From the 1Department of Medicine, University of California, San Francisco, San Francisco, CA; 2Department of Medicine, University of California, San Diego, La Jolla, CA; and 3Departments of ObGyn and Medicine, The Reading Hospital and Medical Center, Reading, PA; Departments of ObGyn and Internal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
Menopause. 2013 Oct;20(10):1092-7. doi: 10.1097/GME.0b013e3182a7c57b.
One of your patients, a 59-year-old postmenopausal Asian woman (menopause, age 52), took hormone therapy for about one year for her menopause symptoms. When she was 54, her mother (age 80) suffered a hip fracture, and she requested a bone density test at her next gynecology visit. The t-score results were spine, -1.1; total hip, -1.8; and femoral neck, -2.1, all in the osteopenic range. After some discussion, she was started on alendronate 70 mg once a week, together with calcium and vitamin D. Follow-up dual-energy x-ray absorptiometry testing after 2 and 5 years of therapy showed increases in bone mineral density, resulting in t-score improvements of about 0.3 to 0.5 units (spine was now normal; femoral neck was -1.8). The Fracture Risk Assessment Tool estimated her 10-year risk of hip fracture to be 0.4% and her 10-year risk of any of 4 major osteoporotic fractures to be 7.5%. During her most recent gynecology visit, she expressed concern about unusual femoral fractures being linked to long-term use of alendronate. She asks if there is reason for her to stop using this drug.
你的一位患者是一位 59 岁的绝经后亚裔女性（绝经年龄为 52 岁），曾因更年期症状接受过大约一年的激素治疗。她 54 岁时，其 80 岁的母亲髋部骨折，于是她要求在下次妇科就诊时进行骨密度检查。结果显示，其 T 评分分别为脊柱 -1.1、全髋 -1.8 和股骨颈 -2.1，均处于骨质疏松范围。经过讨论，她开始每周服用一次阿仑膦酸钠 70mg，同时服用钙和维生素 D。治疗 2 年和 5 年后，双能 X 线吸收仪检测结果显示骨密度增加，T 评分提高了约 0.3 至 0.5 个单位（脊柱现在正常；股骨颈为 -1.8）。骨折风险评估工具估计她 10 年内髋部骨折的风险为 0.4%，任何 4 种主要骨质疏松性骨折的 10 年风险为 7.5%。在最近一次妇科就诊时，她对长期使用阿仑膦酸钠与不寻常的股骨骨折之间的关联表示担忧。她询问是否有理由停止使用这种药物。
