Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Geriatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; College of Medicine, National Cheng Kung University, Tainan, Taiwan.
J Clin Densitom. 2021 Jan-Mar;24(1):3-13. doi: 10.1016/j.jocd.2019.03.004. Epub 2019 Mar 20.
Osteoporosis is a major health issue. By 2050, a greater than 2-fold increase in patients number with hip fractures will occur in Asia representing 50% of all hip fractures worldwide. For the Asia-Pacific (AP) region, more efforts on controlling osteoporosis and the subsequent fractures are crucial. Bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA) is commonly used to diagnose osteoporosis and monitor osteoporosis treatment. However, the inconvenience, cost, limited availability of DXA and the delay in detection of BMD changes after treatment initiation support an important role for bone turnover markers (BTMs), as short-term tools to monitor therapy. With regards to low adherence rates of medical treatment of osteoporosis, the experts reached consensus on the use of BTMs for both raising awareness and short-term monitoring of osteoporosis treatment in the AP region. The experts endorse the use of BTMs, especially serum C-terminal telopeptide of type 1 collagen (CTX) and serum procollagen type 1 N propeptide (P1NP), as short-term monitoring tools to help clinicians assess the responses to osteoporosis therapies and appropriately adjust treatment regimens earlier than BMD. Either the absolute values or the degree of change from baseline in BTMs can be used to monitor the potential efficacy of osteoporosis therapies. The use of BTMs can be incorporated in osteoporosis care programs, such as fracture liaison service (FLS), to improve patient adherence and treatment outcomes. Encouraging sufficient reimbursement from health care systems may facilitate widespread use of BTMs in clinical practice in the AP region.
骨质疏松症是一个主要的健康问题。到 2050 年，亚洲地区髋部骨折患者人数将增加两倍以上，占全球髋部骨折总数的 50%。对于亚太地区（AP），控制骨质疏松症及其后续骨折的工作至关重要。双能 X 射线吸收法（DXA）的骨矿物质密度（BMD）常用于诊断骨质疏松症和监测骨质疏松症的治疗。然而，DXA 的不便、成本、有限的可用性以及治疗开始后 BMD 变化的检测延迟，支持骨转换标志物（BTMs）作为监测治疗的短期工具的重要作用。由于骨质疏松症的医疗治疗依从率低，专家们就 BTMs 在亚太地区提高对骨质疏松症的认识和短期监测骨质疏松症治疗方面达成了共识。专家们认可 BTMs 的使用，特别是血清 1 型胶原 C 端肽（CTX）和血清前胶原 1 N 端肽（P1NP），作为短期监测工具，帮助临床医生评估对骨质疏松症治疗的反应，并在 BMD 之前更早地调整治疗方案。BTMs 的绝对数值或与基线相比的变化程度均可用于监测骨质疏松症治疗的潜在疗效。BTMs 的使用可以纳入骨质疏松症护理计划，如骨折联络服务（FLS），以提高患者的依从性和治疗效果。鼓励医疗保健系统提供足够的报销可能有助于 BTMs 在亚太地区的临床实践中广泛使用。
