骨质疏松性骨折的危险因素

骨量减少、骨微细结构破坏是骨质疏松症最重要的病理变化,这种病变最终将导致骨骼脆性增加和骨折的发生。骨密度测定是临床骨质疏松诊断和骨质疏松性骨折危险性评估的重要基础指标。骨质疏松性骨折同样还受到年龄及衰老、脆性骨折史及骨折家族史、皮质激素应用、低体重指数、跌倒、饮食异常、吸烟、过量饮酒和某些疾病等多种危险因素的影响,这些因素可能依赖或独立于骨密度的变化。     

骨密度与骨折风险的评估

骨质疏松症是以骨量低下、骨微结构破坏，导致骨脆性增加，易发生骨折为特征的全身性骨病。2001年美国国立卫生研究院（NIH）提出骨质疏松症是以骨强度下降、骨折风险性增加为特征的骨骼系统疾病，骨强度反映了骨骼的两个方面，即骨矿密度（简称骨密度）和骨质量。骨质疏松症的严重后果是骨质疏松性骨折（脆性骨折），这是由于骨强度下降，在受到轻微创伤或日常活动中即可发生的骨折，它大大增加了老年人的病残率和死病率。     

骨质疏松性骨折患者抗骨质疏松治疗与管理专家共识

<正>一、概述(一)骨质疏松性骨折的流行病学骨质疏松性骨折是骨质疏松症最严重的后果之一。骨质疏松时骨密度和骨质量下降、骨强度减低,受到轻微暴力即可发生骨折,故属于脆性骨折。常见的骨折部位包括脊椎、髋部、桡骨远端和肱骨近端。据估计,全世界每3秒就发生一次骨质疏松性骨折,50岁以后约三分之一的女性和五分之一的男性将会罹患一次骨折[1]。对女性     

运动对预防老年骨质疏松性骨折的作用

骨质疏松是一种以低骨量和骨组织微结构破坏为特征,导致骨骼脆性增加和骨强度下降、易发生骨折为特征的一种的全身性疾病。据报道,50岁以上人群中,50%的女性、20%的男性在他们的一生当中都至少会出现一次骨质疏松性骨折。又因老年人骨质疏松性骨折致残、致死,以及治疗过程中的巨大     

他汀类药物干预老年骨质疏松的研究概况

老年骨质疏松又称原发性(特发性)骨质疏松,是以骨量减少,骨组织的显微结构发生改变,以松质骨骨小梁变细、断裂、数量减少,皮质骨多孔和变薄为特征,以致骨脆性增高,易于发生骨折的一种全身性骨骼疾病,在临床上表现为腰背疼痛和病理性骨折,主要发生在中老年人,尤其是绝经后妇女中     

跌倒与骨质疏松性骨折

老年人的跌倒是内在因素与外在因素共同作用的结果。跌倒是衰老的标志之一,发生率甚高。跌倒的低能量损伤造成的后果往往是骨质疏松性骨折（脆性骨折）。脆性骨折是骨结构衰退和骨功能衰竭的表现。老年人的健康状况、并存的慢性疾病、遗传因素、步态失控、精神与心理状态、药物应用、行为习惯、生活环境等都是导致跌倒的危险因素。约9％的跌倒老年人会发生骨折,除了外在的损伤应力外,骨骼本身的因素如骨量与骨质量降低和机械强度的减弱在骨折发生中均起重要作用。影响骨量和骨质量的疾病、药物、身高与体重指数（BMI）、营养状态、性腺功能、维生素D的摄入以及既往骨折史等都是预测骨折风险的重要因素。目前应用较广的预测跌倒与脆性骨折风险的方法是世界卫生组织（WHO）推荐的FRAX方法。危险因素分析有助于发现跌倒和骨质疏松骨折的老年高危人群。对高危人群监护、预防干预是降低跌倒发生及骨折风险的有效途径。提高对高危个体的危险因素分析、制定个体化的预防干预措施有望达到有效降低老年人跌倒与骨折发生率的目标。     

骨质疏松症与维生素D受体基因Fok I Bsm I Apa I Taq I多态性的研究进展

骨质疏松症是以骨强度下降、骨折风险增加为特征的骨骼系统疾病。骨强度反映了骨骼的骨密度和骨质量的特性。而骨质疏松症的严重后果是骨质疏松性骨折(即脆性骨折),这是由于骨强度的下降,在受到轻微创伤时即可发生骨折,这大大增加了老年人的病残率和病死率。而骨密度是目前诊断骨质疏松症、预测脆性骨折风险、监测自然病程以及评价药物干预疗效的最佳指标。骨折发生的危险度与低骨密度有关,若同时伴有其他危险因素则会增加骨折的危险性。维生索D受体基因被认为是调控骨量的候选基因之一,但维生素D受体基因多态性与骨质疏松症的关系在不同人群中的研究仍存在较大的争议,该文就维生素D受体基因Fok I、Bsm I、Apa I、Taq I多态性与骨质疏松症的关系作一综述。     

