Seeman E
Austin and Repatriation Medical Centre, University of Melbourne, Heidelberg, 3084, Melbourne, Australia.
Baillieres Best Pract Res Clin Endocrinol Metab. 2000 Jun;14(2):233-49. doi: 10.1053/beem.2000.0071.
Most patients with fractures go untreated because of the lack of awareness of osteoporosis. Treatment is indicated for women and men with osteoporosis and women and men with fractures with either osteoporosis or osteopenia because (a) fractures increase morbidity and mortality, (b) the burden of fractures is increasing because longevity is increasing, and (c) bone loss accelerates, rather than decelerates in old age. The indication for drug therapy is less clear in women or men with osteopenia because drugs have not been proved to reduce fracture risk in this group. There is no evidence that treating individuals with only risk factors reduces the fracture rate. Screening has not been shown to reduce the burden of fractures. Altering the bone mineral density by a few percent in the population is likely to reduce the number of fractures, but how this can be achieved is unknown. The rigorously investigated drugs reducing the spine fracture rate are alendronate, raloxifene and risedronate. Calcium and vitamin D reduce hip fractures in nursing home residents but not community-dwellers. In the community, only alendronate and risedronate have been reported to reduce hip fractures in randomized trials. The evidence for hormone replacement therapy is less satisfactory. It is likely to reduce the number of spinal fractures, but its role in hip fracture prevention is uncertain. Only alendronate has been reported to reduce spine fractures in men with osteoporosis. Evidence for the use of other drugs (calcitonin, fluoride, anabolic steroids and active vitamin D metabolites) in women or men is insufficient to justify their use.
大多数骨折患者因对骨质疏松症缺乏认识而未得到治疗。对于患有骨质疏松症的女性和男性以及患有骨质疏松症或骨量减少且伴有骨折的女性和男性，均需进行治疗，原因如下：(a) 骨折会增加发病率和死亡率；(b) 由于寿命延长，骨折负担正在增加；(c) 骨质流失在老年时会加速而非减缓。对于骨量减少的女性或男性，药物治疗的指征尚不清楚，因为尚未证实药物能降低该群体的骨折风险。没有证据表明仅治疗有风险因素的个体能降低骨折率。筛查尚未显示能减轻骨折负担。在人群中使骨矿物质密度改变几个百分点可能会减少骨折数量，但如何实现这一点尚不清楚。经过严格研究能降低脊柱骨折率的药物有阿仑膦酸盐、雷洛昔芬和利塞膦酸盐。钙和维生素D可降低疗养院居民的髋部骨折发生率，但对社区居民无效。在社区中，随机试验仅报道阿仑膦酸盐和利塞膦酸盐可降低髋部骨折发生率。激素替代疗法的证据不太令人满意。它可能会减少脊柱骨折的数量，但其在预防髋部骨折中的作用尚不确定。仅报道阿仑膦酸盐可降低患有骨质疏松症男性的脊柱骨折发生率。关于在女性或男性中使用其他药物（降钙素、氟化物、合成代谢类固醇和活性维生素D代谢物）的证据不足，不足以证明其使用的合理性。
