Evidence-Based Managementof Osteoporosis：骨质疏松症的证据为基础的管理.ppt

Evidence-Based Managementof Osteoporosis A Systematic Review of Agents Currently Available for Osteoporosis and their Use in Clinical Practice Benefits of Therapy: Summary Contemporary pharmacologic treatments significantly decrease fracture risk: “Antiresorptive” therapy produces a modest increase in bone mineral density (BMD) However, decreases in fracture risk—especially in the spine—occur much faster and to a larger extent than predicted by the relatively small change in BMD. This implies an important improvement in bone “quality” Anabolic therapy with teriparatide increases BMD more than antiresorptive treatment, but it is not yet obvious that fracture protection is greater Objective of Intervention The most important clinical objective is the prevention of fractures—both vertebral and non-vertebral fractures Changes in surrogate markers--bone mineral density (BMD) and biochemical markers of bone turnover--are “necessary” but are not “sufficient” Non-Pharmacological Options Nutrition: Wide range of nutrients studied Calcium supplementation as needed (1500 mg total intake) Vitamin D as needed (400 IU to 800 IU daily) Exercise: Multiple health benefits Fall prevention and/or hip protectors in the frail elderly Other lifestyle modifications Avoiding alcohol and tobacco abuse Non-Pharmacological Options Taken as a whole, non-pharmacological options seem to be relatively inexpensive and modestly effective Exercise, in particular, has other health benefits, although the same is likely to be true for diet optimization Optimization of diet, exercise, and fall prevention should be viewed as an important adjunct to the pharmacologic treatment of osteoporotic patients Resorption = Formation Antiresorptive Treatment: Summary Antiresorptive treatment produces a decrease in the biochemical markers of bone turnover and a modest increase in BMD Because a decrease in resorption is followed by a decrease in formation, BMD improvement tends to “plateau” after several ye