Gordan G S, Genant H K
Clin Geriatr Med. 1985 Feb;1(1):95-118.
The importance of bone loss with aging increases year by year. When Bismarck set the age of retirement at 65, it did not cost Prussia much because few lived to receive pensions. At the turn of the century, only 4.1 per cent of our population was 65 or older. But the present change in demography, called "The Graying of America," means that we now have 13 per cent of the population 65 or older: 35 million people, 20 million women and 15 million men. For the women who are now passing through menopause or who have had oophorectomies, the predictable deformities caused by fractures of the vertebrae, wrists, and hips will make up the single largest cause of hospitalization unless prophylaxis against postmenopausal bone loss is instituted. The best established prophylaxis is now low-dose estrogen-gestagen replacement therapy. Very promising is the combination of very-low-dose estrogen and high-dose oral calcium supplements (Fig. 17). For women who cannot or will not take estrogens, certain progestational agents offer equal protection to bone, though, of course, these agents do not protect against atrophy of the other target organs, most notably the vaginal mucosa.
随着年龄增长骨质流失的重要性逐年增加。当俾斯麦将退休年龄设定为65岁时，这对普鲁士来说成本并不高，因为很少有人能活到领取养老金的年纪。在世纪之交，我国只有4.1%的人口年龄在65岁及以上。但目前被称为“美国老龄化”的人口结构变化意味着，我们现在有13%的人口年龄在65岁及以上：3500万人，其中女性2000万，男性1500万。对于正在经历更年期或已接受卵巢切除术的女性来说，除非采取预防绝经后骨质流失的措施，否则由椎骨、手腕和髋部骨折导致的可预测畸形将成为住院的最大单一原因。目前最成熟的预防措施是低剂量雌激素 - 孕激素替代疗法。非常有前景的是极低剂量雌激素与高剂量口服钙补充剂的组合（图17）。对于不能或不愿服用雌激素的女性，某些孕激素制剂对骨骼提供同等保护，当然，这些制剂不能预防其他靶器官的萎缩，最明显的是阴道黏膜萎缩。
