骨粗鬆症リエゾンサービスによる骨折一次予防

Osteoporosis Liaison Service. Primary fracture prevention through the Osteoporosis Liaison Service.

　脆弱性骨折一次予防には，地域・社会での骨粗鬆症リエゾンサービスの提供が重要である。具体的には，骨粗鬆症の予防，教育，啓発，検査機会の提供，患者早期発見などがある。中でも患者早期発見には検診が有用であるが，低い実施率，受診率，骨密度での評価，対象者，実施間隔，骨密度測定装置の普及などに問題がある。富山県朝日町では，この問題を解決するために骨折リスク評価ツール（FRAX®）やロコチェックを使った検診システムを取り入れ成果を上げている。脆弱性骨折一次予防には，骨粗鬆症マネージャーがそれぞれの専門性を生かして骨折高リスク者を抽出，介入することが必要である。地域・社会でもマネージャーが連携しproject teamとして機能していくことが望まれる。

　It is difficult to prevent primary fragility fractures because the subjects have not yet experienced a fracture. The offers of the community Osteoporosis Liaison Service are important for primary prevention of fragility fractures. The prevention, education, enlightenment, and the offer of osteoporosis examinations are included in this service. It is necessary to deliver the prevention services and osteoporosis education according to the age of the subjects. Hence, for young people, it is effective to include in school education that getting high peak bone mass is important, and for the middle-aged population, it is necessary to include education on the maintenance of bone quantity and the impact on risk factors such as smoking and excessive alcohol consumption. Furthermore, early detection of osteoporosis is important, with an osteoporosis check-up being one of the few opportunities for assessing the bone mineral density（BMD）in elderly women. However, there are some problems with osteoporosis check-ups in Japan. First, the implementation and participation rates of osteoporosis check-ups are low. Second, only BMD is set as the most important value for the assessment. Third, the subjects are limited to women in the range of 40-70 years of age with the knot age set at every 5 years. Finally, the setting of the BMD measuring apparatus is low. We adopted Fracture Risk Assessment Tool（FRAX®）and loco-check for check-ups at Asahi-machi in the Toyama Prefecture to resolve the above problems and have reported its usefulness. Action by the Osteoporosis Liaison Service to enforce osteoporosis check-ups is expected. Various types of professional medical staff participate in the Osteoporosis Liaison Service as osteoporosis managers. It is desired that the managers will cooperate and function as an osteoporosis project team in the community.