Hashimoto Kazunori, Ishitani Ken, Ohta Hiroaki
Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan.
Clin Calcium. 2009 Dec;19(12):1742-8.
With the recent development of diverse therapeutic modalities for osteoporosis, there is an increasingly recognized need to develop cost-effective strategies to determine which patients will benefit most from pharmacologic treatment. The World Health Organization (WHO) has developed a 10-year osteoporotic fracture risk assessment tool (FRAX) based on clinical risk factors combined with bone mineral density measured at the femoral neck. In postmenopausal women, age and prior history of fragility fracture were found to be major contributing factors to osteoporotic fracture risk as assessed by FRAX. In the US, the National Osteoporosis Foundation (NOF) guidelines recommend treatment in patients with osteopenia when the 10-year probability of major osteoporotic fracture is = 20% or the hip fracture is = 3%. On the other hand, in the UK, the National Osteoporosis Guideline Group (NOGG) has developed a case finding approach for individuals whose 10-year probability of major osteoporotic fracture exceeds age-specific thresholds. The FRAX algorithms may be worth incorporating in a cost-effectiveness model for socioeconomic analyses to determine the pharmacological intervention threshold for osteoporosis treatment. FRAX represents a significant advance for practitioners in women's health as an easy-to-use calculator of osteoporotic fracture probability. However, it should be noted that FRAX is intended as a guideline for clinical decision making only and does not force the decision to treat on physicians.
随着骨质疏松症多种治疗方式的最新发展，人们越来越认识到需要制定具有成本效益的策略，以确定哪些患者将从药物治疗中获益最大。世界卫生组织（WHO）基于临床风险因素以及股骨颈骨密度测量值，开发了一种为期10年的骨质疏松性骨折风险评估工具（FRAX）。在绝经后女性中，年龄和既往脆性骨折史被发现是FRAX评估的骨质疏松性骨折风险的主要促成因素。在美国，国家骨质疏松基金会（NOF）指南建议，当主要骨质疏松性骨折的10年概率≥20%或髋部骨折概率≥3%时，对骨质减少患者进行治疗。另一方面，在英国，国家骨质疏松指南小组（NOGG）针对主要骨质疏松性骨折10年概率超过特定年龄阈值的个体制定了一种病例发现方法。FRAX算法可能值得纳入成本效益模型进行社会经济分析，以确定骨质疏松症治疗的药物干预阈值。FRAX作为一种易于使用的骨质疏松性骨折概率计算器，对女性健康从业者来说是一项重大进展。然而，应该注意的是，FRAX仅作为临床决策的指南，并不强制医生做出治疗决定。
