Vondracek Sheryl F, Minne Paul, McDermott Michael T
Department of Clinical Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, CO 80045, USA.
Clin Interv Aging. 2008;3(2):315-29. doi: 10.2147/cia.s2539.
While knowledge regarding the diagnosis and treatment of osteoporosis has expanded dramatically over the last few years, gaps in knowledge still exist with guidance lacking on the appropriate management of several common clinical scenarios. This article uses fictional clinical scenarios to help answer three challenging questions commonly encountered in clinical practice. The first clinical challenge is when to initiate drug therapy in a patient with low bone density. It is estimated that 34 million America have low bone density and are at a higher risk for low trauma fractures. Limitations of using bone mineral density alone for drug therapy decisions, absolute risk assessment and evidence for the cost-effectiveness of therapy in this population are presented. The second clinical challenge is the prevention and treatment of vitamin D deficiency. Appropriate definitions for vitamin D insufficiency and deficiency, the populations at risk for low vitamin, potential consequences of low vitamin D, and how to manage a patient with low vitamin D are reviewed. The third clinical challenge is how to manage a patient receiving drug therapy for osteoporosis who has been deemed a potential treatment failure. How to define treatment failure, common causes of treatment failure, and the approach to the management of a patient who is not responding to appropriate osteoporosis therapy are discussed.
在过去几年里，尽管有关骨质疏松症诊断和治疗的知识有了显著扩展，但在知识方面仍存在差距，对于几种常见临床情况的恰当管理缺乏指导。本文通过虚构的临床案例来帮助回答临床实践中常见的三个具有挑战性的问题。第一个临床挑战是骨密度低的患者何时开始药物治疗。据估计，3400万美国人骨密度低，发生低创伤性骨折的风险更高。本文介绍了仅使用骨密度进行药物治疗决策的局限性、绝对风险评估以及该人群中治疗成本效益的证据。第二个临床挑战是维生素D缺乏的预防和治疗。对维生素D不足和缺乏的恰当定义、维生素D水平低的风险人群、维生素D水平低的潜在后果以及如何管理维生素D水平低的患者进行了综述。第三个临床挑战是如何管理接受骨质疏松症药物治疗但被认为可能治疗失败的患者。讨论了如何定义治疗失败、治疗失败的常见原因以及对未对适当的骨质疏松症治疗作出反应的患者的管理方法。
