[是否所有高龄患者都能从骨质疏松症药物治疗中获益?]

Q4 Medicine
Praxis Pub Date : 2024-01-01
Norbert Suhm, Karl Stoffel
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引用次数: 0

摘要

简介骨质同化骨质疏松症药物已变得越来越好用。与抗骨吸收制剂相比,骨同化治疗原理具有更强、更快的减少骨折效果。人们还新近认识到,首次脆性骨折作为风险因素的重要性与时间有关:自首次骨折后时间越短,再次骨折的风险就越高。因此,65 岁以上、首次脆性骨折发生时间不足两年的患者被归入一个单独的 "濒临骨折风险 "类别。这些创新是通过更新骨质疏松症治疗指南来实现的。根据该指南,"急迫骨折风险 "类别的患者应尽快接受骨质疏松症治疗,以尽可能多地避免骨折。我们对高龄骨折患者过于严格地执行这一算法持批评态度。我们自己的数据显示,在这一人群中,有 30% 以上的患者没有感受到新开始的骨质疏松症治疗的效果。我们主张根据临床情况确定骨质疏松症治疗的适应症。为此,我们提出了一个为骨科学目的而修改的 "惊喜问题"。"如果我不得不在一年内再次治疗同一个骨折患者,我会感到惊讶吗?如果问题的答案是 "不会",那么该患者就有可能接受特定的骨质疏松症治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Do All Very Old Patients Benefit from Osteoporosis Drug Treatment?]

Introduction: Osteoanabolic osteoporosis drugs have become better available. The osteoanabolic therapeutic principle has a stronger, faster-onset fracture-reducing effect than the antiresorptive preparations. It has also been newly recognized that the significance of a first fragility fracture as a risk factor is time-dependent: the less time that has elapsed since the first fracture, the higher the resulting re-fracture risk. Patients older than 65 years whose index fragility fracture occurred less than two years before are therefore grouped in a separate "Imminent Fracture Risk" category. These innovations were implemented by updating the osteoporosis therapy guideline. According to this guideline, patients in the "Imminent Fracture Risk" category should be offered osteoporosis therapy as soon as possible, in order to avoid as many fractures as possible. We are critical of an overly strict implementation of this algorithm in very old fracture patients. Our own data indicate that more than 30 % of this subpopulation do not experience the effect of a newly started osteoporosis therapy. We advocate a clinically based indication for osteoporosis therapy. For this, we propose a "Question Surprise" modified for osteological purposes. "Would I be surprised if I had to treat the same patient for a fracture again in a year?" If the question is answered with "No," then that patient could be a candidate for specific osteoporosis treatment.

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来源期刊
Praxis
Praxis Medicine-Medicine (all)
CiteScore
0.40
自引率
0.00%
发文量
146
审稿时长
12 weeks
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