Very low concentration in blood with wide normal range 血液中的濃度很低，正常範圍很廣
Need dynamic test (stimulatory or inhibitory tests) 需要動態測試（刺激性或抑制性測試）
Most bound to binding protein (total Vs free cortisol, T4) 與結合蛋白結合最多（總皮質醇 Vs 游離皮質醇、T4）
Affected by binding protein change (e.g. oral contraceptive pills) 受結合蛋白變化的影響 (例如口服避孕藥)
Controlled by negative feedback (rarely positive feedback) 由負反饋控制（很少有正反饋）
Primary or secondary lesions 原發性或繼發性病變
Ectopic production 異位生產
Different tumors may product hormones (e.g. ddAVP, FGF23) 不同的腫瘤可能會產生荷爾蒙 (例如 ddAVP、FGF23)
Endocrine disorders：Framework 內分泌失調：框架
辨證論治
－Hormones：Too high or too low -荷爾蒙：過高或過低
－Site：Primary Vs secondary -網站：主要與次要
－Cause：Tumor Vs non－tumor（inflammation／vascular／infection etc） -病因：腫瘤 Vs 非腫瘤（發炎／血管／感染等）
－Investigation： -調查：
－Screening rarr\rightarrow confirm diagnosis rarr\rightarrow localization rarr\rightarrow Medical／Surgical Rx -篩檢 rarr\rightarrow 確診 rarr\rightarrow 定位 rarr\rightarrow 內科／外科用藥
－Measurement interference，drug effects，non－specific illness（cytokines etc） -測量干擾、藥物效應、非特異性疾病（細胞因子等）。
－Management： -管理：
－Surgical Vs Medical Vs Radiotherapy -手術 Vs 內科 Vs 放射線治療
Tests Contents What lx
TFT 01 Toxic on ATD－treatment fT4
TFT 02 Primary hypothyroid on T4 TSH
TFT 03 Pituitary hypothyroid on T4 fT4
TFT 04 Congenital hypothyroid on T4 TSH（fT4）
TFT 05 Toxic in remission（off ATD＜1 y） fT4
TFT 06 Toxic in remission（off ATD＞1y） TSH
TFT 07 RAI＜1y（not on T4 or ATD） fT4
TFT 08 RAI＞1y（not on T4 or ATD） TSH
TFT 09 New case ？Toxic fT4＋TSH
TFT 10 New case ？Primary hypothy TSH（fT4）
TFT 11 New case ？Pituitary hypothy fT4＋TSH
TFT 12 In pregnancy fT4＋TSH（diff N range）
TFT 13 Isotope protocol（toxic） fT4
TFT 14 "Isotope protocol（CA thyroid）
Endocrine protocol" "fT4＋TSH
TFT 15"| Tests | Contents | What lx |
| :--- | :--- | :--- |
| TFT 01 | Toxic on ATD－treatment | fT4 |
| TFT 02 | Primary hypothyroid on T4 | TSH |
| TFT 03 | Pituitary hypothyroid on T4 | fT4 |
| TFT 04 | Congenital hypothyroid on T4 | TSH（fT4） |
| TFT 05 | Toxic in remission（off ATD＜1 y） | fT4 |
| TFT 06 | Toxic in remission（off ATD＞1y） | TSH |
| TFT 07 | RAI＜1y（not on T4 or ATD） | fT4 |
| TFT 08 | RAI＞1y（not on T4 or ATD） | TSH |
| TFT 09 | New case ？Toxic | fT4＋TSH |
| TFT 10 | New case ？Primary hypothy | TSH（fT4） |
| TFT 11 | New case ？Pituitary hypothy | fT4＋TSH |
| TFT 12 | In pregnancy | fT4＋TSH（diff N range） |
| TFT 13 | Isotope protocol（toxic） | fT4 |
| TFT 14 | Isotope protocol（CA thyroid） <br> Endocrine protocol | fT4＋TSH <br> TFT 15 |
－Hyper or Hypo -高或低
－Primary or Secondary -初級或中級
－TSH higher sensitivity than fT4 -TSH 靈敏度高於 fT4
－TSH after suppression，need time to return back to normal （易跌難升） -抑制 TSH 後，需要時間恢復正常（易跌難升）。
－Pregnancy different reference range -妊娠不同的參考範圍
－fT3 only in special conditions -fT3僅在特殊條件下使用
