医学类中英文翻译.docx

The methods of diagnosis and treatment of osteoporosis1. What Measures Can Be Taken to Prevent BoneLoss? R1. Maintain adequate calcium intake; use calciumsupplements, if needed, to meet minimal requiredintake (Grade A; “best evidence” level or BEL 1). R2. Maintain adequate vitamin D intake; supplementvitamin D, if needed, to maintain serum levels of25-hydroxyvitamin D 25(OH)D between 30 and 60ng/mL (Grade A; BEL 1). R3. Limit alcohol intake to no more than 2 servingsper day (Grade B; BEL 2). R4. Limit caffeine intake (Grade C; BEL 3). R5. Avoid or stop smoking (Grade B; BEL 2). R6. Maintain an active lifestyle, including weightbearingexercises for at least 30 minutes daily (GradeB; BEL 2).2. What Nonpharmacologic Measures Can BeRecommended for Treatment of Osteoporosis?All the foregoing measures plus the following: R7. Maintain adequate protein intake (Grade B; BEL3). R8. Use proper body mechanics (Grade B; BEL 1). R9. Consider the use of hip protectors in individualswith a high risk of falling (Grade B; BEL 1). R10. Take measures to reduce the risk of falling(Grade B; BEL 2). R11. Consider referral for physical therapy and occupationaltherapy (Grade B; BEL 1).3. Who Needs to Be Screened for Osteoporosis? R12. Women 65 years old or older (Grade B; BEL 2). R13. Younger postmenopausal women at increasedrisk of fracture, based on a list of risk factors (see section4.5) (Grade C; BEL 2).4. How Is Osteoporosis Diagnosed? R14. Use a central dual-energy x-ray absorptiometry(DXA) measurement (Grade B; BEL 3). R15. In the absence of fracture, osteoporosis is definedas a T-score of -2.5 or below in the spine (anteroposterior),femoral neck, or total hip (Grade B; BEL 2). R16. Osteoporosis is defined as the presence of afracture of the hip or spine (see section 4.4.2) (in theabsence of other bone conditions) (Grade B; BEL 3).5. How Is Osteoporosis Evaluated? R17. Evaluate for secondary osteoporosis (Grade B;BEL 2). R18. Evaluate for prevalent vertebral fractures (seesection 4.7.1) (Grade B; BEL 2).6. Who Needs Pharmacologic Therapy? R19. Those patients with a history of a fracture of thehip or spine (Grade A; BEL 1). R20. Patients without a history of fractures but with aT-score of -2.5 or lower (Grade A; BEL 1). R21. Patients with a T-score between -1.0 and -2.5if FRAX (see section 4.5) major osteoporotic fractureprobability is 20% or hip fracture probability is 3%(Grade A; BEL 2).7. What Drugs Can Be Used to Treat Osteoporosis?Use drugs with proven antifracture efficacy: R22. Use alendronate, risedronate, zoledronic acid,and denosumab as the first line of therapy (Grade A;BEL 1). R23. Use ibandronate as a second-line agent (GradeA; BEL 1). R24. Use raloxifene as a second- or third-line agent(Grade A; BEL 1). R25. Use calcitonin as the last line of therapy (GradeC; BEL 2). R26. Use teriparatide for patients with very high fracturerisk or patients in whom bisphosphonate therapyhas failed (Grade A; BEL 1). R27. Advise against the use of combination therapy(Grade B; BEL 2).8. How Is Treatment Monitored? R28. Obtain a baseline DXA, and repeat DXA every1 to 2 years until findings are stable. Continue withfollow-up DXA every 2 years or at a less frequentinterval (Grade B; BEL 2). R29. Monitor changes in spine or total hip bone mineraldensity (BMD) (Grade C; BEL 2). R30. Follow-up of patients should be in the samefacility, with the same machine, and, if possible, withthe