Sugimoto Toshitsugu
Shimane University Faculty of Medicine.
Nihon Rinsho. 2011 Jul;69(7):1181-7.
The criteria for initiating pharmacotherapy to prevent fragility fractures should be provided separately from the criteria for diagnosis of osteoporosis. In Japan, low BMD (bone mineral density), prevalent fracture, and age are established as fracture risk factors. A meta-analysis conducted by the WHO assured that excessive drinking, current smoking, and family history of hip fracture are fracture risk factors. Pharmacotherapy should be initiated with the consideration of the above risk factors. Recent large scale of RCT demonstrated that bisphosphonates as well as raloxifene are top grade of drugs which prevent fragility fracture. As for secondary osteoporosis, accumulating evidence is available about increased fracture threshold in glucocorticoid- and diabetes mellitus-induced osteoporosis. In osteoporotic patients, atherosclerosis often coexists. Multiple vertebral fractures follwed by kyphosis often causes functional disorders of the digestive and respiratory systems. It is, therefore, required to perform tailor-made medicine, based on the possibility that concomitant diseases exist in osteoporotic patients.
启动药物治疗以预防脆性骨折的标准应与骨质疏松症的诊断标准分开制定。在日本，低骨密度、既往骨折史和年龄被确定为骨折风险因素。世界卫生组织进行的一项荟萃分析证实，过量饮酒、当前吸烟和髋部骨折家族史是骨折风险因素。应在考虑上述风险因素的基础上启动药物治疗。最近大规模的随机对照试验表明，双膦酸盐以及雷洛昔芬是预防脆性骨折的顶级药物。至于继发性骨质疏松症，关于糖皮质激素和糖尿病所致骨质疏松症中骨折阈值升高的证据越来越多。在骨质疏松症患者中，动脉粥样硬化常并存。多个椎体骨折后发生脊柱后凸常导致消化和呼吸系统功能障碍。因此，鉴于骨质疏松症患者可能存在合并症，需要进行个性化治疗。
