骨质疏松症

1990年，世界范围内有130万到170万例的髋骨骨折。髋骨骨折的发病率预计将随着平均寿命的增加而增加，尤其是在非洲、亚洲及拉丁美洲。[3]WHO Scientific Group on the Prevention and Management of Osteoporosis. Prevention and management of osteoporosis: report of a WHO scientific group. (WHO technical report series: 921.) Geneva, Switzerland: WHO; 2000.http://whqlibdoc.who.int/trs/WHO_TRS_921.pdf

骨折后，如果患者可以耐受应使用药物治疗。预防跌倒的措施仍然很重要。在美国，髋骨骨折一年内死亡率为20%，长期看护的制度化约为20%。约有2/3患者无法恢复到骨折前的功能水平。[3]WHO Scientific Group on the Prevention and Management of Osteoporosis. Prevention and management of osteoporosis: report of a WHO scientific group. (WHO technical report series: 921.) Geneva, Switzerland: WHO; 2000.http://whqlibdoc.who.int/trs/WHO_TRS_921.pdf

髋骨骨折

骨质疏松症的老年女性发生肋骨骨折是很常见的。

肋骨骨折

骨质减少会导致桡骨远端骨折的风险增加。骨质减少的老年人中，既往腕部骨折与其他部位骨质疏松性骨折明确相关。

腕部骨折

有新证据表明非典型粗隆下和股骨骨折和颚骨坏死与长期使用双膦酸盐相关。[54]Food and Drug Administration Center for Drug Evaluation and Research. Summary minutes of the joint meeting of the Advisory Committee for Reproductive Health Drugs and Drug Safety and Risk Management Advisory Committee. September 2011. http://www.fda.gov (last accessed 27 September 2016).http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM278481.pdf长期使用双膦酸盐治疗（平均疗程为7年）可出现非典型粗隆下和股骨干骨折。主要特征为无创伤的自发骨折，骨折时断面一般是横断面或稍稍倾斜以及内侧断面稍高。次要特征为皮质增厚、外侧皮质的骨膜反应、联合使用其他抗骨吸收药物、糖皮质激素、或质子泵抑制剂。50%患者骨折前会出现大腿或腹股沟疼痛。

非充分证据表明，对需长期使用双膦酸盐的骨质疏松患者限制其用药持续时间，且强行停药或者终止治疗可能并无益处。[54]Food and Drug Administration Center for Drug Evaluation and Research. Summary minutes of the joint meeting of the Advisory Committee for Reproductive Health Drugs and Drug Safety and Risk Management Advisory Committee. September 2011. http://www.fda.gov (last accessed 27 September 2016).http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM278481.pdf

骨质疏松性骨折是＞65岁患者慢性疼痛综合征的常见病因。

慢性疼痛综合征

雷洛昔芬的雌激素效果增加了血栓的风险，包括深静脉血栓（DVT）。治疗的前4个月风险升高幅度最大。

深静脉血栓形成

雷洛昔芬的雌激素效果增加了血栓的风险，包括肺栓塞（PE）。治疗的前4个月风险升高幅度最大。

肺栓塞

有新证据表明非典型粗隆下和股骨骨折和颚骨坏死与长期使用双膦酸盐相关。[54]Food and Drug Administration Center for Drug Evaluation and Research. Summary minutes of the joint meeting of the Advisory Committee for Reproductive Health Drugs and Drug Safety and Risk Management Advisory Committee. September 2011. http://www.fda.gov (last accessed 27 September 2016).http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM278481.pdf尤其是有口腔问题或拔牙或种牙和/或根管治疗后的患者，静脉注射双膦酸盐之后，更易发生颚骨坏死。

非充分证据表明，对需长期使用双膦酸盐的骨质疏松患者限制其用药持续时间，且强行停药或者终止治疗可能并无益处。[54]Food and Drug Administration Center for Drug Evaluation and Research. Summary minutes of the joint meeting of the Advisory Committee for Reproductive Health Drugs and Drug Safety and Risk Management Advisory Committee. September 2011. http://www.fda.gov (last accessed 27 September 2016).http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM278481.pdf