Author/Editor		Zavratnik, Andrej
Title		Novosti in dileme pri zdravljenju pomenopavzalne osteoporoze
Translated title		Novelties and dilemmas in the treatment of postmenopausal osteoporosis
Type		članek
Source		74267393
Publication year		2013
Volume		str. 78-86
Language		slv
Abstract		Pomenopavzna osteoporoza s posledičnimi zlomi je pomemben vzrok invalidnosti in smrtnosti. Zlome lahko učinkovito preprečujemo z ustreznim zdravljenjem. V skladu z novimi slovenskimi priporočili za odkrivanje in zdravljenje osteoporoze je potrebno zdraviti vse pomenopavzne ženske, pri katerih je tveganje za zlom veliko. Zdravljenje torej porebujejo vse, ki so že utrpele osteoporozni (OP) zlom, ostale pomenopavzne ženske pa zdravimo, če smo jih na temelju ocene tveganja zloma po kliničnih dejavnikih s pomočjo algoritma FRAX ali glede na ustrezno nizko mineralno kostno gostoto (MKG) uvrstili v skupino z velikim tveganjem. Zdravimo vsaj 3-5 let (izjema teriparatid, ki je indiciran le 1x v življenju za obdobje 24 mesecev), ko tveganje za zlom znova ocenimo in v primeru, da je še vedno veliko, podaljšamo zdravljenje. Ker se bisfosfonati akumulirajo v kosti in ostajajo tudi po prekinitvi zdravljenja dolgotrajno vezani za kostni matriks, lahko po večletnem neprekinjenem zdravljenju brez velikega tveganja za zlome zdravljenje prehodno prekinemo - pauza bisfoafonata. Prekinjanje zdravljenja z ostalimi zdravili zaenkrat ni priporočeno. V primeru neučinkovitega zdravljenja pretehtamo vzroke zanj. Glavni vzrok za neučinkovito zdravljenje je slaba adherenca. Če je adherenca dobra in sekundarni vzroki za osteoporozo izključeni, je potrebno zdravilo zamenjati.Postmenopausal osteoporosis with fractures is important cause of disability and death. Fractures can be successfully prevented with appropriate treatment. According to new slovenian guidelines for detection and treatment of osteoporosis the treatment is indicated for all postmenopausal women at high risk for fracture. Because of high probabillity of subsequent fracture, we need to treat all after osteoporotic (OP) fracture. For other postmenopausal women the treatment is indicated in the case of high risk of fracture according to clinical risk factors assesed by FRAX algorithm or in the case of appropriate low bone mineral density. The treatment is indicated for at least 3-5 years (exception teriparatide treatment is indicated once in lifespan for the duration of 24 months). After this period of treatment we reassesed fracture risk, and if it remain high the treatment should be prolonged. Because bisphosphonates accumulates in the bones and remain bound to bone matrix long after the therapy was stoped, the drug holidays can be implemented after some years of continued treatment without significant increase of fracture risk. Drug holidays is not recomended for non-bisphosphonate drugs by now. In case of treatment inefficacy we should reconsider its reasons. Bad adherence is primary reason for the treatment failure. If adherence is appropriate and secondary causes of osteoporosis are excluded we shoud change the therapy.
Keywords		pomenopavzalna osteoporoza zdravljenje priporočila tveganje za zlom