Patel Devon, Gorrell Courtney, Norris Jordan, Liu Jiayong
Department of Medical Education, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH, USA.
Ann Jt. 2023 Jun 20;8:25. doi: 10.21037/aoj-23-2. eCollection 2023.
Osteoporosis is a skeletal disorder classified by the loss of bone density in older adults leading to compromised bone strength and an increased risk of fracture. It can be divided into categories based on its etiology: senile, post-menopausal, and secondary osteoporosis. Specific prevention measures and treatments exist for targeting bone loss. Here we review and summarize the literature regarding the presentation of osteoporosis and discuss pharmaceutical therapies.
PubMed and Google Scholar were searched for articles published in English between 1980 and 2021. Search terms combined "senile osteoporosis", "osteoporosis treatment", "osteoporosis", "bisphosphonates", "denosumab", types of hormone therapy, and other relevant keywords used in various combinations.
Osteoporosis affects millions but often goes undiagnosed until a pathologic fracture. Dual-energy X-ray absorptiometry (DEXA) scans evaluate bone mineral density (BMD) and are a diagnostic tool for osteoporosis. Adults over the age of 65, post-menopausal women, and those with risk factors such as previous fractures are recommended to receive DEXA scans every one to two years. Bisphosphonates, denosumab, and hormonal therapies are among the most common pharmacologic treatments for osteoporosis.
Daily, orally administered bisphosphonates are the first-line therapy for osteoporosis given their efficacy in decreasing fracture risk and favorable safety profile. Denosumab is an alternative that is administered subcutaneously every six months and may be given as initial therapy to select patients. Hormonal therapies are used if patients cannot tolerate bisphosphonates or denosumab or are refractory to these medications. Preventative measures for osteoporosis include tailored exercise and sufficient intake of calcium and vitamin D via diet or supplementation.
骨质疏松症是一种骨骼疾病，其特征为老年人骨密度降低，导致骨强度受损，骨折风险增加。它可根据病因分为几类：老年性、绝经后和继发性骨质疏松症。针对骨质流失有特定的预防措施和治疗方法。在此，我们回顾并总结有关骨质疏松症表现的文献，并讨论药物治疗方法。
在PubMed和谷歌学术上搜索1980年至2021年间以英文发表的文章。搜索词组合了“老年性骨质疏松症”“骨质疏松症治疗”“骨质疏松症”“双膦酸盐”“地诺单抗”、激素治疗类型以及其他各种组合使用的相关关键词。
骨质疏松症影响数百万人，但通常在发生病理性骨折之前未被诊断出来。双能X线吸收法（DEXA）扫描可评估骨矿物质密度（BMD），是诊断骨质疏松症的一种工具。建议65岁以上的成年人、绝经后女性以及有既往骨折等风险因素的人每1至2年接受一次DEXA扫描。双膦酸盐、地诺单抗和激素疗法是骨质疏松症最常见的药物治疗方法。
每日口服双膦酸盐因其在降低骨折风险方面的疗效和良好的安全性，是骨质疏松症的一线治疗方法。地诺单抗是一种替代药物，每六个月皮下注射一次，可作为初始治疗给予选定患者。如果患者不能耐受双膦酸盐或地诺单抗，或对这些药物难治，则使用激素疗法。骨质疏松症的预防措施包括量身定制的运动以及通过饮食或补充剂充分摄入钙和维生素D。
