Bledsoe Lauren, Alessi Kaitlyn, Toro Jose B, Giordano Brian, Hanypsiak Bryan T
Physicians Regional Hospital, 6101 Pine Ridge Road, Desk 23A, Naples FL 34119, USA. Email:
Am J Orthop (Belle Mead NJ). 2018 Dec;47(12). doi: 10.12788/ajo.2018.0112.
Fragility fractures are estimated to affect 3 million people annually in the United States. As they are associated with a significant mortality rate, the prevention of these fractures should be a priority for orthopedists. At-risk patients include the elderly and those with thyroid disease, diabetes, hypertension, and heart disease. Osteoporosis is diagnosed by the presence of a fragility fracture or by dual-energy x-ray absorptiometry (DXA) in the absence of a fragility fracture. In 2011, the United States Preventive Services Task Force (USPSTF) recommended that all women ≥65 years should be screened for osteoporosis by DXA. Women <65 years with a 10-year fracture risk =∕> than that of a 65-year-old white woman should also be screened for osteoporosis. Lifestyle changes, such as calcium and vitamin D supplementation, exercise, and smoking cessation, are non-pharmacologic treatment options. The National Osteoporosis Foundation recommends treating osteoporosis with pharmacotherapy in patients with a high risk for fracture (T score <-2.5) or history of fragility fracture. Understanding risk factors and eliminating medications known to cause decreased BMD are vital to prevention and will be necessary to limit these fractures and their associated expenses in the future.
据估计，在美国每年有300万人发生脆性骨折。由于其与显著的死亡率相关，预防这些骨折应是骨科医生的首要任务。高危患者包括老年人以及患有甲状腺疾病、糖尿病、高血压和心脏病的人群。骨质疏松症通过脆性骨折的存在来诊断，或者在没有脆性骨折的情况下通过双能X线吸收法（DXA）来诊断。2011年，美国预防服务工作组（USPSTF）建议，所有65岁及以上的女性都应通过DXA进行骨质疏松症筛查。65岁以下且10年骨折风险等同于或高于65岁白人女性的女性也应进行骨质疏松症筛查。生活方式的改变，如补充钙和维生素D、运动以及戒烟，是非药物治疗选择。美国国家骨质疏松症基金会建议，对于骨折高危患者（T值＜-2.5）或有脆性骨折病史的患者，采用药物疗法治疗骨质疏松症。了解风险因素并停用已知会导致骨密度降低的药物对于预防至关重要，并且对于未来限制这些骨折及其相关费用是必要的。