same technologist (Grade B; BEL 2). R31. Bone turnover markers may be used at baselineto identify patients with high bone turnover and can beused to follow the response to therapy (Grade C; BEL2).9. What Is Successful Treatment of Osteoporosis? R32. BMD is stable or increasing, and no fractures arepresent (Grade B; BEL 2). R33. For patients taking antiresorptive agents, boneturnover markers at or below the median value forpremenopausal women are achieved (see section 4.9)(Grade B; BEL 2). R34. One fracture is not necessarily evidence of failure.Consider alternative therapy or reassessment forsecondary causes of bone loss for patients who haverecurrent fractures while receiving therapy (Grade B;BEL 2).10. How Long Should Patients Be Treated? R35. For treatment with bisphosphonates, if osteoporosisis mild, consider a “drug holiday” after 4 to 5years of stability. If fracture risk is high, consider adrug holiday of 1 to 2 years after 10 years of treatment(Grade B; BEL 1). R36. Follow BMD and bone turnover markers duringa drug holiday period, and reinitiate therapy if bonedensity declines substantially, bone turnover markersincrease, or a fracture occurs (Grade C; BEL 3).11. When Should Patients Be Referred to ClinicalEndocrinologists? R37. When a patient with normal BMD sustains afracture without major trauma (Grade C; BEL 4). R38. When recurrent fractures or continued bone lossoccurs in a patient receiving therapy without obvioustreatable causes of bone loss (Grade C; BEL 4). R39. When osteoporosis is unexpectedly severe or hasunusual features (Grade C; BEL 4). R40. When a patient has a condition that complicatesmanagement (for example, renal failure, hyperparathyroidism,or malabsorption) (Grade C; BEL 4).Thisfigure is taken from page 28 ofthe 2011 OsteoporosisPrevention and TreatmentGuidelines (in Japanese). a Inpatients taking bisphosphonates,measure after stopping drug forat least 6 months, and inpatients taking otherosteoporosis drugs, measureafter stopping drug for at least1 month. b Measure one typeeach of a resorption marker andformation marker. c Excludingeldecalcitol. d In patientsexpected to be on long-termbisphosphonate therapy,measure bone resorptionmarkers and BAP or P1NP.Changes in the diagnosis and treatment of osteoporosisTogether with significant changes in the disease concept ofosteoporosis, new technology continues to be incorporatedinto clinical diagnosis and treatment of osteoporosis. Withthe introduction of DXA to measure BMD, more precisediagnostic criteria have been established 11. The measurementof bone metabolic markers, approved by NHI inroutine clinical practice in the field of osteoporosis, hasallowed (1) estimation of bone turnover state at the time ofmeasurement, (2) prediction of the rate of BMD change innear future, (3) assessment of the effect of drug treatment,and (4) evaluation of bone quality 10.In addition, with the introduction into clinical practice ofvarious bone antiresorptive drugs which can prevent fracturesbased on scientific evidence, the incidence of fracturesdue to osteoporosis has decreased according toepidemiologic studies 12.In the future, with the goal of ideal treatment to increasebone mass, the risk of fracture or osteoporosis will beevaluated from the bone loss to decide whether to initiatedrug treatment, and strategies will be sought to maintain orincrease QOL in osteoporosis and assess fracture risk