ما هو علاج الخط الأول لهشاشة العظام مع الكسر المرضي؟

References

DOI: 10.1136/bmj‑2024-081250

• For patients at high risk, AACE, Endocrine Society, BHOF, and NOGG recommend alendronate, risedronate, or zoledronate as first line therapy.
• For postmenopausal women and older men, aim for total elemental calcium 1000-1200 mg/day and vitamin D 800-1000 IU/day.
• Osteoporosis and sarcopenia guidelines both stress the need for regular weight bearing, resistance, and balance training exercise for reducing the risk of falls and fractures.
• In patients with low T-scores, a target of T ≥−2.5 is generally adopted as an appropriate threshold for discontinuation of therapy, on the basis of the FLEX and HORIZON-PFT trials, and endorsed by the latest American Society of Bone and Mineral Research guidance on goal directed osteoporosis treatment.
• Experts recommend an improvement in total hip T-score of at least 0.2 units (3%) and in lumbar spine T-score of at least 0.5 units (6%), on the basis of reasonable chances of attaining such increments over three years by most therapies, including anti-resorptives.
• The National Academy of Medicine recommends a target 25-hydroxyvitamin D concentration of 20 ng/mL, whereas other guidelines suggest 30 ng/mL for older adults and at-risk populations.