骨质疏松的患者,无论有无骨折史,在随访结束之前应评估其跌倒风险,并建议患者采取有针对性的干预以降低其跌倒的风险。 如果呈现出步态障碍,应给予物理治疗或作业疗法。 建议让患者进行负重或促进平衡练习,同时补充钙剂和维生素 D 。
阿仑膦酸钠是一种二磷酸盐,该药能显著提高绝经期后有骨质疏松症且有骨折病史的妇女脊柱、非脊柱、髋及腕部骨折的复位;但不认为该药对腕部骨折有预防作用。[43]Wells GA, Cranney A, Peterson J, et al. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev. 2008;(1):CD001155.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001155.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/18253985?tool=bestpractice.com[44]Holder KK, Kerley SS. Alendronate for fracture prevention in postmenopause. Am Fam Physician. 2008;78:579-581.http://www.ncbi.nlm.nih.gov/pubmed/18788232?tool=bestpractice.com[45]National Institute for Health and Care Excellence. Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. October 2008. http://www.nice.org.uk/guidance (last accessed 13 October 2016).http://www.nice.org.uk/guidance/TA161[46]National Institute for Health and Care Excellence. Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women. October 2008. http://www.nice.org.uk/guidance (last accessed 13 October 2016).http://www.nice.org.uk/guidance/TA160 地诺单抗 (denosumab) 是有助于降低骨质疏松性骨折风险的另一个可能选择。[47]National Institute for Health and Care Excellence. Denosumab for the prevention of osteoporotic fractures in postmenopausal women. October 2010. http://www.nice.org.uk/guidance (last accessed 13 October 2016).http://www.nice.org.uk/guidance/TA204
经过骨密度检查的患者更有可能会接受治疗。 骨密度检查可显著提高桡骨远端脆性骨折后骨质疏松症的诊治率。[27]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. 2008;90:953-961.http://www.ncbi.nlm.nih.gov/pubmed/18451385?tool=bestpractice.com