Marci C D, Anderson W B, Viechnicki M B, Greenspan S L
Harvard Medical School, Boston, Massachusetts, USA.
Calcif Tissue Int. 2000 Feb;66(2):113-8. doi: 10.1007/s002230010024.
Although bone mineral density measurements are helpful in predicting future risk for osteoporotic fractures, there is limited information available on how the results of bone densitometry influence a woman's use of therapeutic alternatives. To assess the role of bone mineral densitometry in influencing postmenopausal women to change health behaviors associated with osteoporosis, we prospectively followed, for an average of 2.9 years, 701 postmenopausal women over 50 years of age referred to an osteoporosis prevention program in a large metropolitan area. Assessments included bone mineral densitometry by dual-energy X-ray absorptiometry (with classification of skeletal health), medical history, use of hormone replacement therapy, calcium intake, caffeine intake, exercise, smoking habits, and fall precaution measures. Women classified at baseline with moderate low bone mass were twice as likely (33%), and women with severe low bone mass more than three times as likely (47%) to start hormone replacement therapy compared with women with a normal result (13%, P < 0.001). This was true regardless of whether they had taken hormone replacement therapy in the past. Below-normal BMD was a strong predictor of a woman's initiation of hormone replacement therapy (OR 4.2; 95% CI 2.7-6.4; P < 0.05) even after adjustment for age, education, history of osteoporosis or fracture, and medical condition related to osteoporosis. Women with moderate or severe low bone mass were also much more likely to start calcium supplements (81-90% versus 67%), increase dietary calcium (71-82% versus 60%), decrease use of caffeine (44-60% versus 34%), start exercising (61-76% versus 52%), and quit smoking (22-24% versus 11%) relative to their behaviors prior to testing (P < 0.01). In conclusion, postmenopausal women report that the results of bone densitometry substantially influence the decision to begin hormone replacement therapy and calcium supplements, increase dietary calcium, decrease caffeine, increase exercise, decrease smoking, and take precautions to prevent falls. More studies are needed to measure the long-term effects of this influence.
尽管骨密度测量有助于预测未来骨质疏松性骨折的风险，但关于骨密度测定结果如何影响女性对治疗选择的使用，目前可用信息有限。为了评估骨密度测定在促使绝经后女性改变与骨质疏松相关的健康行为方面的作用，我们对701名年龄超过50岁、被转介到一个大城市地区骨质疏松预防项目的绝经后女性进行了平均2.9年的前瞻性随访。评估内容包括通过双能X线吸收法进行骨密度测定（并对骨骼健康进行分类）、病史、激素替代疗法的使用情况、钙摄入量、咖啡因摄入量、运动情况、吸烟习惯以及预防跌倒措施。与骨密度结果正常的女性（13%，P<0.001）相比，基线时被分类为中度低骨量的女性开始激素替代疗法的可能性是其两倍（33%），而严重低骨量的女性开始激素替代疗法的可能性则超过三倍（47%）。无论她们过去是否使用过激素替代疗法，情况都是如此。即使在对年龄、教育程度、骨质疏松或骨折病史以及与骨质疏松相关的医疗状况进行调整之后，低于正常的骨密度仍是女性开始激素替代疗法的一个强有力的预测因素（比值比4.2；95%可信区间2.7 - 6.4；P<0.05）。与检测前的行为相比，中度或严重低骨量的女性开始补充钙剂（81 - 90%对67%）、增加饮食钙摄入（71 - 82%对60%）、减少咖啡因摄入（44 - 60%对34%）、开始运动（61 - 76%对52%）以及戒烟（22 - 24%对11%）的可能性也大得多（P<0.01）。总之，绝经后女性报告称，骨密度测定结果在很大程度上影响她们开始激素替代疗法和补充钙剂、增加饮食钙摄入、减少咖啡因摄入、增加运动、减少吸烟以及采取预防跌倒措施的决定。需要更多研究来衡量这种影响的长期效果。
