Delmas Pierre D
Claude Bernard University of Lyon and INSERM Research Unit 403, France.
Lancet. 2002 Jun 8;359(9322):2018-26. doi: 10.1016/S0140-6736(02)08827-X.
The aim of treatment of postmenopausal osteoporosis is to reduce the frequency of vertebral and non-vertebral fractures (especially at the hip), which are responsible for morbidity associated with the disease. Results of large placebo controlled trials have shown that alendronate, raloxifene, risedronate, the 1-34 fragment of parathyroid hormone, and nasal calcitonin, greatly reduce the risk of vertebral fractures. Furthermore, a large reduction of non-vertebral fractures has been shown for alendronate, risedronate, and the 1-34 fragment of parathyroid hormone. Calcium and vitamin D supplementation is not sufficient to treat individuals with osteoporosis but is useful, especially in elderly women in care homes. Hormone replacement therapy remains a valuable option for the prevention of osteoporosis in early postmenopausal women. Choice of treatment depends on age, the presence or absence of prevalent fractures, especially at the spine, and the degree of bone mineral density measured at the spine and hip. Non-pharmacological interventions include adequate calcium intake and diet, selected exercise programmes, reduction of other risk factors for osteoporotic fractures, and reduction of the risk of falls in elderly individuals.
绝经后骨质疏松症的治疗目标是降低椎体和非椎体骨折（尤其是髋部骨折）的发生率，这些骨折是该疾病相关发病的原因。大型安慰剂对照试验结果表明，阿仑膦酸盐、雷洛昔芬、利塞膦酸盐、甲状旁腺激素1-34片段和鼻用降钙素可大大降低椎体骨折的风险。此外，阿仑膦酸盐、利塞膦酸盐和甲状旁腺激素1-34片段已显示出可大幅降低非椎体骨折的风险。补充钙和维生素D不足以治疗骨质疏松症患者，但很有用，尤其是对养老院中的老年女性。激素替代疗法仍然是绝经后早期妇女预防骨质疏松症的重要选择。治疗方法的选择取决于年龄、是否存在既往骨折（尤其是脊柱骨折）以及在脊柱和髋部测量的骨矿物质密度程度。非药物干预措施包括充足的钙摄入和饮食、选定的运动计划、降低骨质疏松性骨折的其他危险因素以及降低老年人跌倒的风险。
