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首页> 外文期刊>Gynäkologische Endokrinologie >Prävention der postmenopausalen Osteoporose
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Prävention der postmenopausalen Osteoporose

机译：预防绝经后骨质疏松

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The international recommendations for pharmacological fracture prevention in postmenopausal osteoporosis have changed in 2013. A distinction must now be made between patients who are still within the “window of opportunity” for estrogen administration and those who have already passed this limit. Following the new international recommendations substances acting through the estrogen receptor are the treatment of first choice for fracture prevention in perimenopausal or early postmenopausal women. For women within the “window of opportunity” the menopausal hormone therapy (MHT) including tibolone is the first choice. For subjects at high risk without vasomotor symptoms, selective estrogen receptor modulators (SERMs) are efficient in the prevention of vertebral fractures, particularly in women with an increased breast cancer risk. Non-hormonal drugs are recommended in the presence of contraindications or rejection of MHT or SERMs; however, the current German S3 guidelines established in 2009 still consider MHT as a therapy of second choice. As before, the new recommendations maintain that MHT should not be started in the later postmenopause beyond the “window of opportunity”. For women in the later postmenopause non-hormonal drugs, such as bisphosphonates (long-term effect on bone), denosumab (effect reversible) should be used. In cases of severe osteoporosis strontium ranelate may be prescribed (not approved in Switzerland). In patients of any age suffering from severe osteoporosis, the analogues of parathormone may be used by specialists. For fracture prevention only substances should be used the efficacy of which has been established by an evidence level of grade A. Not all drugs approved for fracture prevention simultaneously reduce the risks for vertebral, non-vertebral and hip fractures.
机译：预防绝经后骨质疏松症的药理性骨折的国际建议在2013年发生了变化。现在必须对仍处于雌激素管理的“机会之窗”内的患者和已通过该限制的患者进行区分。根据新的国际建议，通过雌激素受体起作用的物质是围绝经期或绝经后早期妇女预防骨折的首选方法。对于处于“机会之窗”内的女性，包括替勃龙在内的更年期激素疗法（MHT）是首选。对于没有血管舒缩症状的高风险受试者，选择性雌激素受体调节剂（SERM）可有效预防椎骨骨折，特别是在乳腺癌风险增加的女性中。在存在禁忌症或MHT或SERM禁忌的情况下，建议使用非激素类药物。然而，2009年制定的现行德国S3指南仍将MHT视为第二选择。像以前一样，新的建议认为，不应在绝经后的“机会之窗”之后开始进行MHT。对于绝经后后期的非激素类药物，如双膦酸盐（对骨骼有长期影响），应使用denosumab（可逆作用）。如果出现严重的骨质疏松症，可以开具雷奈酸锶（未在瑞士批准）。在患有严重骨质疏松症的任何年龄的患者中，专家都可以使用副激素的类似物。对于骨折预防，仅应使用已通过A级证据水平确定其功效的物质。并非所有批准用于骨折预防的药物都能同时降低椎骨，非椎骨和髋部骨折的风险。

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