医学类中英文翻译

The methods of diagnosis and treatment of osteoporosis
1. What Measures Can Be Taken to Prevent Bone
Loss?
• R1. Maintain adequate calcium intake; use calcium supplements, if needed, to meet minimal required
intake (Grade A; “best evidence”level or BEL 1).
• R2. Maintain adequate vitamin D intake; supplement vitamin D, if needed, to maintain serum levels of
25-hydroxyvitamin D [25(OH)D] between 30 and 60
ng/mL (Grade A; BEL 1).
• R3. Limit alcohol intake to no more than 2 servings
per day (Grade B; BEL 2).
• R4. Limit caffeine intake (Grade C; BEL 3).
• R5. Avoid or stop smoking (Grade B; BEL 2).
• R6. Maintain an active lifestyle, including weightbearing exercises for at least 30 minutes daily (Grade
B; BEL 2).
2. What Nonpharmacologic Measures Can Be Recommended for Treatment of Osteoporosis?
All the foregoing measures plus the following:
• R7. Maintain adequate protein intake (Grade B; BEL
3).
• R8. Use proper body mechanics (Grade B; BEL 1).
• R9. Consider the use of hip protectors in individuals
with a high risk of falling (Grade B; BEL 1).
• R10. Take measures to reduce the risk of falling
(Grade B; BEL 2).
• R11. Consider referral for physical therapy and occupational therapy (Grade B; BEL 1).
3. Who Needs to Be Screened for Osteoporosis?
• R12. Women 65 years old or older (Grade B; BEL 2).
• R13. Younger postmenopausal women at increased
risk of fracture, based on a list of risk factors (see section 4.5) (Grade C; BEL 2).
4. How Is Osteoporosis Diagnosed?
• R14. Use a central dual-energy x-ray absorptiometry (DXA) measurement (Grade B; BEL 3).
• R15. In the absence of fracture, osteoporosis is defined
as a T-score of -2.5 or below in the spine (anteroposterior), femoral neck, or total hip (Grade B; BEL 2).
• R16. Osteoporosis is defined as the presence of a
fracture of the hip or spine (see section 4.4.2) (in the absence of other bone conditions) (Grade B; BEL 3).
5. How Is Osteoporosis Evaluated?
• R17. Evaluate for secondary osteoporosis (Grade B; BEL 2).
• R18. Evaluate for prevalent vertebral fractures (see section 4.7.1) (Grade B; BEL 2).
6. Who Needs Pharmacologic Therapy?
• R19. Those patients with a history of a fracture of the hip or spine (Grade A; BEL 1).
• R20. Patients without a history of fractures but with a
T-score of -2.5 or lower (Grade A; BEL 1).
• R21. Patients with a T-score between -1.0 and -2.5
if FRAX (see section 4.5) major osteoporotic fracture probability is ≥20% or hip fracture probability is ≥3% (Grade A; BEL 2).
7. What Drugs Can Be Used to Treat Osteoporosis?
Use drugs with proven antifracture efficacy:
• R22. Use alendronate, risedronate, zoledronic acid,
and denosumab as the first line of therapy (Grade A;
BEL 1).
• R23. Use ibandronate as a second-line agent (Grade A; BEL 1).
• R24. Use raloxifene as a second- or third-line agent (Grade A; BEL 1).
• R25. Use calcitonin as the last line of therapy (Grade C; BEL 2).
• R26. Use teriparatide for patients with very high fracture risk or patients in whom bisphosphonate therapy
has failed (Grade A; BEL 1).
• R27. Advise against the use of combination therapy (Grade B; BEL 2).
8. How Is Treatment Monitored?
• R28. Obtain a baseline DXA, and repeat DXA every
1 to
2 years until findings are stable. Continue with follow-up DXA every 2 years or at a less frequent
interval (Grade B; BEL 2).
• R29. Monitor changes in spine or total hip bone mineral density (BMD) (Grade C; BEL 2).
• R30. Follow-up of patients should be in the same facility, with the same machine, and, if possible, with
the same technologist (Grade B; BEL 2).
• R31. Bone turnover markers may be used at baseline
to identify patients with high bone turnover and can be used to follow the response to therapy (Grade C; BEL
2).
9. What Is Successful Treatment of Osteoporosis?
• R32. BMD is stable or increasing, and no fractures are present (Grade B; BEL 2).
• R33. For patients taking antiresorptive agents, bone turnover markers at or below the median value for premenopausal women are achieved (see section 4.9) (Grade B; BEL 2).
• R34. One fracture is not necessarily evidence of failure. Consider alternative therapy or reassessment for
secondary causes of bone loss for patients who have recurrent fractures while receiving therapy (Grade B;
BEL 2).
10. How Long Should Patients Be Treated?
• R35. For treatment with bisphosphonates, if osteoporosis
is mild, consider a “drug holiday”after 4 to 5
years of stability. If fracture risk is high, consider a
drug holiday of 1 to 2 years after 10 years of treatment (Grade B; BEL 1).
• R36. Follow BMD and bone turnover markers during
a drug holiday period, and reinitiate therapy if bone
density declines substantially, bone turnover markers increase, or a fracture occurs (Grade C; BEL 3).
11. When Should Patients Be Referred to Clinical Endocrinologists?
• R37. When a patient with normal BMD sustains a
fracture without major trauma (Grade C; BEL 4).
• R38. When recurrent fractures or continued bone loss occurs in a patient receiving therapy without obvious treatable causes of bone loss (Grade C; BEL 4).
• R39. When osteoporosis is unexpectedly severe or has unusual features (Grade C; BEL 4).
• R40. When a patient has a condition that complicates management (for example, renal failure, hyperparathyroidism, or malabsorption) (Grade C; BEL 4).
Thisfigure is taken from page 28 of
the 2011 Osteoporosis
Prevention and Treatment
Guidelines (in Japanese). a In
patients taking bisphosphonates,
measure after stopping drug for
at least 6 months, and in
patients taking other
osteoporosis drugs, measure
after stopping drug for at least
1 month. b Measure one type
each of a resorption marker and
formation marker. c Excluding
eldecalcitol. d In patients
expected to be on long-term
bisphosphonate therapy,
measure bone resorption
markers and BAP or P1NP.
Changes in the diagnosis and treatment of osteoporosis Together with significant changes in the disease concept of osteoporosis, new technology continues to be incorporated
into clinical diagnosis and treatment of osteoporosis. With
the introduction of DXA to measure BMD, more precise diagnostic criteria have been established [11]. The measurement of bone metabolic markers, approved by NHI in
routine clinical practice in the field of osteoporosis, has
allowed (1) estimation of bone turnover state at the time of measurement, (2) prediction of the rate of BMD change in
near future, (3) assessment of the effect of drug treatment,
and (4) evaluation of bone quality [10].
In addition, with the introduction into clinical practice of
various bone antiresorptive drugs which can prevent fractures based on scientific evidence, the incidence of fractures
due to osteoporosis has decreased according to
epidemiologic studies [12].
In the future, with the goal of ideal treatment to increase
bone mass, the risk of fracture or osteoporosis will be evaluated from the bone loss to decide whether to initiate
drug treatment, and strategies will be sought to maintain or increase QOL in osteoporosis and assess fracture risk in lifestyle-related diseases. In other words, there will be relentless efforts towards establishing a comprehensive
system to manage osteoporosis.
Change in views about the significance of measuring
bone metabolic markers
The significance of measuring bone metabolic markers was originally considered important as a surrogate marker for
BMD change rates, but now its significance as a means to evaluate bone quality [13] and to assess the future risk of fracture has been emphasized [14–16]. In addition, because
the newly available antiresorptive drugs markedly inhibit
bone metabolic markers, the measurement of bone metabolic markers is a useful means to assess drug efficacy [17, 18]. Although the use of bone metabolic markers now has
an important role in the daily management of osteoporosis, their use in Japan is still insufficient because of
insurance coverage limitations [19]. Since the Japan Osteoporosis Society first created the 2001 guidelines,
new bone metabolic markers have been introduced into
clinical practice. The availability of new osteoporosis treatments that promote bone formation has changed the clinical application of bone metabolic markers in current practice. Therefore, the necessity to revise the current
clinical practice led to the proposal to create these new
2012 guidelines
骨质疏松诊治方法
1. 可采取何种措施预防骨丢失？
推荐（R）1. 保持足量钙摄入；如果需要，利用钙添加剂亦最低摄入要求（A级；最佳证据水平[BEL]1）。

