Ohta Hiroaki
Department of Clinical Medical Research Center, International University of Health and Welfare, Women's Medical Center of Sanno Medical Center, Japan.
Clin Calcium. 2014 Nov;24(11):1679-87.
Most of the evidence for osteoporosis treatment comes from that in primary osteoporosis, with very little evidence available for that in secondary osteoporosis including lifestyle-related osteoporosis as a lifestyle-related disease despite the fact that secondary osteoporosis affects more patients than primary osteoporosis. This is in contrast to osteoporosis associated with type 2 diabetes and chronic kidney disease, where accumulating evidence demonstrates that osteoporosis is accounted for by decreases in bone strength associated with deterioration of bone quality due to accumulation of advanced glycation end products (AGEs) in collagen that results from elevated homocysteine and pentosidine levels. In this regard, given the ample evidence for their efficacy against deterioration of bone quality, selective estrogen receptor modulators (SERMs) are currently thought to represent the most efficacious of all available therapeutic agents for lifestyle-related osteoporosis.
大多数骨质疏松症治疗的证据来自原发性骨质疏松症，而继发性骨质疏松症（包括作为生活方式相关疾病的生活方式相关性骨质疏松症）的证据却非常少，尽管继发性骨质疏松症影响的患者比原发性骨质疏松症更多。这与2型糖尿病和慢性肾脏病相关的骨质疏松症形成对比，在这些疾病中，越来越多的证据表明，骨质疏松症是由于同型半胱氨酸和戊糖苷水平升高导致胶原蛋白中晚期糖基化终产物（AGEs）积累，进而引起骨质量恶化，导致骨强度下降所致。在这方面，鉴于有充分证据表明选择性雌激素受体调节剂（SERM）对骨质量恶化有效，目前认为它们是所有可用治疗药物中治疗生活方式相关性骨质疏松症最有效的药物。
