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Guideline
骨质疏松症   OSTEOPOROSIS
骨质疏松症是一种以骨质量和骨密度低下、骨微结构破坏,导致骨骼脆性增加,容易发生骨折为特征的全身性骨病。
- 本文侧重介绍原发性骨质疏松症和糖皮质激素诱发的骨质疏松症。

2006年有报导中国骨质疏松患者数为9000万,占总人口的7.01%。50岁以后,骨质疏松的女性在未来10年内出现髋部、脊柱、前臂或肱骨近端骨折的可能性达45%,>65岁老人在无意识跌倒时,87%会造成脆性骨折。
  查阅疾病用药指南
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医药新闻
2017年4月, Elvira Manzano
一项回顾性分析显示,间断使用双膦酸盐的绝经后骨质疏松症患者骨折风险增加。
2016年12月
新加坡举行的2016国际骨质疏松基金会区域会议上的一项研究显示,骨小梁评分联合双能X线吸收测量法测得的T评分可有效增强单个腰椎骨折风险的评估,对骨折预防具有潜在临床意义。
2016年11月
一项新研究显示,使用短效硝酸盐可显著降低缺血性心脏病老年患者的髋骨骨折风险。
2015年12月
运动防治骨质疏松的效果已被医学界所认可,但是防治骨质疏松的运动方案至今尚未有统一的标准。中国老年学学会骨质疏松委员会的组织和邀请了多名运动与骨代谢领域的专家,结合近年来国内外相关研究,共同撰写了《运动防治骨质疏松专家共识》,旨在为大众及医学工作者提供运动预防骨质疏松的理论基础。
2015年12月, Elvira Manzano
新的研究显示,补充高剂量的维生素D可略微增加绝经后妇女的钙吸收,但不能改善骨密度、肌肉功能和肌肉量或跌倒的发生率。
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药物信息

福美加 Fosamax Plus  [  默沙东 MSD   ]  -  阿仑膦酸钠 + 维生素D3 alendronate sodium + cholecalciferol ,  阿仑膦酸钠 + 维生素D3 alendronate sodium + vitamin D3
适应症: 绝经后妇女骨质疏松症,以增加骨重,并降低骨折发生率,包括髋部和椎骨骨折(椎体压缩性骨折);男性骨质疏松症以增加骨量。
MIMS药理分类 影响骨代谢的药物 Agents Affecting Bone Metabolism  
Fosamax Plus tab 70 mg_5600 IUee4bf831-1f02-4c7c-a967-a30e00c64e40.GIF
迪巧(成人)咀嚼片 D-CAL (Adult) chewtab  [  美国安士制药 A & Z Pharm   /  百洋医药 BAHEAL 碳酸钙+维生素D3 Calcium carbonate + Vitamin D3
适应症: 妊娠和哺乳妇女、更年期妇女、老年人的钙补充剂,并帮助防治骨质疏松症。
MIMS药理分类 钙剂/含维生素 Calcium/with Vitamins  
D-CAL (Adult) chewable tab4711aab6-2998-4265-b23b-a09e0137c76a.GIF
迪巧(儿童) 咀嚼片 D-Cal (Children) chewtab  [  美国安士制药 A & Z Pharm   /  百洋医药 BAHEAL 碳酸钙+维生素D3 Calcium carbonate + Vitamin D3
适应症: 儿童钙补充剂。
MIMS药理分类 钙剂/含维生素 Calcium/with Vitamins  
D-Cal (Children) chewtab8bef2c84-8795-47a8-84a9-a09f00a0a29b.GIF
迪巧(小儿)颗粒剂 D-Cal (Children) granules  [  美国安士制药 A & Z Pharm   /  百洋医药 BAHEAL 碳酸钙+维生素D3 Calcium carbonate + Vitamin D3
适应症: 儿童钙补充。
MIMS药理分类 钙剂/含维生素 Calcium/with Vitamins  
D-Cal (Children) granulesdccb73b1-4658-4b9a-82d2-a09f00a3e517.GIF
力相助 Lixiangzhu  [  同济现代 Tongji Modern   ]   [  西莫药品 Xi Mo Pharm  ]  碳酸钙+维生素D3 Calcium carbonate + Vitamin D3
适应症: 预防和治疗钙缺乏症,如骨质疏松、手足抽搐症、骨发育不全,佝偻病,以及妊娠和哺乳期妇女、绝经期妇女补钙。
MIMS药理分类 钙剂/含维生素 Calcium/with Vitamins  
Lixiangzhu granules for oral soln 3.4 g4764fb6a-ae25-461f-80f2-a22700bcfb3e.GIF
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会议报道
2016年11月
International Osteoporosis Foundation (IOF) Regionals, 6th Asia-Pacific Osteoporosis Meeting
2015年5月
WCO-IOF-ESCEO World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases
2014年11月
IOF Regionals, 5th Asia-Pacific Osteoporosis Meeting 2014
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参考文献
  1. 内分泌代谢疾病诊治策略-上海科学技术出版社,2009年(主编:朱禧星、胡仁明)
  2. 内分泌及风湿病临床诊断与治疗方案 - 科学技术文献出版社,2011年6月(主编:李延兵、梁柳琴)
