Bouxsein Mary L, Karasik David
Orthopedic Biomechanics Laboratory, RN115, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
Curr Osteoporos Rep. 2006 Jun;4(2):49-56. doi: 10.1007/s11914-006-0002-9.
Although low bone mineral density is among the strongest risk factors for fracture, a number of clinical studies have demonstrated the limitations of bone mineral density measurements in assessing fracture risk and monitoring the response to therapy. These observations have brought renewed attention to the broader array of factors that influence skeletal fragility, including bone size, shape, and microarchitecture. This article reviews the relationship between bone geometry and skeletal fragility, focusing on the impact of bone geometry on bone strength and fracture risk. It also reviews recent data on the effect of osteoporosis therapies on femoral geometry. It is clear that characteristics of a bone's size and shape strongly influence its biomechanical strength, but there is no consensus as to the geometric parameters that improve prediction of fracture risk. Recent data from hip structure analysis indicate that antiresorptive and anticatabolic treatments alter femoral geometry, but this observation depends on several assumptions that have not been tested in subjects treated with osteoporosis therapies. Current knowledge is limited, in part, by the predominant use of two-dimensional techniques to assess bone geometry. Additional studies that incorporate three-dimensional imaging are needed to better define the relationship between bone geometry and skeletal fragility, and to establish the clinical utility of bone geometry measurements.
尽管低骨密度是骨折最强的风险因素之一，但多项临床研究已证明骨密度测量在评估骨折风险和监测治疗反应方面存在局限性。这些观察结果使人们重新关注影响骨骼脆弱性的更广泛因素，包括骨骼大小、形状和微结构。本文综述了骨几何结构与骨骼脆弱性之间的关系，重点关注骨几何结构对骨强度和骨折风险的影响。还综述了骨质疏松症治疗对股骨几何结构影响的最新数据。显然，骨骼的大小和形状特征强烈影响其生物力学强度，但对于哪些几何参数能更好地预测骨折风险尚无共识。髋部结构分析的最新数据表明，抗吸收和抗分解代谢治疗会改变股骨几何结构，但这一观察结果依赖于一些尚未在接受骨质疏松症治疗的受试者中得到验证的假设。目前的知识有限，部分原因是主要使用二维技术来评估骨几何结构。需要开展更多纳入三维成像的研究，以更好地界定骨几何结构与骨骼脆弱性之间的关系，并确立骨几何结构测量的临床实用性。
