Clinical Strategies to Address Patients' Concerns in Osteoporosis Management with Bisphosphonates
Clinical Strategies to Address Patients' Concerns in Osteoporosis Management with Bisphosphonates
复制标题
解决患者对双磷酸盐骨质疏松症治疗担忧的临床策略
作者：
R. Cole
大约有4400万美国人患有或处于骨质疏松症的风险中，骨质疏松症是一种与骨折风险增加相关的疾病，因此，发病率和死亡率也会增加。20%至30%的绝经后妇女患有骨质疏松症，由此导致的骨折造成了重大的经济负担，估计每年的直接成本在170亿至190亿美元之间。髋部骨折占大部分费用（约60%），因为除了初始治疗的直接费用外，髋部骨折通常还需要昂贵的长期随访护理。筛查、诊断和疾病管理在治疗有骨质疏松风险的患者时至关重要。国家骨质疏松基金会建议对所有绝经后妇女进行骨质疏松危险因素评估，并建议所有年龄≥65岁的妇女进行骨密度检测。一旦初级保健医生确定患者有骨质疏松相关骨折的风险，医生必须决定是否以及如何治疗患者（即，非药物治疗或药物治疗）。双膦酸盐是50岁以上绝经后骨质疏松症妇女的一线药物治疗。双膦酸盐在临床试验中具有良好的安全性和耐受性，已显示出减少骨折的疗效。然而，实际疗效的实现在很大程度上取决于患者良好的治疗依从性。媒体对罕见不良事件的关注促使一些患者故意不依从。医生应该筛查患者的禁忌症和不良事件风险因素，教育他们骨折的风险和治疗的益处和风险，并在治疗期间监测他们。为了帮助初级保健医生对有骨质疏松症风险或已确诊骨质疏松症的妇女进行临床决策，本文回顾了绝经后骨质疏松症的诊断和治疗指南、延长间隔双膦酸盐的近期长期疗效数据、近期双膦酸盐的安全性问题，最后提出了改善双膦酸盐依从性和患者预后的策略。
Abstract Approximately 44 million Americans either have, or are at risk of developing, osteoporosis, a disease associated with an increased risk of fracture and, consequently, morbidity and mortality. Osteoporosis affects 20% to 30% of postmenopausal women, and resulting fractures pose a major economic burden, with estimated annual direct costs ranging from $17 billion to $19 billion. Hip fractures account for the majority of costs (˜60%) because they often require costly long-term follow-up care in addition to the direct costs of initial treatment. Screening, diagnosis, and disease management are of paramount importance when treating patients at risk for osteoporosis. The National Osteoporosis Foundation recommends that all postmenopausal women be evaluated for osteoporosis risk factors and that all women aged ≥ 65 years undergo bone mineral density testing. Once the primary care physician has identified a patient at risk for osteoporosis-related fracture, the physician must decide whether and how to treat the patient (ie, nonpharmacologic or pharmacologic options). Bisphosphonates are the first-line pharmacologic treatment for women aged ≥ 50 years with postmenopausal osteoporosis. Bisphosphonates—which have a favorable safety and tolerability profile in clinical trials—have shown efficacy in reducing fractures. However, achieved real-world effectiveness is very much dependent on good treatment adherence by the patient. Media attention to rare adverse events has motivated some patients to deliberate nonadherence. Physicians should screen patients for contraindications and adverse event risk factors, educate them on the risks of fracture and benefits and risks of treatment, and monitor them during therapy. To assist primary care physicians in clinical decision making for women at risk for or with confirmed osteoporosis, this article presents a review of the guidelines for the diagnosis and treatment of postmenopausal osteoporosis, recent long-term efficacy data for extended-interval bisphosphonates, recent safety concerns with bisphosphonates, and lastly, suggests strategies for improving bisphosphonate adherence and patient outcomes.
影响因子：
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作者：
Heckbert, Susan R.;Li, Guo;Psaty, Bruce M.
通讯作者：
Psaty, Bruce M.