Essentials in rheumatology: disease managementI34. Metabolic bone diseasesI35. Psoriatic arthritisI36. Antiphospholipid syndromeMimickersn of myositis and treatment update: room for improvement and lessons from neurologyI37. Adult onset metabolic/

摘要

Osteoporosis is characterized by low bone mass and disruption of bone structure, leading to increased risk of fragility fracture. One woman in two and one man in three aged 50 years or older will suffer at least one osteoporotic fracture during their remaining lifetime; these fractures are associated with significant morbidity, increased mortality, and high economic costs. Fracture risk can be assessed using the FRAX algorithm, based on clinical risk factors with or without bone mineral density measurement. Approved treatment options in postmenopausal women include the bisphosphonates (alendronate, risedronate, ibandronate and zoledronate), denosumab, raloxifene, strontium ranelate and parathyroid hormone peptides. Of these, alendronate is the most cost-effective and is generally regarded as the first line option. The optimal duration of therapy has not been established but treatment is usually given for five years in the first instance, followed by reassessment of risk and the need for continued treatment. Alendronate, risedronate, zoledronate and teriparatide are also approved for the management of glucocorticoid-induced osteoporosis. Fracture risk increases rapidly after the onset of oral glucocorticoid therapy and primary prevention with a bone protective agent should be advised in patients at increased risk and should be continued for the duration of glucocorticoid therapy.