McClung Michael R
Department of Medical Education, Providence Portland Medical Center, Portland, OR 97213, USA.
Bone. 2006 Feb;38(2 Suppl 2):S13-7. doi: 10.1016/j.bone.2005.11.012. Epub 2006 Jan 3.
Deciding which patients are appropriate candidates for our effective osteoporosis therapies is a clinical challenge. Current guidelines for treating postmenopausal osteoporosis are based primarily on bone mineral density (BMD) measurements. There is consensus that postmenopausal women with osteoporosis, as defined by T-scores of -2.5 and lower, are at high risk of fracture and are candidates for therapy. However, many older adults without osteoporosis are at increased risk for fracture, and most fractures occur in women with higher T-scores. Current BMD-based guidelines are inconsistent regarding recommendations for treating women without osteoporosis. Fracture risk assessment is improved by combining BMD and other important risk factors for fracture, especially greater age and history of prior fracture. Strategies to estimate absolute fracture risk in individual patients are being developed. Revised treatment guidelines, based upon thresholds of absolute fracture risk, will provide the opportunity to identify and to treat those women who will most benefit from our therapies.
确定哪些患者适合接受我们有效的骨质疏松症治疗是一项临床挑战。目前治疗绝经后骨质疏松症的指南主要基于骨密度（BMD）测量。人们一致认为，根据T值为-2.5及更低定义的绝经后骨质疏松症女性骨折风险高，是治疗的候选对象。然而，许多没有骨质疏松症的老年人骨折风险增加，且大多数骨折发生在T值较高的女性中。目前基于骨密度的指南在治疗无骨质疏松症女性的建议方面并不一致。通过结合骨密度和其他重要的骨折风险因素，尤其是年龄较大和既往骨折史，可改善骨折风险评估。正在制定估算个体患者绝对骨折风险的策略。基于绝对骨折风险阈值的修订治疗指南将为识别和治疗那些将从我们的治疗中获益最大的女性提供机会。
