Weill Cornell Medical College, Cornell University, New York, NY, USA.
J Orthop Trauma. 2011 Sep;25(9):566-73. doi: 10.1097/BOT.0b013e3181f9b389.
To address the cause of fragility fractures, an understanding of the determinants of bone strength is needed. Identifying patients at increased fracture risk should take into account bone quantity, quality, and turnover. Postmenopausal osteoporosis remains the most common derangement of bone strength; however, decreased bone strength can also result from secondary causes of osteoporosis. In order to properly manage patients with fragility fractures, assessment should include a focused medical history and physical examination, proper laboratory investigation, dual-energy x-ray absorptiometry screening, and, if necessary, use of the fracture risk assessment tool (FRAX). Treatment options will include nonpharmacologic treatment such as calcium and vitamin D and pharmacologic treatment with antiresorptive or anabolic agents to prevent future fractures. Bisphosphonates remain the standard treatment for osteoporosis. Concerns of oversuppression of bone turnover on long-term bisphosphonate treatment can be addressed with a drug holiday depending on the patient's fracture risk. An anabolic agent such as teriparatide is a powerful tool for the prevention of fragility fractures and should be reserved for patients at high risk for fracture, such as those with declining bone mineral density despite bisphosphonate treatment. Careful evaluation of all patients with a fragility fracture will enable the orthopaedic surgeon to identify the cause of fracture and implement a treatment plan that can prevent subsequent fractures in this vulnerable population.
为了解决脆性骨折的根本原因，需要了解骨强度的决定因素。确定骨折风险增加的患者时应考虑骨量、质量和转换率。绝经后骨质疏松症仍然是最常见的骨强度紊乱；然而，骨强度的降低也可能是由骨质疏松症的继发性原因引起的。为了正确管理脆性骨折患者，评估应包括重点的病史和体格检查、适当的实验室检查、双能 X 射线吸收法筛查，如果必要，还应使用骨折风险评估工具（FRAX）。治疗选择将包括非药物治疗，如钙和维生素 D，以及药物治疗，包括抗吸收或合成代谢药物，以预防未来的骨折。双磷酸盐仍然是骨质疏松症的标准治疗方法。对于长期双磷酸盐治疗中骨转换过度抑制的担忧，可以根据患者的骨折风险采用药物假期来解决。合成代谢药物如特立帕肽是预防脆性骨折的有力工具，应保留给骨折风险高的患者，如尽管接受双磷酸盐治疗但骨密度仍在下降的患者。仔细评估所有脆性骨折患者，使骨科医生能够确定骨折的原因，并实施治疗计划，以防止这一脆弱人群的后续骨折。