R2. 保持足量维生素D摄入；如果需要，添加维生素D使血清25-羟基维生素D[25(OH)D]水平保持在30~60 ng/ml之间（A级；BEL 1）。

R3. 限制酒精摄入，每日饮酒不超过2次（B级；BEL 2）。

R4. 限制咖啡摄入（C级；BEL 2）。

R5. 避免吸烟或戒烟（B级；BEL 2）。

R6. 保持活动性生活方式，包括每日至少30分钟承重锻炼（B级；BEL 2）。

2. 哪些非药物性方法可被推荐用于治疗骨质疏松？
前述方法加下述方法：
R7. 保持足量蛋白质摄入（B级；BEL 3）。

R8. 机体功能运用适当（B级；BEL 1）。

R9. 在跌倒风险较高的个体中考虑应用髋保护器（B级；BEL 1）。

R10. 采取措施降低跌倒风险（B级；BEL 2）。

R11. 考虑转诊行理疗或职业治疗（B级；BEL 1）。

3. 哪些人需要行骨质疏松筛查？
R12. 65岁以上女性（B级；BEL 2）。

R13. 基于危险因素列表，骨折风险升高的绝经后女性（C级；BEL 2）。

4. 骨质疏松如何诊断？
R14. 采用双能X线吸收（DXA）测定法（B级；BEL 3）。

R15. 无骨折时，骨质疏松被定义为脊柱、股骨颈或髋骨T评分≤-2.5（B级；BEL 2）。

R16. 无其他骨骼疾病时，骨质疏松被定义为髋骨或脊柱骨折（B级；BEL 3）。

5. 骨质疏松如何评估？
R17. 对继发性骨质疏松进行评估（B级；BEL 2）。

R18. 对椎骨骨折情况进行评估（B级；BEL 2）。

6. 哪些人需要接受药物治疗？
R19. 伴有髋骨或脊柱骨折史的患者（A级；BEL 1）。

R20. 无骨折史但T评分≤-2.5的患者（A级；BEL 1）。

R21. T评分为-1.0至-2.5之间，但FRAX严重骨质疏松性骨折概率≥20%或髋骨骨折概率≥3%的患者（A级；BEL 2）。

7. 哪些药物可用于治疗骨质疏松？
使用具有明确抗骨折效果的药物：
R22. 以阿伦膦酸盐、利塞膦酸盐、唑来膦酸和denosumab作为一线治疗药物（A级；BEL 1）。

