〜かかりつけ医でみる〜 骨粗鬆症Q&A

出版社: 先端医学社
著者:
発行日: 2010-01-15
分野: 臨床医学:外科  >  整形外科学
ISBN: 9784884076122
電子書籍版: 2010-01-15 (第1版第1刷)
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本書では、実診療に即した問いかけに対し、骨粗鬆症、骨代謝学の第一線の専門家が全40項目の「Q&A」形式で実践的にわかりやすく解説している。すべてのかかりつけ医の診療机に置いておきたい一冊。

目次

  • 〜かかりつけ医でみる〜 骨粗鬆症Q&A

    ―目次―

    Part 1 骨粗鬆症の現状とその課題をみる
     Q.1 骨粗鬆症とはどのような疾患か最新の
        定義について教えてください.
       また,わが国の骨粗鬆症の患者さんは
        どのくらいいるか教えてください.
     Q.2 骨粗鬆症の患者さんは女性が多いとのことですが,女性
        骨粗鬆症と男性骨粗鬆症の違いについて教えてください.
     Q.3 かかりつけ医が骨粗鬆症の積極的治療・薬物介入をする
        ことにはどのような意義がありますか?
        日常生活における QOL 向上の視点から教えてください.

    Part 2 骨粗鬆症の病態と診断をみる
     Q.4 近年,CKD−MBD という概念が提唱されていますが,慢性
        腎臓病が骨粗鬆症に与える影響について教えてください.
     Q.5 糖尿病と骨粗鬆症発症に関連性はありますか?
        糖尿病が骨代謝に与える影響について教えてください.
     Q.6 飲酒・喫煙などの生活習慣と骨粗鬆症や骨折の発生に
        関連性はありますか?また,骨粗鬆症にならないために
        どのような生活習慣に気をつければよいか教えてください.
     ほか

    Part 3 骨粗鬆症の治療戦略を探る
     Q.14 『骨粗鬆症の予防と治療ガイドライン 2006 年版』での
        骨粗鬆症の治療開始基準とその根拠を教えてください.
     Q.15 骨粗鬆症の治療時に避けたほうがよい食物などは
        ありますか?また,積極的に摂取したほうがよい食物など
        があれば教えてください.
     Q.16 骨粗鬆症患者さんに対する運動療法はどのように
        すすめればよいか教えてください.
     Q.17 骨粗鬆症患者さんに対する治療薬の選択について
        教えてください.
     ほか

    Part 4 治療に注意を要する骨粗鬆症患者さんの治療戦略を探る
     Q.25 甲状腺機能亢進症を合併した骨粗鬆症患者さんに対する
        治療法・治療薬の選択について教えてください.
     Q.26 骨粗鬆症治療において,関節リウマチ・呼吸器疾患等で
        長期間ステロイドを使用している患者さんへの
        注意点・治療戦略について教えてください.
     Q.27 糖尿病を伴った患者さんの治療法に注意点はありますか?
        また,生活習慣指導で気をつけるべき点がありましたら
         教えてください.
     Q.28 慢性腎臓病を合併する骨粗鬆症患者さんへの
        治療法・治療薬の選択について教えてください.
     ほか

    Part 5 きめの細かい服薬指導のために知識を得る
     Q.32 処方薬の有効性,安全性をどのように服薬指導のなかで
        伝えたらよいか教えてください.
     Q.33 ビスフォスフォネート製剤服用時に起こりうる副作用
        としてどのようなものがあるか教えてください.
        また,週 1 回製剤と 1 日 1 回製剤では副作用の発現に
        差はあるか教えてください.
     Q.34 ステロイド性骨粗鬆症の服薬指導で注意すべき点を
        教えてください.
     Q.35 骨粗鬆症患者さんへ薬物治療を開始する際の説明ポイント
        は何か教えてください.
        また,自己判断で服薬を中断する患者さんへの
        対処方法を教えてください.