  3. 原发性骨质疏松症诊治指南(2011年),中华医学会骨质疏松和骨矿盐疾病分会 - 中华骨质疏松和骨矿盐疾病杂志,2011年3月第4卷第1期
  4. 骨质疏松及骨矿盐疾病诊疗指南(讨论稿) - 中华医学会骨质疏松和骨矿盐疾病分会,国际内分泌代谢杂志,2006年7月第26卷第4期;291-298页
  5. 骨质疏松骨折诊疗指南,中华医学会骨科学分会-中国骨科杂志,2008年10月第28卷第10期;875-878页
  6. Brown JP, Fortier M, et al; Osteoporosis Guidelines Committee. Canadian Consensus Conference on osteoporosis, 2006 update. J Obstet Gynaecol Can. 2006 Feb;28(2)(Suppl 1):S95-S112. http://www.ncbi.nlm.nih.gov/pubmed/?term=16626523. PMID: 16626523
  7. Compston J, Cooper A, Cooper C, et al; National Osteoporosis Guideline Group (NOGG). Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas. 2009 Feb;62(2):105-108. doi: 10.1016/j.maturitas.2008.11.022. PMID: 19135323
  8. Finkelstein JS. Diagnosis and evaluation of osteoporosis in men. UpToDate. http://www.uptodate.com/online/content/topic.do?topicKey=bone_dis/2229&selectedTitle=1~150&. 2010. Accessed 11 Jan 2011
  9. Grossman JM, Gordon R, Ranganath VK, et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Jul 26, 2010. Arthritis Care Res (Hoboken). 2010 Nov;62(11):1515-1526. http://www.rheumatology.org/practice/clinical/guidelines/GIOP_Guidelines_Nov_2010.pdf. Accessed 13 Sep 2013. PMID: 20662044
  10. Hodgson SF, Watts NB, Bilezikian JP, et al; AACE Osteoporosis Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract. 2003 Nov;9(6):544-564. http://www.ncbi.nlm.nih.gov/pubmed/?term=14715483. PMID: 14715483
  11. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-1930. doi: 10.1210/jc.2011-0385. PMID: 21646368
  12. Kanis JA, Burlet N, Cooper C, et al; European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2008 Apr;19(4):399-428. http://www.ncbi.nlm.nih.gov/pubmed/?term=18266020. PMID: 18266020
  13. Lau EM, Sambrook P, Seeman E, et al. Guidelines for diagnosing, prevention and treatment of osteoporosis in Asia. APLAR J Rheumatol. 2006 Apr;9(1):24-36
  14. Leweicki EM. Current and emerging pharmacologic therapies for the management of postmenopausal osteoporosis. J Womens Health (Larchmt). 2009 Oct;18(10):1615-1626. http://www.ncbi.nlm.nih.gov/pubmed/?term=19857095. PMID: 19857095
  15. Leweicki EM. Managing osteoporosis: challenges and strategies. Cleve Clin J Med. 2009 Aug;76(8):457-466. http://www.ncbi.nlm.nih.gov/pubmed/?term=19652039. PMID: 19652039
  16. Leweicki EM. Prevention and treatment of postmenopausal osteoporosis. Obstet Gynecol Clin North Am. 2008 Jun;35(2):301-315. doi: 10.1016/j.ogc.2008.03.007. PMID: 18486843
  17. Malaysian Osteoporosis Society, Academy of Medicine Malaysia. Clinical practice guideline for the management of osteoporosis. http://www.msr.org.my/html/CPG_on_Osteoporosis-2006.pdf. 2006. Accessed 18 May 2010.
