Yves Rolland, Service de Médecine Interne et Gérontologie Clinique, Gérontopôle, CHU Toulouse, INSERM 1027, France,
J Frailty Aging. 2021;10(2):168-175. doi: 10.14283/jfa.2021.4.
Interactions among physiological pathways associated with osteoporosis and sarcopenia are thought to contribute to the onset of frailty. The International Conference on Frailty and Sarcopenia Research Task Force thus met in March 2020 to explore how emerging interventions to manage fracture and osteoporosis in older adults may reduce frailty, disability, morbidity, and mortality in the older population. Both pharmacological and non-pharmacological interventions (including nutritional intervention, exercise, and other lifestyle changes) were discussed, including nutritional intervention, exercise, and other lifestyle changes. Pharmacological treatments for osteoporosis include bone-forming and antiresorptive agents, which may optimally be used in sequential or combination regimens. Since similar mechanisms related to resorption underlie physiological changes in muscle and bone, these interventions may provide benefits beyond treating osteoporosis. Clinical trials to test these interventions, however, often exclude frail older persons because of comorbidities (such as mobility disability and cognitive impairment) or polypharmacy. The Task Force recommended that future clinical trials use harmonized protocols, including harmonized inclusion criteria and similar outcome measures; and that they test a range of multidomain therapies. They further advocated more high-quality research to develop interventions specifically for people who are frail and old. The ICOPE program recommended by WHO appears to be highly recommended to frail older adults with osteoporosis.
骨质疏松症和肌肉减少症相关生理途径的相互作用被认为是导致虚弱的原因之一。因此，国际虚弱和肌肉减少症研究工作组于 2020 年 3 月召开会议，探讨新兴的骨折和骨质疏松症管理干预措施如何降低老年人群的虚弱、残疾、发病率和死亡率。会上讨论了包括营养干预、运动和其他生活方式改变在内的药物和非药物干预措施。骨质疏松症的药物治疗包括促进骨形成和抗吸收药物，这些药物可能以序贯或联合方案最佳使用。由于与骨骼吸收相关的类似机制也存在于肌肉的生理变化中，因此这些干预措施可能除了治疗骨质疏松症之外还有其他益处。然而，由于合并症（如行动不便和认知障碍）或多种药物治疗，这些临床试验往往排除了虚弱的老年人。工作组建议未来的临床试验使用协调一致的方案，包括协调一致的纳入标准和类似的结果衡量标准；并测试一系列多领域治疗方法。他们进一步提倡开展更多高质量的研究，为虚弱和老年患者开发专门的干预措施。世卫组织推荐的 ICOPE 方案似乎非常适合患有骨质疏松症的虚弱老年人。
