Ringe J D, Dorst A J
Medizinische Klinik 4, Klinikum Leverkusen.
Dtsch Med Wochenschr. 1994 Jul 8;119(27):943-7. doi: 10.1055/s-2008-1058783.
In a prospective study, 321 consecutive male patients, aged between 16 and 86 years, referred to the Department of Medicine of the Medical Centre at Leverkusen from many parts of Germany over a three-year period with the diagnosis of osteoporosis, underwent a standardized programme of clinical investigation: 254 (79%) were found to have the condition. The programme consisted of a detailed history, physical examination, a battery of laboratory tests, X-ray examination of the skeleton and osteodensitometry. Where, as a result, underlying disease or risk factors were suspected, further tests were performed. 98 patients (39%) were found by densitometric criteria to have preclinical, 156 (61%) manifest osteoporosis with one or more vertebral body fractures. There was no significant difference regarding bone density between the preclinical and manifest cases. 76 of the 254 (30%) patients had no detectable pathogenetic factors, i. e. their osteoporosis was classified as idiopathic (mean age 51 years), while as senile osteoporosis in 16 elderly patients (mean age 78 years). The remaining 162 patients had 286 risk factors within 24 different categories. Depending on duration, intensity and combination of these risk factors, the osteoporosis was classified as primary with few risk factors or as secondary osteoporosis of single or multiple aetiology (mean age of these three groups was 51, 56 and 52 years, respectively). The most important demonstrable risk factors were (in decreasing order of frequency) glucocorticoid treatment, alcohol consumption, smoking, hypogonadism, hypercalciuria, liver disease, Crohn's disease, low calcium nutrition, hyperthyroidism, physical inactivity, stomach operation and plasmacytoma.--This study indicates that if there is evidence of significant risk factors detailed bone densitometry should be performed so that any necessary treatment can be initiated early. If there is known osteoporosis, staging and exact analysis of risk factors is a precondition for any cause-oriented treatment.
在一项前瞻性研究中，321名年龄在16至86岁之间的连续男性患者，在三年时间里从德国各地被转诊至勒沃库森医疗中心内科，诊断为骨质疏松症，他们接受了标准化的临床调查程序：其中254人（79%）被确诊患有该疾病。该程序包括详细的病史、体格检查、一系列实验室检查、骨骼X线检查和骨密度测定。如果据此怀疑存在潜在疾病或风险因素，则进行进一步检查。通过骨密度测定标准，98名患者（39%）被发现患有临床前期骨质疏松症，156名患者（61%）患有明显的骨质疏松症且伴有一处或多处椎体骨折。临床前期和明显病例之间的骨密度无显著差异。254名患者中有76名（30%）未检测到致病因素，即他们的骨质疏松症被归类为特发性（平均年龄51岁），而16名老年患者（平均年龄78岁）的骨质疏松症被归类为老年性骨质疏松症。其余162名患者在24个不同类别中有286个风险因素。根据这些风险因素的持续时间、强度和组合情况，骨质疏松症被分类为风险因素较少的原发性骨质疏松症或单一或多种病因的继发性骨质疏松症（这三组的平均年龄分别为51岁、56岁和52岁）。最重要的可证实风险因素依次为（按频率递减顺序）糖皮质激素治疗、饮酒、吸烟、性腺功能减退、高钙尿症、肝病、克罗恩病、低钙饮食、甲状腺功能亢进、身体活动不足、胃部手术和浆细胞瘤。——这项研究表明，如果有明显风险因素的证据，应进行详细的骨密度测定，以便尽早开始任何必要的治疗。如果已知患有骨质疏松症，对风险因素进行分期和精确分析是任何针对性治疗的前提条件。
