找黃貞瑜醫師聊療不孕、助孕規劃與荷爾蒙

 

依臨床狀況不同而定的個別化的治療
< 病人條件 >	< 建議用藥 >
ü年紀大患者且可服從口服雙磷酸類 藥物順從性者	口服雙磷酸鹽
ü髖骨骨折的高風險族群	口服或長效型針劑雙磷酸鹽, 或 denosumab
ü口服雙磷酸鹽後出現腸胃不適副作用	長效型針劑雙磷酸鹽, 鈣穩EVISTA(Raloxifene),或 denosumab
ü年紀輕之病患族群	鈣穩EVISTA(Raloxifene)
ü擔心齒槽骨壞死問題者	昇鈣素鼻噴劑（近來因致癌可能性，已下架）, 鈣穩EVISTA(Raloxifene), 或補骨挺疏PROTOS(strontium)
ü併有停經症候群症狀者	荷爾蒙療法
ü年紀大患者且無法服用口服雙磷酸鹽類藥物者	昇鈣素鼻噴劑（近來因致癌可能性，已下架）,補骨挺疏PROTOS(strontium), 長效型針劑雙磷酸鹽,或 denosumab
ü為骨折高風險者	骨穩注射液FORTEO(Teriparatide) 或 denosumab
ü腎功能不佳者	Denosumab
ü為居家照護者 (長效針劑尤佳)	Denosumab 或長效型針劑雙磷酸鹽(若無腎功能不全)

Denosumab: 半年打一針; 

鈣穩EVISTA(Raloxifene): 口服,尤適合乳癌患者; 

補骨挺疏PROTOS(strontium):口服

昇鈣素鼻噴劑: 可緩解骨質疏鬆所造成之疼痛，但近來因致癌可能性，已下架

參考資料

1.      McCloskey E (2010) FRAX: identifying people at high risk of fracture. International Osteoporosis Foundation. Accessed 12 January 2011
2.      Osteoporos Int (2012) 23:797–809  DOI 10.1007/s00198-011-1775-y
3.      Endocrine (2012) 41:11–18  DOI 10.1007/s12020-011-9554-2
4.      National Osteoporosis Foundation (2010) Clinician's guide to prevention and treatment of osteoporosis. Available a at http://www.nof.org/sites/default/files/
pdfs/NOF_ClinicianGuide2009_v7.pdf. Accessed 23 July 2010
5.      European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428, Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster JY, Borgstrom F, Rizzoli R (2008)
6.      North American Menopause Society (2010) Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 17:25–54
7.      Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev (1):CD001155, Wells GA, Cranney A, Peterson J, Boucher M, Shea B, Robinson V, Coyle D, Tugwell P (2008)
8.      Oral bisphosphonate use and breast cancer incidence in postmenopausal women. J Clin Oncol 28:3582–3590, Chlebowski RT, Chen Z, Cauley JA, Anderson G, Rodabough RJ, McTiernan A, Lane DS, Manson JE, Snetselaar L, Yasmeen S, O'Sullivan MJ, Safford M, Hendrix SL, Wallace RB (2010)
9.      Bisphosphonates for postmenopausal osteoporosis: determining duration of treatment. Curr Osteoporos Rep 7:12–17, Geusens P (2009)
10.  Outcomes after switching from one bisphosphonate to another in 146 patients at a single university hospital. Osteoporos Int 19:1777–1783, Ideguchi H, Ohno S, Takase K, Ueda A, Ishigatsubo Y (2008)
11.  國民健康局骨質疏鬆症臨床治療指引, 2011年版