Japan Health Technology Assessment, Eli Lilly Japan K.K., Sannomiya Plaza Building, 7-1-5, Isogamidori, Chuo-ku, Kobe, 651-0086, Japan.
J Bone Miner Metab. 2013 Jul;31(4):367-80. doi: 10.1007/s00774-013-0444-y. Epub 2013 Mar 28.
Prevalent fractures are major contributors to an increased risk of subsequent fractures, particularly in people with osteoporosis. While many studies have been conducted to assess the incidence of fracture in Japanese people with osteoporosis, far fewer have been conducted to assess the risk of subsequent fractures. This article reviews the morbidity, mortality, and risk of fracture in patients who are at high risk of subsequent fracture in Japan and the current treatment options available for these patients. Osteoporotic fractures in Japan are associated with high morbidity and mortality that result in significant financial and social costs. The rise in the proportion of elderly women in the Japanese population is contributing to a greater proportion of people with osteoporotic fractures and the high cost of osteoporosis. Although hip fractures have a significant effect on costs, a greater proportion of the Japanese population experience vertebral fractures. An increase in the incidence of vertebral fractures is concerning because preexisting vertebral fractures in older patients are associated with an increased risk of subsequent fractures. Hence, there is a clear rationale for pharmacological treatment of patients with prevalent vertebral fractures, or for those who are hospitalized or undergo surgery for osteoporotic fractures. Several pharmacological therapies are now available in Japan for the treatment of patients with osteoporosis. Understanding the consequences of subsequent fractures and the treatment options available for patients at high risk of subsequent fractures may contribute to clinical decision-making and improved outcomes for patients with osteoporosis.
高发骨折是导致后续骨折风险增加的主要因素，尤其是在骨质疏松症患者中。尽管已经有许多研究评估了日本骨质疏松症患者的骨折发生率，但评估后续骨折风险的研究却少得多。本文综述了日本骨折高风险患者的发病率、死亡率和骨折风险，以及目前这些患者的治疗选择。日本的骨质疏松性骨折与高发病率和死亡率相关，导致了巨大的经济和社会成本。日本老年女性人口比例的上升导致了更多的骨质疏松性骨折患者和骨质疏松症的高成本。尽管髋部骨折对成本有重大影响，但更多的日本人口经历了椎体骨折。椎体骨折发病率的上升令人担忧，因为老年患者的先前存在的椎体骨折与后续骨折的风险增加相关。因此，对于患有普遍存在的椎体骨折的患者，或者因骨质疏松性骨折而住院或接受手术治疗的患者，进行药物治疗有明确的理由。目前，日本有几种药物治疗方法可用于治疗骨质疏松症患者。了解后续骨折的后果和高风险骨折患者的治疗选择，可能有助于临床决策制定和改善骨质疏松症患者的结局。