R23. 以伊班膦酸盐作为二线药物（A级；BEL 1）。

R24. 以雷洛昔芬作为二线或三线治疗治疗药物（A级；BEL 2）。

R25. 以降钙素作为最后治疗药物（C级；BEL 2）。

R26. 使用特立帕肽治疗二膦酸盐无效的极高危骨折风险患者（A级；BEL 1）。

R27. 不建议采用联合治疗（B级；BEL 2）。

8. 治疗如何监测？
R28. 测定基线DXA，并且每1至2年重复测定DXA直至结果稳定。

其后每2年或更长的时间间隔进行DXA随访（B级；BEL 2）。

R29. 监测脊柱或髋骨骨密度（BMD）变化（C级；BEL 2）。

R30. 随访患者应由同一所医疗机构、同样的设备以及（可能时）相同的技师来实施（B 级；BEL 2）。

R31. 在基线时可应用骨转换标志物确定骨转换较高的患者，并且可用于随访治疗反应（C级；BEL 2）。

9. 何谓骨质疏松治疗成功？
R32. BMD稳定或升高，并且无骨折出现（B级；BEL 2）。

R33. 对于服用抗重吸收药物的患者，骨转换标志物水平处于绝经前女性中位值或以下（B级；BEL 2）。

R34. 骨折并非治疗失败的必需证据。

对于接受治疗时出现复发性骨折的患者，可考虑调整治疗或对骨丢失的继发性原因进行重新评估（B级；BEL 2）。

10. 患者应接受多长时间的治疗？
R35. 对于双膦酸盐治疗而言，如果骨质疏松轻微，可考虑在稳定4至5年后短期停药。

如果骨折风险较高，可考虑在治疗10年后停药1至2年（B级；BEL 1）。

R36. 在药物停用期间随访BMD和骨转换标志物，如果骨密度显著降低、骨转换标志物升高或骨折发生，则应重新启动治疗（C级；BEL 3）。

11. 何时应将患者转诊至内分泌医师？
R37. 当患者BMD正常，在无严重创伤的情况下仍出现骨折（C级；BEL 4）。

10 mg/日。

（下图是用画图工具做的）
这个图表来源于2011年骨质疏松症的预防和治疗指南(日文版)第28页。

a．服用双膦酸盐类药物患者在停药至少6个月后进行测量，服用其他骨质疏松症药物的患者在停药至少1个月后进行测量。

b．测量骨吸收标记物和形成标记物各一种。

c．不包括艾地骨化醇。

d．预计长期应用双膦酸盐治疗的患者，测量骨吸收标志物和BAP或PlNP。

骨质疏松诊断和治疗的变化
随着骨质疏松症疾病概念的更新，新的技术不断被纳入骨质疏松症的临床诊断和治疗中。

随着DxA测量BMD的引进，已经建立了更精确的诊断标准。

NHI允许在骨质疏松常规临床检查中测量骨代谢指标：(1)评估测量时的骨代谢状态，(2)预测未来近期BMD变化的速度，
(3)评估药物治疗的效果，(4)评价骨质量。

此外，随着各种可预防骨折的抗骨吸收药物引入临床实践，流行病学研究显示，骨质疏松性骨折的发生率已经有所下降。

在未来，理想治疗方法的目标是增加骨量，根据骨丢失评估骨质疏松症或骨折的风险，以决定是否开始药物治疗，策略将寻求保持或提高骨质疏松症患者的生活质量评估与生活方式有关疾病的骨折风险。

换句话说，将努力建立一个完善的骨质疏松症管理体系。

骨代谢指标测量的意义的变化
骨代谢指标测量的意义最初被认为是一种重要的BMD变化率的替代指标，但现在其意义为一种评估骨质量的手段。

和评估未来发生骨折的风险。

此外，由于新的抗骨吸收药物能明显抑制骨代谢指标，因此骨代谢指标的测量也成为一个有效的评估药物疗效的方法。

虽然现在骨代谢指标的使用在骨质疏松症的日常管理中具有重要的作用，但由于医疗保险覆盖的限制，他们的使用在日本仍然是不够的。

自从日本骨质疏松症学会第一次制定了2001年指南，新的骨代谢指标已引入临床实践。

新的促进骨形成的骨质疏松症治疗方法的应用，已经改变了骨代谢指标在目前实践中的临床应用。

因此，有必要修改目前的临床实践，提出了制定新的2012年指南的建议。