Cummings Steven R, Bates David, Black Dennis M
The UCSF Coordinating Center, University of California, San Francisco, USA.
JAMA. 2002 Oct 16;288(15):1889-97. doi: 10.1001/jama.288.15.1889.
Osteoporosis causes substantial morbidity and costs $13.8 billion annually in the United States. Measurement of bone mass by densitometry is a primary part of diagnosing osteoporosis and deciding a preventive treatment course. Bone mineral densitometry has become more widely available and commonly used in practice.
To review evidence about the value of various clinical applications of bone densitometry.
A MEDLINE search was performed to update previous meta-analyses of the relationship between various measurements of bone density and risk of vertebral and hip fracture. We used data from the prospective Study of Osteoporotic Fractures to estimate risk of fracture from bone density and age in postmenopausal women.
When available, meta-analyses and systematic reviews are emphasized in the review.
Bone mineral density (BMD) predicts fracture and can be used in combination with age to estimate absolute risk of fractures in postmenopausal white women. Hip BMD predicts hip fracture more strongly than other measurements of BMD. There are insufficient data to translate BMD results into risk of fracture for men and nonwhite women. The benefits of treatments to prevent fractures depend on BMD: women with osteoporosis have a greater risk of fractures and greater benefit from treatments than women without osteoporosis.
Guidelines based on systematic reviews and a cost-effectiveness analysis have suggested that it is worthwhile to measure BMD in white women older than 65 years and perhaps to use risk factors to select younger postmenopausal women for densitometry. Other potential clinical applications of BMD that have not yet been adequately studied include screening men or nonwhite women, monitoring BMD in patients receiving treatment, and using BMD to identify patients who should be evaluated for secondary causes of osteoporosis.
在美国，骨质疏松症导致大量发病，每年造成138亿美元的损失。通过骨密度测定法测量骨量是诊断骨质疏松症和确定预防治疗方案的主要部分。骨矿物质密度测定在实践中已变得更为普及和常用。
综述有关骨密度测定各种临床应用价值的证据。
进行了一项MEDLINE检索，以更新先前关于各种骨密度测量与椎体和髋部骨折风险之间关系的荟萃分析。我们使用来自骨质疏松性骨折前瞻性研究的数据来估计绝经后女性骨密度和年龄相关的骨折风险。
如有可能，本综述强调荟萃分析和系统评价。
骨矿物质密度（BMD）可预测骨折，并可与年龄结合用于估计绝经后白人女性骨折的绝对风险。髋部BMD比其他BMD测量方法更能强烈预测髋部骨折。对于男性和非白人女性，没有足够的数据将BMD结果转化为骨折风险。预防骨折治疗的益处取决于BMD：患有骨质疏松症的女性比没有骨质疏松症的女性骨折风险更高，从治疗中获益也更大。
基于系统评价和成本效益分析的指南表明，对65岁以上白人女性测量BMD是值得的，或许还可利用风险因素来选择较年轻的绝经后女性进行骨密度测定。BMD其他潜在的临床应用尚未得到充分研究，包括筛查男性或非白人女性、监测接受治疗患者的BMD，以及利用BMD识别应评估骨质疏松症继发原因的患者。