－Suspect T3 toxicosis -懷疑 T3 中毒
－Some hypothyroidism -部分甲狀腺功能減退
Hyperthvroidism 甲狀腺功能亢進
Symptoms 症狀
Signs 標誌
Constitutional 憲法
儘管食慾增加，但體重下降；與熱相關的症狀（熱不耐受、出汗和多尿症）
Weight loss despite increased appetite;
heat-related symptoms (heat intolerance,
sweating, and polydipsia)
Weight loss despite increased appetite;
heat-related symptoms (heat intolerance,
sweating, and polydipsia)| Weight loss despite increased appetite; |
| :--- |
| heat-related symptoms (heat intolerance, |
| sweating, and polydipsia) |
Tremor of the extremities;
hyperactivity; hyper-reflexia; pelvic
and girdle muscle weakness| Tremor of the extremities; |
| :--- |
| hyperactivity; hyper-reflexia; pelvic |
| and girdle muscle weakness |
Diplopia; sense of irritation in the eyes;
eyelid swelling; retro-orbital pain or
discomfort| Diplopia; sense of irritation in the eyes; |
| :--- |
| eyelid swelling; retro-orbital pain or |
| discomfort |
突眼；眼瞼縮回和滯後；眶周水腫；結膜注射和化膿；眼球麻痺
Proptosis; eyelid retraction and lag;
periorbital oedema; conjunctival
injection and chemosis;
ophthalmoplegia
Proptosis; eyelid retraction and lag;
periorbital oedema; conjunctival
injection and chemosis;
ophthalmoplegia| Proptosis; eyelid retraction and lag; |
| :--- |
| periorbital oedema; conjunctival |
| injection and chemosis; |
| ophthalmoplegia |
Symptoms Signs
Constitutional "Weight loss despite increased appetite;
heat-related symptoms (heat intolerance,
sweating, and polydipsia)" Weight loss
Neuromuscular "Tremor; nervousness; anxiety; fatigue;
weakness; disturbed sleep; poor
concentration" "Tremor of the extremities;
hyperactivity; hyper-reflexia; pelvic
and girdle muscle weakness"
Cardiovascular Palpitations "Tachycardia; systolic hypertension;
irregular heartbeat (atrial
fibrillation)"
Pulmonary Dyspnoea, shortness of breath "Tachypnoea"
Gastrointestinal Hyperdefecation; nausea, vomiting Abdominal tenderness
Skin Increased perspiration "Warm and moist skin"
Reproductive .. "Menstrual disturbances"
Ocular (Graves' disease) "Diplopia; sense of irritation in the eyes;
eyelid swelling; retro-orbital pain or
discomfort" "Proptosis; eyelid retraction and lag;
periorbital oedema; conjunctival
injection and chemosis;
ophthalmoplegia"| | Symptoms | Signs |
| :--- | :--- | :--- |
| Constitutional | Weight loss despite increased appetite; <br> heat-related symptoms (heat intolerance, <br> sweating, and polydipsia) | Weight loss |
| Neuromuscular | Tremor; nervousness; anxiety; fatigue; <br> weakness; disturbed sleep; poor <br> concentration | Tremor of the extremities; <br> hyperactivity; hyper-reflexia; pelvic <br> and girdle muscle weakness |
| Cardiovascular | Palpitations | Tachycardia; systolic hypertension; <br> irregular heartbeat (atrial <br> fibrillation) |
