Резюме
Определение
Анамнез и осмотр
Ключевые диагностические факторы
- asymptomatic
Другие диагностические факторы
- back pain
- kyphosis
- height loss
- vertebral tenderness
Факторы риска
- prior fragility fracture
- female sex
- white ancestry
- older age (>50 years for women and >65 years for men)
- low BMI
- loss of height
- family history of maternal hip fracture
- postmenopause
- secondary amenorrhea
- primary hypogonadism
- tobacco use
- excessive alcohol use
- prolonged immobilization
- low calcium intake
- vitamin D deficiency
- diabetes
- rheumatoid arthritis
- sarcopenia
- glucocorticoid excess
- corticosteroid use
- proton-pump inhibitor use
- hyperthyroidism
- heparin use
- anticonvulsant use
- androgen deprivation treatment (men)
- aromatase inhibitor treatment (women)
- use of drugs associated with an increased risk of falls
Диагностические исследования
Исследования, которые показаны в первую очередь
- dual-energy x-ray absorptiometry (DXA)-bone mineral density (BMD)
Исследования, проведение которых нужно рассмотреть
- Fracture Risk Assessment Tool (FRAX)
- vertebral fracture assessment (DXA-VFA)
- trabecular bone score
- quantitative ultrasound (QUS) of the heel
- x-ray (wrist, heel, spine, and hip)
- quantitative CT
- biochemical markers of bone resorption and bone formation
- serum alkaline phosphatase
- serum calcium
- serum albumin
- serum creatinine
- serum phosphate
- serum 25-hydroxy vitamin D
- serum parathyroid hormone
- thyroid function tests
- urinary free cortisol
- serum testosterone (men)
- urine protein electrophoresis
- serum protein electrophoresis
Алгоритм лечения
not glucocorticoid-induced: women
not glucocorticoid-induced: men
glucocorticoid-induced
Составители
Авторы
Khashayar Sakhaee, MD
Professor in Internal Medicine
Division Chief of Mineral Metabolism
Center for Mineral Metabolism and Clinical Research
UT Southwestern Medical Center at Dallas
Dallas
TX
Раскрытие информации
KS declares that he has no competing interests.
Alireza Zomorodian, MD
Research Associate
Charles and Jane Pak Center for Mineral Metabolism and Clinical Research
UT Southwestern Medical Center
Dallas
TX
Раскрытие информации
AZ declares that he has no competing interests.
Выражение благодарностей
Dr Khashayar Sakhaee and Dr Alireza Zomorodian would like to gratefully acknowledge Dr Alberto V Cabo-Chan Jr and Dr Lisa Leinau, the previous contributors to this topic. AVCC and LL declare that they have no competing interests.
Раскрытие информации
AVCC declares that he has no competing interests. LL declares that she has no competing interests.
Рецензенты
Kimberly Olson, MD
Internist
Veterans Administration Hospital
Minneapolis
MN
Раскрытие информации
KO declares that she has no competing interests.
David Reid, MBBS
Head of Division of Applied Medicine & Professor of Rheumatology
School of Medicine & Dentistry
University of Aberdeen
Aberdeen
UK
Раскрытие информации
DMR has attended meetings sponsored by or been paid speaker fees by Amgen, Merck, Novartis, Procter & Gamble, Roche, and Servier. He has been a paid advisor to Amgen, Merck, Novartis, Procter & Gamble, Roche, Servier, and Shire Pharmaceuticals. He has undertaken research studies funded by Amgen, Merck, Novartis, Procter & Gamble, and Roche.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Список литературы
Основные статьи
ACOG Committee on Clinical Practice Guidelines–Gynecology. Osteoporosis prevention, screening, and diagnosis: ACOG clinical practice guideline no. 1. Obstet Gynecol. 2021 Sep 1;138(3):494-506. Аннотация
LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049-102.Полный текст Аннотация
ACOG Committee on Clinical Practice Guidelines–Gynecology. Management of postmenopausal osteoporosis: ACOG clinical practice guideline no. 2. Obstet Gynecol. 2022 Apr 1;139(4):698-717. Аннотация
Humphrey MB, Russell L, Danila MI, et al. 2022 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheumatol. 2023 Dec;75(12):2088-102.Полный текст Аннотация
Eastell R, Rosen CJ, Black DM, et al. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society* clinical practice guideline. J Clin Endocrinol Metab. 2019 May 1;104(5):1595-622.Полный текст Аннотация
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
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Больше ОтличияРекомендации
- Screening for osteoporosis to prevent fractures
- Pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults
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Osteoporosis: what is it?
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Больше Лифлеты для пациента
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