Divittorio Gino, Jackson Kirk L, Chindalore Vishala L, Welker Weston, Walker J Bryan
Rheumatology Center of Mobile, 6701 Airport Boulevard, Suite A101, Mobile, AL 36608, USA.
Pharmacotherapy. 2006 Jan;26(1):104-14. doi: 10.1592/phco.2006.26.1.104.
Osteoporosis is a skeletal disorder characterized by compromised bone strength that predisposes the patient to an increased risk for fracture. Elements of bone strength include bone mineralization, architecture, turnover, size, and bone mineral density (BMD). Measurement of BMD is the most readily available, noninvasive method for assessing osteoporotic fracture risk and is used by the World Health Organization for diagnostic purposes. Because low BMD is predictive of increased fracture risk, it was believed that changes in BMD during pharmacologic therapy for osteoporosis would strongly predict observed fracture risk reductions. We examined the relationship between changes in BMD and reduction in fracture risk during pharmacologic therapy in postmenopausal women with osteoporosis. The correlation between BMD increases and fracture risk reduction during treatment is not consistent; larger increases in BMD do not necessarily correlate with greater reductions in fracture risk. Multiple factors, in addition to BMD, appear to contribute to the increased bone strength and decreased fracture risk achieved with approved drug therapies for osteoporosis. Until the exact relationship of these factors is fully understood, clinicians should continue to evaluate drug efficacy for osteoporosis based on the fracture risk reductions from well-designed clinical trials.
骨质疏松症是一种骨骼疾病，其特征是骨强度受损，使患者面临骨折风险增加的问题。骨强度的要素包括骨矿化、结构、更新、大小和骨密度（BMD）。测量骨密度是评估骨质疏松性骨折风险最容易获得的非侵入性方法，世界卫生组织将其用于诊断目的。由于低骨密度可预测骨折风险增加，因此人们认为在骨质疏松症药物治疗期间骨密度的变化将强烈预测观察到的骨折风险降低情况。我们研究了绝经后骨质疏松症女性在药物治疗期间骨密度变化与骨折风险降低之间的关系。治疗期间骨密度增加与骨折风险降低之间的相关性并不一致；骨密度的较大增加并不一定与骨折风险的更大降低相关。除了骨密度之外，多种因素似乎都有助于通过批准的骨质疏松症药物治疗实现骨强度增加和骨折风险降低。在充分了解这些因素的确切关系之前，临床医生应继续根据精心设计的临床试验中骨折风险的降低情况来评估骨质疏松症药物的疗效。
