Reginster J L
Bone and Cartilage Metabolism Unit, University of Liège, Belgium.
Calcif Tissue Int. 1996;59 Suppl 1:S24-9. doi: 10.1007/s002239900172.
Europe is a patchwork of various medical cultures and financial resources. Variations abound with respect to financing, accessibility to public health systems, health expenditures, drug registration and reimbursement, the prescription of drugs, and clinical applications, as well as the perception of osteoporosis itself. However, there are possibilities for the harmonization of medical services among the various countries within Europe. The European Agency for the Evaluation of Medicinal Products (EAEMP) is attending to the centralized or decentralized procedures for the registration of drugs. The Group for the Respect of Ethics and Excellence in Science (GREES) is investigating guidelines for drug registration as well as gathering and making available medical references. The European Foundation for Osteoporosis and Bone Diseases (EFFO) is increasing awareness of the prevalence of the disease and the need for prevention and treatment. Finally, the International Federation of Societies on Skeletal Diseases (IFSSD) is coordinating epidemiologic, clinical, and social research. There is a need for increased awareness of osteoporosis throughout Europe. Health authorities are in need of cost/benefit reports leading to the registration and reimbursement of agents. Primary care physicians need information about osteoporosis and need to become involved in the diagnosis and science of the disease. Awareness needs to be generated among specialists; they need to be educated in the latest techniques for diagnosis and treatment. Finally, the general population needs to become aware of osteoporosis and to be encouraged to participate in the prevention and treatment of this disease. Current screening and detection in Europe is being done by densitometry. However, other techniques on the horizon include ultrasound and biochemical markers. Primary prevention, i.e., maximizing peak bone mass, includes examining the genetics of osteoporosis to determine the high-risk population and promoting reasonable physical exercise and dietary/life-style habits (e.g., increased calcium and avoidance of tobacco). Secondary prevention includes the identification of high-risk groups through risk factors, biochemical markers, and densitometry and adherence to the World Health Organization definition of osteopenia-osteoporosis (adapted to financial concerns by GREES guidelines). Other therapies include hormone replacement agents (although there are risks for cancer and concerns about durability), calcium and other inhibitors of bone resorption, physical activity, and vitamin D prophylaxis in the elderly. Treatment of established or severe osteoporosis includes drugs upon availability (inhibitors of bone resorption and stimulators of bone formation), surgery, and experimental approaches.
欧洲是多种医学文化和财政资源的拼凑体。在融资、公共卫生系统的可及性、卫生支出、药品注册与报销、药品处方和临床应用，以及对骨质疏松症本身的认知等方面存在诸多差异。然而，欧洲各国之间的医疗服务仍有协调统一的可能性。欧洲药品评估局（EAEMP）正在处理药品注册的集中或分散程序。科学伦理与卓越尊重小组（GREES）正在研究药品注册指南，并收集和提供医学参考文献。欧洲骨质疏松症和骨病基金会（EFFO）正在提高对该疾病患病率以及预防和治疗必要性的认识。最后，国际骨骼疾病协会联合会（IFSSD）正在协调流行病学、临床和社会研究。整个欧洲都需要提高对骨质疏松症的认识。卫生当局需要成本/效益报告，以促成药物的注册和报销。初级保健医生需要有关骨质疏松症的信息，并需要参与该疾病的诊断和研究。需要在专家中提高认识；他们需要接受最新诊断和治疗技术的培训。最后，普通民众需要了解骨质疏松症，并被鼓励参与该疾病的预防和治疗。欧洲目前通过骨密度测定法进行筛查和检测。然而，即将出现的其他技术包括超声和生化标志物。一级预防，即最大化峰值骨量，包括研究骨质疏松症的遗传学以确定高危人群，并推广合理的体育锻炼和饮食/生活方式习惯（例如，增加钙摄入和避免吸烟）。二级预防包括通过风险因素、生化标志物和骨密度测定法识别高危人群，并遵循世界卫生组织对骨质减少 - 骨质疏松症的定义（GREES指南根据财务状况进行了调整）。其他治疗方法包括激素替代药物（尽管存在癌症风险和对疗效持久性的担忧）、钙和其他骨吸收抑制剂、体育活动以及老年人的维生素D预防。对已确诊或严重的骨质疏松症的治疗包括可用药物（骨吸收抑制剂和骨形成刺激剂）、手术和实验性方法。