原发性骨质疏松症诊疗指南(2017)

正一、概述(一)定义和分类骨质疏松症(osteoporosis,OP)是最常见的骨骼疾病,是一种以骨量低,骨组织微结构损坏,导致骨脆性增加,易发生骨折为特征的全身性骨病[1]。2001年美国国立卫生研究院(National Institutes of Health,NIH)将其定义为以骨强度下降和骨折风险增加为特征的骨骼疾病,提示骨量降低是骨质疏松性骨折的主要危险因素,但还存在其他危险因     

原发性骨质疏松症诊疗指南(2017)

正1概述1.1定义和分类骨质疏松症(osteoporosis,OP)是最常见的骨骼疾病,是一种以骨量低,骨组织微结构损坏,导致骨脆性增加,易发生骨折为特征的全身性骨病~[1]。2001年美国国立卫生研究院(national institutes of health,NIH)将其定义为以骨强度下降和骨折风险增加为特征的骨骼疾病,提示骨量降低是骨质疏松性骨折的主要危险因素,但还存在其他危     

上海地区绝经后女性患者脆性骨折危险因素的回顾性病例研究

目的调查绝经后女性患者在就诊后10年期间的脆性骨折的发生率,并分析其危险因素。方法以2008年11月-2010年11月就诊于华东医院的947例45~84岁绝经后女性为研究对象,于基线水平调查研究对象的一般情况、骨折史、慢性疾病史等,并用双能X射线(DXA)检测患者腰椎、股骨颈、髋部的骨密度。于2019年11月对患者进行电话随访,记录患者随访期间发生的骨质疏松性骨折的部位和次数,采用Logistic回归分析骨质疏松性骨折的危险因素。结果(1)本研究基线时筛选1100例,最终947例患者完成研究,入组时平均年龄为(63.6±9.3)岁。在平均10年的随访期间,共有10.3%的女性发生了骨质疏松性骨折。在入组时年龄段为45~54岁,55~64岁,65~74岁,75~84岁的患者,在随访期间的脆性骨折发生率分别为7.4%,11.1%,12.9%和7.5%。(2)随访期间最常见的骨折部位为椎体骨折,涉及4.5%的患者,前臂、髋部、肱骨部位的骨折分别为1.4%,0.8%和0.4%。(3)Logistic回归分析显示:脆性骨折史、慢性阻塞性肺病、长期激素使用史以及腰椎低骨量是随访期间老年女性骨质疏松性骨折的危险因素。结论(1)椎体骨折是老年女性患者最常见的脆性骨折类型。(2)除腰椎低骨量外,脆性骨折史、慢性阻塞性肺病、长期使用激素可增加脆性骨折风险,需给予重视。     

Prevention and Treatment of Postmenopausal Osteoporosis

Osteoporosis is a systemic disease characterized by low bone mass and microarchitectural deterioration of the skeleton leading to enhanced bone fragility and an increased risk of fracture. Prior to fracture, diagnosis is established by documenting low bone mass. In the first section of this article we review the clinical use of bone mass measurements and biochemical markers of bone remodeling in selecting patients most in need of preventive therapy at menopause. Women with high bone turnover lose bone at menopause more rapidly than those with normal bone turnover and are more likely to derive benefit from the several preventive therapies available. The second section addresses the available technologies used to diagnose osteoporosis and/or establish fragility fracture risk using noninvasive bone mass measurement and biochemical markers of bone remodeling separately or in combination. In the third section we review the several treatment options available for patients with osteoporosis, including alendronate (alendronic acid), risendronate (risedronic acid), calcitonin, teriparatide, and raloxifene, and the approaches to monitoring the therapeutic response. The final section deals with fall protection--an often forgotten aspect of management of the patient at risk for sustaining and osteoporotic fragility fracture.     

Evaluation and treatment of bone disease after fragility fracture

Bone mineral density and other measuring tests are part of the risk assessment of primary and secondary osteoporosis necessary in treating patients after fragility fracture. A better understanding of factors contributing to insufficiency fracture in osteoporotic bone is essential to guide the clinician's intervention in this disease affecting 25 million women in the United States and responsible for an estimated 700,000 vertebral and 300,000 hip fractures every year. Prevention of future fractures by slowing or stopping bone loss, maintaining bone strength, and minimizing or eliminating factors contributing to fractures, through pharmacotherapy, education, and lifestyle changes, can help slow annual health care expenditures for osteoporotic fractures, which now exceed 17 billion dollars, more than for breast and gynecological cancers combined.     

