医学
德诺苏马布
骨质疏松症
重症监护医学
预期寿命
乳腺癌
健骨
雌激素
激素替代疗法(女性对男性)
骨重建
选择性雌激素受体调节剂
合成代谢剂
特立帕肽
更年期
三苯氧胺
内科学
生物信息学
癌症
骨矿物
人口
环境卫生
生物
睾酮(贴片)
作者
Joaquím Calaf,Antonio Cano,Núria Guañabens,Santiago Palacios,Marı́a Jesús Cancelo,Camil Castelo-Branco,Ricardo Larraínzar-Garijo,José Luís Neyro,Xavier Nogués,Adolfo Díez-Pérez
出处
期刊:Maturitas
[Elsevier]
日期:2023-11-01
卷期号:177: 107846-107846
被引量:1
标识
DOI:10.1016/j.maturitas.2023.107846
摘要
Increased life expectancy means that women are now in a hypoestrogenic state for approximately one-third of their lives. Overall health and specifically bone health during this period evolves in accordance with aging and successive exposure to various risk factors. In this review, we provide a summary of the approaches to the sequential management of osteoporosis within an integrative model of care to offer physicians a useful tool to facilitate therapeutic decision-making. Current evidence suggests that pharmacologic agents should be selected based on the risk of fractures, which does not always correlate with age. Due to their effect on bone turnover and on other hormone-regulated phenomena, such as hot flushes or breast cancer risk, we position hormone therapy and selective estrogen receptor modulators as an early postmenopause intervention for the management of postmenopausal osteoporosis. When the use of these agents is not possible, compelling evidence supports antiresorptive agents as first-line treatment of postmenopausal osteoporosis in many clinical scenarios, with digestive conditions, kidney function, readiness for compliance, or patient preferences playing a role in choosing between bisphosphonates or denosumab during this period. For patients at high risk of osteoporotic fracture, the "anabolic first" approach reduces that risk. The effect on bone health with these bone-forming agents or with denosumab should be consolidated with the subsequent use of antiresorptive agents. Regardless of the strategy, follow-up and treatment should be maintained indefinitely to help prevent fractures.
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