inlifestyle-related diseases. In other words, there will berelentless efforts towards establishing a comprehensivesystem to manage osteoporosis.Change in views about the significance of measuringbone metabolic markersThe significance of measuring bone metabolic markers wasoriginally considered important as a surrogate marker forBMD change rates, but now its significance as a means toevaluate bone quality 13 and to assess the future risk offracture has been emphasized 1416. In addition, becausethe newly available antiresorptive drugs markedly inhibitbone metabolic markers, the measurement of bone metabolicmarkers is a useful means to assess drug efficacy 17, 18.Although the use of bone metabolic markers now hasan important role in the daily management of osteoporosis,their use in Japan is still insufficient because ofinsurance coverage limitations 19. Since the JapanOsteoporosis Society first created the 2001 guidelines,new bone metabolic markers have been introduced intoclinical practice. The availability of new osteoporosistreatments that promote bone formation has changed theclinical application of bone metabolic markers in currentpractice. Therefore, the necessity to revise the currentclinical practice led to the proposal to create these new2012 guidelines骨质疏松诊治方法1.可采取何种措施预防骨丢失？推荐（R）1.保持足量钙摄入；如果需要，利用钙添加剂亦最低摄入要求（A级；最佳证据水平BEL1）。R2.保持足量维生素D摄入；如果需要，添加维生素D使血清25-羟基维生素D25(OH)D水平保持在3060ng/ml之间（A级；BEL1）。R3.限制酒精摄入，每日饮酒不超过2次（B级；BEL2）。R4.限制咖啡摄入（C级；BEL2）。R5.避免吸烟或戒烟（B级；BEL2）。R6.保持活动性生活方式，包括每日至少30分钟承重锻炼（B级；BEL2）。 2.哪些非药物性方法可被推荐用于治疗骨质疏松？前述方法加下述方法：R7.保持足量蛋白质摄入（B级；BEL3）。R8.机体功能运用适当（B级；BEL1）。R9.在跌倒风险较高的个体中考虑应用髋保护器（B级；BEL1）。R10.采取措施降低跌倒风险（B级；BEL2）。R11.考虑转诊行理疗或职业治疗（B级；BEL1）。 3.哪些人需要行骨质疏松筛查？R12.65岁以上女性（B级；BEL2）。R13.基于危险因素列表，骨折风险升高的绝经后女性（C级；BEL2）。 4.骨质疏松如何诊断？R14.采用双能X线吸收（DXA）测定法（B级；BEL3）。R15.无骨折时，骨质疏松被定义为脊柱、股骨颈或髋骨T评分-2.5（B级；BEL2）。R16.无其他骨骼疾病时，骨质疏松被定义为髋骨或脊柱骨折（B级；BEL3）。 5.骨质疏松如何评估？R17.对继发性骨质疏松进行评估（B级；BEL2）。R18.对椎骨骨折情况进行评估（B级；BEL2）。 6.哪些人需要接受药物治疗？R19.伴有髋骨或脊柱骨折史的患者（A级；BEL1）。R20.无骨折史但T评分-2.5的患者（A级；BEL1）。R21.T评分为-1.0至-2.5之间，但FRAX严重骨质疏松性骨折概率20%或髋骨骨折概率3%的患者（A级；BEL2）。 7.哪些药物可用于治疗骨质疏松？使用具有明确抗骨折效果的药物：R22.以阿伦膦酸盐、利塞膦酸盐、唑来膦酸和denosumab作为一线治疗药物（A级；BEL1）。R23.以伊班膦酸盐作为二线药物（A级；BEL1）。R24.以雷洛昔芬作为二线或三线治疗治疗药物（A级；BEL2）。R25.以降钙素作为最后治疗药物（C级；BEL2）。R26.使用特立帕肽治疗二膦酸盐无效的极高危骨折风险患者（A级；BEL1）。R27.不建议采用联合治疗（B级；BEL2）。 8.治疗如何监测？R28.测定基线DXA，并且每1至2年重复测定DXA直至结果稳定。其后每2年或更长的时间间隔进行DXA随访（B级；BEL2）。R29.监测脊柱或髋骨骨密度（BMD）变化（C级；BEL2）。R30.随访患者应由同一所医疗机构、同样的设备以及（可能时）相同的技师来实施（B级；BEL2）。R31.在基线时可应用骨转换标志物确定骨转换较高的患者，并且可用于随访治疗反应（C级；BEL2）。 9.何谓骨质疏松治疗成功？R32.BMD稳定或升高，并且无骨折出现（B级；BEL2）。R33.对于服用抗重吸收药物的患者，骨转换标志物水平处于绝经前女性中位值或以下（B级；BEL2）。R34.骨折并非治疗失败的必需证据。对于接受治疗时出现复发性骨折的患者，可考虑调整治疗或对骨丢失的继发性原因进行重新评估（B级；BEL2）。 10.患者应接受多长时间的治疗？R35.对于双膦酸盐治疗而言，如果骨质疏松轻微，可考虑在稳定4至5年后短期停药。如果骨折风险较高，可考虑在治疗10年后停药1至2年（B级；BEL1）。R36.在药物停用期间随访BMD和骨转换标志物，如果骨密度显著降低、骨转换标志物升高或骨折发生，则应重新启动治疗（C级；BEL3）。 11.何时应将患者转诊至内分泌医师？R37.当患者BMD正常，在无严重创伤的情况下仍出现骨折（C级；BEL4）。R38.当患者接受治疗期间，在无明显治疗所致骨丢失的情况下仍出现复发性骨折或持续性骨丢失（C级；BEL4）。R39.当骨质疏松严重度超出预期或线非常见骨折（C级；BEL4）。R40.当患者伴有需要复发治疗的疾病时（如肾衰、甲状旁腺功能亢进或吸收不良）（C级；BEL4）。表 美国FDA批准用于治疗骨质疏松的药物药物绝经后骨质疏松糖皮质激素诱导性骨质疏松预防治疗预防治疗男性雌激素（多种制剂）多种方案降钙素（Miacalcin，Fortical）200IU鼻内应用1次/日或100IUSQqodDenosumab（Prolia）60mgSQ1次/6个月雷洛昔芬（Evista）60mgPO1次/日伊班膦酸盐（Boniva）2.5mgPO1次/日150mgPO1次/月2.5mgPO1次/日3mgIV1次/3个月阿伦膦酸盐（Fosamax）5mgPO1次/日35mgPO1次/周10mgPO1次/日70mgPO1次/周70mg+D5mgPO1次/日10mgPO1次/日10mgPO1次/日70mgPO1次/周利塞膦酸盐（Actonel）5mgPO1次/日35mgPO1次/周150mgPO1次/月5mgPO1次/日35mgPO1次/周150mgPO1次/月5mgPO1次/日5mgPO1次/日35mgPO1次/周