Advances in the management of osteoporosis

The BMJ Pub Date : 2025-07-30 DOI:10.1136/bmj-2024-081250
Caroline Wei Shan Hoong, Dominik Saul, Sundeep Khosla, Jad G Sfeir
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Abstract

Osteoporosis is a chronic disease mainly prevalent in older people. A hip fracture, its most devastating complication, is associated with a one in five chance of mortality in the first year. This review discusses emerging risk factors for bone fragility including diabetes, sarcopenia, and bariatric surgery. Recency of fracture represents an imminent risk that deserves prompt recognition. The new FRAXplus calculator accounts for additional risk factors to refine existing risk stratification. Advances in imaging techniques such as trabecular bone score and radiofrequency echographic multi-spectrometry may have potential roles in specific populations. Treatment of osteoporosis requires a multifaceted approach. Non-drug interventions include fall prevention and resistance exercises, supplementation with calcium, vitamin D and possibly vitamin K, and effective bridging of care gaps with fracture liaison services. An overview of drug therapy is provided, drawing attention to the importance of sequential therapy starting with potent anabolic agents for the patients at the highest risk, as opposed to a traditional step-up approach. An individualized, goal directed care plan is necessary for a treat-to-target approach, with total hip bone mineral density being the best specific target. Future research in cellular senescence points to the role of senolytics and senomorphics to alleviate osteoporosis, among other age related conditions.
骨质疏松症的治疗进展
骨质疏松症是一种常见于老年人的慢性疾病。髋部骨折是其最具破坏性的并发症,第一年死亡率为五分之一。这篇综述讨论了骨质脆弱的新危险因素,包括糖尿病、肌肉减少症和减肥手术。新近发生的骨折代表着一种迫在眉睫的危险,值得及时认识。新的FRAXplus计算器考虑了额外的风险因素,以完善现有的风险分层。成像技术的进步,如骨小梁评分和射频超声多光谱可能在特定人群中有潜在的作用。骨质疏松症的治疗需要多方面的方法。非药物干预措施包括预防跌倒和抵抗运动,补充钙、维生素D和可能的维生素K,以及通过骨折联络服务有效弥合护理缺口。概述药物治疗提供,提请注意顺序治疗的重要性,开始与强效合成代谢药物的患者在最高的风险,而不是传统的逐步方法。个体化的、目标导向的护理计划对于治疗到目标的方法是必要的,髋部总骨矿物质密度是最好的特定目标。未来对细胞衰老的研究指出,在其他与年龄相关的疾病中,衰老因子和异形因子在缓解骨质疏松症中的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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