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PŘEHLEDOVÉ479422701004388130181216258306358404446
ČLÁNKY525622701003973122176223272
Farmakologická29483370100376892153187222260275314353368398433468
léčba34323370100155182120155
osteoporózy36033370100386795130169208247271310340378
a3997337010034
prevence40473370100376196132167205236270
zlomenin:43333370100304685145180218233271286
doporučení463533701003877115154179217248282320335
pro498633701003762100
klinickou51033370100335065102118148182220258
praxi53773370100376297134150
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E7564222701004174
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Vnitř3708804301074592111139166
Lék.3893804301074184122140
2024;70(2):E7-E234053804301074487128168182224265290333355369411455478521566610
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VNITŘNÍ48058043010746106127172220280301
LÉKAŘSTVÍ5128804301074084130188235279324377399
www.casopisvnitrnilekarstvi.cz42580430107651332012142542953293774274464795215705896176436927117307748128548809159449871007102310631101
https://doi.org/10.36290/vnl.2024.02843434480100376493132161177199218456044801004081994659448010015537711513747974480100287389124167204247293316355396414432470516552591609652689730
Farmakologická4259870275117234327513634761883949107512031269137014971618
léčba2120987027560179281410531
osteoporózy27289870275120224312429556684810902102811311260
a40659870275116
prevence42299870275123215334457571700801918
zlomenin:4251247027599165292478597725791919987
doporučení14891247027512425037850459672382494110701136
pro270212470275123216342
klinickou312112470275121189255383448549676799926
praxi412412470275123216335460525
Vít425163501377098138
Zikán585163501376493153212276
3.425178901335678
interní526178901332686121175211272297
klinika846178901335279104164189240293
VFN11631789013361115185
a13711789013353
1.1448178901335673
LF15441789013352105
UK,16721789013371131156
Praha1852178901335892145206258
Klinický425229801215582106164189235284336
význam7932298012148101148206256342
osteoporózy1166229801215697133184242302360395452495548
spočívá1745229801214099157204229279330
v21062298012149
nárůstu21862298012157107141198240275332
výskytu25502298012148101143192244282339
nízkotraumatických2921229801215681126175231265300350407493543577602649698750796853
zlomenin.3805229801214469127213266324348406429
Zlomeniny4265229801215681138224277335360417465
zvyšují4761229801214396149190247273297
morbiditu50902298012184142177236261320345380437
a4252438012148
mortalitu4922438012183139172209258282306339395
a9062438012148
vedou974243801214797155210266
ke1259243801214796
snížené1375243801213995118162213269320
kvalitě1714243801214798147171195228278
života2012243801214266115169203252
a22832438012148
ztrátě2351243801214279112161194243
autonomie.26142438012148103136191247303387410461482
Léčba3115243801214797143200250
osteoporózy3384243801215594129179235292349382437480530
zahrnuje3934243801214292148181237292317368
posouzení43212438012157113153208264308358414438
rizikových4778243801213357100125172226273325369424
faktorů5222243801212978126162216250306
zlomenin,425257801214266121205255311334390411
snížení855257801213994117161211266290
ovlivnitelných11642578012154101126149197254277310360384439485529584
rizikových176725780121325699123169223270321365420
faktorů2206257801212978125161215248303
prostřednictvím2528257801215690144184218250300357413436481517567592674
úpravy32212578012155112145193240291
výživy3531257801214798143167215266
a38162578012147
životního3882257801214366115169202257281338393
stylu4294257801213973123147202
a45152578012148
vedení4582257801214796154204260283
farmakologické4884257801212978111194242289343367422479503547594643
léčby425271801212475121178226
u6702718012155
pacientů7452718012157107152176227284317372
s11372718012140
vysokým1197271801214899139195244295380
rizikem1596271801213358101126173223307
zlomenin.1923271801214367123207259315339395417
Osteoporóza23602718012169109144194251309366399455497548
je2928271801212475
chronické30232718012145101134189246270316363413
onemocnění,34552718012155112163247303350406457513537559
a40342718012148
proto4102271801215690146179234
potřebuje43562718012157113147180231289345370421
dlouhodobý4797271801215680136192248304362418476523
plán5340271801215782131187
léčby425285801212475122179226
s6762858012140
individuálním741285801212480137162211236293349398422479503587
přístupem1353285801215791115155190246304356440
k18182858012147
léčbě.1890285801212475122179231251
Současné21672858012149105161207257297353405
léky2597285801212375123174
