Wark J D
Baillieres Clin Endocrinol Metab. 1993 Jan;7(1):151-81. doi: 10.1016/s0950-351x(05)80274-5.
Osteoporosis has emerged as a major and increasing health problem requiring interventions at both the individual and community levels. Most cases of osteoporosis are found among women after the menopause, since menopausal status and age are key predictors of fracture risk. This review has focused particularly on osteoporosis occurring in postmenopausal women: the magnitude of the problem, how it occurs, how it is diagnosed, strategies in prevention and treatment. The diagnosis of osteoporosis and identification of individuals with heightened fracture risk due to osteopenia have been greatly facilitated by the development of dual energy X-ray absorptiometry, a simple, safe, highly precise technique for bone density measurement. Where possible, intervention strategies in osteoporosis have been related to what is known about the pathogenesis of bone loss, especially the management of modifiable risk factors. Oestrogen deficiency of any cause results in accelerated bone turnover, with an increase in the rate of net bone loss. Exogenous oestrogens can control this form of bone loss. In established osteoporosis, hormone replacement therapy can achieve clinically-significant gains in bone mass. Consideration of hormone replacement therapy is pivotal in preventive and therapeutic strategies. Issues other than osteoporosis must be taken into account when hormone replacement is considered. Attention to other modifiable risk factors, both in the lifestyle and of a medical nature, is also indicated. A number of promising agents for the treatment of established osteoporosis are described. However, available data on fracture prevention by these agents are limited. There is concern that an ideal therapy for established osteoporosis may not be achievable. Therefore, strong emphasis is placed on the need for osteoporosis prevention now and in the foreseeable future. Although much has been learnt in recent years, more research is needed in the long-term prediction of fracture risk, broadly-applicable measures to reduce the prevalence of osteoporosis, and targeted interventions for individuals at high risk.
骨质疏松症已成为一个日益严重的重大健康问题，需要在个人和社区层面进行干预。大多数骨质疏松症病例见于绝经后的女性，因为绝经状态和年龄是骨折风险的关键预测因素。本综述特别关注绝经后女性发生的骨质疏松症：问题的严重程度、发病机制、诊断方法、预防和治疗策略。双能X线吸收法的发展极大地促进了骨质疏松症的诊断以及对因骨质减少而骨折风险增加的个体的识别，这是一种简单、安全、高度精确的骨密度测量技术。在可能的情况下，骨质疏松症的干预策略与已知的骨质流失发病机制相关，尤其是对可改变风险因素的管理。任何原因导致的雌激素缺乏都会导致骨转换加速，净骨丢失率增加。外源性雌激素可以控制这种形式的骨质流失。在已确诊的骨质疏松症中，激素替代疗法可以使骨量在临床上显著增加。激素替代疗法的考量在预防和治疗策略中至关重要。在考虑激素替代疗法时，必须考虑骨质疏松症以外的其他问题。还需要关注生活方式和医学性质方面的其他可改变风险因素。文中描述了一些用于治疗已确诊骨质疏松症的有前景的药物。然而，关于这些药物预防骨折的现有数据有限。人们担心可能无法实现针对已确诊骨质疏松症的理想治疗方法。因此，现在和可预见的未来都强烈强调预防骨质疏松症的必要性。尽管近年来已经取得了很多进展，但在骨折风险的长期预测、广泛适用的降低骨质疏松症患病率的措施以及针对高危个体的靶向干预方面，仍需要更多的研究。
