百度文库 - 让每个人平等地提升自我
The methods of diagnosis and treatment of osteoporosis 1. What Measures Can Be Taken to Prevent Bone Loss?
? R1. Maintain adequate calcium intake; use calcium supplements, if needed, to meet minimal required intake (Grade A; “best evidence” level or BEL 1).
? R2. Maintain adequate vitamin D intake; supplement vitamin D, if needed, to maintain serum levels of 25-hydroxyvitamin D [25(OH)D] between 30 and 60 ng/mL (Grade A; BEL 1).
? R3. Limit alcohol intake to no more than 2 servings per day (Grade B; BEL 2).
? R4. Limit caffeine intake (Grade C; BEL 3). ? R5. Avoid or stop smoking (Grade B; BEL 2).
? R6. Maintain an active lifestyle, including weightbearing exercises for at least 30 minutes daily (Grade B; BEL 2).
2. What Nonpharmacologic Measures Can Be Recommended for Treatment of Osteoporosis? All the foregoing measures plus the following:
? R7. Maintain adequate protein intake (Grade B; BEL 3).
? R8. Use proper body mechanics (Grade B; BEL 1). ? R9. Consider the use of hip protectors in individuals with a high risk of falling (Grade B; BEL 1).
? R10. Take measures to reduce the risk of falling (Grade B; BEL 2).
? R11. Consider referral for physical therapy and occupational therapy (Grade B; BEL 1).
3. Who Needs to Be Screened for Osteoporosis?
? R12. Women 65 years old or older (Grade B; BEL 2). ? R13. Younger postmenopausal women at increased
risk of fracture, based on a list of risk factors (see section 4.5) (Grade C; BEL 2).
4. How Is Osteoporosis Diagnosed?
? R14. Use a central dual-energy x-ray absorptiometry (DXA) measurement (Grade B; BEL 3).
? R15. In the absence of fracture, osteoporosis is defined as a T-score of -2.5 or below in the spine (anteroposterior), femoral neck, or total hip (Grade B; BEL 2).
? R16. Osteoporosis is defined as the presence of a fracture of the hip or spine (see section 4.4.2) (in the absence of other bone conditions) (Grade B; BEL 3).
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百度文库 - 让每个人平等地提升自我
5. How Is Osteoporosis Evaluated?
? R17. Evaluate for secondary osteoporosis (Grade B; BEL 2).
? R18. Evaluate for prevalent vertebral fractures (see section 4.7.1) (Grade B; BEL 2).
6. Who Needs Pharmacologic Therapy?
? R19. Those patients with a history of a fracture of the hip or spine (Grade A; BEL 1).
? R20. Patients without a history of fractures but with a T-score of -2.5 or lower (Grade A; BEL 1).
? R21. Patients with a T-score between -1.0 and -2.5 if FRAX (see section 4.5) major osteoporotic fracture probability is ≥20% or hip fracture probability is ≥3% (Grade A; BEL 2).
7. What Drugs Can Be Used to Treat Osteoporosis? Use drugs with proven antifracture efficacy:
? R22. Use alendronate, risedronate, zoledronic acid, and denosumab as the first line of therapy (Grade A; BEL 1).
? R23. Use ibandronate as a second-line agent (Grade A; BEL 1).
? R24. Use raloxifene as a second- or third-line agent (Grade A; BEL 1).
? R25. Use calcitonin as the last line of therapy (Grade C; BEL 2).
? R26. Use teriparatide for patients with very high fracture risk or patients in whom bisphosphonate therapy has failed (Grade A; BEL 1).
? R27. Advise against the use of combination therapy (Grade B; BEL 2).
8. How Is Treatment Monitored?
? R28. Obtain a baseline DXA, and repeat DXA every 1 to 2 years until findings are stable. Continue with follow-up DXA every 2 years or at a less frequent interval (Grade B; BEL 2).
? R29. Monitor changes in spine or total hip bone mineral density (BMD) (Grade C; BEL 2).
? R30. Follow-up of patients should be in the same facility, with the same machine, and, if possible, with the same technologist (Grade B; BEL 2).
? R31. Bone turnover markers may be used at baseline to identify patients with high bone turnover and can be used to follow the response to therapy (Grade C; BEL
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百度文库 - 让每个人平等地提升自我
2).
9. What Is Successful Treatment of Osteoporosis?
? R32. BMD is stable or increasing, and no fractures are present (Grade B; BEL 2).
? R33. For patients taking antiresorptive agents, bone turnover markers at or below the median value for premenopausal women are achieved (see section 4.9) (Grade B; BEL 2).
? R34. One fracture is not necessarily evidence of failure. Consider alternative therapy or reassessment for
secondary causes of bone loss for patients who have recurrent fractures while receiving therapy (Grade B; BEL 2).
10. How Long Should Patients Be Treated?
? R35. For treatment with bisphosphonates, if osteoporosis is mild, consider a “drug holiday” after 4 to 5
years of stability. If fracture risk is high, consider a drug holiday of 1 to 2 years after 10 years of treatment (Grade B; BEL 1).
? R36. Follow BMD and bone turnover markers during a drug holiday period, and reinitiate therapy if bone density declines substantially, bone turnover markers increase, or a fracture occurs (Grade C; BEL 3). 11. When Should Patients Be Referred to Clinical Endocrinologists?
? R37. When a patient with normal BMD sustains a fracture without major trauma (Grade C; BEL 4).
? R38. When recurrent fractures or continued bone loss occurs in a patient receiving therapy without obvious treatable causes of bone loss (Grade C; BEL 4).
? R39. When osteoporosis is unexpectedly severe or has unusual features (Grade C; BEL 4).
? R40. When a patient has a condition that complicates
management (for example, renal failure, hyperparathyroidism, or malabsorption) (Grade C; BEL 4).
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百度文库 - 让每个人平等地提升自我
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百度文库 - 让每个人平等地提升自我
Thisfigure is taken from page 28 of the 2011 Osteoporosis Prevention and Treatment Guidelines (in Japanese). a In patients taking bisphosphonates, measure after stopping drug for at least 6 months, and in patients taking other
osteoporosis drugs, measure after stopping drug for at least 1 month. b Measure one type each of a resorption marker and formation marker. c Excluding eldecalcitol. d In patients expected to be on long-term bisphosphonate therapy, measure bone resorption markers and BAP or P1NP.
Changes in the diagnosis and treatment of osteoporosis Together with significant changes in the disease concept of osteoporosis, new technology continues to be incorporated into clinical diagnosis and treatment of osteoporosis. With the introduction of DXA to measure BMD, more precise
diagnostic criteria have been established [11]. The measurement of bone metabolic markers, approved by NHI in
routine clinical practice in the field of osteoporosis, has allowed (1) estimation of bone turnover state at the time of measurement, (2) prediction of the rate of BMD change in near future, (3) assessment of the effect of drug treatment, and (4) evaluation of bone quality [10].
In addition, with the introduction into clinical practice of
various bone antiresorptive drugs which can prevent fractures based on scientific evidence, the incidence of fractures due to osteoporosis has decreased according to epidemiologic studies [12].
In the future, with the goal of ideal treatment to increase bone mass, the risk of fracture or osteoporosis will be evaluated from the bone loss to decide whether to initiate drug treatment, and strategies will be sought to maintain or increase QOL in osteoporosis and assess fracture risk in lifestyle-related diseases. In other words, there will be relentless efforts towards establishing a comprehensive system to manage osteoporosis.
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医学类中英文翻译
