Nihon rinsho. Japanese journal of clinical medicine
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It is well-known that osteoporosis treatment should be discussed from the view point of bone quality, however, in vivo assessment of bone quality is limited only for bone geometry and trabecular microstructure. Hip structure analysis (HSA) is a program to evaluate geometry and biomechanical property using two-dimensional DXA data of proximal femur. In vivo assessment of trabecular microstructure has been realized by the benefit of recent developments of imaging technique and technology, such as high resolution clinical CT and MR. These imaging techniques are going to be applied to assess risk of fracture and efficacy of anti-osteoporotic agents, although their spatial resolution is lower than real trabecular structure.
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Only bisphosphonates have reliable evidence to decrease the risk of vertebral fractures in patients taking glucocorticoids. Relative risk at 1 year treatment with bisphosphonates for incident vertebral fractures and non-vertebral fractures were 0.46 (95% confidence interval: 0.28-0.77) and 0.77 (95% confidence interval: 0.39-1.51), respectively. Two year extension of the alendronate trial showed that relative risk for incident vertebral fractures was 0.10 (95% confidence interval: 0.01-0.90). The bisphosphonates have been recommended as first-line drugs and active vitamin D3 and vitamin K2 have been recommended as second-line drugs in Japanese guidelines on the management and treatment of glucocorticoid-induced osteoporosis of The Japanese Society for Bone and Mineral Research (2004 edition).
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The aim of the pharmacotherapy for osteoporosis is to prevent osteoporotic fractures. It is important to identify the patients who have the risk for fractures and to assess how high the risk is. The Japanese guideline for prevention and treatment of osteoporosis showed the criteria to start the pharmacotherapy of osteoporosis. ⋯ Those factors are patients' history of femoral neck fractures, excessive alcohol or tobacco smoker. Recently 10-year absolute risk for fractures can be estimated by fracture risk assessment tool by WHO group, which is named as FRAX. The way of clinical application of this tool should be discussed in each country.