The clinician's guide to prevention and treatment of osteoporosis.
The clinician's guide to prevention and treatment of osteoporosis.
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DOI：
10.1007/s00198-021-05900-y
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发表时间：
2022-10
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骨质疏松症是美国和世界上最常见的代谢性骨病。它是一种亚临床症状，直到并发骨折。这些骨折给患者带来了巨大的医疗和个人负担，并造成了重大的经济损失。50岁或以上的成年人发生任何新的骨折都意味着后续骨折的风险即将增加，特别是在初次骨折后的一年内。患者认为的不幸事故可能被视为骨质脆弱和未来骨折风险增加的前哨事件，即使是由于相当大的创伤。临床或亚临床椎体骨折是最常见的骨质疏松性骨折类型，其发生额外椎体骨折的风险增加5倍，其他部位骨折的风险增加2- 3倍。未经治疗的骨质疏松症可导致复发性骨折的恶性循环，往往导致残疾和过早死亡。在适当的患者中，使用有效的抗骨折药物治疗可预防骨折并改善预后。初级保健提供者和医学专家是关键的看门人，他们可以识别骨折并启动经证实的骨质疏松症干预措施。骨质疏松症的检测、诊断和治疗应成为所有成人医疗机构的常规做法。骨健康和骨质疏松基金会（BHOF）——前身为国家骨质疏松基金会——于1999年首次出版了《临床医生指南》，提供了骨质疏松预防和治疗的准确信息。从那时起，骨质疏松症的诊断技术和治疗取得了重大进展。尽管取得了这些进步，但在病人护理方面仍然存在令人不安的差距。高危患者通常没有经过筛查以确定骨折的可能性，也没有接受骨折预防方面的教育。最令人担忧的是，大多数高风险的女性和男性骨折患者没有得到诊断，也没有接受fda批准的有效治疗。即使是那些开了适当治疗的人也不太可能按处方服药。临床医生指南提供了关于预防，风险评估，诊断和治疗骨质疏松症在绝经后的妇女和50岁及以上的男性简明的建议。它包括骨密度测定的适应症以及药物干预的骨折风险阈值。目前的药物可以增强骨骼和/或减少骨骼破坏，并显著减少意外骨折。所有的抗骨折疗法治疗但不能治愈疾病。当药物停药后，骨骼退化迟早会恢复——非双磷酸盐类药物停药早，双磷酸盐类药物停药晚。即使达到了正常的骨密度，骨质疏松和骨折风险升高仍然存在。即使随后的DXA t评分高于- 2.5，骨质疏松的诊断仍然存在。如果要避免骨折，持续监测和战略干预是必要的。除药物治疗外，适当摄入钙和维生素D、避免吸烟和过量饮酒、负重和抗阻力训练、预防跌倒也包括在预防骨折的措施中。在可能的情况下，本指南中的建议基于随机对照试验的证据；然而，相关发表的数据和专家临床经验的指导为目前RCT证据不足或不适用于许多因年龄和发病率而不考虑参加RCT的骨质疏松症患者的建议提供了基础。
Osteoporosis is the most common metabolic bone disease in the USA and the world. It is a subclinical condition until complicated by fracture(s). These fractures place an enormous medical and personal burden on individuals who suffer from them and take a significant economic toll. Any new fracture in an adult aged 50 years or older signifies imminent elevated risk for subsequent fractures, particularly in the year following the initial fracture. What a patient perceives as an unfortunate accident may be seen as a sentinel event indicative of bone fragility and increased future fracture risk even when the result of considerable trauma. Clinical or subclinical vertebral fractures, the most common type of osteoporotic fractures, are associated with a 5-fold increased risk for additional vertebral fractures and a 2- to 3-fold increased risk for fractures at other sites. Untreated osteoporosis can lead to a vicious cycle of recurrent fracture(s), often resulting in disability and premature death. In appropriate patients, treatment with effective antifracture medication prevents fractures and improves outcomes. Primary care providers and medical specialists are critical gatekeepers who can identify fractures and initiate proven osteoporosis interventions. Osteoporosis detection, diagnosis, and treatment should be routine practice in all adult healthcare settings. The Bone Health and Osteoporosis Foundation (BHOF) – formerly the National Osteoporosis Foundation – first published the Clinician’s Guide in 1999 to provide accurate information on osteoporosis prevention and treatment. Since that time, significant improvements have been made in diagnostic technologies and treatments for osteoporosis. Despite these advances, a disturbing gap persists in patient care. At-risk patients are often not screened to establish fracture probability and not educated about fracture prevention. Most concerning, the majority of highest risk women and men who have a fracture(s) are not diagnosed and do not receive effective, FDA-approved therapies. Even those prescribed appropriate therapy are unlikely to take the medication as prescribed. The Clinician’s Guide offers concise recommendations regarding prevention, risk assessment, diagnosis, and treatment of osteoporosis in postmenopausal women and men aged 50 years and older. It includes indications for bone densitometry as well as fracture risk thresholds for pharmacologic intervention. Current medications build bone and/or decrease bone breakdown and dramatically reduce incident fractures. All antifracture therapeutics treat but do not cure the disease. Skeletal deterioration resumes sooner or later when a medication is discontinued—sooner for nonbisphosphonates and later for bisphosphonates. Even if normal BMD is achieved, osteoporosis and elevated risk for fracture are still present. The diagnosis of osteoporosis persists even if subsequent DXA T-scores are above − 2.5. Ongoing monitoring and strategic interventions will be necessary if fractures are to be avoided. In addition to pharmacotherapy, adequate intake of calcium and vitamin D, avoidance of smoking and excessive alcohol intake, weight-bearing and resistance-training exercise, and fall prevention are included in the fracture prevention armamentarium. Where possible, recommendations in this guide are based on evidence from RCTs; however, relevant published data and guidance from expert clinical experience provides the basis for recommendations in those areas where RCT evidence is currently deficient or not applicable to the many osteoporosis patients not considered for RCT participation due to age and morbidity.
影响因子：
4.1
作者：
McKenna MJ;McKiernan FE;McGowan B;Silke C;Bennett K;van der Kamp S;Ward P;Hurson C;Heffernan E
通讯作者：
Heffernan E