特立帕肽序贯治疗进展：基于中国国情的个体化治疗

Advances in Sequential Therapy with Teriparatide: Toward Individualized Treatment in the Context of China

摘要: 中国65岁以上女性中近一半人患有骨质疏松。特立帕肽能够促进骨形成并改善骨微结构，从而提高骨密度，降低骨质疏松性骨折风险。然而，其促骨形成作用在停药后会迅速减弱，因此及时的序贯治疗非常重要。目前常用的序贯方案包括特立帕肽序贯阿仑膦酸、唑来膦酸及地舒单抗等，临床治疗中具体序贯药物需根据患者情况选择。在中国，特立帕肽价格较为昂贵，再加上使用方式相对不便，以致许多患者难以长期坚持用药。因此，个体化的序贯时机及药物选择尤为关键。对于经济条件有限或依从性较差的患者，在获得特立帕肽的促骨形成效益后，或许可以根据具体情况选择合适的抗骨吸收药物，适时实施早期序贯治疗。虽然目前已有相关临床研究，但还需要大样本的临床研究去验证此方案。这样不仅能够减轻患者的经济负担，还可提升骨质疏松症长期治疗的依从性和有效性。

Abstract: Nearly half of women aged 65 years and older in China are affected by osteoporosis. Teriparatide promotes bone formation and improves bone microarchitecture, thereby increasing bone mineral density and reducing the risk of osteoporotic fractures. However, its anabolic effect diminishes rapidly after discontinuation, making timely sequential therapy essential. Common sequential regimens include teriparatide followed by alendronate, zoledronic acid, or denosumab, with the choice of subsequent therapy determined by individual patient characteristics. In China, the high cost of teriparatide and its inconvenient mode of administration make long-term adherence challenging for many patients. Therefore, individualized timing and selection of sequential therapy are particularly important. For patients with limited financial resources or poor adherence, an appropriate antiresorptive agent may be selected after achieving the anabolic benefits of teriparatide, with early sequential therapy implemented as appropriate based on individual circumstances. Although relevant clinical studies are available, large-scale clinical trials are still needed to validate this approach. Such a strategy may not only reduce the economic burden on patients but also improve adherence and the long-term effectiveness of osteoporosis treatment.