Department of Internal Medicine, Michigan State University College of Osteopathic Medicine, Brooklyn, MI 49230, USA.
Postgrad Med. 2011 Mar;123(2):131-44. doi: 10.3810/pgm.2011.03.2271.
Approximately 44 million Americans either have, or are at risk of developing, osteoporosis, a disease associated with an increased risk of fracture and, consequently, morbidity and mortality. Osteoporosis affects 20% to 30% of postmenopausal women, and resulting fractures pose a major economic burden, with estimated annual direct costs ranging from $17 billion to $19 billion. Hip fractures account for the majority of costs (~60%) because they often require costly long-term follow-up care in addition to the direct costs of initial treatment. Screening, diagnosis, and disease management are of paramount importance when treating patients at risk for osteoporosis. The National Osteoporosis Foundation recommends that all postmenopausal women be evaluated for osteoporosis risk factors and that all women aged ≥ 65 years undergo bone mineral density testing. Once the primary care physician has identified a patient at risk for osteoporosis-related fracture, the physician must decide whether and how to treat the patient (ie, nonpharmacologic or pharmacologic options). Bisphosphonates are the first-line pharmacologic treatment for women aged ≥ 50 years with postmenopausal osteoporosis. Bisphosphonates-which have a favorable safety and tolerability profile in clinical trials-have shown efficacy in reducing fractures. However, achieved real world effectiveness is very much dependent on good treatment adherence by the patient. Media attention to rare adverse events has motivated some patients to deliberate nonadherence. Physicians should screen patients for contraindications and adverse event risk factors, educate them on the risks of fracture and benefits and risks of treatment, and monitor them during therapy. To assist primary care physicians in clinical decision making for women at risk for or with confirmed osteoporosis, this article presents a review of the guidelines for the diagnosis and treatment of postmenopausal osteoporosis, recent long-term efficacy data for extended-interval bisphosphonates, recent safety concerns with bisphosphonates, and lastly, suggests strategies for improving bisphosphonate adherence and patient outcomes.
大约有 4400 万美国人患有骨质疏松症，或者有患骨质疏松症的风险，这是一种与骨折风险增加相关的疾病，因此会导致发病率和死亡率上升。骨质疏松症影响了 20%至 30%的绝经后妇女，由此产生的骨折给经济带来了巨大负担，估计每年的直接成本在 170 亿至 190 亿美元之间。髋部骨折占了大部分成本（约 60%），因为它们通常除了初始治疗的直接成本外，还需要昂贵的长期后续护理。在治疗有骨质疏松症风险的患者时，筛查、诊断和疾病管理至关重要。国家骨质疏松基金会建议所有绝经后妇女都要评估骨质疏松症风险因素，所有年龄≥65 岁的妇女都要进行骨密度测试。一旦初级保健医生确定了有骨质疏松症相关骨折风险的患者，医生必须决定是否以及如何治疗患者（即，非药物或药物选择）。双膦酸盐是治疗年龄≥50 岁绝经后骨质疏松症妇女的一线药物治疗方法。双膦酸盐在临床试验中具有良好的安全性和耐受性，已被证明能有效减少骨折。然而，实际效果在很大程度上取决于患者的良好治疗依从性。媒体对罕见不良反应的关注促使一些患者故意不遵医嘱。医生应该筛查患者的禁忌症和不良反应风险因素，对他们进行骨折风险和治疗获益与风险的教育，并在治疗期间对他们进行监测。为了帮助初级保健医生对有骨质疏松症风险或已确诊的妇女做出临床决策，本文回顾了绝经后骨质疏松症的诊断和治疗指南、延长间隔双膦酸盐的最新长期疗效数据、双膦酸盐的最新安全性问题，并提出了改善双膦酸盐依从性和患者结局的策略。