mají27962858012184133158182
osteoanabolické3003285801215595130180237287343392450506531555601648698
účinky37272858012155101124181228280
nebo40322858012155107165221
a/nebo4279285801214884138190248304
snižují4609285801213995119163219244268
kostní49022858012147102142177233257
resorpci5184285801213384124180214273319343
a4252998012148
dramaticky494299801215690139223272306330376423474
snižují989299801213995120163219244268
výskyt12772998012149100141188240277
zlomenin.1575299801214267123208259316340396418
U20142998012165
osob2099299801215595151209
s23292998012139
vysokým2389299801214899140196245296381
rizikem2790299801213358102126174224308
zlomeniny3119299801214267123208259316340396443
je3582299801212476
poměr36782998012157114199250284
přínosu3982299801215791115172228268323
oproti43262998012155113147202236260
rizikům4607299801213257101125173229313
léčby4941299801212374121178226
příznivý5187299801215791115159216240289341
až425313801214892
po5443138012157114
dobu6853138012157113171227
10939313801215199
let1065313801212475110
při1202313801215690115
léčbě1344313801212375121179230
aminobisfosfonáty16013138012149133157213269327352392423479520551607664712746797
nebo24253138012155107165222
denosumabem.26743138012156107164220260316400449507559643665
Léčba3366313801214898145202252
denosumabem36453138012157108165221261316401450507559644
ale4316313801214872124
nesmí44673138012155107147231255
být47493138012157105142
přerušena4918313801215791141175232272323380429
bez53743138012157109153
zahájení425327801214394150199224275332356
alternativní804327801214873107157191248297330354404461485
léčby,1312327801212475122179227244
aby15793278012149106154
se1756327801214091
zabránilo1871327801214293151185234291315339395
rychlé2290327801213284129185209261
ztrátě2574327801214379113163196246
BMD28443278012154135203
a30713278012148
zvýšení3142327801214395147187239295319
rizika3485327801213257101125173223
zlomenin3732327801214267123208259316340396
obratlů.41523278012155113147196230254310331
U45073278012164
osob4595327801215595151209
s48283278012139
velmi4891327801214898123207231
vysokým51463278012148100140196245296381
rizikem425341801213358102127175226311
zlomeniny767341801214368125210262320344401448
je1246341801212476
třeba1353341801213367118177227
zvážit1611341801214396146190215250
v18913418012149
1.1971341801215169
volbě20703418012149104130188240
osteoanabolickou2341341801215596132182240290347397455512538562608656712769
léčbu3140341801212476123181238
teriparatidem3409341801213384118143202252286336370394452504590
nebo40293418012156108167224
romosozumabem.4284341801213389175232272329373429514564622675760783
Vzhledem50983418012156100157181233292344430
k4253558012147
tomu,493355801213388173229251
že765355801214394
délka8803558012157108133181231
léčby1132355801212475122179227
těmito1380355801213383168192226281
léky1683355801212374123174
je1878355801212576
omezena19763558012154139191235286343392
na23893558012156105
12–242515355801215196145193242
měsíců,27793558012183134175199244300322
musí31223558012184139180203
vždy3347355801214894151200
navázat35683558012156105152202246297330
antiresorpční39203558012148104138162195246286343376435481538562
léky.4503355801212475123175192
Včasná4716355801215699149189245294
diagnostika5032355801215680129186242298339374398445495
a4253698012148
léčba496369801212475122179229
osteoporózy748369801215595130181237296352386442485536
dramaticky1307369801215690139224273306330376423475
snižuje1805369801214096120163219244296
výskyt2124369801214899140188239276
zlomenin2424369801214267123208259316340396
a28443698012148
umožní29153698012155139195239295319
zachovat3257369801214394140196252300350383
mobilitu,36633698012184140198223247271305361383
autonomii40693698012148104138193250306390415439
a45313698012148
kvalitu4602369801214799149173197231287
života.4913369801214267116171205255277
Klíčová425386501246190118163221273326
slova:771386501244472131183236261
osteoporóza,1054386801215594128177233290346379434475525546
riziko162238680121325699122169222
zlomenin,1866386801214266121205255311334389410
antiresorpční22973868012149104136159192241281336369426472527550
a28683868012149
osteoanabolické2938386801215594128177233282337385442497521544589636684
léky.3644386801212374121171188
Pharmacological4254120015073141205255355419473539574641709744797862897
treatment1360412001504696159224271373436504552
of19504120015066114
osteoporosis21024120015066121168230298366433482550605639694
and28354120015063132200
prevention30744120015067116179245306374422457524592
of37044120015066114
fractures:3856412001504796159213261329378441497533
