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预防老年人骨折的药理学和非药理学方法

Pharmacological and Non-pharmacological Means for Prevention of Fractures among Elderly.

作者信息

Fares Auda

机构信息

Department of Acute Geriatric Medicine and Rehabilitation, St. Willibrord-Spital Emmerich-Rees, Germany.

出版信息

Int J Prev Med. 2018 Sep 17;9:78. doi: 10.4103/ijpvm.IJPVM_114_18. eCollection 2018.

Abstract

Fractures are major cause of morbidity, mortality, and healthcare and social services expenditure in elderly. Fractures often have multifactorial etiologies and the condition emerges due to the interaction between the different predisposing and precipitating factors. One of the most common causes leading to fractures after minimal trauma in older people is osteoporosis. The objective of this article is to describe the clinical concept and summarize the evidence and to explain the future directions for research, focusing on specific issues related to prevent fracture in the elderly. This study reviewed the scientific literature addressing strategies for primary and secondaryprevention of fractures among elderly in the context of pharmacological and non-pharmacological means. A growing body of scientific evidence supports the use of both non-pharmacological and pharmacological interventions for the prevention of fracture. Research on these interventions has yielded positive outcomes in fracture rates. The bisphosphonates and vitamin D and calcium suppliments are the preferred therapy for prevention of osteoporotic fractures. Weight-bearing exercise and reducing home hazards have beneficial effects in reducing the incidence of falls and consequently reduce fractures. Prevention of fractures in elderly consists of therapy and prevention of osteoporosis, fall prevention, and using injury-site protection by high-risk elderly patients. Special consideration needs to be taken to reduce home hazard, and falls prevention education can be recommended to the elderly with history of fall or mobility limitations. Future research to prevent fractures in elderly population should not only concentrate on improving bone density and strength but also need to be focused on falls reduction strategies.

摘要

骨折是老年人发病、死亡以及医疗和社会服务支出的主要原因。骨折往往具有多因素病因,这种情况是由于不同的易感因素和促发因素之间的相互作用而出现的。老年人在受到极小创伤后导致骨折的最常见原因之一是骨质疏松症。本文的目的是描述临床概念、总结证据并解释未来的研究方向,重点关注与预防老年人骨折相关的具体问题。本研究回顾了在药物和非药物手段背景下针对老年人骨折一级和二级预防策略的科学文献。越来越多的科学证据支持使用非药物和药物干预措施来预防骨折。对这些干预措施的研究在骨折发生率方面取得了积极成果。双膦酸盐以及维生素D和钙补充剂是预防骨质疏松性骨折的首选疗法。负重运动和减少家庭危险因素对降低跌倒发生率有有益作用,从而减少骨折。老年人骨折的预防包括治疗和预防骨质疏松症、预防跌倒以及高危老年患者使用损伤部位保护措施。需要特别考虑减少家庭危险因素,对于有跌倒史或行动不便的老年人可推荐进行预防跌倒教育。未来预防老年人群骨折的研究不仅应专注于提高骨密度和强度,还需要侧重于减少跌倒的策略。

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