Leslie William D, Morin Suzanne N
Departments of Medicine and Radiology, University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada.
Department of Medicine, McGill University- McGill University Health Center, Montreal, Quebec, Canada.
Curr Osteoporos Rep. 2020 Jun;18(3):115-129. doi: 10.1007/s11914-020-00590-7.
Identifying individuals at high fracture risk can be used to target those likely to derive the greatest benefit from treatment. This narrative review examines recent developments in using specific risk factors used to assess fracture risk, with a focus on publications in the last 3 years.
There is expanding evidence for the recognition of individual clinical risk factors and clinical use of composite scores in the general population. Unfortunately, enthusiasm is dampened by three pragmatic randomized trials that raise questions about the effectiveness of widespread population screening using clinical fracture prediction tools given suboptimal participation and adherence. There have been refinements in risk assessment in special populations: men, patients with diabetes, and secondary causes of osteoporosis. New evidence supports the value of vertebral fracture assessment (VFA), high resolution peripheral quantitative CT (HR-pQCT), opportunistic screening using CT, skeletal strength assessment with finite element analysis (FEA), and trabecular bone score (TBS). The last 3 years have seen important developments in the area of fracture risk assessment, both in the research setting and translation to clinical practice. The next challenge will be incorporating these advances into routine work flows that can improve the identification of high risk individuals at the population level and meaningfully impact the ongoing crisis in osteoporosis management.
识别骨折高风险个体可用于确定那些可能从治疗中获益最大的人群。本叙述性综述探讨了用于评估骨折风险的特定风险因素的最新进展，重点关注过去3年的相关出版物。
越来越多的证据支持在普通人群中识别个体临床风险因素并临床应用综合评分。遗憾的是，三项实用的随机试验削弱了人们的热情，这些试验对使用临床骨折预测工具进行广泛人群筛查的有效性提出了质疑，因为参与度和依从性欠佳。特殊人群（男性、糖尿病患者和骨质疏松症的继发原因）的风险评估有了改进。新证据支持椎体骨折评估（VFA）、高分辨率外周定量CT（HR-pQCT）、利用CT进行机会性筛查、采用有限元分析（FEA）评估骨骼强度以及小梁骨评分（TBS）的价值。在过去3年里，骨折风险评估领域在研究和转化为临床实践方面都取得了重要进展。下一个挑战将是把这些进展纳入常规工作流程，以改善在人群层面识别高风险个体的情况，并切实影响当前骨质疏松症管理方面的危机。
