Osteoporosis Center, Columbia University Medical Center, 180 Fort Washington Avenue, New York, NY 10032, USA.
Postgrad Med. 2010 Jan;122(1):82-90. doi: 10.3810/pgm.2010.01.2102.
Osteoporosis-related fractures (low-trauma or fragility fractures) cause substantial disability, health care costs, and mortality among postmenopausal women and older men. Epidemiologic studies indicate that at least half the population burden of osteoporosis-related fractures affects persons with osteopenia (low bone density), who comprise a larger segment of the population than those with osteoporosis. The public health burden of fractures will fail to decrease unless the subset of patients with low bone density who are at increased risk for fracture are identified and treated. Risk stratification for medically appropriate and cost-effective treatment is facilitated by the World Health Organization (WHO) FRAX algorithm, which uses clinical risk factors, bone mineral density, and country-specific fracture and mortality data to quantify a patient's 10-year probability of a hip or major osteoporotic fracture. Included risk factors comprise femoral neck bone mineral density, prior fractures, parental hip fracture history, age, gender, body mass index, ethnicity, smoking, alcohol use, glucocorticoid use, rheumatoid arthritis, and secondary osteoporosis. FRAX was developed by the WHO to be applicable to both postmenopausal women and men aged 40 to 90 years; the National Osteoporosis Foundation Clinician's Guide focuses on its utility in postmenopausal women and men aged >50 years. It is validated to be used in untreated patients only. The current National Osteoporosis Foundation Guide recommends treating patients with FRAX 10-year risk scores of > or = 3% for hip fracture or > or = 20% for major osteoporotic fracture, to reduce their fracture risk. Additional risk factors such as frequent falls, not represented in FRAX, warrant individual clinical judgment. FRAX has the potential to demystify fracture risk assessment in primary care for patients with low bone density, directing clinical fracture prevention strategies to those who can benefit most.
骨质疏松性骨折（低创伤或脆性骨折）会导致绝经后妇女和老年男性严重残疾、医疗费用增加和死亡率上升。流行病学研究表明，至少一半的骨质疏松性骨折负担影响到骨量减少（低骨密度）的人群，这些人比骨质疏松症患者的比例更大。除非确定并治疗骨折风险增加的低骨密度患者亚组，否则骨折的公共卫生负担将不会减少。世界卫生组织（WHO）FRAX 算法有助于骨折风险分层，从而进行适当的医学治疗和具有成本效益的治疗，该算法使用临床危险因素、骨密度以及特定国家的骨折和死亡率数据来量化患者发生髋部或主要骨质疏松性骨折的 10 年概率。包括的危险因素有：股骨颈骨密度、既往骨折、父母髋部骨折史、年龄、性别、体重指数、种族、吸烟、饮酒、糖皮质激素使用、类风湿关节炎和继发性骨质疏松症。FRAX 是由世界卫生组织开发的，适用于绝经后妇女和 40 至 90 岁的男性；国家骨质疏松基金会临床医生指南重点关注其在绝经后妇女和 >50 岁男性中的应用。它经过验证仅适用于未接受治疗的患者。目前的国家骨质疏松基金会指南建议对 FRAX 10 年风险评分 > 3%的髋部骨折或 > 20%的主要骨质疏松性骨折的患者进行治疗，以降低其骨折风险。FRAX 中未包含的其他危险因素，如频繁跌倒，需要进行个体临床判断。FRAX 有可能为低骨密度患者在初级保健中评估骨折风险提供帮助，将临床骨折预防策略针对最受益的人群。
