View More View Less
  • 1 Semmelweis Egyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Budapest Korányi S. u. 2/A 1083

Az osteoporosis miatt kialakuló csonttörés jelentős többlethalálozást okoz. Több hatékony, töréskockázatot csökkentő kezelési lehetőség áll rendelkezésünkre, de a nagy töréskockázatú egyének azonosítása nem megoldott. Az osteoporosis diagnózisának alapját képező kis csontsűrűség a csonttörés fontos, de nem egyetlen kockázati tényezője. Számos olyan, a csontsűrűségtől részben vagy teljesen független klinikai kockázati tényező ismert, amelyek befolyásolják a töréskockázatot. Ilyenek többek között az életkor, a megelőző osteoporoticus eredetű törés, a szülőkben előfordult csípőtáji combcsonttörés, a dohányzás, a mértéktelen alkoholfogyasztás, a glükokortikoidkezelés, a rheumatoid arthritis és egyéb, másodlagos osteoporosisra vezető betegségek fennállása. A FRAX® rendszer a fenti klinikai jellemzők felhasználásával, a csontsűrűségadattal vagy a nélkül számol 10 éves abszolút töréskockázatot a csípőtáji combcsonttörésekre és a nagy osteoporoticus törésekre (csigolya, femur, alkar és humerus) együttesen. Az adatok használata még nem egységes, de a FRAX® ígéretes lehetőség a nagy töréskockázatú egyének azonosítására. A hazai tapasztalatok is gyűlnek, amelyek módosíthatják a jelenlegi diagnosztikus és terápiás ajánlásokat. Orv. Hetil., 2011, 152, 1304–1311.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • Cummings, S. R., Melton, L. J.: Epidemiology and outcomes of osteoporotic fractures. Lancet, 2002, 359 (9319), 1761–1767.

    Melton L. J. , 'Epidemiology and outcomes of osteoporotic fractures ' (2002 ) 359 Lancet : 1761 -1767.

    • Search Google Scholar
  • Johnell, O., Kanis J. A.: Epidemiology of osteoporotic fractures. Osteoporos. Int., 2005, 16, S3–S7.

    Kanis J. A. , 'Epidemiology of osteoporotic fractures ' (2005 ) 16 Osteoporos. Int. : S3 -S7.

  • Péntek, M., Horváth, C., Boncz, I. és mtsai: Epidemiology of osteoporosis related fractures in Hungary from the nationwide health insurance database, 1999–2003. Osteoporos. Int., 2008, 19, 243–249.

    Boncz I. , 'Epidemiology of osteoporosis related fractures in Hungary from the nationwide health insurance database, 1999–2003 ' (2008 ) 19 Osteoporos. Int. : 243 -249.

    • Search Google Scholar
  • Keene, G. S., Parker, M. J., Pryor, G. A.: Morbidity and mortality after hip fractures. Br. Med. J., 1993, 307, 1248–1250.

    Pryor G. A. , 'Morbidity and mortality after hip fractures ' (1993 ) 307 Br. Med. J. : 1248 -1250.

    • Search Google Scholar
  • Center, J. R., Nguyen, T. V., Schneider, D. és mtsai: Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet, 1999, 393, 878–882.

    Schneider D. , 'Mortality after all major types of osteoporotic fracture in men and women: an observational study ' (1999 ) 393 Lancet : 878 -882.

    • Search Google Scholar
  • Cooper, C., Campion, G., Melton, L. J. III: Hip fractures in the elderly: a world-wide projection. Osteoporos. Int., 1992, 2, 285–289.

    Melton L. J. , 'Hip fractures in the elderly: a world-wide projection ' (1992 ) 2 Osteoporos. Int. : 285 -289.

    • Search Google Scholar
  • Haney, E. M., Chan, B. K., Diem, S. I. és mtsai: Association of low bone mineral density with selective serotonin reuptake inhibitor use by older men. Arch. Intern. Med., 2007, 167, 1246–1251.

    Diem S. I. , 'Association of low bone mineral density with selective serotonin reuptake inhibitor use by older men ' (2007 ) 167 Arch. Intern. Med. : 1246 -1251.

