Gourlay Margaret, Richy Florent, Reginster Jean-Yves
Robert Wood Johnson Clinical Scholars Program, Department of Family Medicine, University of North Carolina, Chapel Hill 27599-7105, USA.
Am J Med. 2003 Sep;115(4):309-17. doi: 10.1016/s0002-9343(03)00371-1.
Hip fractures are associated with 10% to 20% excess mortality in the first year and cause functional disability in most survivors. An estimated 17% of white women in the United States will sustain a hip fracture after the age of 50 years. Despite the availability of evidence-based guidelines for hip fracture prevention, routine screening and preventive measures have not been incorporated into standard primary care practice. Many physicians lack adequate knowledge to initiate bone mineral density testing and treatment with preventive medications to decrease the incidence of osteoporosis and fractures. Furthermore, patients are less likely to request information about bone health than about diseases for which systematic screening and prevention protocols have been established. This review describes preventive measures to decrease hip fracture in postmenopausal women, including screening by bone mineral density testing, risk factor assessment, and chemoprevention. Existing guidelines are summarized, and dilemmas regarding their implementation are discussed.
髋部骨折在第一年会导致额外10%至20%的死亡率，并使大多数幸存者出现功能残疾。据估计，美国17%的白人女性在50岁以后会发生髋部骨折。尽管有基于证据的髋部骨折预防指南，但常规筛查和预防措施尚未纳入标准的初级保健实践。许多医生缺乏启动骨密度检测和使用预防性药物治疗以降低骨质疏松症和骨折发生率的足够知识。此外，与已建立系统筛查和预防方案的疾病相比，患者要求获得有关骨骼健康信息的可能性较小。本综述描述了降低绝经后女性髋部骨折的预防措施，包括通过骨密度检测进行筛查、风险因素评估和化学预防。总结了现有指南，并讨论了其实施过程中存在的困境。
