(Osteoporosis) (Bone mineral density) 3 1. posmenopausal osteoporosis estrogen osteoclast 2. age-related osteoporosis parathyroid 3. secondary osteoporosis hyperparathyroidism, chronic renal failure, furosemide, MTX (BMD) osteoporosis BMD gold standard BMD Dual-ennergy x-ray absorbtion metry (DXA) 1. 2. 3. 4. 5. 5.1. Calcium and vitamin D supplementation200-300 mg/ 2-3 500 mg/ 4-8 800 mg/ ( 9-18 ) 1300 mg/1000 mg/ 50 1200 mg/saltsolubilityElemental calcium (%)

Calcium carbonateinsoluble40

Calcium citratesoluble21

Calcium lactatesoluble18

Calcium gluconatesoluble9

Calcium carbonate active transport 500-600 mg elemental calcium (SE )- iron,tetracycline,Fluoroquinolone, bisphosphonate, phenytoin - PPI ( calcium carbonate) fiberVitamin D 7-dehydrocholesterol 25(OH)D3 active metabolite 1,25(OH)2D3 (calcitriol) parathyroid hormone2. 2.1 bisphosphanate osteoclast FDA osteoporosis 3 Alendronate, Risedronate, Ibandronate 1/2 - 1 . 30 Alendronate 70 . 1 1 ( ) 2 2.2 estrogen estrogen (BMD) estrogen osteoporosis breast cancer cardiovascular disease2.3 selective Estrogen Receptor Modulators (SERM) Roxifenne osteoporosis estrogen agonist ( osteoclast) antagonist breast uterus breast cancer Raloxifene osteoporosis breast cancer Raloxifene venous thromboembolism vasomotor symptom hot flush2.4 Calcitonin thyroid gland calcitonin bone resorption osteoclast calcitonin non-vertibral BMD calcitonin calcium 1000 mg D 400 iu calcitonin salmon calcitonin (Rhinitis) 3. (bone foamation)3.1 Teripratide amino acid 34 parathyroid Teriparatide vertebral non-vertebral lumba spine BMD hip BMD Teripratide bisphosphanate Teripratide 20 mg sc daily3.2 Strontium ranelate osteoporosis lumba spine BMD femoral neck BMD vertebral