ガイドライン2004

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きゅうたかりこめ
6 years ago
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1 GUIDELINE NIH 1) compromized bone strength bone mineral densitybmdbone quality 2,3) BMDBMD 4) 2 BMD DXA 5) 11(191)

2 6) QOL 3 BMD 7) 810) 11,12) 13) 1416) ) ) BMD 2 BMD BMD NIH 1) 12(192)

3 12004 BMD I 3 II. 1 DPD 1DPD DPD I 13(193)

4 1I I N NTX I C CTX DPDNTXCTX 1990 I DPD NTX DPD TM TM ELISA 2003 CTX TM DPD NTXCTXNTX NTx TM ALP ALP 14(194)

5 2 I 3 ALP50 50BAP BAP BAP BAP TM EIA TM IRMA 15(195)

6 61 CTX I N PINP 1 III. BMD BMD QOL BMD BMDQOL 19,20) BMD 21) BMD BMD 16(196)

7 22) IV. 1 DPDNTXCTX CTX NTXPINPBAP DPDNTXCTX 1 6wash out 2 18,23) 24) 1.96SD SD 3 17(197)

8 SD DPDNTXCTX SERM) D 3 18(198)

9 4 4 6 SERM (199)

10 5 minimum significant change: MSC SERM DPDNTXCTXBAPPINP 26,27) DPD 11,28) minimum significant changemsc MSC MSC 6 DPD NTX CTXBAPPINP K 2 (ucoc) 20(200)

11 5 NTX MSC NTX nmolbce/mmolcr 2 DPDNTXCTX BAPPINP MSC 5 NTX V. BAP, DPD, NTXCTX 21(201)

12 29,30 2,7 22(202)

13 1) NIH Consensus Development Panel on Osteoporosis Prevention. Diagnosis and Therapy. JAMA 2001;285: ) Weinstein RS. True strength. J Bone Miner Res 2000;15: ) Chesnut III CH, Rosen CJ for the Bone Quality Discussion Group. Reconsidering the effects of antiresorptive therapies in reducing osteoporotic fracture. J Bone Miner Res 2001;16: ) Marcus R, Wong M, Heath III H, et al. Antiresorptive treatment of postmenopausal osteoporosis: comparison of study designs and outcomes in large clinical trials with fracture as an endpoint. Endocrine Rev 2002;23: ) Orimo H, Hayashi Y, Fukunaga M, et al. Diagnostic criteria for primary osteoporosis: year 2000 revision. J Bone Miner Metab 2001;19: ) Cummings SR, Karpf DB, Harris F, et al. Improvement of spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med 2002;112: ) Heaney RP. Is the paradigm shifting? Bone 2003;33: ) Garnero P, Hausherr E, Chapuy MC, et al. Markers of bone resorption predict hip fracture in elderly women; EPIDOS prospective study. J Bone Mineral Res 1996;11: ) Garnero P, Sornay Rendu E, Claustrar B, et al. Biochemical markers of bone turnover, endogenous hormones and the risk of fracture in postmenpausal women: the OFELY study. J Bone Miner Res 200;15: ) Ross PD, Kress BC, Parson RE, et al. Serum bone alkaline phosphatase and calcaneus bone density predict fractures; a prospective study. Osteoporos Int 2000;11: ) Shiraki M, Kushida K, Fukunaga M for the Alendronate Phase Osteoporosis Research Group. A double masked multicenter comparative study between alendronate and alfacalcidol in Japanese patients with osteoporosis. Osteoporos Int 1999;10: ) Morii H, Ohashi Y, Taketani Y, et al. Effect of raloxifene on bone mineral density and biochemical markers of bone turnover in Japanese postmenopausal women with osteoporosis: results from a randomized placebo controlled trial. Osteoporos Int 2003;14: ). Osteoporosis Jpn 2003;11: ) Miller PD, Baran DT, Bilezikian JP, et al. Practical clinical application of biochemical markers of bone turnover: consensus of an expert panel. J Clin Densitom 1999;2: ) Delmas PD, Eastell R, Garnero P et al. A position paper on the use of biochemical markers of bone turnover in osteoporosis. Osteoporos Int 2000;10 (Suppl.6):S ) Looker A, Bauer DC, Chesnut C III et al. Clinical use of biochemical markers of bone remodeling: current status, future directions. Osteoporos Int 2000;11: ) Osteoporosis Jpn 2001;9: ) Osteoporosis Jpn 2002;10: ) Bjarnason NH, Sarker S, Duong T, et al. Six and twelve month changes in bone turnover are related to reduction in vertebral fracture risk during 3 years of raloxifene treatment in postmenpausal osteoporosis. Osteoporos Int 2001;12: ) Eastell R, Barton I, Hannon RA, et al. Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate. J Bone Miner Res 2003;18: ) Delmas PD, Seeman E. Changes in bone mineral density explain little of the reduction in vertebral or nonvertebral fracture risk with anti resorptive therapy. Bone (in press), ) Delmas PD, Vrijens B, Roux C, et al. A reinforcement message based on bone turnover marker response influences long term persistence with risedronate in osteoporosis: IMPACT study. J Bone Miner Res 2003;18(Suppl 2):S ). I N NTX I N PINP. Osteoporosis Jpn 2002;10: ). 23(203)

14 Osteoporosis Jpn 2003;11: ) Clinical Calcium 2001;11: ). 2001;19:63. 27). I N PINP I N (PINP). Osteoporosis Jpn 2004;12: ) Greenspan SL, Parker RA, Ferguson L, et al. Early changes in biochemical markers of bone turnover predict the long term response to alendronate therapy in representative elderly women: a randomized clinical trial. J Bone Miner Res 1998;13: ) Eastell R, Brainbridge PR. Bone turnover markers: their place in the investigation of osteoporosis. In: Osteoporosis: Pathophysiology and clinical management (eds by Orwoll ES, Bliziotes M). Humana Press Totowa, NJ, pp ) ;50: ) Osteoporosis Jpn 2004;12: (204)

15 1 IOF 1 K Gla BGPbone gla protein N IOF BGP OC OC GlaGlaundercarboxylated osteocalcin uncarboxylated osteocalcin CSA IOF ucoc 2 ALP 25(205)

16 ALP ALP CSA IOF ALP BAP 3I I IN C II I N PINP I C PICP HypPYD DPD I N C I N NTXNTX I I I C CTXCTX I I MMPIC I C CSA IOFCTX MMPICTP 5 ACP TRACP5a 5b5b TRACP 5b 26(206)

17 2MSC 3 27(207)

32 1 BRONJ BRONJ II BRONJ BRONJ 4 BP BRONJ 6 1 III BP BRONJ

32 1 BRONJ BRONJ II BRONJ BRONJ 4 BP BRONJ 6 1 III BP BRONJ 29 1 31 40 2014 31 Bisphosphonate related osteonecrosis of jaw; BRONJ 2008 4 2012 3 36 98 8 11 19 BRONJ 0 13 2 5 3 1 1 0 BP 4 15 10 5 α-streptococcus 0 BRONJ BRONJ BP I Paget 1 409-3898 1110 2014 1 27