Postmenopausal osteoporosis: Fracture consequences and treatment efficacy vary by skeletal site

被引:13
作者
Epstein, S [1 ]
机构
[1] Med Coll Penn & Hahnemann Univ, Sch Med, Philadelphia, PA 19102 USA
关键词
hip fractures; postmenopausal osteoporosis; spinal fractures; treatment of osteoporosis;
D O I
10.1007/BF03339858
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
At least half of all postmenopausal women will experience fractures during their lifetime, and the consequences are often serious, but most women at risk are not receiving adequate treatment. The objective of this paper is to summarize the literature concerning the consequences of osteoporotic fractures, and the effectiveness of pharmacologic agents for preventing fractures and their consequences, emphasizing a systematic, evidence-based summary of treatment results from randomized, controlled trials that were published previously. Osteoporosis is associated with increased risk of fractures at most skeletal sites. Hip fractures have much greater prognostic significance in terms of health than any other single type of fracture. However, symptomatic vertebral fractures and other non-hip fractures also represent enormous morbidity and economic burdens, and signal increased risk of future fractures of all types, including the hip. There is convincing evidence that true bisphosphonates (alendronate and risedronate) reduce the risk of both spine and non-spine fractures. The evidence for reducing hip fracture risk is greater for alendronate, with a consistent similar to 50% reduction in hip fractures across studies. Alendronate has also been demonstrated to maintain quality of life by reducing outcomes such as hospitalization and bed rest related to back pain. Among other agents, raloxifene reduces the risk of vertebral fractures by approximately 30%; the published evidence for most other agents is inconclusive. Osteoporosis should be regarded as seriously as other important chronic disorders such as hypertension and hyperlipidemia. Postmenopausal patients with a high risk of fractures - such as those with prior fractures or osteoporosis as measured by BMD - need to be treated. Although other therapeutic modalities are available, the evidence is most convincing for the bisphosphonates, alendronate; and risedronate. (C)2000, Editrice Kurtis.
引用
收藏
页码:330 / 341
页数:12
相关论文
共 81 条
[21]   Risk assessment for osteoporosis using bone mineral density determination - A Belgian perspective [J].
Geusens, P ;
Boonen, S .
JOURNAL OF CLINICAL DENSITOMETRY, 1998, 1 (04) :355-358
[22]   The clinical impact of vertebral fractures: Quality of life in women with osteoporosis [J].
Gold, DT .
BONE, 1996, 18 (03) :S185-S189
[23]   LATE PHYSICAL AND FUNCTIONAL-EFFECTS OF OSTEOPOROTIC FRACTURE IN WOMEN - THE RANCHO-BERNARDO STUDY [J].
GREENDALE, GA ;
BARRETTCONNOR, E ;
INGLES, S ;
HAILE, R .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 1995, 43 (09) :955-961
[24]   World-wide projections for hip fracture [J].
Gullberg, B ;
Johnell, O ;
Kanis, JA .
OSTEOPOROSIS INTERNATIONAL, 1997, 7 (05) :407-413
[25]   Evidence-based management of patients with osteoporosis [J].
Guyatt, GH .
JOURNAL OF CLINICAL DENSITOMETRY, 1998, 1 (04) :395-402
[26]   THE INCIDENCE OF FRACTURES OF THE PROXIMAL FEMUR AND THE DISTAL RADIUS IN TOTTORI PREFECTURE, JAPAN [J].
HAGINO, H ;
YAMAMOTO, K ;
TESHIMA, R ;
KISHIMOTO, H ;
KURANOBU, K ;
NAKAMURA, T .
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, 1989, 109 (01) :43-44
[27]   Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis - A randomized controlled trial [J].
Harris, ST ;
Watts, NB ;
Genant, HK ;
McKeever, CD ;
Hangartner, T ;
Keller, M ;
Chesnut, CH ;
Brown, J ;
Eriksen, EF ;
Hoseyni, MS ;
Axelrod, DW ;
Miller, PD .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1999, 282 (14) :1344-1352
[28]  
Hayes Wilson C., 1995, P93
[29]  
Hochberg MC, 1999, ARTHRITIS RHEUM-US, V42, P1246, DOI 10.1002/1529-0131(199906)42:6<1246::AID-ANR22>3.0.CO
[30]  
2-U