Morales-Torres Jorge
University of Guanajuato at León, Osteoporosis Unit, Hospital Aranda de la Parra, Hidalgo 329-704, León 37000, GTO, Mexico.
Clin Rheumatol. 2007 Feb;26(2):139-43. doi: 10.1007/s10067-006-0314-2. Epub 2006 May 3.
The frequency of osteoporosis and fragility fractures has been studied to a very limited extent in few developing countries. The aim of this paper is to review briefly the burden of osteoporosis and fragility fractures in these countries and to propose some strategies for the prevention and control of those conditions, considering barriers and facilitators for their implementation. The evolution of the demographic composition in most regions with developing countries shows a considerable increase in life expectancy and therefore, a significant growth in elderly population can be expected. Reports on the incidence of fragility fractures show figures in many of those countries that are comparable to those found in developed nations. Health resources (for acute treatment of fractures, their rehabilitation and chronic management, for diagnostic centers and drug therapy for osteoporosis) are limited in most of those regions and are allocated to other health priorities. Internationally accepted guidelines can be adapted to the realities of developing nations and may be promoted by organizations of health professionals and patients, but require endorsement and support by health authorities. The steps should include: (a) campaigns to increase awareness, both among the population at risk and relevant health workers; (b) the promotion of a preventive lifestyle in the general population; (c) the development of national or regional, evidence-based guidelines for the diagnosis and treatment of osteoporosis; (d) development and implementation of guidelines for the treatment of fragility fractures, their rehabilitation and prevention of falls; (e) collection of economic data on fractures and osteoporosis; and (f) development of country-specific fracture databases. These steps may help in reducing the increasing burden of osteoporotic fractures. Their implementation will require solid scientific basis and commitment from policy makers, health professionals, patient organizations, and ultimately the general population.
在少数发展中国家，骨质疏松症和脆性骨折的发生率仅在非常有限的范围内得到研究。本文旨在简要回顾这些国家骨质疏松症和脆性骨折的负担，并考虑实施过程中的障碍和促进因素，提出一些预防和控制这些疾病的策略。大多数发展中国家所在地区的人口构成演变表明，预期寿命大幅增加，因此老年人口有望显著增长。关于脆性骨折发生率的报告显示，其中许多国家的数字与发达国家相当。在这些地区的大多数地方，卫生资源（用于骨折的急性治疗、康复和慢性病管理、诊断中心以及骨质疏松症的药物治疗）有限，并被分配用于其他卫生优先事项。国际认可的指南可以根据发展中国家的实际情况进行调整，并可由卫生专业人员组织和患者组织加以推广，但需要卫生当局的认可和支持。这些步骤应包括：(a) 在高危人群和相关卫生工作者中开展提高认识运动；(b) 在普通人群中推广预防性生活方式；(c) 制定国家或区域基于证据的骨质疏松症诊断和治疗指南；(d) 制定和实施脆性骨折治疗、康复及预防跌倒的指南；(e) 收集骨折和骨质疏松症的经济数据；以及(f) 建立针对特定国家的骨折数据库。这些步骤可能有助于减轻骨质疏松性骨折日益加重的负担。其实施将需要坚实的科学依据以及政策制定者、卫生专业人员、患者组织乃至普通民众的承诺。
