Dobbs M B, Buckwalter J, Saltzman C
Department of Orthopaedic Surgery, The University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Iowa Orthop J. 1999;19:43-52.
Osteoporosis is an ever-increasing problem as our population ages. However, it is also to a large extent a preventable problem. The orthopaedist now has the ability to determine bone mass, the rate of turnover, and the fracture risk. Skeletal bone mass can be evaluated with DXA; the rate of bone resorption can be determined by assessment of collagen-degradation urinary products; and the weight status, fracture history, and history of smoking can be used to predict the fracture risk in individual patients. The orthopaedic physician also needs to take an active role in advising their younger patients about achieving peak bone mass. All individuals should follow a program that includes adequate calcium replacement, 400 to 800 units of vitamin D, appropriate exercise, avoidance of significant weight loss, and cessation of smoking. At menopause, women should evaluate their risk factors and consider the use of estrogen not only for its skeletal benefits but also for its nonosseous effects. In patients with contraindications or an aversion to hormone therapy, bone densitometry should be performed to determine risks before expensive nonhormonal treatment is initiated. Additional studies such as measurement of collagen degradation products will help establish whether the patient's resorptive rate is high or stable. If the bone mass is 2.5 SDs below normal peak or if there is an increase in resorption, use of either estrogen, bisphosphontes, or calcitonin may be appropriate. If there is evidence of low-turnover osteoporosis with decreased osteoblast formation, sodium fluoride should be considered. Two thirds of the cost of osteoporosis in the United States is due to hip fractures. The orthopaedist is the primary physician who comes in contact with these fracture patients. It is therefore his or her responsibility to become knowledgeable about the treatment and prevention of osteoporosis. The bisphosphonates, hormones, and calcitonin provide predictable restoration of bone mass and significantly decrease the rate of osteoporotic fractures.
随着人口老龄化，骨质疏松症已成为一个日益严重的问题。然而，在很大程度上，这也是一个可预防的问题。骨科医生现在有能力测定骨量、骨转换率和骨折风险。可用双能X线吸收法（DXA）评估骨骼骨量；通过评估尿中胶原降解产物来测定骨吸收速率；体重状况、骨折史和吸烟史可用于预测个体患者的骨折风险。骨科医生还应积极向年轻患者提供关于达到峰值骨量的建议。所有人都应遵循一个包含充足钙补充、400至800单位维生素D、适当运动、避免体重显著下降以及戒烟的方案。在绝经后，女性应评估其风险因素，并考虑使用雌激素，这不仅是因其对骨骼有益，还因其具有非骨骼方面的作用。对于有激素治疗禁忌证或不愿接受激素治疗的患者，在开始昂贵的非激素治疗之前，应进行骨密度测定以确定风险。其他研究，如测量胶原降解产物，将有助于确定患者的骨吸收速率是高还是稳定。如果骨量低于正常峰值2.5个标准差，或者骨吸收增加，使用雌激素、双膦酸盐或降钙素可能是合适的。如果有证据表明存在成骨细胞形成减少的低转换型骨质疏松症，则应考虑使用氟化钠。在美国，三分之二的骨质疏松症治疗费用是由髋部骨折导致的。骨科医生是接触这些骨折患者的主要医生。因此，了解骨质疏松症的治疗和预防是其责任。双膦酸盐、激素和降钙素可使骨量得到可预测的恢复，并显著降低骨质疏松性骨折的发生率。
