；非典型股骨骨折；股骨骨折

並列摘要

Bisphosphonate is a common agent to treat osteoporosis nowadays. Several complications, including osteonecrosis of jaw bone, have been reported after the long-term use of bisphosphonate. After the first case report in 2005, atypical femur fractures nowadays have also been taken seriously. The exact cause of bisphosphonate-related atypical femoral fracture has not been established, and it is probably the result of suppression of osteoclast. Second report of a task force of the American Society for Bone and Mineral Research (ASBMR) in 2013 revised the definition of atypical femur fractures: at least four of five major features must be present, and none of the minor features is required. The concept of ＂drug holiday＂ was proposed to reduce incidence of atypical femur fractures after long-term use of bisphosphonate, and experts had made guidelines for period of bisphosphonate use. Surgical treatments of such patients with atypical fractures have increased complication rates, and some authors suggested prophylactic fixation for those who have non-displaced atypical fractures. Regarding the issue of delayed union or nonunion in atypical femoral fracture, some experts have used teriparatide or strontium ranelate to promote bone formation and fracture healing, but the effect is still controversial.

並列關鍵字

osteoporosis ； bisphosphonate ； atypical femoral fractures ； femur fractures

國際替代計量

與雙磷酸鹽類藥物相關的非典型股骨骨折

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