摘要
骨密度的测定通常采用双能X线吸收测量法，结果用T值表示。T值反应了年轻女性骨密度平均值的标准差。我们现在意识到测定骨矿密度只是解决骨质疏松症临床诊断负担的一个低效率的方法。骨质疏松症的筛查和治疗方法必须改变。绝经前骨丢失就已经开始了，70岁开始骨量丢失加速。激素对骨密度有直接重要的影响作用，这或许可以解释早期的骨丢失。抗骨吸收治疗（主要是雌激素替代疗法）的应用，保护性地防止了骨量随着时间的推移而丢失。T值不接近-2．5这个阈值的患者，如没有额外的加速骨丢失的危险因素，骨密度测量可以安全地延长至每5年而不是每2～3年重复一次。骨折风险性随着衰老急剧增加，骨密度的变化只是使这种风险性增加的一个原因。应用FRAX算法，综合考虑年龄、性别和其他骨折危险因素，有助于制定新的骨质疏松症诊断和治疗方针。关于何时检测和治疗骨质疏松的决定将越来越多地集中于绝对骨折风险的确定上。
Bone density is usually measured by dual energy x-ray absorptiometry with the results expressed as a T score. The T score reflects the number of standard deviations above or below the density seen in young women. We are now realizing that measuring bone mineral density alone is an inefficient way of addressing the clinical burden of osteoporosis. Our approach to osteoporosis screening and treatment needs to change Bone loss begins before menopause and accelerated from age 70 onward. Hormones have now been linked to important direct effects on bone density and might account for this early loss. The use of antiresorptive therapy （predominantly hormone replacement therapy in this cohort） protected against bone loss over time. Individuals with T scores that are not close to threshold of -2.5 and who have no additional risk factors for rapid bone loss, the interval between assessments of bone mineral density can safely be extended to repeated every 5 years rather than every 2-3 years The risk for fracture increases dramatically with age, and changes in bone density account for only a proportion of this increase. By FRAX algorithm, combining the factors including age, sex and other risk factors for fracture will help formulate new guidelines for the diagnosis and management of osteoporosis. Decisions about when to test and treat will increasingly focus on estimates of absolute fracture risk.
出处
《中国骨质疏松杂志》
CAS
CSCD
2008年第11期842-843,781,共3页
Chinese Journal of Osteoporosis