recommendations44274120015048111165231331432495564633697745780847915970
for4254260015047114163
clinical626426001505388122190225278343378
practice10424260015067116179233281316369432
The4254458012150107157
clinical61144580121456891146170215264287
significance927445801213962118174197227253298347403448497
of1452445801215685
osteoporosis1565445801215595129178234292348381436475498538
lies213144580121244797137
in2296445801212479
the2404445801213388139
low-trauma2571445801212479153184218250299354438486
fractures3085445801213063112157193248280330370
that3484445801213388136169
arise.3681445801214981105144195215
Fractures3925445801214979128173208263296346386
lead4339445801212474123180
to4547445801213388
increased4663445801212379124157207255294345403
morbidity,50944458012184139172230253310334367417433
excess425459801215097141190229269
mortality,7144598012183138171207256279302335385401
decreased11354598012157107153185235283322373430
quality15854598012156111159182205238288
of1893459801215584
life199745980121244776126
and21434598012149104161
loss2324459801212378118157
of2501459801215584
autonomy.26054598012148103136190245301384430446
Management30714598012181129185232288339422473528561
of3652459801215584
osteoporosis3756459801215594128177233290346379433473496535
involves4311459801212378125179203251300339
assessing4670459801214988127177217256279334390
risk508045980121335695142
factors5242459801212978123158212245286
for425473801212984117
fracture,560473801212962111156191246278328348
reducing926473801213282139194239262317373
modifiable13174738012183138195218248274321378402452
risk178747380121335695142
factors1947473801212978123158212245285
through2250473801213388120175230286341
dietary2609473801215780130163212244295
and29224738012148103159
lifestyle309947380121244776126166200249273324
changes,3441473801214499147202258309348369
and38284738012148103160
the4006473801213388138
use4162473801215594145
of4325473801215584
pharmacologic44274738012156112160193276324369423447502558581626
therapy5071473801213388138171220276322
for5411473801213085117
patients4254878012157105137159209264296336
at779487801214779
significant876487801213962117172194223249293342396428
risk132248780121325594140
of1479487801215584
fractures.1580487801212962110154189243275325364385
Osteoporosis19824878012169108141190245302357389443482504543
is2543487801212361
a26224878012148
chronic2687487801214599131185240263307
condition3012487801214497152208231264286341396
and34254878012148103159
therefore3601487801213388138170219249303336385
needs40034878012155105156212251
a42724878012147
long-term4337487801212378133188220253301334417
management47714878012183131185233288338420470526557
plan5346487801215680127182
with425501801217497130186
a6345018012148
personalized7065018012157108141181236292340364387429479537
approach12665018012148105162195250298343398
to1688501801213387
treatment.1799501801213365115163196279329385417439
Current22615018012158111144177227282315
medications25995018012184134192215260308341364419475514
build31365018012157112136159215
bone33755018012157113168219
and/or36175018012149104160196246279
decrease39205018012156106152185234282322372
bone43165018012157112168218
breakdown4558501801215790140188235290345418474
and50555018012149104161
reduce5239501801213383140195240289
incident425515801212379124147203253309341
fractures.791515801212963111156191246279329368389
In1205515801212479
individuals1309515801212479135158207231287342390413452
at1786515801214881
high1892515801215578134189
risk210651580121335695142
of2273515801215584
fracture,2381515801213063112156192247279329349
the2754515801213489139
benefit29185158012157108163214244270303
versus3246515801214897130170224264
risk353451580121335796142
profile3701515801215790144174200223273
is3999515801212363
likely408651580121244793142166214
to4324515801213488
be44365158012157108
favourable4569515801212978125178234266315371396446
for5040515801212984117
up51815158012156112
to5318515801213387
105430515801215198
years425529801214796144177217
of662529801215584
treatment766529801213366116164196279330386418
with1204529801217397130185
bisphosphonates1409529801215781120176232287327383439494550598630680719
or2148529801215588
denosumab.22555298012157107163218257312395443500519
However,27945298012165121194243291340373389
denosumab32035298012156107162217257311394442499
should3722529801213995150205228285
not40275298012155111143
be41905298012157108
stopped4318529801213973127185242293350
without4688529801217397130185240296329
considering5037529801214598154193216272323356379434491
alternative425543801214872104154186242290322345394443