    • Search Google Scholar
  • Ahlborg, H. G., Rosengren, B. E., Järvinen, T. P. és mtsai: Prevalence of osteoporosis and incidence of hip fracture in women – secular trends over 30 years. BMC Musculoskeletal Disord., 2010, 11, 48–54.

    Järvinen T. P. , 'Prevalence of osteoporosis and incidence of hip fracture in women – secular trends over 30 years ' (2010 ) 11 BMC Musculoskeletal Disord. : 48 -54.

    • Search Google Scholar
  • Kannus, P., Niemi, S., Parkkari, J. és mtsai: Nationwide decline in incidence of hip fracture. J. Bone Miner. Res., 2006, 21, 1836–1838.

    Parkkari J. , 'Nationwide decline in incidence of hip fracture ' (2006 ) 21 J. Bone Miner. Res. : 1836 -1838.

    • Search Google Scholar
  • Schuit, S. C., van der Klift, M., Weel, A. E. és mtsai: Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone, 2004, 34, 195–202.

    Weel A. E. , 'Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study ' (2004 ) 34 Bone : 195 -202.

    • Search Google Scholar
  • Delmas, P. D., Seeman, E.: Changes in bone mineral density explain little of the reduction in vertebral or nonvertebral fracture risk with anti-resorptive therapy. Bone, 2004, 34, 599–604.

    Seeman E. , 'Changes in bone mineral density explain little of the reduction in vertebral or nonvertebral fracture risk with anti-resorptive therapy ' (2004 ) 34 Bone : 599 -604.

    • Search Google Scholar
  • Miller, P. D., Delmas, P. D., Huss, H. és mtsai: Increases in hip and spine bone mineral density are predictive for vertebral antifracture efficacy with ibandronate. Calcif. Tissue Int., 2010, 87, 305–313.

    Huss H. , 'Increases in hip and spine bone mineral density are predictive for vertebral antifracture efficacy with ibandronate ' (2010 ) 87 Calcif. Tissue Int. : 305 -313.

    • Search Google Scholar
  • Hans, D., Durosier, C., Kanis, J. A. és mtsai: Assessment of the 10-year probability of osteoporotic hip fracture combining clinical risk factors and heel bone ultrasound: the EPISEM prospective cohort of 12,958 women. J. Bone Miner. Res., 2008, 23, 1045–1051.

    Kanis J. A. , 'Assessment of the 10-year probability of osteoporotic hip fracture combining clinical risk factors and heel bone ultrasound: the EPISEM prospective cohort of 12,958 women ' (2008 ) 23 J. Bone Miner. Res. : 1045 -1051.

    • Search Google Scholar
  • Garnero, P.: Biomarkers for osteoporosis management: utility in diagnosis, fracture risk prediction and therapy monitoring. Mol. Diagn. Ther., 2008, 12, 157–170.

    Garnero P. , 'Biomarkers for osteoporosis management: utility in diagnosis, fracture risk prediction and therapy monitoring ' (2008 ) 12 Mol. Diagn. Ther. : 157 -170.

    • Search Google Scholar
  • Hui, S. L., Slemenda, C. W., Johnston, C. C.: Age and bone mass as predictors of fracture in a prospective study. J. Clin. Invest., 1988, 81, 1804–1809.

    Johnston C. C. , 'Age and bone mass as predictors of fracture in a prospective study ' (1988 ) 81 J. Clin. Invest. : 1804 -1809.

    • Search Google Scholar
  • Center, J. R., Bliuc, D., Nguyen, T. V. és mtsa: Risk of subsequent fracture after low-trauma fracture in men and women. JAMA, 2007, 297, 387–394.

    Nguyen T. V. , 'Risk of subsequent fracture after low-trauma fracture in men and women ' (2007 ) 297 JAMA : 387 -394.

    • Search Google Scholar
  • Kanis, J. A., Johansson, H., Oden, A. és mtsai: A family history of fracture and fracture risk: a meta-analysis. Bone, 2004, 35, 1029–1037.

    Oden A. , 'A family history of fracture and fracture risk: a meta-analysis ' (2004 ) 35 Bone : 1029 -1037.

