Atrium Health One Health, Huntersville, North Carolina.
Atrium Health One Health, Charlotte, North Carolina.
Am Fam Physician. 2023 Mar;107(3):238-246.
Osteoporosis affects 10.2% of adults older than 50 years and is expected to increase to 13.6% by 2030. Osteoporotic fractures, specifically hip fractures, significantly affect morbidity, mortality, and quality of life. Screening for osteoporosis with dual energy x-ray absorptiometry should be considered for all women 65 years and older or women who are postmenopausal with clinical risk factors. The Bone Health and Osteoporosis Foundation recommends screening men 70 years and older and men with clinical risk factors; however, the U.S. Preventive Services Task Force did not find sufficient evidence to support routine screening in men. Osteoporosis can be diagnosed by a T-score of -2.5 or less or the presence of a fragility fracture. All patients with osteoporosis should be counseled on weight-bearing exercise, smoking cessation, moderation of alcohol intake, and calcium and vita-min D supplementation. Treatment of osteoporosis is influenced by the patient's fracture risk, the effectiveness of fracture risk reduction, and medication safety. Patients at high risk of fracture should consider treatment with antiresorptive therapy, including bisphosphonates and denosumab. Anabolic agents such as teriparatide, abaloparatide, and romosozumab should be considered for patients at very high risk or with previous vertebral fractures.
骨质疏松症影响 50 岁以上成年人的 10.2%，预计到 2030 年将增加到 13.6%。骨质疏松性骨折，特别是髋部骨折，显著影响发病率、死亡率和生活质量。应考虑对所有 65 岁及以上的女性或有临床危险因素的绝经后女性进行双能 X 线吸收法（DXA）骨质疏松筛查。骨骼健康和骨质疏松基金会建议对 70 岁及以上的男性和有临床危险因素的男性进行筛查；然而，美国预防服务工作组没有发现足够的证据支持对男性进行常规筛查。骨质疏松症可以通过 T 评分-2.5 或更低或脆性骨折来诊断。所有骨质疏松症患者都应接受有关负重锻炼、戒烟、限制饮酒和钙及维生素 D 补充的咨询。骨质疏松症的治疗受患者骨折风险、骨折风险降低的效果和药物安全性的影响。有高骨折风险的患者应考虑使用抗吸收治疗，包括双磷酸盐类药物和地舒单抗。对于有极高风险或有先前椎体骨折的患者，应考虑使用特立帕肽、abaloparatide 和 romosozumab 等合成代谢药物。
