50岁及以上患有骨质疏松症或近期发生临床骨折患者的继发性骨质疏松症和代谢性骨病：临床视角
Secondary osteoporosis and metabolic bone disease in patients 50 years and older with osteoporosis or with a recent clinical fracture: a clinical perspective.
作者信息
Bours Sandrine P G, van den Bergh Joop P W, van Geel Tineke A C M, Geusens Piet P M M
机构信息
aDepartment of Rheumatology, Atrium Medical Centre, Heerlen bDepartment of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht cDepartment of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands dUniversity of Hasselt, Hasselt, Belgium eDepartment of General Practice, Maastricht University, Maastricht, The Netherlands.
出版信息
Curr Opin Rheumatol. 2014 Jul;26(4):430-9. doi: 10.1097/BOR.0000000000000074.
PURPOSE OF REVIEW
The purpose of this review is to provide guidance to clinicians about which laboratory tests should be performed in patients with osteoporosis or with a recent fracture.
RECENT FINDINGS
Newly diagnosed secondary osteoporosis and other metabolic bone diseases (SECOB) have been found in 5-48% of patients with osteoporosis. In patients with a recent fracture, new SECOB is found in 10-47% of patients with osteoporosis, and in 26-51% if all patients with a fracture regardless of bone mineral density (BMD) are screened. More than one SECOB can be found in the same patient, even when they have already known SECOB. In primary hyperparathyroidism, hyperthyroidism, hypercortisolism, and multiple myeloma, both SECOB and its treatment have an impact on BMD and fractures. For other SECOBs, no treatment is available, or there are no data about the effect of treatment of the SECOB on BMD and fractures.
SUMMARY
We recommend performing the following tests in all patients with osteoporosis or a recent clinical fracture: calcium, phosphate, creatinine, albumin, erythrocyte sedimentation rate in all patients, 24 h urine calcium in men and serum testosterone in men less than 70 years. On indication, additional tests can be performed.
综述目的
本综述旨在为临床医生提供指导，告知其对于骨质疏松症患者或近期发生骨折的患者应进行哪些实验室检查。
最新发现
在5%至48%的骨质疏松症患者中发现了新诊断的继发性骨质疏松症和其他代谢性骨病（SECOB）。在近期发生骨折的患者中，10%至47%的骨质疏松症患者发现了新的SECOB；若对所有骨折患者（无论骨密度[BMD]如何）进行筛查，这一比例为26%至51%。同一患者可能发现不止一种SECOB，即便他们已患有已知的SECOB。在原发性甲状旁腺功能亢进症、甲状腺功能亢进症、皮质醇增多症和多发性骨髓瘤中，SECOB及其治疗均会对BMD和骨折产生影响。对于其他SECOB，尚无可用的治疗方法，或者没有关于SECOB治疗对BMD和骨折影响的数据。
总结
我们建议对所有骨质疏松症患者或近期发生临床骨折的患者进行以下检查：所有患者均需检查钙、磷、肌酐、白蛋白、红细胞沉降率，男性患者需检查24小时尿钙，70岁以下男性患者需检查血清睾酮。根据指征，可进行其他检查。
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