treatment886543801213365115163195278329384416
in1320543801212479
order1417543801215587143194226
to1661543801213387
prevent1766543801215790140187236292324
rapid2108543801213381138161218
BMD23435438012155135202
loss2563543801212378117156
and27375438012148104160
a29155438012148
potential29815438012157113145195250282305353377
rebound3375543801213383140195251306362
in3755543801212479
vertebral3852543801214897129165214271304353376
fracture4246543801212963111156191246278328
risk.459254380121325695141164
In4774543801212479
people48715438012157108164221245295
at5184543801214880
a52825438012148
very5348543801214897130181
high425557801215578134189
risk63255780121335695142
of791557801215584
fracture,893557801212963111156191246278328348
therapy1258557801213388139171220276323
with1598557801217497130185
teriparatide1801557801213382115139195244276324357380436486
or2305557801215588
romosozumab2410557801213388171226265320362417500548604
should3032557801214095150205228284
be33345578012157108
considered3460557801214598154193215272322355404461
in3939557801212479
the4036557801213388138
first419255780121295587127161
choice;43715578012145100155178223271291
however,46805578012155110183232279328361377
since5075557801213962117162211
treatment53045578012133651151631954255718012183134190222
duration6715718012157111144192225248303359
with1054571801217497130186
these1264571801213388138178228
drugs1517571801215689144200239
is1781571801212362
restricted1867571801213383122156189212257292342399
to2290571801213387
12–242402571801215195143189238
months,26645718012184139194227282321342
treatment3030571801213366116164196280330386418
should3472571801214095150206229286
be37825718012157108
continued3914571801214598154187210265319370427
with4365571801217498131186
an45755718012148104
antiresorptive47035718012148103136159191241280336369426459482530579
drug.5307571801215689144200221
Early425585801214998131154202
diagnosis651585801215780128184239294333356395
and10715858012148104160
appropriate12565858012148105162195249307339363411443493
management17735858012184132187235291341425475531563
of2361585801215584
skeletal2470585801213986135159209243292315
fragility2810585801212963111167190213236269319
can3154585801214593149
dramatically3327585801215789138221269302325369418442465512
reduce3864585801213282140194239288
fractures,4177585801212963111156191246279329368389
and45915858012148103160
preserve4776585801215689139179229262313362
mobility,51635858012183139196219243266299349365
autonomy,4255998012148103136190246301384430446
and8925998012148104160
quality10735998012157112160183206239289
of1383599801215584
life.148859980121244776127147
Key4256165012461113164
words:6106165012475133171232276302
osteoporosis,933616801215594128177233290346379434473496535556
fracture1510616801212963111156191246279329
risk,186061680121335695142165
antiresorptive20466168012148104136159192241281336369426459482531580
and26476168012148103160
osteoanabolic2828616801215594128178233282337385442498522545590
drugs.3439616801215689144200239261
Úvod4256614013874137198262
Osteoporotické565678301076297127171222273324352401429449490529574
zlomeniny1167678301073757107183229279298347387
jsou1582678301072054103153
spojeny1763678301073485136156201251290
se2081678301073480
zhoršenou2189678301073787137165200246296346395
kvalitou2612678301073984127147166195243293
života,425692301073757100149178221237
zvýšenou690692301073783128163208258309358
morbiditou10766923010776126154206226277297326374424
a15286923010742
v15986923010741
případě166769230107517999150194245290
zlomenin1985692301073758108184230280300349
obratlů,23626923010749101129172201221270286
pánve2676692301075194144185229
a30476643010740
kyčle3103664301073779117135177
i32966643010718
se3330664301073375
zvýšenou3421664301073578120153195242289336
mortalitou37736643010772119145175215233251278323370
(1).41586643010724627991
Předpokládá4265664301074469110159207255292312351399439
se,471966430107337690
že4824664301073677
stárnutí4917664301073361101126174220247265
populace5197664301074997146193211250289330
povede3047678301075099139182232276
k33466783010738
nárůstu3406678301074889115163196225273
počtu3701678301075099140170218
osteoporotických3942678301074781110152201252301328375402421461499542581629
zlomenin4594678301073655104178222270289337
do4953678301074997
roku5072678301072774112161
20305255678301074487128172
až5449678301074178
o30476923010748
233118692301074387
%32286923010766
(2).331769230107246789102
Osteoporóza3442692301076094123166215265314341388423466
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