| Pulmonary | Dyspnoea, shortness of breath | Tachypnoea |
| Gastrointestinal | Hyperdefecation; nausea, vomiting | Abdominal tenderness |
| Skin | Increased perspiration | Warm and moist skin |
| Reproductive | .. | Menstrual disturbances |
| Ocular (Graves' disease) | Diplopia; sense of irritation in the eyes; <br> eyelid swelling; retro-orbital pain or <br> discomfort | Proptosis; eyelid retraction and lag; <br> periorbital oedema; conjunctival <br> injection and chemosis; <br> ophthalmoplegia |
Table 2: Clinical manifestation of thyrotoxicosis 表 2：甲狀腺毒症的臨床表現
Treatment of Graves' disease (autoimmune thyroid disease) 治療巴塞杜氏病（自體免疫性甲狀腺疾病）
Anti-thyroid drug ATD: Carbimazole CMZ or Propylthiouracil PTU 抗甲状腺药物 ATD：卡比马唑 CMZ 或丙基硫氧嘧啶 PTU
Medical (pre-operative blood pressure control) 醫療（術前血壓控制）
Alpha-blocker α-受體阻滯劑
Beta-blocker β-受體阻斷劑
others 其他
Targeted Treatments for Mediating Pathways of Hyperglycemia 調節高血糖通路的靶向療法
The Time Is Right for a New Classification System for Diabetes: Rationale and Implications of the beta\beta-Cell-Centric Classification Schema 糖尿病新分類系統的時機已成熟：以細胞為中心的分類模式 beta\beta 的理據和意義
Random/ 2-h post oral glucose tolerance test >/= 11.0 mmol/l 隨機/ 2 小時後口服葡萄糖耐量測試 >/= 11.0 mmol/l
HbA1c >/=6.5%
If no symptom, need to repeat at least once 如果沒有症狀，需要重複至少一次
New 2024 IDF proposal also include 1-h post oral glucose tolerance test >/= 11.6mmol//I11.6 \mathrm{mmol} / \mathrm{I} (not yet routine practice) 新的 2024 IDF 建議也包括 1 小時口服後葡萄糖耐量測試 >/= 11.6mmol//I11.6 \mathrm{mmol} / \mathrm{I} （尚未成為常規做法）
HbA1c: pitfalls of measurement HbA1c：測量的陷阱
Falsely high 假高
Chronic Fe deficiency anaemia 慢性缺鐵性貧血
HyperTG
Hyperbilirubinemia 高膽固醇血症
Uremia 尿毒症
High dose aspirin 大劑量阿斯匹靈
Falsely low 假低
Acute blood loss 急性失血
Hemolytic anemia 溶血性貧血
Variable 可變
Hemoglobinopathies/ variants 血紅蛋白病/變異體
After blood transfusion 輸血後
Opiate/ alcohol 鴉片/酒精
Continuous glucose monitoring system (CGMS): continuous measurement of interstitial fluid glucose through a small tubule inserted through skin 連續葡萄糖監測系統 (CGMS)：透過皮膚插入的小管連續測量組織間液葡萄糖。 Glucose Variability 葡萄糖變異性
21 April 2020-4 May 2020
1) % Time CGM is Active 2020 年 4 月 21 日至 2020 年 5 月 4 日 1) CGM 啟動時間百分比
14 Days 14 天
75%
(2)
Defined as percent confficient of variation (%.cy): target sse% quad38.4%\quad 38.4 \% 定義為變異係數百分比 (%.cy)：目標 sse% quad38.4%\quad 38.4 \%
AGP is a summary of glucose values from the report period, with median (50%) and other percentiles shown as if they occurred in a single day. AGP 是報告期間葡萄糖值的摘要，中位數 (50%) 和其他百分位數顯示為單日發生的葡萄糖值。
Daily Glucose Profiles 每日血糖譜
Each daily profile represents a midnight-to-midnight period. 每個每日輪廓代表一個午夜到午夜的時段。
Frequent/ suspected hypoglycemia 經常/疑似低血糖
Wide variability within day 日內變化大
Drug adjustment 藥物調整
Discrepancy between home monitoring & A1c 家庭監測與 A1c 之間的差異
