Schweser Kyle M, Crist Brett D
Department of Orthopaedic Surgery, University of Missouri, N116, One Hospital Dr, Columbia, MO, 65212, USA.
Curr Rev Musculoskelet Med. 2017 Jun;10(2):265-274. doi: 10.1007/s12178-017-9410-y.
The purposes of this study are to examine the literature within the past 5 years regarding osteoporosis and offer a discussion on new topics and controversies.
Patient compliance with therapy remains an issue. The effectiveness of Vitamin D and calcium are being called into question Atypical femur fractures have been associated with bisphosphonate and denosumab use. Treatment is both surgical and pharmaceutical. A multidisciplinary approach to osteoporotic fractures is important and having some form of fracture liaison service (FLS) improves the efficacy of osteoporotic care and decreases secondary fractures. Screening for osteoporosis remains low. Ultrasound may be cost-effective for diagnosis. Understanding of osteoporosis has come a long way in the medical community, but the translation to the lay community has lagged behind. Patients often take a laissez-faire attitude toward osteoporosis that can affect compliance. Information read by patients often focuses on complications, such as atypical femur fractures and myocardial infarctions. It is essential for providers to be able to discuss these issues with patients. Newer medications and more cost-effective diagnostic tests exist, but availability may be limited. FLS are effective, but the most cost-effective model for therapy still eludes us. Areas for further investigation include FLS models, the effectiveness of vitamin supplementation, and more ubiquitous and cost-effective diagnostic tools.
本研究旨在审视过去5年里有关骨质疏松症的文献，并就新主题和争议展开讨论。
患者对治疗的依从性仍是一个问题。维生素D和钙的有效性受到质疑。非典型股骨骨折与双膦酸盐和地诺单抗的使用有关。治疗方法包括手术和药物治疗。采用多学科方法治疗骨质疏松性骨折很重要，设立某种形式的骨折联络服务（FLS）可提高骨质疏松症护理的疗效并减少二次骨折。骨质疏松症的筛查率仍然很低。超声检查在诊断方面可能具有成本效益。在医学界，对骨质疏松症的认识已经有了很大进展，但向普通大众的普及却滞后了。患者对骨质疏松症往往持放任态度，这可能会影响依从性。患者阅读的信息通常侧重于并发症，如非典型股骨骨折和心肌梗死。医疗服务提供者能够与患者讨论这些问题至关重要。有了更新的药物和更具成本效益的诊断测试，但可及性可能有限。FLS是有效的，但最具成本效益的治疗模式仍未找到。有待进一步研究的领域包括FLS模式、维生素补充剂的有效性以及更普遍且具成本效益的诊断工具。
