Yodfat Yair
Family Medicine, Hebrew-University Hadassah Medical School, Jerusalem.
Harefuah. 2007 Feb;146(2):134-9, 164.
The ability of bone to resist fracture is the best indicator of bone quality and is potentially related to several bone properties, including quality, turnover rate, microarchitecture, geometry, and mineralization. The U.S. Preventive Services Task Force recommends routine osteoporosis screening (by DXA) beginning at age 65 years for all women, and beginning at age 60 years for those at high risk. These recommendations are controversial, because no randomized trial results have shown that screening ultimately prevents fractures. Additional radiologic procedures may be helpful, particularly to define bone fractures. Several serum and urine biochemical tests are now available that provide an index of the overall rate of bone turnover and are usually characterized as those related primarily to bone formation or bone resorption. The results of clinical trials have shown that antiresorptive agents reduce fracture risk to varying degrees and that the magnitude of the reduction in fracture risk is proportional to the magnitude of changes in bone turnover and bone mineral density (BMD). The bisphosphonates are currently the preferred agents for the prevention and treatment of osteoporosis with the goal of reducing the risk of both vertebral and nonvertebral fractures. They are retained over time in the skeleton and may exert long-term effects. A 10-year course is safe and effective in women with high risk for fractures. A temporary stop may be considered after 5 years of treatment in less severe cases, on an individual basis. Calcitonin and raloxifene have no significant effect on the risk of hip and other nonvertebral fractures. Teriparatide, a synthetic 1-34 parathormone stimulates new bone formation, repairing architectural defects and reducing the risk of vertebral and all nonvertebral (but not hip) fractures in severe postmenopausal osteoporosis. Its administration is limited by time (no more than 2 years) and cost. The effect of vitamin D and calcium on the fracture's risk is controversial and its administration as the sole treatment is recommended mainly for elderly and other populations with Vitamin D deficiency. It is mandatory to supply the recommended vitamin D and calcium to the whole population independent of the need for therapy. Strontium ranelate appears to stimulate bone formation and reduce resorption and has been shown to reduce moderately vertebral and non-vertebral fractures in postmenopausal women with established osteoporosis. New medications are in development, including antiresorptive and bone formation stimulating agents.
骨骼抵抗骨折的能力是衡量骨质量的最佳指标，并且可能与多种骨骼特性相关，包括质量、转换率、微观结构、几何形状和矿化。美国预防服务工作组建议，所有女性从65岁开始进行常规骨质疏松症筛查（通过双能X线吸收法），高危女性从60岁开始。这些建议存在争议，因为没有随机试验结果表明筛查最终能预防骨折。其他放射学检查可能会有帮助，特别是用于确定骨折情况。现在有几种血清和尿液生化检测方法，可提供骨转换总体速率的指标，通常分为主要与骨形成或骨吸收相关的检测。临床试验结果表明，抗吸收药物能不同程度地降低骨折风险，且骨折风险降低的幅度与骨转换和骨密度（BMD）变化的幅度成正比。双膦酸盐类药物目前是预防和治疗骨质疏松症的首选药物，目标是降低椎体和非椎体骨折的风险。它们在骨骼中能长期留存，并可能产生长期效果。对于骨折高危女性，一个10年疗程是安全有效的。在病情较轻的情况下，可在治疗5年后根据个体情况考虑暂时停药。降钙素和雷洛昔芬对髋部及其他非椎体骨折风险没有显著影响。特立帕肽，一种合成的1-34甲状旁腺激素，可刺激新骨形成，修复结构缺陷，并降低严重绝经后骨质疏松症患者的椎体和所有非椎体（但不包括髋部）骨折风险。其使用受到时间（不超过2年）和成本的限制。维生素D和钙对骨折风险的影响存在争议，仅作为唯一治疗方法推荐给老年人和其他维生素D缺乏人群。无论是否需要治疗，都必须向全体人群提供推荐剂量的维生素D和钙。雷奈酸锶似乎能刺激骨形成并减少骨吸收，已被证明可适度降低患有确诊骨质疏松症的绝经后女性的椎体和非椎体骨折风险。新药物正在研发中，包括抗吸收药物和刺激骨形成的药物。
