當(dāng)前,，我國已進入老齡社會,，老年病的防治成為重要的研究課題。其中,，老年性骨質(zhì)疏松癥是老年人,，尤其是絕經(jīng)期后婦女的常見病、多發(fā)病,。
二膦酸鹽類藥物是近二十年發(fā)展起來的一類新藥,，能防治老年性骨質(zhì)疏松，其用于臨床有如下特點：①不僅能抑制骨吸收,，還能增加骨量，使喪失的骨組織恢復(fù),；②能促進骨小梁的重建,，也能減少吸收陷窩深度；③短期用藥,，長期顯效,。
近日，一項研究證實骨靶向藥物的一項最新適應(yīng)癥：治療乳腺癌,。癌癥患者接受靶向骨的藥物二膦酸鹽和狄諾塞麥治療會減少骨吸收,，可以減少骨骼并發(fā)癥的風(fēng)險，防止惡性骨疾病患者在治療過程中引發(fā)的骨質(zhì)流失,。
此外,，這些藥物可能會抑制腫瘤細(xì)胞和骨細(xì)胞之間的“惡性循環(huán)”即骨髓微環(huán)境內(nèi)生長因子和細(xì)胞因子。藥物對干細(xì)胞生存環(huán)境也有影響,，對癌細(xì)胞和免疫調(diào)節(jié)也有直接作用,。
在乳腺癌早期階段（Ⅰ，Ⅱ,，Ⅲ期）,，雙磷酸鹽類藥物唑來膦酸治療病人后,，患者生存期和整體身體質(zhì)量都得到明顯改善。但在晚期乳腺癌階段,，藥物治療并未觀察到生存益處,。研究人員認(rèn)為應(yīng)開展更多研究得到越來越多的證據(jù)來支持的骨靶向治療乳腺癌的功效。（生物谷：Bioon.com）
doi:10.1093/jnci/djs263
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Effects of Bone-Targeted Agents on Cancer Progression and Mortality
Robert Coleman, Michael Gnant, Gareth Morgan and Philippe Clezardin
Bone-targeted treatments with bisphosphonates and denosumab, which reduce bone resorption, are known to reduce the risk of skeletal complications and prevent treatment-induced bone loss in patients with malignant bone disease. Additionally, these drugs may modify the course of bone destruction via inhibitory effects on the “vicious cycle” of growth factor and cytokine signaling between tumor and bone cells within the bone marrow microenvironment. Effects of the drugs on the stem cell niche, direct effects on the cancer cells, and immune modulation may also contribute. In early-stage (stages I, II, and III) breast cancer, treatment with the bisphosphonate zoledronic acid has shown improvements in disease-free and overall survival. Improved survival was particularly notable in women with established menopause at diagnosis and in premenopausal women with endocrine-responsive disease who received treatment with goserelin, which suppresses ovarian function by inhibiting the production of ovarian hormones. Additionally, in castrate-resistant prostate cancer, treatment with denosumab delays the development of bone metastases. These results strongly support the adjuvant use of bone-targeted treatments but suggest that reproductive hormones are an important treatment modifier to take into account. In advanced-stage (stage IV, ie, metastatic) cancers, survival benefits have been observed in patients with multiple myeloma and in patients with other solid tumors with rapid rates of bone destruction who received treatment with zoledronic acid. Here, we have critically reviewed the increasing evidence to support a disease-modifying effect of bone-targeted treatment and discussed the impact on clinical management.
