strontium ranelate in osteoporosis

							骨質疏鬆症
骨質疏鬆症的危險因子




 體型瘦小
 Bone modeling and remodeling
Bone modeling
 Child and adolescent

 Non-coupling : bone formation and
  resorption occur on separate surfaces
Bone remodeling
 The replacement of old bone tissue by new
  bone tissue in the adult skeleton
 Coupling
      Osteoporosis 
imbalance in bone remodeling




               Results in thinning
                 and eventual
               loss of trabecular
                  connectivity
        Definition of Osteoporosis
Osteoporosis is defined as a skeletal disorder characterized by
compromised bone strength predisposing a person to an increased risk of
fracture. Bone strength primarily reflects the integration of bone density
and bone quality.
                                                             NIH Consensus Conference




             Normal bone                               Osteoporosis
                           NIH Consensus Development Panel on Osteoporosis. JAMA 285:785-95, 2001
                               Osteoporosis
   Primary osteoporosis                              Primary prevention
        Older persons and women past
                                                           Should provided all the people as
         menopause in which bone loss is
         accelerated over that predicted for age            comprehensive measures against other
         and sex.                                           lifestyle-related diseases
   Secondary osteoporosis
                                                      Secondary prevention
        Metabolic bone disease
              hyperparathyroidism                         Should target people at higher risk of
        Neoplasia                                          osteoporotic fractures
              multiple myeloma or metastatic
                                                      Tertiary prevention
               carcinoma
        Malnutrition                                      Should be provided the patients and at
        Drug therapy                                       frail elderly people using medical or
              with corticosteroids                         long-term care insurance
        Prolonged immobilization
        Weightlessness with space travel

                                                                        Osteoporosis Tutorial
       雙能量X光骨密度檢查




超音波
Factors affecting bone metabolism
 Medical treatment for osteoporosis
Anti-resorptive agent     Anabolic agent
 Estrogen
                           PTH (cyclic use)
 SERM
                          ( Bone formation)
  Raloxifene (Evista)      Strontium ranelate
 Calcitonin
                          ( Bone formation)
 Bisphosphonate
                          ( Bone resorption)
  Alendronate (Fosamax)
  Risedronate (Actonel)
  Ibandronate (Bonviva)
( Bone resorption)
Protos




         OPG
NEJM 2004;350:459-468
AEs of strontium ranelate (Protos)

Symptoms (%)           PROTOS              Placebo               p

Gastritis                  3.6                  5.5            0.066

Gastric ulcer              1.0                  1.1              NS

Esophagitis                0.8                  0.6              NS

Diarrhea                   6.1                  3.6            0.019

                •2g of strontuim ranelate mix with a glass of water and
                drink immediately.
                •Taken before bedtime or 2-h before/after the meals

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