    • Search Google Scholar
  • Cumming, S. R., Black, D. M., Nevitt, M. C. és mtsai: Risk factors for hip fracture in white women. N. Engl. J. Med., 1995, 332, 767–773.

    Nevitt M. C. , 'Risk factors for hip fracture in white women ' (1995 ) 332 N. Engl. J. Med. : 767 -773.

    • Search Google Scholar
  • Dargent-Molina, P., Favier, F., Grandjean, H. és mtsai: Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet, 1996, 348, 145–149.

    Grandjean H. , 'Fall-related factors and risk of hip fracture: the EPIDOS prospective study ' (1996 ) 348 Lancet : 145 -149.

    • Search Google Scholar
  • Kanis, J. A., Borgstrom, F., De Laet, C. és mtsai: Assessment of fracture risk. Osteoporos. Int., 2005, 16, 581–589.

    Laet C. , 'Assessment of fracture risk ' (2005 ) 16 Osteoporos. Int. : 581 -589.

  • Cumming, S. R., Black, D. M., Rubin, S. M.: Lifetime risk of hip, Colles’, or vertebral fracture and coronary heart disease among Caucasian postmenopausal women. Arch. Intern. Med., 1989, 149, 2445–2448.

    Rubin S. M. , 'Lifetime risk of hip, Colles’, or vertebral fracture and coronary heart disease among Caucasian postmenopausal women ' (1989 ) 149 Arch. Intern. Med. : 2445 -2448.

    • Search Google Scholar
  • Kanis, J. A., Johnell, O., Oden, A. és mtsai: Long-term risk of osteoporotic fractures in Malmö. Osteoporos. Int., 2000, 11, 669–674.

    Oden A. , 'Long-term risk of osteoporotic fractures in Malmö ' (2000 ) 11 Osteoporos. Int. : 669 -674.

    • Search Google Scholar
  • Kanis, J. A., Borgstrom, F., De Laet, C. és mtsai: Assessment of fracture risk. Osteoporos. Int., 2005, 16, 581–589.

    Laet C. , 'Assessment of fracture risk ' (2005 ) 16 Osteoporos. Int. : 581 -589.

  • Kanis, J. A., McCloskey, E. V., Johansson, H. és mtsai: Development and use of FRAX in osteoporosis. Osteoporos. Int., 2010, 21 (Suppl. 2), 407–413.

    Johansson H. , 'Development and use of FRAX in osteoporosis ' (2010 ) 21 Osteoporos. Int. : 407 -413.

    • Search Google Scholar
  • Kanis, J. A., Oden, A., Johnell, O. és mtsai: The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos. Int., 2007, 18, 1033–1044.

    Johnell O. , 'The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women ' (2007 ) 18 Osteoporos. Int. : 1033 -1044.

    • Search Google Scholar
  • Kanis, J. A., McCloskey, E. V., Johansson, H. és mtsai, National Osteoporosis Guideline Group: Case finding for the management of osteoporosis with FRAX – assessment and intervention thresholds for the UK. Osteoporos. Int., 2008, 19, 1395–1408.

    Johansson H. , 'Case finding for the management of osteoporosis with FRAX – assessment and intervention thresholds for the UK ' (2008 ) 19 Osteoporos. Int. : 1395 -1408.

    • Search Google Scholar
  • National Osteoporosis Foundation (NOF): Clinician’s Guide to prevention and treatment of osteoporosis. National Osteoporosis Fundation, Washington, 2008. www.nof.org

    '', in Clinician’s Guide to prevention and treatment of osteoporosis , (2008 ) -.

  • Watts, S. B., Siris, E. S., Cummings, S. R. és mtsai: Filtering FRAX®. Osteoporos. Int., 2010, 21, 537–541.

    Cummings S. R. , 'Filtering FRAX® ' (2010 ) 21 Osteoporos. Int. : 537 -541.

  • Black, D. M., Steinbuch, M., Palermo, L. és mtsai: An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos. Int., 2001, 12, 519–528.

    Palermo L. , 'An assessment tool for predicting fracture risk in postmenopausal women ' (2001 ) 12 Osteoporos. Int. : 519 -528.

