Clinical calcium
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There are several lines of evidence about the effectiveness of parathyroid hormone (PTH) as a bone anabolic reagent for the treatment of osteoporosis, and the large-scale randomized controlled trial revealed that PTH increases and reduces lumbar spine bone mineral density and fracture risk, respectively, more potently than other inhibitors for bone resorption. Moreover, alendronate was useful for the further increase in bone mineral density after the withdrawal of PTH treatment, and the combined treatment of PTH and raloxifene was additive. On the other hand, strontium ranelate significantly inhibited osteoporotic fractures in randomized placebo controlled trial, which is expected as a new bone anabolic reagent for osteoporosis.
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World Health Organization (WHO) has proposed the use of 10-year absolute risk for fracture (calculated based on incidence and life span) using clinical risk factors as new intervention thresholds. Eight risk factors to be included in the fracture assessment risk tool are age, bone mineral density or body mass index (BMI) when bone density is not available, steroid use, parental history of femoral neck fracture, history of osteoporotic fracture, smoking, excessive alcohol consumption, and rheumatoid arthritis. WHO has proposed that a treatment-intervention threshold be established in accordance with the medical situation in each country.