Læknablaðið - 15.02.2002, Síða 18

FRÆÐIGREINAR / BEINÞYNNING
Meðhöndla aðra áhættuþætti
(tafla II og III)
Barksterameðferöin
er þegar hafin
Akvörðun um að hefja
meðferð með barksterum
DEXA-mæling í
upphafl meöferöar
(tafla IV)
DEXA-mæling
(tafla IV)
Bisfosfónöt
(tafla V)
Forvörn
eöa meðferð
(tafla VI)
Ihuga
bisfosfónöt
ja
DEXA-mæling
> 3% beintap á ári

ef barksterameðferö
er haldið áfram
Staöreyndir
- sterar og bein ■
(tafla I)
WHO T-gildi
Beingisnun -1,0 til -2,5
Beinþynning < -2,5
ATH ef barksterameöferð
beinþynning viö T-gildi < -1,5
Sérhæfö lyfjameðferð
ef T-gildi er < -1,5
Lífsstíll
Kalk og D-vítamín
Hormónauppbótarmeðferð
Endurmeta steraskammta
ja
Endurskoöa meöferö
Endurtekin DEXA-mæling
Meöhöndlun samkvæmt
almennum ráðleggingum
um beinþynningu
18. Consensus Development Conference. Diagnosis, prophylaxis,
and treatment of osteoporosis. Am J Med 1992; 6: 852-7.
19. Homik J, Suarez-Almazor ME, Shea B, Cranney A, Wells G, et
al. Calcium and vitamin D for corticosteroid-induced osteo-
porosis (Cochrane Review). In: The Cochrane Library, 3,
2001. Oxford: Update Software
20. Sambrook P, Birmingham J, Kelly P, Kempler S, Nguyen T,
Pocock N, et al. Prevention of corticsosteroid osteoporosis: A
comparison of calcium, calcitriol and calcitonin. N Engl J Med
1993; 328:1747-52.
21. Saag KG, Emkey R, Schnitzer TJ, Brown JP, Hawkins F,
Goemaere S, et al. Alendronate for the prevention and treat-
ment of glucocorticoid-induced osteoporosis. Glucocorticoid-
induced Osteoporosis Intervention Study Group. N Engl J
Med 1998; 339: 292-9.
22. Adachi JD, Bensen WG, Brown J, Hanley D, Hodsman A,
Josse R, et al. Intermittent cyclical etidronate therapy in the
prevention of corticosteroid-induced osteoporosis. N Engl J
Med 1997; 337: 382-7.
23. Cohen S, Levy RM, Keller M, Boling E, Emkey RD, Green-
wald M, et al. Risedronate therapy prevents corticosteroid-
induced bone loss: a twelve-month, multicenter, randomized,
double-blind, placebo-controlled, parallel-group study. Arth-
ritis Rheum 1999; 42: 2309-18.
24. Boutsen Y, Jamart J, Esselinckx W, Stoffel M, Devogelaer J.
Primary prevention of glucoocorticoid-induced osteoporosis
with internmittent intravenous pamindronate: A randomised
trial. Calcif Tissue Int 1997; 61: 266-71.
25. Homik J, Cranney A, Shea B, Tugwell P, Wells G, Adachi R, et
al. Bisphosphonates for steroid induced osteoporosis.
[systematic review] Cochrane Musculoskeletal Group.
Cochrane Database of Systematic Reviews 2001; 3.
26. Wallach S, Cohen S, Reid DM, Hughes RA, Hosking DJ, Laan
RF, et al: Efffects of risedronate treatment on bone density
and vertibral fracture in patients on corticosteroid therapy.
Calcif tissue Int 2000; 67: 277-85.
27. Adachi JD, Saag KG, Delmas PD, Liberman UA, Emkey RD.
Seeman E, et al: Two-year effects of alendronate on bone
mineral density and vertbral fracture in patients receiving
glucocorticosteroids: A randomized, double-blind, placebo-
controlled extension trial. Arthritis Rheum 2001; 44: 202-11.
28. Lukert BP, Johnson BE, Robinson RG. Estrogen and proges-
terone replacement therapy reduces glucocorticoid-induced
bone loss. J Bone Miner Res 1992: 7; 1063-9.
29. Hall GM, Daniels M, Doyle DV, Spector TD. Effect of
hormone replacement therapy on bone mass in rheumatoid
arthritis patients treated with and without steroids. Arthritis
Rheum 1994; 37: 1499-505.
30. Reid IR, Wattie DJ, Evans MC, Stapleton JP. Testosterone
therapy in glucocorticoid - treated men. Arch Int Med 1996;
156:1173-7.
31. Cranney A, Welch V, Adachi JD, Homik J, Shea B, Suarez-
Almazor ME, et al. Calcitonin for preventing and treating
corticosteroid-induced osteoporosis (Cochrane Review). The
Cochrane Library 2001; 3.
32. LaCroix AZ, Ott SM, Ichikawa L, Scholes D, Barlow WE.
Low-dose hydrochlorothiazide and preservation of bone
mineral density in older adults. A randomized, double-blind,
placebo-controlled trial. Ann Intern Med 2000; 133: 516-26.
33. Lane NE, Roe B, Genant HK, Arnaud C. Parathyroid hor-
mone treatment reverses glucocorticoid-induced osteoporosis:
results of a randomized controlled trial. J Clin Invest 1998;
102:1627-33.
34. Schnitzer T, Bone HG, Crepaldi G, Adami S, McClung M, Kiel
D, et al. Therapeutic equivalence of alendronate 70 mg once-
weekly and alendronate 10 mg daily in the treatment of
osteoporosis. Alendronate Once-Weekly Study Group. Aging
(Milano). 2000; 12:1-12.
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