Sheu Angela, Diamond Terry
University of New South Wales, Sydney.
Aust Prescr. 2016 Jun;39(3):85-7. doi: 10.18773/austprescr.2016.038. Epub 2016 Jun 1.
Secondary osteoporosis is less common than primary osteoporosis. It may be suspected in patients who present with a fragility fracture despite having no risk factors for osteoporosis. In addition, secondary osteoporosis should be considered if the bone density Z-score is -2.5 or less. Consider the fracture site and presence of other clinical clues to guide investigations for an underlying cause. The tests to use are those that are indicated for the suspected cause. Baseline investigations include tests for bone and mineral metabolism (calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D, parathyroid hormone), liver and kidney function, full blood count and thyroid-stimulating hormone. More detailed testing may be required in patients with severe osteoporosis.
继发性骨质疏松症比原发性骨质疏松症少见。对于虽无骨质疏松症危险因素但发生脆性骨折的患者,可能怀疑患有继发性骨质疏松症。此外,如果骨密度Z值小于或等于 -2.5,也应考虑继发性骨质疏松症。考虑骨折部位及其他临床线索,以指导对潜在病因的检查。应采用针对可疑病因的检查。基线检查包括骨与矿物质代谢检查(钙、磷、碱性磷酸酶、25-羟维生素D、甲状旁腺激素)、肝肾功能、全血细胞计数及促甲状腺激素检查。重度骨质疏松症患者可能需要更详细的检查。