Binkley Neil, Adler Robert, Bilezikian John P
University of Wisconsin Osteoporosis Clinical Research Program, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA,
Curr Osteoporos Rep. 2014 Dec;12(4):403-9. doi: 10.1007/s11914-014-0242-z.
Osteoporosis becomes common with aging in both sexes, but is often ignored in men. The 2013 International Society for Clinical Densitometry consensus conference endorsed a Caucasian female referent database for T-score calculation in men. This recommendation has generated controversy and concern. Accumulating data indicate that at the same DXA-measured body mineral density (BMD) (g/cm(2)), men and women are at approximately the same fracture risk. With this point in mind, using the same database to derive the T-score in men and women is reasonable. As a result, a greater proportion of men who sustain a fragility fracture will have T-scores that are higher than they would if a male database were used; in fact, many men will fracture at T-scores that are "normal." This highlights the importance of diagnosing osteoporosis not just by T-score, but also by the presence of fragility fracture and/or by estimations of fracture risk as generated by tools such as the FRAX calculator. The practical consequences of this change in densitometric definition of osteoporosis in men should be monitored, including the proportion of men at risk identified and treated as well as defining the response to treatment in those assessed by this more comprehensive approach.
骨质疏松症在男女两性中都随着年龄增长而变得常见，但在男性中常常被忽视。2013年国际临床骨密度测量学会共识会议认可使用白种女性参考数据库来计算男性的T值。这一建议引发了争议和关注。越来越多的数据表明，在双能X线吸收法（DXA）测量的相同骨矿物质密度（BMD）（克/平方厘米）下，男性和女性的骨折风险大致相同。考虑到这一点，使用相同的数据库来推导男性和女性的T值是合理的。因此，与使用男性数据库相比，更多发生脆性骨折的男性其T值会更高；事实上，许多男性会在T值“正常”时发生骨折。这凸显了不仅通过T值，还通过脆性骨折的存在和/或通过如FRAX计算器等工具生成的骨折风险评估来诊断骨质疏松症的重要性。应监测男性骨质疏松症骨密度定义这一变化的实际后果，包括被识别和治疗的高危男性比例，以及确定通过这种更全面方法评估的患者对治疗的反应。
