臨床整形外科49巻9号

2014年09月発行

誌上シンポジウム 骨粗鬆症に対する治療戦略

骨折の連鎖を断つための新たな活動

著者： 萩野浩¹

所属機関： ¹鳥取大学医学部保健学科

ページ範囲：P.775 - P.780

　脆弱性骨折の既往は，骨密度や加齢とは独立して脆弱性骨折のリスクを高める．骨折のリスクが高い例を治療対象とするほど費用対効果に優れるが，実際に骨折後の症例のうちで適切な骨粗鬆症治療がなされている例の割合は極めて小さい．そこで，近年，コーディネータを介して2次骨折防止を実施するリエゾンサービスが注目されている．リエゾンサービスによる脆弱性骨折後の骨粗鬆症例を対象とした治療は高い治療効率とそれに裏付けられた優れた費用対効果から，高齢者骨折予防改善のための突破口となると期待される．

参考文献

1) Bogoch ER, Elliot-Gibson V, Beaton DE, et al:Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg Am 88:25-34, 2006

2) Cadarette SM, Katz JN, Brookhart MA, et al:Trends in drug prescribing for osteoporosis after hip fracture, 1995-2004．J Rheumatol 35:319-326, 2008

3) Dell R, Greene D, Schelkun SR, et al:Osteoporosis disease management:the role of the orthopaedic surgeon. J Bone Joint Surg Am 90 Suppl 4:188-194, 2008

4) Dell R, Greene D:Is osteoporosis disease management cost effective? Curr Osteoporos Rep 8:49-55, 2010

5) Gardner MJ, Brophy RH, Demetrakopoulos D, et al:Interventions to improve osteoporosis treatment following hip fracture. A prospective, randomized trial. J Bone Joint Surg Am 87:3-7, 2005

6) Gehlbach S, Saag KG, Adachi JD, et al:Previous fractures at multiple sites increase the risk for subsequent fractures:the Global Longitudinal Study of Osteoporosis in Women. J Bone Miner Res 27:645-653, 2012

7) Hagino H, Sawaguchi T, Endo N, et al:The risk of a second hip fracture in patients after their first hip fracture. Calcif Tissue Int 90:14-21, 2012

8) Hagino H, Shiraki M, Fukunaga M, et al:Number and severity of prevalent vertebral fractures and the risk of subsequent vertebral fractures in Japanese women with osteoporosis:results from the minodronate trial. J Bone Miner Metab 31:544-550, 2013

9) Jaglal SB, Hawker G, Cameron C, et al:The Ontario Osteoporosis Strategy:implementation of a population-based osteoporosis action plan in Canada. Osteoporos Int 21:903-908, 2010

10) Klotzbuecher CM, Ross PD, Landsman PB, et al:Patients with prior fractures have an increased risk of future fractures:a summary of the literature and statistical synthesis. J Bone Miner Res 15:721-739, 2000

11) 骨粗鬆症の予防と治療ガイドライン作成委員会　(2011)：骨粗鬆症の予防と治療ガイドライン2011年版．ライフサイエンス出版，東京，2011

12) Leslie WD, Giangregorio LM, Yogendran M, et al:A population-based analysis of the post-fracture care gap 1996-2008:the situation is not improving. Osteoporos Int 23:1623-1629, 2012

13) McLellan AR, Gallacher SJ, Fraser M, et al:The fracture liaison service:success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int 14:1028-1034, 2003

14) McLellan AR, Wolowacz SE, Zimovetz EA, et al:Fracture liaison services for the evaluation and management of patients with osteoporotic fracture:a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int 22:2083-2098, 2011

15) Mitchell PJ:Fracture liaison services:the UK experience. Osteoporos Int 22 Suppl 3:487-494, 2011

16) Osaki M, Tatsuki K, Hashikawa T, et al:Beneficial effect of risedronate for preventing recurrent hip fracture in the elderly Japanese women. Osteoporos Int 23:695-703, 2012

17) Roerholt C, Eiken P, Abrahamsen B:Initiation of anti-osteoporotic therapy in patients with recent fractures:a nationwide analysis of prescription rates and persistence. Osteoporos Int 20:299-307, 2009

18) Rozental TD, Makhni EC, Day CS, et al:Improving evaluation and treatment for osteoporosis following distal radial fractures. A prospective randomized intervention. J Bone Joint Surg Am 90:953-961, 2008

19) 宗圓　聰，福永仁夫，杉本利嗣・他：原発性骨粗鬆症の診断基準(2012年度改訂版)．Osteoporosis Japan 21(1):9-21, 2013

20) Solomon DH, Johnston SS, Boytsov NN, et al:Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011．J Bone Miner Res 2014 Feb. 18 (e-pub ahead)