Christenson E S, Jiang X, Kagan R, Schnatz P
Department of ObGyn, Reading Hospital and Medical Center, Reading, PA, USA.
Minerva Ginecol. 2012 Jun;64(3):181-94.
Osteoporosis is most prevalent in women over the age of 50 as the hormonal influence of estrogen on bone health dissipates with the onset of menopause. The progressive changes in bone structure, quality and density lead to pathological fractures and an increase in morbidity and mortality among menopausal women. This review will examine the 2010 North American Menopause Society (NAMS) position statement and other recent publications to summarize the data and combinations of therapies used to treat women 50 years or older with osteoporosis. To review the latest research and guidelines for osteoporosis management we performed a PubMed search using the parameters Linked to free full text, Humans, Female, Review, English, Middle Age (45-64 years and 45+ years), Age 65+ years, and published in the last five years. Articles were sorted by relevance and hand searching of these articles was done to further increase the yield. While a perfect treatment has yet to be discovered to completely cure this progressive disease, many breakthroughs have been made in order to prevent fractures and improve quality of life. Calcium and vitamin D supplementation are recommended for patients undergoing pharmacological treatment, however, trials looking at their effectiveness have mixed findings. Bisphosphonates are considered the first line therapy in the treatment of osteoporosis and reduce vertebral fractures by 40% to 70% and non-vertebral fractures by 20% to 35%. Calcitonin showed promise during early trials in 2000 with a 33% reduction in fractures but these results have not been replicated and this therapy is now relegated to a second line treatment. Teriparatide is recommended for patients with severe osteoporosis and has been shown to reduce vertebral fractures 65% and non-vertebral fractures 53%. Selective estrogen receptor modulators (SERMs) are another useful therapy resulting in a 55% reduction in vertebral fractures without any documented advantage when looking at non-vertebral fractures. The currently available SERMs for this indication include raloxifene, available in the USA, and bazedoxifene, in Europe. Estrogen is effective, with a 27% reduction in fractures, but often is reserved for concomitant use for other menopausal symptoms or in patients intolerant of other available osteoporosis therapies. The newly approved monoclonal antibody for osteoporosis treatment in postmenopausal women, denosumab, leads to a 68% and 19% reduction of vertebral and non-vertebral fractures, respectively. In conclusion, the 2010 NAMS position statement provides an excellent framework to discuss treatment options with patients. Lifestyle optimization should be the bedrock of any good treatment approach. When pharmacological intervention is warranted, many good therapies are available which have been shown to reduce the risk of fractures in osteoporotic patients. Any treatment plan, however, will be ineffective if the patient is not compliant. Therefore, a detailed discussion regarding each therapeutic intervention should ensue, including its usefulness and side effects.
骨质疏松症在50岁以上女性中最为普遍，因为随着更年期的到来，雌激素对骨骼健康的激素影响逐渐消失。骨骼结构、质量和密度的渐进性变化会导致绝经后女性发生病理性骨折，并增加发病率和死亡率。本综述将审视2010年北美更年期协会（NAMS）的立场声明及其他近期出版物，以总结用于治疗50岁及以上骨质疏松症女性的数据和治疗组合。为了回顾骨质疏松症管理的最新研究和指南，我们使用与免费全文链接、人类、女性、综述、英语、中年（45 - 64岁及45岁以上）、65岁及以上以及过去五年内发表等参数在PubMed上进行了搜索。文章按相关性排序，并对这些文章进行人工检索以进一步提高检索结果的质量。虽然尚未发现能完全治愈这种渐进性疾病的完美治疗方法，但为预防骨折和改善生活质量已取得了许多突破。对于正在接受药物治疗的患者，建议补充钙和维生素D，然而，关于其有效性的试验结果不一。双膦酸盐被认为是治疗骨质疏松症的一线疗法，可使椎体骨折减少40%至70%，非椎体骨折减少20%至35%。降钙素在2000年的早期试验中显示出有前景的结果，骨折减少了33%，但这些结果并未得到重复验证，现在这种疗法已沦为二线治疗。特立帕肽推荐用于重度骨质疏松症患者，已显示可使椎体骨折减少65%，非椎体骨折减少53%。选择性雌激素受体调节剂（SERM）是另一种有用的疗法，可使椎体骨折减少55%，但在非椎体骨折方面未显示出任何显著优势。目前用于该适应症的SERM包括美国的雷洛昔芬和欧洲的巴多昔芬。雌激素是有效的，可使骨折减少27%，但通常保留用于伴有其他更年期症状或不耐受其他现有骨质疏松症疗法的患者。新批准的用于治疗绝经后女性骨质疏松症的单克隆抗体地诺单抗，可使椎体骨折和非椎体骨折分别减少68%和19%。总之，2010年NAMS立场声明为与患者讨论治疗方案提供了一个很好的框架。生活方式优化应是任何良好治疗方法的基石。当需要进行药物干预时，有许多已被证明可降低骨质疏松症患者骨折风险的良好疗法。然而，如果患者不依从，任何治疗计划都将无效。因此，应就每种治疗干预措施进行详细讨论，包括其有效性和副作用。
