Addressing the Crisis in the Treatment of Osteoporosis: A Path Forward
Addressing the Crisis in the Treatment of Osteoporosis: A Path Forward
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DOI：
10.1002/jbmr.3074
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发表时间：
2017-03-01
影响因子：
6.2
通讯作者：
Shane, Elizabeth
中科院分区：
文献类型：
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作者：
Khosla, Sundeep;Cauley, Jane A.;Shane, Elizabeth
大量的数据和媒体的关注已经突出了骨质疏松症治疗的潜在“危机”。具体来说，尽管有几种有效的药物可以预防骨折，但许多需要药物治疗的患者要么没有被开这些药物，要么即使开了药，也根本不服用。尽管骨质疏松症治疗中存在这种“差距”的原因很多，但一个主要因素是医生和患者对副作用风险的担忧，特别是与双膦酸盐（和可能的其他抗吸收）药物治疗相关的非典型股骨骨折（AFFs）。从这个角度来看，我们回顾了骨折风险增加的患者治疗不足的现状，并提出了可能的短期、中期和长期方法来解决患者的问题，特别是与AFF风险相关的问题。我们建议改善患者和医生对前驱症状的教育，使用双能X线吸收测定法（DXA）进行股骨扫描以监测患者的抗吸收治疗，更好地识别高风险患者，可能使用DXA的几何参数和其他风险因素，以及更多的药物基因组学研究以识别风险标志物。尽管AFFS不是骨质疏松症适当治疗的唯一障碍，但对AFFS的关注仍然是一个主要问题，需要解决现有治疗方法的有效传播，以降低骨折风险。(C)2016年美国骨与矿物质研究学会。
Considerable data and media attention have highlighted a potential "crisis" in the treatment of osteoporosis. Specifically, despite the availability of several effective drugs to prevent fractures, many patients who need pharmacological therapy are either not being prescribed these medications or if prescribed a medication, are simply not taking it. Although there are many reasons for this "gap" in the treatment of osteoporosis, a major factor is physician and patient concerns over the risk of side effects, especially atypical femur fractures (AFFs) related to bisphosphonate (and perhaps other antiresorptive) drug therapy. In this perspective, we review the current state of undertreatment of patients at increased fracture risk and suggest possible short-, intermediate-, and long-term approaches to address patient concerns, specifically those related to AFF risk. We suggest improved patient and physician education on prodromal symptoms, extended femur scans using dual-energy X-ray absorptiometry (DXA) to monitor patients on antiresorptive treatment, better identification of high-risk patients perhaps using geometrical parameters from DXA and other risk factors, and more research on pharmacogenomics to identify risk markers. Although not the only impediment to appropriate treatment of osteoporosis, concern over AFFs remains a major issue and one that needs to be resolved for effective dissemination of existing treatments to reduce fracture risk. (C) 2016 American Society for Bone and Mineral Research.