ABSTRACT
La finalidad del tratamiento de la osteoporosis es la prevención primaria y secundaria de fracturas. Las indicaciones para las intervenciones terapéuticas en la osteoporosis deben derivarse de la determinación del riesgo absoluto de fractura, que tiene en cuenta la evaluación de los factores de riesgo y la densidad ósea. El propósito de este estudio es comentar algunos enfoques terapéuticos empleados en la osteoporosis, destacando el mecanismo de acción del ranelato de estroncio que aumenta la formación de hueso y disminuye la resorción. La causa más común de osteoporosis en las mujeres es la disminución de los niveles de estrógeno durante la menopausia, lo que lleva a un aumento significativo en el recambio de masa ósea y el consiguiente desequilibrio entre la formación y reabsorción ósea con un aumento de la pérdida ósea y el deterioro de la estructura y fuerza óseas. El ranelato de estroncio sigue siendo una opción farmacológica eficaz y viable en la prevención de las fracturas vertebrales y del cuello femoral en mujeres posmenopáusicas y hombres adultos con osteoporosis, en cuanto a indicaciones, contraindicaciones y una cuidadosa evaluación de sus efectos y riesgos. Representa una alternativa a los medicamentos antirresortivos en caso de contraindicación, intolerancia o fracaso(AU)
The purpose of the treatment of osteoporosis is the primary and secondary prevention of fractures. The indications for therapeutic interventions in osteoporosis should be derived from the determination of the absolute risk of fracture, which takes into account the evaluation of risk factors and bone density. To comment on some therapeutic approaches used in osteoporosis, highlighting the mechanism of action of strontium ranelate that increases bone formation and reduces resorption. The most common cause of osteoporosis in women is the decrease in estrogen levels during menopause, which leads to a significant increase in the turnover of bone mass and the consequent imbalance between bone formation and resorption with an increase in bone loss and deterioration of bone structure and strength. Strontium ranelate continues to be an effective and viable pharmacological option in the prevention of vertebral and femoral neck fractures in postmenopausal women and adult men with osteoporosis, in terms of indications, contraindications and a careful evaluation of its effects and risks. It represents an alternative to antiresorptive drugs in case of contraindication, intolerance or failure(AU)
Subject(s)
HumansABSTRACT
BACKGROUND: Percutaneous kyphosis is improved on the basis of vertebroplasty, which can well restore the height of compressed vertebral body and reduce bone cement leakage. In recent years, it has been widely used in the treatment of osteoporotic vertebral compression fracture. However, it is often reported that there are recurrent fractures of the enhanced vertebral body and adjacent vertebral body after surgery, and the related factors affecting the recurrent fracture are still controversial. OBJECTIVE: To identify the risk factors for the fractures secondary to percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures in the elderly by meta-analysis. METHODS: A comprehensive search was conducted for the studies published from January 2009 to April 2019 on the risk factors for secondary fractures after percutaneous kyphoplasty in the Cochrane Library, PubMed, CBM, CNKI and WanFang databases and manually as well. After the relevant data were extracted, statistical analysis was carried out with RevMan 5.3 software. RESULTS AND CONCLUSION: (1) The secondary fracture after percutaneous kyphoplasty for osteoporotic vertebral compression fracture was related to age [WMD=1.87, 95%C/ (0.79, 2.95), P 0.05], body mass index [WMD=-0.27, 95% Cl (-1.06, 0.51), P=0.49], cement volume [WMD=0.06, 95% Cl (-0.21, 0.32), P=0.68], surgical approach [OR=0.87, 95%C/(0.61,1.25), P=0.46], primary fracture was thoracolumbar segment (T11-L2) [OR=1.48, 95% C/(0.93, 2.38), P=0.1]. These results suggest that age, bone mineral density, bone cement leakage, correction of kyphosis angle after primary operation and recovery rate of vertebral height after primary operation may be the risk factors closely correlative to the secondary fracture after percutaneous kyphoplasty. There has not been enough evidence to support the associations between the secondary fracture and sex, body mass index, cement volume, surgical approach or thoracolumbar spine, and the above conclusions need to be studied and verified by more high quality literature in the future.
ABSTRACT
Vários estudos têm avaliado o risco de fraturas futuras associado a diversas fraturas, em vários sítios esqueléticos; uma fratura prévia em qualquer sítio duplica o risco de fraturas futuras. Aparentemente ocorrem fraturas secundárias rapidamente após a primeira fratura. O risco de fraturas subsequentes parece ser maior logo após o primeiro episódio, especialmente no primeiro ano. Tem-se como objetivo reduzir o número de fraturas de quadril em 20% até 2020...
Many scientific studies have been evaluated the risk of future fractures related to multiple fractures, at several skeletal sites; one previous fracture at any site it doubles the risk of future fractures. Seemingly many secondary fractures ocurr quickly thereupon the first fracture. The risk of subsequent fractures it seems to be higher thereupon the first episode, especially in the first year. The goal is to decrease the amount of hip fractures by 20% until 2020...