Wallach S
Clin Orthop Relat Res. 1979 Oct(144):284-92.
Primary osteoporosis is a ubiquitous disease of unknown etiology. The condition undoubtedly has multiple causes and the metabolic pattern of bone loss may vary significantly from case to case. Five hormones, PTH, gonadal steroids, CT, T3 and T4, and glucocorticoids, and possibly a sixth, GH, have fundamental actions on bone metabolism and may therefore be causally involved in primary osteoporosis. A consideration of selected data on hormonal interactions culled from a much larger body of experimental and clinical data leads to the conclusion that in vitro studies, animal research, and data obtained in postmenopausal women with age-related bone atrophy, but not osteoporosis, have yielded considerable data relating to bone metabolism, but have failed to define the causes or treatment of primary osteoporosis. There has been excessive emphasis on hormonal reactions relating to bone metabolism and bone cell function, and too little concern for nonhormonal factors which might influence the kinetics of skeletal turnover through alterations in bone cell activity. A practical approach to the cause(s) and treatment in the only suitable model, the human with osteoporosis, is proposed with the expectation that a better insight into the pathogenesis of the condition will be achieved.
原发性骨质疏松症是一种病因不明但普遍存在的疾病。这种情况无疑有多种病因，而且骨质流失的代谢模式在不同病例之间可能有很大差异。甲状旁腺激素（PTH）、性腺类固醇、降钙素（CT）、三碘甲状腺原氨酸（T3）和甲状腺素（T4）以及糖皮质激素这五种激素，可能还有第六种激素生长激素（GH），对骨代谢具有重要作用，因此可能与原发性骨质疏松症的病因有关。从大量实验和临床数据中挑选出有关激素相互作用的特定数据进行考量后得出结论：体外研究、动物研究以及在患有与年龄相关的骨萎缩而非骨质疏松症的绝经后女性中获得的数据，已经产生了大量与骨代谢相关的数据，但未能确定原发性骨质疏松症的病因或治疗方法。人们过度强调了与骨代谢和骨细胞功能相关的激素反应，而对可能通过改变骨细胞活性来影响骨骼周转动力学的非激素因素关注过少。本文提出了一种针对唯一合适模型——患有骨质疏松症的人类——的病因及治疗方法的实用途径，期望能对该病的发病机制有更深入的了解。
