绝经后骨质疏松症--现代的跨学科问题

I. S. Zakharov, G. Kolpinsky, S. V. Beskrovny
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摘要

绝经后骨质疏松症是现代医学中一个重要的跨学科问题。本讲座重点介绍了诊断、预后和治疗这种病症的现代方法。辐射诊断方法在检测骨质疏松症变化方面发挥着主导作用,这种方法可以确定骨矿密度水平--相当于骨量。为了研究骨组织的新陈代谢紊乱,使用了评估骨合成和吸收活性的实验室方法。在预测骨质疏松性骨折时,FRAX 模型被广泛使用,该模型根据是否存在风险因素来确定未来 10 年发生骨折的可能性。鉴于骨质疏松性变化的形成具有多因素性质,因此有必要采用综合方法来治疗这种疾病。根据欧洲内分泌学会的建议,双膦酸盐应被视为一线疗法。地诺单抗、罗莫索单抗、特立帕肽可作为二线药物。此外,鉴于雌激素过低在绝经后骨质疏松症发病中的主导作用,使用绝经激素治疗制剂在预防和治疗骨质疏松症病变中占有重要地位。决定绝经后骨质疏松症患者治疗效果的一个重要方面是需要各科医生(包括妇科医 生、内分泌科医生、风湿免疫科医生、创伤科医生、放射科医生和实验室诊断医生) 之间的相互配合。
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Postmenopausal osteoporosis — an interdisciplinary problem of modern
Postmenopausal osteoporosis is an important interdisciplinary problem of modern medicine. The presented lecture highlights modern approaches to the diagnosis, prognosis and treatment of this pathology. The leading role in the detection of osteoporotic changes is played by radiation diagnostic methods that determine the level of bone mineral density - the equivalent of bone mass. In order to study metabolic disorders of bone tissue, laboratory methods are used that evaluate the activity of bone synthesis and resorption. When predicting osteoporotic fractures, the FRAX model is widely used, which determines the likelihood of fractures in the next 10 years, based on the presence of risk factors. Given the multifactorial nature of the formation of osteoporotic changes, an integrated approach to the treatment of this disease is necessary. According to the recommendations of the European Society of Endocrinology, bisphosphonates should be considered as first-line therapy. Denosumab, romosozumab, teriparatide can be used as second-line drugs. In addition, given the leading role of hypoestrogenism in the development of postmenopausal osteoporosis, the use of menopausal hormone therapy preparations occupies an important place in the prevention and treatment of osteoporotic changes. An important aspect that determines the effectiveness of the treatment of patients with postmenopausal osteoporosis is the need for interaction between doctors of various specialties, including gynecologists, endocrinologists, rheumatologists, traumatologists, doctors of radiation and laboratory diagnostics.
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