Empowerment & personal preference 授權與個人偏好
DM complications DM 併發症
Microvascular 微血管
Diabetic retinopathy 糖尿病視網膜病變
Diabetic nephropathy 糖尿病腎病
Diabetic neuropathy 糖尿病神經病變
Macrovascular 大血管
Cardiac diseases 心臟疾病
(ischemic heart, heart failure) (缺血性心臟、心力衰竭)
Peripheral vascular diseases 周邊血管疾病
Strokes 中風
Others 其他
Hypoglycemia 低血糖症
Infection 感染
Periodontal disease 牙周病
Dementia 失智症
What are we managing? 我們在管理什麼？
USE OF GLUCOSE-LOWERING MEDICATIONS IN THE MANAGEMENT OF TYPE 2 DIABETES 使用降血糖藥物治療 2 型糖尿病
HEALTHY LIFESTYLE BEHAVIORS; DLABETES SELF-MAMAGEMENT EDUCATION AND SUPPORT (DSMES); SOCLAL DETERMIMANTS OF HEALTH (SDOH) 健康生活方式行為；糖尿病自我管理教育與支援 (DSME)；健康的社會決定因素 (SDOH)
Coast Activevement and Meintenance of flycemic and Weipht Wenayement Goals 海岸活動及維護蒼蠅和鳥類的目標
Obesity 肥胖症
BMI >23 (overweight), > 25 (obesity), lower criteria comparing to western countries BMI >23（超重），>25（肥胖），與西方國家相比標準較低
Higher complications with the same BMI 相同 BMI 的併發症較高
Figure 2: Age-adjusted and sex-adjusted BMI cutoffs in minority ethnic populations in England equivalent to a BMI cutoff of 30.0kg//m^(2)30.0 \mathrm{~kg} / \mathrm{m}^{2} in White populations in relation to type 2 diabetes incidence 圖 2：英格蘭少數族群中經年齡與性別調整的 BMI 臨界值，相當於白人族群中與 2 型糖尿病發病率相關的 30.0kg//m^(2)30.0 \mathrm{~kg} / \mathrm{m}^{2} BMI 臨界值。
The incidence of type 2 diabetes for a BMI of 30.0kg//m^(2)30.0 \mathrm{~kg} / \mathrm{m}^{2} in the White population can be read off the graph at the intersection of the grey horizontal line and the fitted line for the White population. 白種人口中 BMI 為 30.0kg//m^(2)30.0 \mathrm{~kg} / \mathrm{m}^{2} 的 2 型糖尿病發病率可從圖中灰色水平線與白種人口擬合線的交點讀出。
The Science of Obesity Management: An Endocrine 肥胖管理的科學：內分泌學
Society Scientific Statement 協會科學聲明
Table 11. Weight Loss and Reversal of Diabetes Mellitus after Metabolic/Bariatric Surgery 表 11.代謝/減肥手術後的體重下降和糖尿病逆轉情況
Procedure 程序
過度減重 (%)
Excess Weight
Loss (%)
Excess Weight
Loss (%)| Excess Weight |
| :--- |
| Loss (%) |
T2DM 解析度 (%)
Resolution of
T2DM (%)
Resolution of
T2DM (%)| Resolution of |
| :--- |
| T2DM (%) |
Criteria for Classification of Osteopenia and Osteoporosis 骨質疏鬆症和骨質疏鬆症的分類標準
Category 類別
T-score
Normal 正常
-1.0 or above -1.0或以上
Low bone mass (osteopenia) ^("a "){ }^{\text {a }} 骨質密度低（骨質疏鬆症） ^("a "){ }^{\text {a }}
Between -1.0 and -2.5 介於 -1.0 和 -2.5 之間
Osteoporosis 骨質疏鬆症
-2.5 or below -2.5或以下
Severe or established osteoporosis 嚴重或已確診的骨質疏鬆症
-2.5 or below with fragility fracture -2.5或以下，有脆性骨折
a 此類別中的骨折率差異很大。骨質疏鬆」類型對於流行病學研究和臨床研究很有用，但應用在個別病患身上就有問題，必須結合臨床資訊才能做出治療決定。
a Fracture rates within this category vary widely. The category of "osteopenia" is useful for
epidemiology studies and clinical research but is problematic when applied to individual patients and
must be combined with clinical information to make treatment decisions.
