Seeman E, Tsalamandris C, Formica C
Austin Hospital, University of Melbourne, Australia.
Int J Fertil Menopausal Stud. 1993;38 Suppl 2:77-82.
The focus of attention in osteoporosis research has been on factors influencing bone fragility and the propensity for trauma (falls) during adulthood and old age. The purpose of this review is to change the focus of this attention toward consideration of skeletal growth in the first 20 years of life and to demonstrate the importance of mineral accrual (and the factors influencing this accrual) in determining bone density in adulthood and old age. We suggest that the epidemiology of fractures may be unified by a central role of reduced peak bone density in the pathogenesis of the low bone density found in patients with fractures. The reduced peak bone density establishes the relevance of age-related and sex hormone-dependent bone loss. Risk and protective factors in the first 20 years of life may have quantitatively larger, and qualitatively different effects on the axial and appendicular skeleton than exposure during adulthood. Public health measures focussed on optimising mineral accrual in the first 20 years of life may be more important than health care measures more proximate to the age at which fractures occur.
骨质疏松症研究的关注焦点一直是影响成年期和老年期骨脆性以及创伤（跌倒）倾向的因素。本综述的目的是将这一关注焦点转向对生命最初20年骨骼生长的考量，并证明矿物质积累（以及影响这种积累的因素）在决定成年期和老年期骨密度方面的重要性。我们认为，骨折的流行病学可能通过峰值骨密度降低在骨折患者低骨密度发病机制中的核心作用而得到统一。峰值骨密度降低确立了与年龄相关和性激素依赖性骨质流失的相关性。生命最初20年中的风险和保护因素对轴向和附属骨骼的影响在数量上可能更大，在质量上也与成年期暴露不同。关注于在生命最初20年优化矿物质积累的公共卫生措施可能比在骨折发生年龄更接近时采取的医疗保健措施更为重要。
