Department of Medicine, University of British Columbia, Vancouver, Canada.
Department of Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom.
J Clin Densitom. 2019 Oct-Dec;22(4):489-500. doi: 10.1016/j.jocd.2019.07.010. Epub 2019 Jul 17.
Bone mineral density (BMD) can be measured at multiple skeletal sites using various technologies to aid clinical decision-making in bone and mineral disorders. BMD by dual-energy X-ray absorptiometry (DXA) has a critical role in predicting risk of fracture, diagnosis of osteoporosis, and monitoring patients. In clinical practice, DXA remains the most available and best validated tool for monitoring patients. A quality baseline DXA scan is essential for comparison with all subsequent scans. Monitoring patients with serial measurements requires technical expertise and knowledge of the least significant change in order to determine when follow-up scans should be repeated. Prior ISCD Official Positions have clarified how and when repeat DXA is useful as well as the interpretation of results. The 2019 ISCD Official Positions considered new evidence and clarifies if and when BMD should be repeated. There is good evidence showing that repeat BMD measurement can identify people who experience bone loss, which is an independent predictor of fracture risk. There is good evidence showing that the reduction in spine and hip fractures with osteoporosis medication is proportional to the change in BMD with treatment. There is evidence that measuring BMD is useful following discontinuation of osteoporosis treatment. There is less documentation addressing the effectiveness of monitoring BMD to improve medication adherence, whether monitoring of BMD reduces the risk of fracture, or effectively discriminates patients who should and should not recommence treatment following an interruption of medication. Further research is needed in all of these areas.
骨密度（BMD）可在多个骨骼部位使用各种技术进行测量，以帮助临床决策，解决骨骼和矿物质紊乱问题。双能 X 射线吸收法（DXA）测定的 BMD 在预测骨折风险、骨质疏松症诊断和监测患者方面具有重要作用。在临床实践中，DXA 仍然是监测患者最常用和最有效的工具。基线 DXA 扫描质量对于与所有后续扫描进行比较至关重要。要对患者进行系列测量监测，需要具备技术专业知识和最小有意义变化的知识，以便确定何时需要重复进行随访扫描。先前的国际临床骨密度学会（ISCD）官方立场已经澄清了何时以及如何重复 DXA 是有用的，以及如何解释结果。2019 年的 ISCD 官方立场考虑了新的证据，并澄清了是否应重复 BMD。有充分的证据表明，重复 BMD 测量可以识别发生骨质流失的人群，骨质流失是骨折风险的独立预测因素。有充分的证据表明，骨质疏松症药物治疗后脊柱和髋部骨折的减少与治疗过程中 BMD 的变化成正比。有证据表明，在停止骨质疏松症治疗后，测量 BMD 是有用的。关于监测 BMD 是否可以提高药物依从性、监测 BMD 是否可以降低骨折风险或有效区分中断药物治疗后应继续治疗和不应继续治疗的患者，这些方面的文件记录较少。所有这些领域都需要进一步研究。