a Fracture rates within this category vary widely. The category of "osteopenia" is useful for
epidemiology studies and clinical research but is problematic when applied to individual patients and
must be combined with clinical information to make treatment decisions.| a Fracture rates within this category vary widely. The category of "osteopenia" is useful for |
| :--- |
| epidemiology studies and clinical research but is problematic when applied to individual patients and |
| must be combined with clinical information to make treatment decisions. |
Table 5
World Health Organization Criteria for Classification of Osteopenia and Osteoporosis
Category T-score
Normal -1.0 or above
Low bone mass (osteopenia) ^("a ") Between -1.0 and -2.5
Osteoporosis -2.5 or below
Severe or established osteoporosis -2.5 or below with fragility fracture
"a Fracture rates within this category vary widely. The category of "osteopenia" is useful for
epidemiology studies and clinical research but is problematic when applied to individual patients and
must be combined with clinical information to make treatment decisions." | Table 5 | |
| :--- | :--- |
| World Health Organization | Criteria for Classification of Osteopenia and Osteoporosis |
| Category | T-score |
| Normal | -1.0 or above |
| Low bone mass (osteopenia) ${ }^{\text {a }}$ | Between -1.0 and -2.5 |
| Osteoporosis | -2.5 or below |
| Severe or established osteoporosis | -2.5 or below with fragility fracture |
| a Fracture rates within this category vary widely. The category of "osteopenia" is useful for <br> epidemiology studies and clinical research but is problematic when applied to individual patients and <br> must be combined with clinical information to make treatment decisions. | |
表 6 2020 AACE 絕經後女性骨質疏鬆症診斷表
Table 6
2020 AACE Diagnosis of Osteoporosis in Postmenopausal women
Table 6
2020 AACE Diagnosis of Osteoporosis in Postmenopausal women| Table 6 |
| :---: |
| 2020 AACE Diagnosis of Osteoporosis in Postmenopausal women |
1.
T-score -2.5 or below in the lumbar spine, femoral neck, total proximal femur, or 1//31 / 3 radius 腰椎、股骨頸、全股骨近端或 1//31 / 3 橈骨的 T 值 -2.5 或以下
2. Low-trauma spine or hip fracture (regardless of bone mineral density) 2.低創傷脊椎或髖部骨折（不論骨礦密度為何）
3.
T-score between -1.0 and -2.5 and a fragility fracture of proximal humerus, pelvis, or distal forearm T 值介於 -1.0 和 -2.5 之間，且肱骨近端、骨盆或前臂遠端的脆性骨折
4.
T-score 介於 -1.0 和 -2.5 之間，且 FRAX 高於特定國家的臨界值
T-score between -1.0 and -2.5 and high FRAX
on country-specific thresholds
T-score between -1.0 and -2.5 and high FRAX
on country-specific thresholds| T-score between -1.0 and -2.5 and high FRAX |
| :--- |
| on country-specific thresholds |
縮寫：縮寫：AACE == 美國臨床內分泌學家協會；FRAXtrabecular bone score。
Abbreviations: AACE == American Association of Clinical Endocrinologists; FRAX
trabecular bone score.
Abbreviations: AACE = American Association of Clinical Endocrinologists; FRAX
trabecular bone score.| Abbreviations: AACE $=$ American Association of Clinical Endocrinologists; FRAX |
| :--- |
| trabecular bone score. |
"Table 6
2020 AACE Diagnosis of Osteoporosis in Postmenopausal women"
1. T-score -2.5 or below in the lumbar spine, femoral neck, total proximal femur, or 1//3 radius
2. Low-trauma spine or hip fracture (regardless of bone mineral density)
3. T-score between -1.0 and -2.5 and a fragility fracture of proximal humerus, pelvis, or distal forearm
4. "T-score between -1.0 and -2.5 and high FRAX
on country-specific thresholds"
"Abbreviations: AACE = American Association of Clinical Endocrinologists; FRAX
trabecular bone score." | | Table 6 <br> 2020 AACE Diagnosis of Osteoporosis in Postmenopausal women |
| :--- | :--- |
| 1. | T-score -2.5 or below in the lumbar spine, femoral neck, total proximal femur, or $1 / 3$ radius |
| 2. Low-trauma spine or hip fracture (regardless of bone mineral density) | |
| 3. | T-score between -1.0 and -2.5 and a fragility fracture of proximal humerus, pelvis, or distal forearm |
| 4. | T-score between -1.0 and -2.5 and high FRAX <br> on country-specific thresholds |
| Abbreviations: AACE $=$ American Association of Clinical Endocrinologists; FRAX <br> trabecular bone score. | |
AIDS/HIV
Ankylosing spondylitis Chronic obstructive pulmonary disease Gaucher disease Hemophilia
Hypercalciuria
Immobilization
Major depression
Myeloma and some cancers
Organ transplantation Renal insufficiency/ failure
Renal tubular acidosis Rheumatoid arthritis Systemic mastocytosis Thalassemia| AIDS/HIV |
| :--- |
| Ankylosing spondylitis Chronic obstructive pulmonary disease Gaucher disease Hemophilia |
| Hypercalciuria |
| Immobilization |
| Major depression |
| Myeloma and some cancers |
| Organ transplantation Renal insufficiency/ failure |
| Renal tubular acidosis Rheumatoid arthritis Systemic mastocytosis Thalassemia |
AIDS = acquired immunodeficiency syndrome; GI=\mathrm{GI}= gastrointestinal; HIV = human immunodeficiency virus; SCL AIDS = 獲得性免疫缺陷綜合症； GI=\mathrm{GI}= 胃腸道；HIV = 人類免疫缺陷病毒；SCL
glucose cotransporter 2 . 葡萄糖共轉移因子 2 .
