Harvey Nicholas C, Al-Daghri Nasser, Beaudart Charlotte, Brandi Maria Luisa, Burlet Nansa, Campusano Claudia, Cavalier Etienne, Chandran Manju, Cooper Cyrus, Dawson-Hughes Bess, Halbout Philippe, Hough Teréza, Lazaretti-Castro Marise, Matijevic Radmila, Mithal Ambrish, Njeze Ngozi, Rizzoli René, Saleh Yousef, Kanis John A, Ward Kate, McCloskey Eugene
MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK.
Osteoporos Int. 2025 Aug 22. doi: 10.1007/s00198-025-07628-5.
Our ability to optimally manage bone health across the lifecourse, and so minimise the risk of fractures, has advanced substantially in recent decades. Whilst fractures and osteoporosis in older age were historically viewed simply as inherent in normal ageing, they are now recognised as manifestations of age-related disease. Key to advancing the field was the development of conceptual (relating to impaired bone mass and microarchitecture with increased propensity to fracture), and subsequent World Health Organization densitometric definitions of osteoporosis, cementing the role of dual-energy X-ray absorptiometry in bone health management. However, whilst low bone mineral density is a strong risk factor for fracture, many individuals who do fracture have normal or only modestly reduced bone mineral density. Furthermore, the existence of two definitions constituting a condition called "osteoporosis", one based on a measurement, and the other conceptual, has led to uncertainty in clinical practice. The field is therefore moving towards calculation of an individual's absolute fracture risk, based on clinical risk factors, with the option to incorporate bone mineral density (if available) as a risk factor rather than as an indication for treatment. Uptake of this new direction has been variable internationally, with many parts of the world, particularly low- and middle-income countries, still predicating treatment (where osteoporosis services exist) on bone mineral density, despite poor availability of densitometry in many such settings. In this Position Paper, on behalf of the International Osteoporosis Foundation, we review the current barriers which prevent equitable access to optimal bone health management worldwide and recommend potential solutions which might be implemented to overcome them.
近几十年来，我们在整个生命历程中优化骨骼健康管理、从而将骨折风险降至最低的能力有了显著提高。虽然老年人的骨折和骨质疏松症在历史上一直被简单地视为正常衰老的固有现象，但现在它们被认为是与年龄相关疾病的表现。该领域取得进展的关键在于概念的发展（与骨量受损和微结构受损以及骨折倾向增加有关），以及随后世界卫生组织对骨质疏松症的骨密度定义，巩固了双能X线吸收法在骨骼健康管理中的作用。然而，虽然低骨密度是骨折的一个重要风险因素，但许多发生骨折的个体骨密度正常或仅略有降低。此外，存在两种构成 “骨质疏松症” 这一病症的定义，一种基于测量，另一种基于概念，这导致了临床实践中的不确定性。因此，该领域正在朝着基于临床风险因素计算个体的绝对骨折风险发展，可以选择将骨密度（如果可用）作为一个风险因素纳入，而不是作为治疗的指征。国际上对这一新方向的接受程度各不相同，世界上许多地区，特别是低收入和中等收入国家，尽管在许多此类环境中骨密度测量的可及性很差，但在有骨质疏松症服务的地方，仍然根据骨密度来决定治疗方案。在本立场文件中，我们代表国际骨质疏松症基金会，回顾了目前阻碍全球公平获得最佳骨骼健康管理的障碍，并推荐了可能实施的潜在解决方案以克服这些障碍。
