Forbes A P
Clin Orthop Relat Res. 1991 Aug(269):128-41.
Fifty years ago Albright contributed the following to understanding osteoporosis: (1) He recognized it as a deficiency of formation, not of mineralization of bone matrix; (2) he observed that 40 of 42 patients with osteoporosis before age 65 were women past menopause or young women postoophorectomy; (3) he concluded that estrogen stimulates osteoblasts (a conclusion later challenged); (4) he demonstrated by metabolic balance studies that estrogen causes a positive calcium balance in postmenopausal osteoporosis; (5) he introduced periodic progesterone to prevent or treat endometrial hyperplasia from prolonged estrogen therapy; and (6) he showed that long-term therapy arrested vertebral damage and height loss in postmenopausal osteoporosis and prevented them if started early. Since Albright's time, more sensitive methods of assessing bone density have replaced conventional roentgenograms. Some large scale trials of estrogen have indicated increased bone density and fewer fractures. Unopposed estrogen increases risk of endometrial cancer and decreases mortality from other cancers, myocardial infarction, stroke, and osteoporosis. Trials of calcitonin, diphosphonates, fluoride, vitamin D, and high calcium intake have not proved more effective than estrogen.
五十年前，奥尔布赖特对骨质疏松症的认识有以下贡献：（1）他认识到这是骨形成不足，而非骨基质矿化不足；（2）他观察到，42名65岁之前患骨质疏松症的患者中有40名是绝经后的女性或绝经后接受卵巢切除术的年轻女性；（3）他得出结论，雌激素刺激成骨细胞（这一结论后来受到质疑）；（4）他通过代谢平衡研究证明，雌激素在绝经后骨质疏松症中可导致钙平衡呈正向；（5）他引入周期性孕激素以预防或治疗因长期雌激素治疗引起的子宫内膜增生；（6）他表明，长期治疗可阻止绝经后骨质疏松症患者的椎体损伤和身高降低，若早期开始治疗则可预防这些情况。自奥尔布赖特时代以来，更敏感的骨密度评估方法已取代了传统的X线片。一些雌激素的大规模试验表明骨密度增加且骨折减少。单纯使用雌激素会增加子宫内膜癌风险，但可降低其他癌症、心肌梗死、中风和骨质疏松症导致的死亡率。降钙素、双膦酸盐、氟化物、维生素D和高钙摄入的试验尚未证明比雌激素更有效。
