Riggs B L, Melton L J
Endocrine Research Unit, Mayo Clinic, Rochester, MN 55905, USA.
Bone. 1995 Nov;17(5 Suppl):505S-511S. doi: 10.1016/8756-3282(95)00258-4.
Osteoporosis is one of the major problems facing women and older people of both sexes. The morbid event in osteoporosis is fracture. However, the definition of osteoporosis should not require the presence of fractures but only a decrease in bone mass that is associated with an unacceptably high risk of fracture. In the USA, approximately 1.5 million fractures annually are attributable to osteoporosis: these include 700,000 vertebral fractures, 250,000 distal forearm (Colles') fractures, 250,000 hip fractures, and 300,000 fractures of other limb sites. The lifetime risk of fractures of the spine (symptomatic), hip, and distal radius is 40% for white women and 13% for white men from 50 years of age onwards. Following a hip fracture, there is a 10%-20% mortality over the subsequent 6 months, 50% of sufferers will be unable to walk without assistance, and 25% will require long-term domiciliary care. Contrary to prevailing opinion, the morbidity and suffering associated with wrist and spine fractures are also considerable. The annual cost of osteoporosis to the US healthcare system is at least $5-$10 billion with similar incidence and cost in other developed countries. These already high costs will increase further with continued aging of the population. In addition, the population explosion in underdeveloped countries will change the demography of osteoporosis; for example, the incidence of hip fracture, and, presumably, other osteoporotic fractures will increase four-fold worldwide during the next 50 years and the attendant costs will threaten the viability of the healthcare systems of many countries. Unless decisive steps for preventive intervention are taken now, a catastrophic global epidemic of osteoporosis seems inevitable.
骨质疏松症是女性和老年男女面临的主要问题之一。骨质疏松症的病态事件是骨折。然而，骨质疏松症的定义不应要求存在骨折，而仅应是与不可接受的高骨折风险相关的骨量减少。在美国，每年约有150万例骨折归因于骨质疏松症：其中包括70万例椎体骨折、25万例桡骨远端（科勒斯氏）骨折、25万例髋部骨折以及30万例其他肢体部位骨折。从50岁起，白人女性脊柱（有症状）、髋部和桡骨远端骨折的终生风险为40%，白人男性为13%。髋部骨折后，在随后的6个月内死亡率为10% - 20%，50%的患者在没有帮助的情况下无法行走，25%的患者需要长期家庭护理。与普遍看法相反，手腕和脊柱骨折相关的发病率和痛苦也相当可观。美国医疗保健系统每年因骨质疏松症产生的费用至少为50亿至100亿美元，其他发达国家的发病率和费用情况类似。随着人口持续老龄化，这些本已高昂的费用还将进一步增加。此外，欠发达国家的人口爆炸将改变骨质疏松症的人口统计学特征；例如，在未来50年内，全球髋部骨折以及其他骨质疏松性骨折的发病率将增加四倍，随之而来的费用将威胁到许多国家医疗保健系统的生存能力。除非现在就采取决定性的预防干预措施，否则骨质疏松症的灾难性全球流行似乎不可避免。
