University of Cambridge School of Clinical Medicine, Cambridge, UK.
Best Pract Res Clin Rheumatol. 2009 Dec;23(6):781-8. doi: 10.1016/j.berh.2009.09.007.
Bone mineral density (BMD) measurements are recommended in some guidelines for monitoring osteoporosis treatment. However, evidence to support this approach is lacking, since treatment-induced changes in bone density may take up to 3 years to detect and do not predict fracture reduction. Biochemical markers of bone turnover have potential for monitoring since they change rapidly in response to treatment and are more predictive of fracture reduction, but variability of their measurement reduces their value in clinical practice. Neither approach has been shown to improve adherence to therapy. By contrast, there is evidence that discussion with a health-care professional improves treatment adherence, regardless of feedback about monitoring tests. At present, there is no justification for the use of bone-density measurement or bone-turnover markers in routine monitoring, but patients should be fully informed about their treatment and provided with the opportunity to discuss treatment-related issues with a health-care professional.
骨密度（BMD）测量在一些骨质疏松症治疗监测指南中被推荐使用。然而，这种方法的证据是缺乏的，因为骨密度的治疗诱导变化可能需要长达 3 年才能检测到，并且不能预测骨折减少。骨转换的生化标志物具有监测的潜力，因为它们可以快速响应治疗而发生变化，并且更能预测骨折减少，但它们的测量的可变性降低了它们在临床实践中的价值。这两种方法都没有显示出可以提高治疗的依从性。相比之下，有证据表明，与医疗保健专业人员进行讨论可以提高治疗的依从性，而不论监测测试的反馈如何。目前，在常规监测中使用骨密度测量或骨转换标志物没有任何理由，但应充分告知患者其治疗情况，并为其提供与医疗保健专业人员讨论治疗相关问题的机会。
