RESUMO
Osteoporosis is a huge global problem both socially and economically- in the South Korea alone, in 2011 66 million dollar was spent on treatment and social care of the 773,000 osteoporotic patients- and therefore variable preventative and therapeutic approaches are keys to managing this problem within the aging population of today. This review discusses the main issues- who should be treated, what pharmacological agents should be used, and how long they should be administered-surrounding current osteoporosis management. Identifying patients at risk is challenging before they develop a fracture. Probability of fracture based on the Korea-adapted WHO algorithm should be used in making decision of treatment. Though bisphosphonates are the most commonly used drugs for the treatment of osteoporosis, the majority of data on fracture effect is from studies of 3 or 4 years. The long-term treatment should balance fracture efficacy against the risk of adverse events. Although evidence is limited regarding the risk of fracture with the continuation of bisphosphonate therapy, it might be useful to continue treat osteoporosis up to 10 years, to prevent vertebral fractures in the high risk elderly. There are currently no data to guide clinicians in determining who should continue treatment after 5 years. The duration of treatment and the agent selected should be based on individual assessment of risks and benefits and on patient preference.
Assuntos
Idoso , Humanos , Envelhecimento , Difosfonatos , Osteoporose , Preferência do Paciente , República da Coreia , Medição de RiscoRESUMO
Osteoporosis is a huge global problem both socially and economically- in the South Korea alone, in 2011 66 million dollar was spent on treatment and social care of the 773,000 osteoporotic patients- and therefore variable preventative and therapeutic approaches are keys to managing this problem within the aging population of today. This review discusses the main issues- who should be treated, what pharmacological agents should be used, and how long they should be administered-surrounding current osteoporosis management. Identifying patients at risk is challenging before they develop a fracture. Probability of fracture based on the Korea-adapted WHO algorithm should be used in making decision of treatment. Though bisphosphonates are the most commonly used drugs for the treatment of osteoporosis, the majority of data on fracture effect is from studies of 3 or 4 years. The long-term treatment should balance fracture efficacy against the risk of adverse events. Although evidence is limited regarding the risk of fracture with the continuation of bisphosphonate therapy, it might be useful to continue treat osteoporosis up to 10 years, to prevent vertebral fractures in the high risk elderly. There are currently no data to guide clinicians in determining who should continue treatment after 5 years. The duration of treatment and the agent selected should be based on individual assessment of risks and benefits and on patient preference.
Assuntos
Idoso , Humanos , Envelhecimento , Difosfonatos , Osteoporose , Preferência do Paciente , República da Coreia , Medição de RiscoRESUMO
Osteoporosis is recognized worldwide as a major public health problem since many decades ago, mainly due to the cost of treatment for related fragility fractures. Fortunately, WHO has provided new strategies for identifying populations with a high ten-year fracture risk, which together with increasingly sensitive diagnostic methods make it feasible for decision makers in this field to design cost effective fracture prevention strategies. These strategies are aimed at preventing falls and improving bone strength and therefore diminishing the prevalence and incidence of new or recurrent osteoporosis related fractures. Herein we review the content of these new strategies, and the medical treatments available, as well as their efficacy in the Mexican context. Several countries are now reporting a decreasing incidence and prevalence of osteoporosis related fractures, after 30 years of clinical and population-based interventions. Mexico has several effective anti-fracture drug treatments available. Such drugs can be classified according to the mechanism that makes them effective as: 1) antidestuctive or anticatabolic, 2) bone forming or anabolic, and 3) those with both actions or mixed drugs. The authors argue that treatment strategies that use drugs to strengthen bone tissue must assure normal mineralization of the already formed, remnant bone tissue and/or the newly formed bone tissue in order to encourage biochemical outcomes like formation of mature hydroxyapatite crystals with complete biomechanical and biochemical properties and therefore long term benefits. The present review includes some perspectives that will surely enhance osteoporosis management in the near future and which will bring about a decrease in the impact of the problems in Mexico.
La osteoporosis se reconoce mundialmente como un problema de salud pública desde hace muchas décadas, principalmente por el impacto global implícito en la atención de las fracturas que ocasiona. Afortunadamente, cada vez contamos con más y mejores estrategias desarrolladas por la OMS para identificar oportunamente a las personas en riesgo de sufrir una fractura; actualmente es posible definir este riesgo para los siguientes diez años. Lo cual, aunado a métodos cada vez más sensibles para establecer diagnósticos definitivos y opciones de tratamiento costo-eficaces para evitar caídas y disminuir significativamente la presentación de fracturas, permite a quien toma decisiones en este problema diseñar y poner en práctica planes de atención sustentados en la mejor evidencia científica, que son motivo de esta revisión. Varios países empiezan a informar un abatimiento del número de fracturas, después de haber establecido programas dirigidos a este fin desde hace 30 años. Contamos con medicamentos que han demostrado su eficacia para abatir la presentación de la primera fractura o de fracturas recurrentes de manera costo-eficiente, estos se pueden dividir para su estudio de acuerdo al mecanismo de acción que los vuelve eficaces. Así, aquellos que frenan la destrucción del tejido óseo se clasifican como anti-catabólicos, los que estimulan la formación de tejido óseo nuevo son anabólicos, los que tienen ambas acciones se conocen como de acción mixta. En todos los casos, el tejido remanente, previamente formado o en vías de destrucción, que se fortalecerá o el tejido de nueva formación, requieren medidas para garantizar que el proceso de mineralización suceda normalmente y se genere hidroxiapatita o un compuesto con características similares para que la eficiencia biomecánica del tejido realmente mejore a largo plazo. Esta revisión incluye algunas perspectivas que seguramente mejorarán nuestro manejo de la osteoporosis en el futuro inmediato y que...