Cefalu Charles A
Department of Family Medicine, Louisiana State University Medical Center, New Orleans, LA 70112, USA.
Curr Med Res Opin. 2004 Mar;20(3):341-9. doi: 10.1185/030079903125003062.
Bone mineral density (BMD) measurement is a widely available noninvasive means of identifying individuals with osteoporosis and, possibly, those at high risk for fracture. This nonsystematic review examines the relationship between BMD increase and fracture risk reduction in clinical trials evaluating osteoporosis therapy. The trials examined here are predominantly in postmenopausal women. BMD increase correlates poorly with fracture risk reduction in clinical trials of osteoporosis therapy conducted in postmenopausal women. Although BMD may increase with therapy, the increase is not measurable until later, and the overall increase is too small to account for the timing and magnitude of fracture risk reduction. BMD is only one of many contributors to bone strength and fracture risk reduction. Bone strength is derived from bone quantity, which consists of density and size, and bone quality, which, in turn, consists of structure (micro- and macroarchitecture), material properties, and turnover. Data are beginning to accrue suggesting that changes in bone turnover markers may be an accurate predictor of fracture risk reduction. Future research will elucidate the link between changes in bone turnover markers and bone architecture as a measure of osteoporosis treatment efficacy. Until then, physicians will continue to rely on fracture risk reduction data from well-designed clinical trials when judging the efficacy of different treatments for osteoporosis.
骨密度（BMD）测量是一种广泛应用的非侵入性方法，用于识别骨质疏松症患者以及可能的骨折高危人群。这篇非系统性综述探讨了在评估骨质疏松症治疗的临床试验中，骨密度增加与骨折风险降低之间的关系。此处所研究的试验主要针对绝经后女性。在绝经后女性进行的骨质疏松症治疗临床试验中，骨密度增加与骨折风险降低之间的相关性较差。尽管治疗可能会使骨密度增加，但这种增加在后期才会显现出来，而且总体增加幅度太小，无法解释骨折风险降低的时间和程度。骨密度只是影响骨强度和降低骨折风险的众多因素之一。骨强度源自骨量，骨量由密度和大小组成，还源自骨质量，而骨质量又由结构（微观和宏观结构）、材料特性和骨转换组成。越来越多的数据表明，骨转换标志物的变化可能是骨折风险降低的准确预测指标。未来的研究将阐明骨转换标志物变化与骨结构之间的联系，以此作为评估骨质疏松症治疗效果的一种方法。在此之前，医生在判断不同骨质疏松症治疗方法的疗效时，将继续依赖精心设计的临床试验中的骨折风险降低数据。
