Lim Lionel S, Hoeksema Laura J, Sherin Kevin
Department of Internal Medicine, Griffin Hospital, Derby, Connecticut, USA.
Am J Prev Med. 2009 Apr;36(4):366-75. doi: 10.1016/j.amepre.2009.01.013.
Osteoporosis is a common and costly disease that is associated with high morbidity and mortality. There is a lack of direct evidence supporting the benefits of bone mineral density (BMD) screening on osteoporosis outcomes. However, there is indirect evidence to support screening for osteoporosis given the availability of medications with good antifracture efficacy. This paper addresses the position of the American College of Preventive Medicine (ACPM) on osteoporosis screening.
The medical literature was reviewed for studies examining the benefits and harms of osteoporosis screening. An overview is also provided of available modalities for osteoporosis screening, risk-assessment tools, cost effectiveness, benefits and harms of screening, rationale for the study, and recommendations from leading health organizations and ACPM. A review was done of English language articles published prior to September 2008 that were retrieved via search on PubMed, from references from pertinent review or landmark articles, and from websites of leading health organizations.
There were no randomized controlled trials (RCTs) of osteoporosis screening on fracture outcomes. However, there was one observational study that demonstrated reduced fracture incidence among recipients of BMD testing. Dual energy x-ray absorptiometry is currently one of the most widely accepted and utilized methods for assessing BMD. Other potential tests for detecting osteoporosis include quantitative ultrasound, quantitative computer tomography, and biochemical markers of bone turnover. Testing via BMD is a cost-effective method for detecting osteoporosis in both men and women. Osteoporosis risk-assessment tools such as the WHO fracture-risk algorithm are useful supplements to BMD assessments as they provide estimates of absolute fracture risks. They can also be used with or without BMD testing to assist healthcare providers and patients in making decisions regarding osteoporosis treatments.
All adult patients aged >or=50 years should be evaluated for risk factors for osteoporosis. Screening with BMD testing for osteoporosis is recommended in women aged >or=65 years and in men aged >or=70 years. Younger postmenopausal women and men aged 50-69 years should undergo screening if they have at least one major or two minor risk factors for osteoporosis. It is also recommended that clinicians consider using an osteoporosis risk-assessment tool to evaluate absolute fracture risk to determine appropriate osteoporosis therapies.
骨质疏松症是一种常见且代价高昂的疾病，与高发病率和死亡率相关。缺乏直接证据支持骨密度（BMD）筛查对骨质疏松症结局的益处。然而，鉴于有抗骨折疗效良好的药物，有间接证据支持进行骨质疏松症筛查。本文阐述了美国预防医学学院（ACPM）对骨质疏松症筛查的立场。
查阅医学文献以研究骨质疏松症筛查的益处和危害。还概述了骨质疏松症筛查的可用方式、风险评估工具、成本效益、筛查的益处和危害、研究原理以及主要健康组织和ACPM的建议。对2008年9月之前发表的英文文章进行了综述，这些文章通过在PubMed上搜索、从相关综述或标志性文章的参考文献以及主要健康组织的网站上检索获得。
没有关于骨质疏松症筛查对骨折结局的随机对照试验（RCT）。然而，有一项观察性研究表明，接受骨密度检测者的骨折发生率降低。双能X线吸收法目前是评估骨密度最广泛接受和使用的方法之一。其他检测骨质疏松症的潜在方法包括定量超声、定量计算机断层扫描和骨转换生化标志物。通过骨密度检测进行检测是检测男性和女性骨质疏松症的一种具有成本效益的方法。骨质疏松症风险评估工具，如世界卫生组织骨折风险算法，是骨密度评估的有用补充，因为它们提供绝对骨折风险的估计。它们也可在有或没有骨密度检测的情况下使用，以协助医疗保健提供者和患者做出关于骨质疏松症治疗的决策。
所有年龄≥50岁的成年患者都应评估骨质疏松症的风险因素。建议对年龄≥65岁的女性和年龄≥70岁的男性进行骨密度检测筛查骨质疏松症。年龄较轻的绝经后女性和50 - 69岁的男性，如果有至少一个主要或两个次要骨质疏松症风险因素，应接受筛查。还建议临床医生考虑使用骨质疏松症风险评估工具来评估绝对骨折风险，以确定合适的骨质疏松症治疗方法。