    Part 6 骨粗鬆症治療における各科の役割を探る
     Q.36 ビスフォスフォネート系薬剤関連顎骨壊死(BRONJ)
        について教えてください.
        また,医科・歯科の連携はどのようにおこなえばよいか
        教えてください.
     Q.37 骨粗鬆症患者さんは,さまざまな生活習慣病を伴っている
        ことが多いとのことですが,骨粗鬆症患者さんの内科診療
        における課題について教えてください.
     Q.38 骨粗鬆症患者さんを診察する医師の大半が整形外科医で
        あるといわれていますが,整形外科での課題と他科との
        連携について教えてください.
     Q.39 骨粗鬆症治療における産婦人科の果たす役割と
        ライフスタイルの管理の重要性について教えてください.
     Q.40 大腿骨近位部骨折のクリティカルパスについて,
        現在どのような取り組みがなされているか教えてください.

この書籍の参考文献

参考文献のリンクは、リンク先の都合等により正しく表示されない場合がありますので、あらかじめご了承下さい。

本参考文献は電子書籍掲載内容を元にしております。

[Part1] 骨粗鬆症の現状とその課題をみる

P.13 掲載の参考文献
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[Part2] 骨粗鬆症の病態と診断をみる

P.27 掲載の参考文献
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2) Nickolas TL, McMahon DJ, Shane E et al:Relationship between moderate to severe kidney disease and hip fracture in the United States. J Am Soc Nephrol 17:3223-3232, 2006
3) Coresh J, Astor BC, Greene T et al:Prevalence of chronic kidney disease and decreased kidney func-tion in the adult US population:Third National health and Nutrition Examination Survey. Am J Kidney Dis 41:1-12, 2003
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1) Vestergaard P:Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes--a meta-analysis. Osteoporos Int 18:427-444, 2007
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3) Yamamoto M, Yamaguchi T, Yamauchi M et al:Bone mineral density is not sensitive enough to assess the risk of vertebral fractures in type 2 diabetic women. Calcif Tissue Int 80:353-358, 2007
4) Saito M, Fujii K, Mori Y et al:Role of collagen enzymatic and glycation induced cross-links as a determi-nant of bone quality in spontaneously diabetic WBN/Kob rats. Osteoporos Int 17:1514-1523, 2006
5) 山本昌弘, 山内美香, 矢野彰三ほか:閉経後2型糖尿病患者におけるHip structure analysisによる大腿骨皮質骨構造の解析(第一報). Osteoporosis Jpn 16(Suppl 1):133, 2008
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4) 骨粗鬆症による骨折の危険因子. 骨粗鬆症の予防と治療ガイドライン2006年版, 骨粗鬆症の予防と治療ガイドライン作成委員会編, ライフサイエンス出版, 東京, 2006, pp.34-35
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P.45 掲載の参考文献
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3) Green AD, Colon-Emeric CS, Bastian L et al:Does this woman have osteoporosis? JAMA 292:2890-2900, 2004
4) Koh LKH, Sedrine WB, Torralba TP et al:A simple tool to indentify Asian women at increased risk of osteoporosis. Osteoporos Int 12:699-705, 2001
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P.50 掲載の参考文献
1) 高柳涼一, 大中佳三:グルココルチコイドの骨代謝作用機構. 骨粗鬆症治療 5:10-15, 2006
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5) Lane NE, Yao W, Balooch M et al:Glucocorticoid-treated mice have localized changes in trabecular bone material properties and osteocyte lacunar size that are not observed in placebo-treated or estro-gen-deficient mice. J Bone Miner Res 21:466-476, 2006
6) Yao W, Cheng Z, Pham A et al:Glucocorticoid-induced bone loss in mice can be reversed by the actions of parathyroid hormone and risedronate on different pathways for bone formation and mineralization. Arthritis Rheum 58:3485-3497, 2008
7) Hofbauer LC, Zeitz U, Schoppet M et al:Prevention of glucocorticoid-induced bone loss in mice by inhi-bition of RANKL. Arthritis Rheum 60:1427-1437, 2009
P.53 掲載の参考文献
1) 折茂 肇, 林 泰史, 福永仁夫ほか:原発性骨粗鬆症の診断基準(2000年度改訂版). 日骨代謝会誌 18:76-82, 2001
2) Nawata H, Soen S, Takayanagi R et al:Subcommittee to Study Diagnostic Criteria for Glucocorticoid-Induced Osteoporosis:Guidelines on the management and treatment of glucocorticoid-induced osteo-porosis of the Japanese Society for Bone and Mineral Research(2004). J Bone Miner Metab 23:105-109, 2005
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P.59 掲載の参考文献
1) NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy:Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785-795, 2001
2) 骨粗鬆症の予防と治療のガイドライン2006年版, 骨粗鬆症の予防と治療ガイドライン作成委員会編, ライフサイエンス出版, 東京, 2006
3) Green AD, Colon-Emeric CS, Bastian L et al:Does this woman have osteoporosis? JAMA 292:2890-2900, 2004
P.64 掲載の参考文献
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9) Chestnut CH III, Majumdar S, Newitt DC et al:Effects of salmon calcitonin on trabecular microarchitec-ture as determined by magnetic resonsnce imaging:results from the QUEST study. J Bone Miner Res 20:1548-1561, 2005
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P.67 掲載の参考文献
1) Kanis JA, Borgstrom F, De Laet C et al:Assessment of fracture risk. Osteoporos Int 16:581-589, 2005
2) Fujiwara S, Nakamura T, Orimo H et al:Development of application of a Japanese model of the WHO fracture risk assessment tool(FRAX(TM)). Osteoporos Int 19:429-435, 2008
3) Kanis JA, Oden A, Johnell O et al:The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18:1033-1046, 2007

