South-Paul J E
Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA.
Am Fam Physician. 2001 Mar 1;63(5):897-904, 908.
Osteoporosis afflicts 75 million persons in the United States, Europe and Japan and results in more than 1.3 million fractures annually in the United States. Because osteoporosis is usually asymptomatic until a fracture occurs, family physicians must identify the appropriate timing and methods for screening those at risk. Prevention is the most important step, and women of all ages should be encouraged to take 1,000 to 1,500 mg of supplemental calcium daily, participate in regular weight-bearing exercise, avoid medications known to compromise bone density, institute hormone replacement therapy at menopause unless contraindicated and avoid tobacco and excessive alcohol intake. All postmenopausal women who present with fractures as well as younger women who have risk factors should be evaluated for the disease. Physicians should recommend bone mineral density testing to younger women at risk and postmenopausal women younger than 65 years who have risk factors for osteoporosis other than being postmenopausal. Bone mineral density testing should be recommended to all women 65 years and older regardless of additional risk factors. Bone mineral density screening should be used as an adjunct to clinical judgment only if the results would influence the choice of therapy or convince the patient to take appropriate preventive measures.
在美国、欧洲和日本，有7500万人患有骨质疏松症，在美国每年导致超过130万例骨折。由于骨质疏松症在骨折发生前通常没有症状，家庭医生必须确定对高危人群进行筛查的合适时机和方法。预防是最重要的一步，应鼓励所有年龄段的女性每天补充1000至1500毫克钙，定期进行负重锻炼，避免使用已知会损害骨密度的药物，除非有禁忌，在绝经后开始激素替代疗法，并避免吸烟和过量饮酒。所有因骨折前来就诊的绝经后女性以及有危险因素的年轻女性都应接受该疾病的评估。医生应建议对有风险的年轻女性以及65岁以下有除绝经以外的骨质疏松症危险因素的绝经后女性进行骨密度检测。无论是否有其他危险因素，都应建议所有65岁及以上的女性进行骨密度检测。只有当骨密度筛查结果会影响治疗选择或说服患者采取适当的预防措施时，才应将其作为临床判断的辅助手段。