  18. Mayes SL. Review of postmenopausal osteoporosis pharmacotherapy. Nutr Clin Pract. 2007 Jun;22(3):276-285. http://www.ncbi.nlm.nih.gov/pubmed/?term=17507728. PMID: 17507728
  19. Miller PD. Safety of parathyroid hormone for the treatment of osteoporosis. Curr Osteoporos Rep. 2008 Mar;6(1):012-16. http://www.ncbi.nlm.nih.gov/pubmed/?term=18430395. PMID: 18430395
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  21. National Osteoporosis Foundation. Clinician's guide to prevention and treatment of osteoporosis. http://nof.org/files/nof/public/content/resource/913/files/580.pdf. 2010
  22. North American Menopause Society (NAMS). Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010 Mar;17(2):242-255. http://www.ncbi.nlm.nih.gov/pubmed/?term=20154637. PMID: 20154637
  23. North American Menopause Society (NAMS). Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010 Jan;17(1):25-54. http://www.ncbi.nlm.nih.gov/pubmed/?term=20061894. PMID: 20061894
  24. Rahmani P, Morin S. Prevention of osteoporosis-related fractures among postmenopausal women and older men. CMAJ. 2009 Nov;181(11):815-820. PMID: 19841053
  25. Rosen HN, Saag KG. Prevention and treatment of glucocorticoid-induced osteoporosis. UpToDate. http://www.uptodate.com/contents/prevention-and-treatment-of-glucocorticoid-induced-osteoporosis?detectedLanguage=en&source=search_result&search=Prevention+and+treatment+of+glucocorticoid-induced+osteoporosis&selectedTitle=1~38&provider=noProvider. May 2011.
  26. Saag KG, Shane E, Boonen S, et al. Teriparatide or alendronate in glucocorticoid-induced osteoporosis. N Engl J Med. 2007 Nov;357(20):2028-2039. http://www.ncbi.nlm.nih.gov/pubmed/?term=18003959. PMID: 18003959
  27. Stránský M, Rysavá L. Nutrition as prevention and treatment of osteoporosis. Physiol Res. 2009;58(Suppl 1):S7-S11. http://www.ncbi.nlm.nih.gov/pubmed/?term=19857038. PMID: 19857038
  28. The Hongkong College of Obstetricians and Gynaecologist. Guidelines for the administration of hormone replacement therapy. 2003 Jan(2):001-8. http://hkcog.obg.cuhk.edu.hk/docs/college_guidelines/Hormonal%20Replacement%20Therapy%20Revised_2003.pdf.
  29. Watts NB, Adler RA, Bilezikian JP, et al. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012 Jun;97(6):1802-1822. doi: 10.1210/jc.2011-3045. PMID: 22675062
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医学会议
Society for Emergency Medicine in Singapore Annual Scientific Meeting / International Resuscitation Science Symposium 27th-28th February 2016
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