Dominguez Ligia J, Scalisi Rosalinda, Barbagallo Mario
Geriatric Unit, Department of Clinical Medicine and Emergent Pathologies, University of Palermo, Italy.
Acta Biomed. 2010;81 Suppl 1:55-65.
Osteoporosis is a major and global public health concern. This disorder is characterized by a compromised bone strength and increased susceptibility to fractures, with important health and socioeconomic consequences. Age remains a cardinal, independent determinant of fracture risk; hence, the prevalence of osteoporotic fractures is expected to rise as the proportion of older populations increases worldwide. The prevention of osteoporosis should begin early and continue all the way through life with measures that improve or maintain bone health including regular physical activity and a balanced diet, considering not only an adequate intake of calcium but also of other minerals, proteins, and food rich in antioxidants. Smoking and alcohol abuse should be avoided. In older persons, who are particularly at risk of fragility fractures, the prevention of falls and the maintenance of an adequate vitamin D status are essential. Assessment of fracture risk followed by proved effective nonpharmacological and pharmacological management is still low, even in patients who have sustained a fragility fracture. Nonpharmacologic strategies should always be implemented, but many patients also need pharmacologic intervention to achieve adequate fracture protection. It is clear today that although low bone mineral density (BMD) is an important determinant of bone fragility, it is not the only one, hence, drugs used in the treatment of osteoporosis must not only show to promote changes in BMD, but to reduce the incidence of fractures. Safety issues should be always considered in an individual basis. This article reviews the available nonpharmacologic and pharmacologic interventions -proved to be effective- that may be implemented to reduce the risk of osteoporotic fractures.
骨质疏松症是一个重大的全球性公共卫生问题。这种疾病的特征是骨强度受损以及骨折易感性增加，会产生重要的健康和社会经济后果。年龄仍然是骨折风险的主要独立决定因素；因此，随着全球老年人口比例的增加，骨质疏松性骨折的患病率预计将会上升。骨质疏松症的预防应尽早开始，并贯穿一生，采取改善或维持骨骼健康的措施，包括定期进行体育活动和均衡饮食，不仅要考虑充足的钙摄入，还要考虑其他矿物质、蛋白质以及富含抗氧化剂的食物的摄入。应避免吸烟和酗酒。在特别容易发生脆性骨折的老年人中，预防跌倒和维持充足的维生素D水平至关重要。即使在发生过脆性骨折的患者中，骨折风险评估以及随后经证实有效的非药物和药物治疗的实施率仍然很低。应始终实施非药物策略，但许多患者也需要药物干预以实现足够的骨折预防。如今很明显，尽管低骨密度（BMD）是骨脆性的一个重要决定因素，但并非唯一因素，因此，用于治疗骨质疏松症的药物不仅必须显示出能促进骨密度变化，而且要降低骨折发生率。安全问题应始终根据个体情况加以考虑。本文综述了已被证明有效的非药物和药物干预措施，这些措施可用于降低骨质疏松性骨折的风险。