ant meant to be a complete list. 螞蟻的意思是完整的清單。
bPhenobarbital, phenytoin, primidone, valproate, and carbamazepine have been associated with low bone mass. b 苯巴比妥、苯妥英、primidone、丙戊酸钠和卡马西平与低骨量有关。
Endocrine or metabolic causes Nutritional/ GI conditions Drugs Disorders of collagen metabolism Other
"Acromegaly
Diabetes mellitus
Type 1
Type 2
Growth hormone deficiency
Hypercortisolism
Hyperparathyroidism
Hyperthyroidism
Hypogonadism
Hypophosphatasia
Porphyria
Pregnancy" "Alcoholism
Anorexia nervosa Calcium deficiency Chronic liver disease Malabsorption syndromes/ malnutrition (including celiac disease, cystic fibrosis, Crohn disease, and gastric resection or bypass)
Total parenteral nutrition
Vitamin D deficiency" "Anti-epileptic drugs ^("b ")
Aromatase inhibitors
Chemotherapy/
immunosuppressants
Medroxyprogesterone acetate
Glucocorticoids
Gonadotropin-releasing
hormone agents
Heparin
Lithium
Proton pump inhibitors
Selective serotonin- reuptake inhibitors
SGLT2-inhibitors
Thiazolidinediones
Thyroid hormone (in supraphysiologic doses)" "Ehlers-Danlos syndrome
Homocystinuria due to cystathionine deficiency
Marfan syndrome Osteogenesis imperfecta" "AIDS/HIV
Ankylosing spondylitis Chronic obstructive pulmonary disease Gaucher disease Hemophilia
Hypercalciuria
Immobilization
Major depression
Myeloma and some cancers
Organ transplantation Renal insufficiency/ failure
Renal tubular acidosis Rheumatoid arthritis Systemic mastocytosis Thalassemia"
AIDS = acquired immunodeficiency syndrome; GI= gastrointestinal; HIV = human immunodeficiency virus; SCLglucose cotransporter 2 .ant meant to be a complete list.bPhenobarbital, phenytoin, primidone, valproate, and carbamazepine have been associated with low bone mass. | Endocrine or metabolic causes | Nutritional/ GI conditions | Drugs | Disorders of collagen metabolism | Other |
| :---: | :---: | :---: | :---: | :---: |
| Acromegaly <br> Diabetes mellitus <br> Type 1 <br> Type 2 <br> Growth hormone deficiency <br> Hypercortisolism <br> Hyperparathyroidism <br> Hyperthyroidism <br> Hypogonadism <br> Hypophosphatasia <br> Porphyria <br> Pregnancy | Alcoholism <br> Anorexia nervosa Calcium deficiency Chronic liver disease Malabsorption syndromes/ malnutrition (including celiac disease, cystic fibrosis, Crohn disease, and gastric resection or bypass) <br> Total parenteral nutrition <br> Vitamin D deficiency | Anti-epileptic drugs ${ }^{\text {b }}$ <br> Aromatase inhibitors <br> Chemotherapy/ <br> immunosuppressants <br> Medroxyprogesterone acetate <br> Glucocorticoids <br> Gonadotropin-releasing <br> hormone agents <br> Heparin <br> Lithium <br> Proton pump inhibitors <br> Selective serotonin- reuptake inhibitors <br> SGLT2-inhibitors <br> Thiazolidinediones <br> Thyroid hormone (in supraphysiologic doses) | Ehlers-Danlos