Complex association between body weight and fracture risk in postmenopausal women

Osteoporosis is a common disease, characterized by low bone mass with micro‐architectural disruption and skeletal fragility, resulting in an increased risk of fracture. A substantial number of studies has examined the possible relationship between body weight, bone mineral density and fracture risk in post‐menopausal women, with the majority of them concluding that low body weight correlates with increased risk of fracture, especially hip fracture. Controversies about the potential protective effect of obesity on osteoporosis and consequent fracture risk still exist. Several recent studies question the concept that obesity exerts a protective effect against fractures, suggesting that it stands as a risk factor for fractures at specific skeletal sites, such as upper arm. The association between body weight and fracture risk is complex, differs across skeletal sites and body mass index, and is modified by the interaction between body weight and bone mineral density. Some potential explanations that link obesity with increased fracture risk may be the pattern of falls and impaired mobility in obese individuals, comorbidities, such as asthma, diabetes and early menopause, as well as, increased parathyroid hormone and reduced 25‐hydroxy‐vitamin D concentrations.     

Prescribing by general practitioners after an osteoporotic fracture

OBJECTIVES—Osteoporosis is a major cause of morbidity and cost. Patients sustaining one osteoporotic fracture are at increased risk of having another fracture. The objective of this study was to examine the use of "bone drugs" for the prevention of further osteoporotic fractures among patients who have had a "typical" osteoporotic fracture.
METHODS—This study took a random sample of 300 women aged 50 and over who had sustained either a vertebral, hip or Colles fracture in 1995 from the General Practice Research Database (GPRD) and compared their use of bone drugs with 300 age and practice matched controls.
RESULTS—Compared with age and practice matched control patients only vertebral fracture patients showed a statistically significant increase in the use of bone drugs in the year after fracture (39% and 2% for cases and controls respectively; 95% CI of difference 27% to 47%). Etidronate was the most commonly used compound.
CONCLUSION—The majority of patients sustaining an osteoporotic fracture are not prescribed any pharmaceutical agents for the secondary prevention of fracture one year after a primary fracture.

Keywords: osteoporosis; fracture     

Osteoporosis in men

Osteoporosis is defined as "a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture". Approximately 40-50% of women sustain osteoporotic fractures in their lifetime; as such, it is appropriate that studies initially focused upon females. Despite an increased recognition of osteoporotic fractures in men, there continues to be neglect of this disease in males. This ongoing neglect is inappropriate as 25-33% of men in some populations will sustain osteoporotic fractures in their lifetime. Testosterone plays an important role in male skeletal health. However, recent data suggest that estrogen may in fact be the dominant hormone regulating skeletal status in both men and women. BMD measurement may be utilized for osteoporosis diagnosis and to assist with fracture risk prediction in men prior to their sustaining a fracture. Recognizing this need, the International Society for Clinical Densitometry (ISCD) recommended and recently reaffirmed use of a BMD T-score of -2.5 or below be utilized to diagnose osteoporosis in men. Androgen therapy of hypogonadal men may be considered with the caveat that data do not exist to document that this treatment reduces fracture risk. At this time, the data is inadequate to support use of androgen treatment in eugonadal men with osteoporosis. Parathyroid hormone treatment does increase BMD; existing studies have not been of adequate size or duration to document fracture reduction efficacy. Bisphosphonate therapy increases BMD, reduces vertebral fracture risk and is considered the standard of care for osteoporotic men at this point in time.     

抗骨质疏松治疗对骨质疏松性骨折的治疗影响及建议

骨质疏松性骨折是骨质疏松的严重并发症,骨折的愈合对骨质疏松患者的功能恢复、术后生活质量有着重要的作用。由于目前对于抗骨质疏松治疗是否对骨折愈合有影响在临床上存在争议,部分学者认为抗骨质疏松治疗有提高骨密度、缓解骨折疼痛、促进骨折愈合等积极作用,但也有学者则认为抗骨质疏松治疗不但对骨折愈合无影响,甚至可能抑制骨折愈合。因此,本文对抗骨质疏松治疗药物对骨质疏松性骨折愈合的影响进行综述,以期指导临床上骨质疏松性骨折患者的治疗。     

Osteoporotic fracture among older U.S. women: risk factors quantified.

The purpose of this study was to develop a predictive model for osteoporotic fracture among a national sample of 2,325 women ages 50 years and older. Predictors for examination included age, race, heredity, body mass index (BMI), physical activity, smoking status, alcohol use, and dairy product use. Analyses were conducted using Standard Analysis System (SAS) procedures. Strong risk factors predicting osteoporotic fracture included age, race, low BMI, and inactivity. Recommendations emphasize screening of high-risk women, achieving and maintaining health body weights for underweight women, and obtaining moderate physical activity. Promotion of healthy body weights for women of all ages is emphasized. Recommendations also include encouraging widespread physician, patient, and public education regarding osteoporotic fracture.     

老年人髋部二次骨折风险因素的研究进展

老年髋部骨折后部分患者会发生髋部二次骨折。老年髋部二次骨折会导致老年人的活动能力减弱和自理能力下降,并造成死亡风险的升高。了解此类骨折的风险因素,有助于临床医师在处理高危人群时制定行之有效的预防策略。因此,本文将从患者自身特点、生活习惯、并存疾病和干预措施4个方面对老年髋部二次骨折的风险因素做一综述。