Willvonseder R, Resch H
Medizinische Abteilung des Krankenhauses der Barmherzigen Brüder, Ludwig-Boltzmann-Institut für Altersforschung, Wien.
Z Gerontol. 1988 May-Jun;21(3):156-60.
Treatment of idiopathic osteoporosis in the elderly presupposes exact radiological diagnosis, the exclusion of a primary illness as the cause of the pathological process and exact differential diagnosis from other metabolic osteopathies. We consider possible means of prevention of the immobilization of old people, and appropriate hormonal substitution in cases of previous illnesses which coincide with a disturbance of the gonadal function, as important prophylactic measures. In the case of manifest osteoporosis, if possible, an assignment of the disease to a manifestation with high or low bone turnover should be made, by means of biochemical adjuvants. In high bone turnover, the substitution of sex hormones or the administration of calcitonin is indicated, particularly if symptoms of pain are distinct. In osteoporosis with low bone turnover, fluoride in long-term therapy is the preferred medication. The latest studies show that a combination of fluoride and active vitamin D metabolites is preferable to monotherapy. All therapy for this disease, independent of the age of the patient, should be supported by isometric exercises, analgesics and appropriate dietary measures. Orthopaedic supporting measures should be applied only if conservative measures in acute vertebral fractures fail.
老年人特发性骨质疏松症的治疗需要准确的放射学诊断，排除作为病理过程病因的原发性疾病，并与其他代谢性骨病进行准确的鉴别诊断。我们认为，预防老年人失能的可能方法以及在既往疾病伴有性腺功能障碍时进行适当的激素替代，是重要的预防措施。对于明显的骨质疏松症，如有可能，应借助生化辅助手段将疾病归类为高骨转换或低骨转换表现。在高骨转换时，应补充性激素或给予降钙素，尤其是疼痛症状明显时。在低骨转换的骨质疏松症中，长期治疗首选氟化物。最新研究表明，氟化物与活性维生素D代谢物联合使用优于单一疗法。无论患者年龄如何，该病的所有治疗都应辅以等长运动、镇痛药和适当的饮食措施。只有在急性椎体骨折的保守治疗失败时才应采取骨科支持措施。
