华法林引发骨质疏松症的发病机制及治疗策略

Pathological mechanism and therapeutic strategy of warfarin-related osteoporosis

摘要:

骨质疏松症是一种以骨矿物质含量低下、骨微结构损坏、骨强度降低、骨脆性增加、易发生骨折为主要特征的全身性骨代谢障碍性疾病。华法林可拮抗维生素K，使骨钙素的羧化受抑制，减少骨钙沉积，抑制骨矿化，从而干扰骨代谢，导致骨质疏松症或骨折，对于老年患者的影响尤其明显。长期服用华法林导致骨质疏松症的风险可能与用药剂量和时间相关。目前预防和治疗华法林引起的骨质疏松症主要依据原发性骨质疏松症的治疗原则，对于长期服用华法林的患者应补充钙剂和维生素D以预防骨质疏松症，对于已出现骨质疏松症的患者根据具体病情选择用双膦酸盐、降钙素、雌激素和甲状旁腺类似物治疗。本文对华法林引发骨质疏松症的发病机制、研究进展和治疗策略进行综述。

Abstract:

Osteoporosis is a systemic bone metabolism disorder characterized by reduced bone mineral content, damaged bone microstructure and compromised bone strength that may predispose to an increased risk of fracture and an increased bone fragility. Warfarin, a vitamin K antagonist, can inhibit carboxylation of osteocalcin, reduce bone calcium deposition, and thus interact with bone metabolism and induce osteoporosis or bone fracture, especially in the elderly patients. The osteoporosis risk related with the use of warfarin may be associated with dosage and time of duration. The basic principle to prevent drug-induced osteoporosis is the same as that for primary osteoporosis. Calcium and vitamin D should be used for prevention. Bisphosphonates, calcitonin, estrogens and parathyroid hormone analogues can be selected for the treatment of osteoporosis or fracture induced by warfarin according to the individual condition of patients. In this paper, we reviewed the advances on pathological mechanism, research progress and therapeutic strategy of osteoporosis induced by warfarin.