    • Search Google Scholar
  • Leslie, W. D., Majumdar, S. R., Lix, L. M. és mtsai: High fracture probability with FRAX usually indicates densitometric osteoporosis: implications for clinical practice. Osteoporos. Int., 2011. (közlés folyamatban)

  • Vestergaard, P.: Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes: a meta-analysis. Osteoporos. Int., 2007, 18, 427–444.

    Vestergaard P. , 'Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes: a meta-analysis ' (2007 ) 18 Osteoporos. Int. : 427 -444.

    • Search Google Scholar
  • Schwartz, A. V., Vittinghoff, E., Bauer, D. C. és mtsai: Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. JAMA, 2011, 305, 2184–2192.

    Bauer D. C. , 'Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes ' (2011 ) 305 JAMA : 2184 -2192.

    • Search Google Scholar
  • Cowie, C. C., Rust, K. F., Ford, E. S. és mtsai: Full accounting of diabetes and pre-diabetes in the U.S. population in 1988–1994 and 2005–2006. Diabetes Care, 2009, 32, 287–294.

    Ford E. S. , 'Full accounting of diabetes and pre-diabetes in the U.S. population in 1988–1994 and 2005–2006 ' (2009 ) 32 Diabetes Care : 287 -294.

    • Search Google Scholar
  • Van Staa, T. P., Leufkens, H. G., Abenhaim, I. és mtsai: Fracture and oral corticosteroids: relationship to daily and cumulative dose. Rheumatology, 2000, 39, 1383–1389.

    Abenhaim I. , 'Fracture and oral corticosteroids: relationship to daily and cumulative dose ' (2000 ) 39 Rheumatology : 1383 -1389.

    • Search Google Scholar
  • Kanis, J. A., Johansson, H., Oden, A. és mtsa: Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos. Int., 2011, 22, 809–816.

    Oden A. , 'Guidance for the adjustment of FRAX according to the dose of glucocorticoids ' (2011 ) 22 Osteoporos. Int. : 809 -816.

    • Search Google Scholar
  • Ettinger, B., Black, D. M., Dawson-Hughes, B. és mtsai: Updated fracture incidence rates for the US version of FRAX®. Osteoporos. Int., 2010, 21, 25–33.

    Dawson-Hughes B. , 'Updated fracture incidence rates for the US version of FRAX® ' (2010 ) 21 Osteoporos. Int. : 25 -33.

    • Search Google Scholar
  • Bolland, M. J., Siu, A. T., Mason, B. H. és mtsai: Evaluation of the FRAX and Garvan fracture risk calculators in older women. J. Bone Miner. Res., 2011, 26, 420–427.

    Mason B. H. , 'Evaluation of the FRAX and Garvan fracture risk calculators in older women ' (2011 ) 26 J. Bone Miner. Res. : 420 -427.

    • Search Google Scholar
  • Committee for Medicinal Products for Human Use (CHMP): Guideline on the evaluation of medical products in the treatment of primary osteoporosis. CPMP/EWP/552/95/Rev2. London, CHMP.

  • Quandt, S. A., Thompson, D. E., Schneider, D. L. és mstai: Effect of alendronate on vertebral fracture risk in women with bone mineral density T scores of –1.6 to –2.5 at the femoral neck: The Fracture Intervention Trial. Mayo Clin. Proc., 2005, 80, 343–349.

    Schneider D. L. , 'Effect of alendronate on vertebral fracture risk in women with bone mineral density T scores of –1.6 to –2.5 at the femoral neck: The Fracture Intervention Trial ' (2005 ) 80 Mayo Clin. Proc. : 343 -349.

    • Search Google Scholar
  • McCloskey, E. V., Johansson, H., Oden, A. és mtsai: Efficacy of clodronate on the risk of hip fracture in elderly women. J. Bone Miner. Res., 2007, 22 (Suppl. 1), S46.

    Oden A. , 'Efficacy of clodronate on the risk of hip fracture in elderly women ' (2007 ) 22 J. Bone Miner. Res. : S46 -.

    • Search Google Scholar
  • Black, D. M., Schwartz, A. V., Ensrud, K. E. és mtsai: Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA, 2006, 296, 2927–2938.

    Ensrud K. E. , 'Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial ' (2006 ) 296 JAMA : 2927 -2938.

    • Search Google Scholar