Wehren Lois E
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore 21201, USA.
Int J Fertil Womens Med. 2002 May-Jun;47(3):116-22.
It is estimated that 28,000,000 women in the United States have low bone mass (osteopenia) or osteoporosis. More than 1.5 million osteoporotic fractures occur annually. Because osteoporosis is asymptomatic until fracture occurs, early diagnosis requires both an awareness of risk and specific testing. The National Osteoporosis Foundation (NOF) has published guidelines for diagnosis and treatment, but these have important limitations. Bone mineral density (BMD) testing is the method of choice for diagnosis, and is more predictive of fracture risk than hypertension is of stroke or hypercholesterolemia is of myocardial infarction. Although the diagnosis of osteoporosis, as defined by the World Health Organization, is a T-score of < or =-2.5, the association between BMD and fracture risk is a continuous rather than threshold effect, and NOF guidelines suggest treating at higher T-scores, depending on risk factors. Important risk factors include age, current smoking, low body weight (<127 lbs.), maternal history of fracture, and personal history of fracture. Data from the National Osteoporosis Risk Assessment (NORA) study are presented, demonstrating the usefulness of peripheral BMD measurements in identifying postmenopausal women at risk of fracture. Several therapeutic options, including hormone replacement therapy, raloxifene, calcitonin, alendronate, and risendronate, are now available to the clinician. It can be argued that we currently have all necessary tools to eliminate osteoporosis and osteoporotic fracture.
据估计，美国有2800万女性患有低骨量（骨质减少）或骨质疏松症。每年发生超过150万例骨质疏松性骨折。由于骨质疏松症在骨折发生前没有症状，早期诊断需要意识到风险并进行特定检测。美国国家骨质疏松基金会（NOF）已发布诊断和治疗指南，但这些指南有重要局限性。骨密度（BMD）检测是诊断的首选方法，并且比高血压对中风或高胆固醇血症对心肌梗死更能预测骨折风险。虽然世界卫生组织定义的骨质疏松症诊断标准是T值≤ -2.5，但BMD与骨折风险之间的关联是一种连续效应而非阈值效应，NOF指南建议根据风险因素在较高T值时进行治疗。重要的风险因素包括年龄、当前吸烟、体重过低（<127磅）、母亲骨折史和个人骨折史。本文展示了来自国家骨质疏松症风险评估（NORA）研究的数据，证明了外周BMD测量在识别有骨折风险的绝经后女性中的有用性。临床医生现在有几种治疗选择，包括激素替代疗法、雷洛昔芬、降钙素、阿仑膦酸盐和利塞膦酸盐。可以说，我们目前拥有消除骨质疏松症和骨质疏松性骨折的所有必要工具。