syndrome <br> Homocystinuria due to cystathionine deficiency <br> Marfan syndrome Osteogenesis imperfecta | AIDS/HIV <br> Ankylosing spondylitis Chronic obstructive pulmonary disease Gaucher disease Hemophilia <br> Hypercalciuria <br> Immobilization <br> Major depression <br> Myeloma and some cancers <br> Organ transplantation Renal insufficiency/ failure <br> Renal tubular acidosis Rheumatoid arthritis Systemic mastocytosis Thalassemia |
| AIDS = acquired immunodeficiency syndrome; $\mathrm{GI}=$ gastrointestinal; HIV = human immunodeficiency virus; SCLglucose cotransporter 2 .ant meant to be a complete list.bPhenobarbital, phenytoin, primidone, valproate, and carbamazepine have been associated with low bone mass. | | | | |
Drug Name 藥物名稱
Brand Name 品牌名稱
Drug Class 藥物類別
Form/Dosing 形式/劑量
Alendronate 阿仑膦酸钠
Fosamax 福善美
Bisphosphonate 雙磷酸鹽
Oral (daily, weekly) 口服（每日、每週）
lbandronate
Boniva
Bisphosphonate 雙磷酸鹽
Oral or injection (daily, monthly) 口服或注射（每日、每月）
Risedronate 利塞膦酸鈉
Actonel/Atelvia
Bisphosphonate 雙磷酸鹽
Women and Men 女性與男性
Zoledronic acid 唑來膦酸
Reclast
Bisphosphonate 雙磷酸鹽
Women 婦女
Raloxifene 雷洛昔芬
Evista
SERM
IV (yearly/once every 2 years) 靜脈注射（每年/每兩年一次）
Abaloparatide 阿巴帕肽
Tymlos
Parathyroid hormone analog 甲狀旁腺激素類似物
Wom and Men 女性與男性
Teriparatide 特立帕肽
Forteo
Parathyroid hormone analog 甲狀旁腺激素類似物
Injection daily for 2 years 每日注射，連續 2 年
Denosumab
Prolia
RANKL inhibitor RANKL 抑制劑
Injection daily for 2 years 每日注射，連續 2 年
Romosozumab
Evenity 平均性
Sclerostin Inhibitor 硬骨蛋白抑制劑
Women 婦女
Drug Name Brand Name Drug Class Form/Dosing
Alendronate Fosamax Bisphosphonate Oral (daily, weekly)
lbandronate Boniva Bisphosphonate Oral or injection (daily, monthly)
Risedronate Actonel/Atelvia Bisphosphonate Women and Men
Zoledronic acid Reclast Bisphosphonate Women
Raloxifene Evista SERM IV (yearly/once every 2 years)
Abaloparatide Tymlos Parathyroid hormone analog Wom and Men
Teriparatide Forteo Parathyroid hormone analog Injection daily for 2 years
Denosumab Prolia RANKL inhibitor Injection daily for 2 years
Romosozumab Evenity Sclerostin Inhibitor Women| Drug Name | Brand Name | Drug Class | Form/Dosing |
| :--- | :--- | :--- | :--- |
| Alendronate | Fosamax | Bisphosphonate | Oral (daily, weekly) |
| lbandronate | Boniva | Bisphosphonate | Oral or injection (daily, monthly) |
| Risedronate | Actonel/Atelvia | Bisphosphonate | Women and Men |
| Zoledronic acid | Reclast | Bisphosphonate | Women |
| Raloxifene | Evista | SERM | IV (yearly/once every 2 years) |
| Abaloparatide | Tymlos | Parathyroid hormone analog | Wom and Men |
| Teriparatide | Forteo | Parathyroid hormone analog | Injection daily for 2 years |
| Denosumab | Prolia | RANKL inhibitor | Injection daily for 2 years |
| Romosozumab | Evenity | Sclerostin Inhibitor | Women |
Glucose Variability 葡萄糖變異性