[Part3] 骨粗鬆症の治療戦略を探る

P.74 掲載の参考文献
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P.89 掲載の参考文献
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P.94 掲載の参考文献
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2) 竹内靖博:骨粗鬆症患者の専門医への紹介のタイミング. 日医師会誌 136:312, 2007
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P.98 掲載の参考文献
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11) Wells GA, Cranney A, Peterson J et al:Risedronate for the primary and secondary prevention of osteo-porotic fractures in postmenopausal women. Cochrane Database Syst Rev(1):CD004523, 2008
12) Matsumoto T, Hagino H, Shiraki M et al:Effect of daily oral minodronate on vertebral fractures in Japa-nese postmenopausal women with established osteoporosis:a randomized placebo-controlled double-blind study. Osteoporos Int 20:1429-1437, 2009
P.103 掲載の参考文献
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P.107 掲載の参考文献
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P.111 掲載の参考文献
1) 中村利孝:骨粗しょう薬物治療におけるビスフォスフォネート治療の位置づけ. Med Sci Digest 31:388-391, 2005
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P.115 掲載の参考文献
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[Part4] 治療に注意を要する骨粗鬆症患者さんの治療戦略を探る

P.126 掲載の参考文献
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6) Nawata H, Soen S, Takayanagi R et al;Subcommittee to Study Diagnostic Criteria for Glucocorticoid-Induced Osteoporosis:Guidelines on the management and treatment of glucocorticoid-induced osteo-porosis of the Japanese Society for Bone and Mineral Research(2004). J Bone Miner Metab 23:105-109, 2005
7) 大島久二, 田中郁子:ステロイド性骨粗鬆症とその管理--SERMを含めて. 産婦治療 94:935-939, 2007
8) 大島久二:ステロイド性骨粗鬆症と骨代謝マーカー. リウマチ科 29:406-411, 2003
9) 大島久二, 田中郁子:ステロイド薬は関節リウマチに使用すべきか. medicina 42:800-802, 2005
10)大島久二, 田中郁子:ステロイド使い方のコツ--内服剤の使い方. 研修医のためのステロイドの使い方のコツ, 川合眞一編, 文光堂, 東京, 2009, pp.20-31
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1) 岡崎亮:糖尿病と骨粗鬆症. 治療 91:1871-1875, 2009
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[Part5] きめの細かい服薬指導のために知識を得る

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[Part6] 骨粗鬆症治療における各科の役割を探る

P.178 掲載の参考文献
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