Baim Sanford
Department of Medicine, Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, USA.
J Clin Densitom. 2017 Jul-Sep;20(3):451-457. doi: 10.1016/j.jocd.2017.06.015. Epub 2017 Jul 21.
There have been many advances in the field of osteoporosis that add to a greater understanding of skeletal integrity and the adverse effects menopause and aging have on bone. The World Health Organization, the International Osteoporosis Foundation, and numerous additional governmental and privately sponsored organizations, societies, and their respective task forces have provided guidance for the use of appropriate fracture assessment methodologies and fracture risk assessment tools, and for the prevention and management of osteoporosis. Despite these worldwide efforts, a majority of patients at high risk of fracture have not had bone density testing and are not diagnosed or offered osteoporosis treatment before or even after sustaining a fragility fracture. The future of fracture risk assessment and, in general, osteoporosis management requires health-care systems to develop customizable electronic medical record (EMR) systems that incorporate the tools necessary to identify patients at high fracture risk. As provided in the example of an advanced health-care osteoporosis model, an EMR can be fully customizable to identify fractures and patients at high risk of fracture, to assist clinicians in selecting the most efficacious osteoporosis treatments, and to provide long-term follow-up with or without serial bone density testing. Future fracture risk assessment models will likely be further refined by incorporating advanced fracture predictive technologies for integration into algorithms that have improved discrimination, calibration, risk reclassification capabilities, and clinical utility. These models will include accurate and reproducible bone biomarkers and genomic testing that will be automatically integrated into worldwide EMR systems for screening large numbers of at-risk populations and younger patients for future prediction and prevention of disease. The integration of this type of a fracture prediction model into future electronic medical record systems will result in the prevention of osteoporosis fractures.
骨质疏松领域已经取得了许多进展，这有助于人们更深入地了解骨骼完整性以及绝经和衰老对骨骼的不利影响。世界卫生组织、国际骨质疏松基金会以及众多其他政府和私人赞助的组织、协会及其各自的特别工作组，为使用适当的骨折评估方法和骨折风险评估工具以及骨质疏松症的预防和管理提供了指导。尽管有这些全球范围的努力，但大多数骨折高风险患者尚未进行骨密度检测，在发生脆性骨折之前甚至之后都未被诊断或接受骨质疏松症治疗。骨折风险评估以及总体上骨质疏松症管理的未来，要求医疗保健系统开发可定制的电子病历（EMR）系统，该系统应纳入识别骨折高风险患者所需的工具。如先进的医疗保健骨质疏松模型示例所示，EMR可以完全定制，以识别骨折和骨折高风险患者，协助临床医生选择最有效的骨质疏松症治疗方法，并在进行或不进行连续骨密度检测的情况下提供长期随访。未来的骨折风险评估模型可能会通过纳入先进的骨折预测技术进一步完善，以便集成到具有更好的辨别力、校准、风险重新分类能力和临床实用性的算法中。这些模型将包括准确且可重复的骨生物标志物和基因检测，这些检测将自动集成到全球EMR系统中，用于筛查大量高危人群和年轻患者，以预测和预防未来的疾病。将这种类型的骨折预测模型集成到未来的电子病历系统中，将有助于预防骨质疏松性骨折。
