Kruse H P, Kuhlencordt F
Lancet. 1980 Feb 9;1(8163):280-2. doi: 10.1016/s0140-6736(80)90779-5.
A new concept of the pathogenesis and natural course of osteoporosis is described, based on histomorphometric evaluation of iliac crest bone biopsies of 108 patients with untreated primary osteoporosis. It is suggested that primary osteoporosis spontaneously runs a three-phase course: during the initial period of negative bone balance, bone mass falls below the normal range; during the second phase bone mass remains consistently below age-related normal values; in the third phase restitution of osteoporosis is introduced by a positive bone balance. It is suggested that only about a quarter of patients with a skeletal mass below the age-related normal range have true primary osteoporosis; the remaining three-quarters may have secondary forms of osteoporosis where the underlying disease responsible for the bone loss had been missed before the osteoporosis was diagnosed.
基于对108例未经治疗的原发性骨质疏松症患者髂嵴骨活检的组织形态计量学评估，描述了骨质疏松症发病机制和自然病程的新概念。研究表明，原发性骨质疏松症自然病程呈三个阶段：在骨平衡为负的初始阶段，骨量降至正常范围以下；在第二阶段，骨量持续低于与年龄相关的正常值；在第三阶段，通过骨平衡为正实现骨质疏松症的恢复。研究表明，骨骼质量低于与年龄相关正常范围的患者中，只有约四分之一患有真正的原发性骨质疏松症；其余四分之三可能患有继发性骨质疏松症，在骨质疏松症被诊断之前，导致骨质流失的潜在疾病被漏诊。
