Miller Paul D, Hochberg Marc C, Wehren Lois E, Ross Philip D, Wasnich Richard D
Colorado Center for Bone Research, Lakewood, CO, USA.
Curr Med Res Opin. 2005 Apr;21(4):545-54. doi: 10.1185/030079905x41390.
Measurements of bone mineral density (BMD) and biochemical markers of bone turnover are useful in the diagnosis and management of osteoporosis, as well as in research relating to the pathogenesis and treatment of the disease. Recent challenges to the utility of these measures have resulted in some confusion among both researchers and clinicians. BMD accounts for the great majority of bone strength and is the current gold standard for the diagnosis of osteoporosis, as well as for prediction of fracture risk. Although bone turnover increases sharply after menopause, biochemical markers of bone turnover have limited usefulness in fracture risk prediction. Persistently elevated bone turnover throughout the menopause is associated with structural decrements, cannot be measured routinely and non-invasively. In research applications, both BMD and markers of bone turnover are used to identify candidate agents in preclinical and clinical studies. In addition, head-to-head comparisons of treatments utilize these measures, because fracture endpoint trials would need to be extraordinarily large and complex. Analyses that have suggested that change in BMD or bone turnover 'explains' little of change in fracture risk with treatment appear to be flawed. Although neither can perfectly predict fracture, they are our current best alternatives.
骨密度（BMD）测量和骨转换生化标志物在骨质疏松症的诊断和管理以及该疾病的发病机制和治疗研究中都很有用。最近这些测量方法的实用性受到挑战，这在研究人员和临床医生中都造成了一些困惑。骨密度占骨强度的绝大部分，是目前诊断骨质疏松症以及预测骨折风险的金标准。尽管绝经后骨转换急剧增加，但骨转换生化标志物在骨折风险预测中的作用有限。整个绝经期间持续升高的骨转换与结构破坏有关，无法常规且非侵入性地测量。在研究应用中，骨密度和骨转换标志物都用于在临床前和临床研究中识别候选药物。此外，治疗的直接比较利用这些测量方法，因为骨折终点试验需要非常庞大和复杂。那些表明骨密度或骨转换的变化对治疗中骨折风险变化的“解释”很少的分析似乎存在缺陷。尽管两者都不能完美预测骨折，但它们是我们目前最好的选择。
