Lips P, Ooms M E
Department of Endocrinology, Academic Hospital Vrije Universiteit, 1007 MB Amsterdam, The Netherlands.
Baillieres Best Pract Res Clin Endocrinol Metab. 2000 Jun;14(2):265-77. doi: 10.1053/beem.2000.0073.
The aim of non-pharmacological intervention for osteoporosis is to prevent, treat or alleviate the consequences of osteoporosis, the main one of which is fracture. Non-pharmacological interventions consist of a wide spectrum of treatment modalities to decrease pain, correct postural change, improve mobility, enable the patient to follow a normal social life and prevent (further) fracture. An exercise programme can increase bone mass in adolescents and adults, but in the elderly its main emphasis should be on improving muscle strength and balance in order to decrease the risk of falls. Physiotherapy is commonly prescribed to mobilize the patient after a fracture, to decrease muscle spasm and pain, and to improve balance and co-ordination. An orthesis or back support may be used to correct kyphosis and decrease pain. Medication for pain is often needed and should cover both acute severe pain following fracture and chronic pain caused by postural change. A hip fracture is the most severe consequence of osteoporosis. The risk of hip fracture can be decreased by pharmacological treatment to increase bone mass and bone strength. However, in the very elderly the occurrence of falling may be more important than the failure of bone strength. Hip protectors have recently become available and have been shown to decrease the risk of hip fracture after a fall. These shunt the energy from the trochanter away to the sides. Non-pharmacological approaches to treatment are often neglected in daily practice, the emphasis being instead on treatment with drugs that decrease bone resorption and thereby increase bone strength.
骨质疏松症的非药物干预旨在预防、治疗或减轻骨质疏松症的后果，其中主要后果是骨折。非药物干预包括多种治疗方式，以减轻疼痛、纠正姿势改变、改善活动能力、使患者能够正常参与社会生活并预防（进一步）骨折。运动计划可以增加青少年和成年人的骨量，但对于老年人，其主要重点应是提高肌肉力量和平衡能力，以降低跌倒风险。骨折后通常会开物理治疗的处方，以帮助患者恢复活动能力、减轻肌肉痉挛和疼痛，并改善平衡和协调能力。矫形器或背部支撑物可用于矫正脊柱后凸并减轻疼痛。通常需要使用止痛药物，药物应涵盖骨折后的急性剧痛以及姿势改变引起的慢性疼痛。髋部骨折是骨质疏松症最严重的后果。通过药物治疗增加骨量和骨强度可降低髋部骨折的风险。然而，对于高龄老人，跌倒的发生可能比骨强度下降更为重要。髋部保护器最近已上市，并已证明可降低跌倒后髋部骨折的风险。这些保护器可将来自大转子的能量分散到身体两侧。在日常实践中，非药物治疗方法常常被忽视，重点反而放在使用减少骨吸收从而增加骨强度的药物治疗上。
