Improving osteoporosis management in patients with fractures

A history of fracture is an independent risk factor for future fractures, but patients who have sustained a fracture are rarely evaluated for osteoporosis (OP). The objective of this study was to determine if a simple intervention in a general orthopedic clinic would lead to more fracture patients receiving evaluation and treatment for OP. Patients with a history of fracture visiting a weekly orthopedic clinic during a 6-month intervention period were educated about OP, and a bone mineral density (BMD) test was offered. The number of BMD tests performed and other OP-specific actions taken as a result of the intervention were compared with a 6-month pre-intervention period. The prevalence of OP in those who underwent BMD testing was examined. In the pre-intervention period, only 12.7% (16 of 126) had a BMD test as compared with 62.5% of the 136 intervention-period subjects (odds ratio [OR] 11.5, 95% confidence interval [CI] 6.1, 21.4). Based on BMD test results, 11.9% of the pre-intervention patients, and 41.9% of the intervention patients received OP-specific recommendations (OR 5.3, 95% CI 2.8, 10.1). The intervention led to more patients being treated for low bone mass (9.5% vs 23.5%); OR 2.9, 95% CI 1.4, 5.9. Low bone mass was common among all types of fracture patients: 20% had osteoporosis and 41%, osteopenia. BMD testing in patients with fractures should identify those at risk for future fractures, leading to appropriate treatment.     

骨盆骨折N个损伤变数与临床对策

骨盆骨折多系高能量损伤,尤其是交通伤和坠落伤,尤为多见。临床上具有较高的病死率和致残率。本期发表的文章之临床资料,其骨盆骨折所涉及的N个损伤变数中包括：髋臼骨折（包括前后柱壁和臼顶）、骶髂分离/骶髂复合体骨折和其继发的失血性休克及下腰椎骨折、耻骨联合分离、耻骨上下支骨折和其继发的泌尿系损伤;其他涉及到颅脑、胸肺和腹部、上下肢骨折等。     

Dietary recommendations in the prevention and treatment of osteoporosis

IntroductionThis article presents the initial recommendations of the French Rheumatology Society (Société Française de Rhumatologie – SFR) and the Osteoporosis Research and Information Group (Groupe de Recherche et d’Informations sur les Ostéoporoses – GRIO) on the role of diet in the prevention and treatment of osteoporosis.MethodsThe recommendations were produced by a working group composed of rheumatologists, physician nutrition specialists and a geriatrician. Fifteen (15) questions pertaining to “daily practices” were preselected by the working group. For the literature review, the working group focussed mainly on the effects of diet on bone mineral density (BMD) and fractures, and primarily on meta-analyses of longitudinal studies and dietary intervention studies.ResultsA Mediterranean-type diet and the daily consumption of 2 to 3 dairy products are recommended. Together, these provide the calcium and “high quality” protein required to maintain a normal calcium-phosphorus balance and bone metabolism, and are associated with lower fracture risk. Conversely, unbalanced Western diets, vegan diets, weight-loss diets in non-overweight individuals, alcohol consumption and daily consumption of sodas are advised against. In terms of the beneficial effects on bone mineral density and fracture risk, current scientific data are either insufficient or too divergent to recommend increasing or restricting the consumption of tea or coffee, vitamins other than vitamin D, vitamin D-enriched or phytoestrogen-rich foods, calcium-enriched plant-based beverages, oral nutritional supplements, or dietary sources of prebiotics and probiotics.ConclusionsThese are the first set of recommendations addressing the role of diet in the prevention and treatment of osteoporosis. More research is necessary to direct and support guidelines.     

静脉伊班膦酸钠冲击治疗类固醇性骨质疏松症的临床对照研究

目的评价伊班膦酸钠治疗类固醇性骨质疏松症的有效性和安全性。方法采用随机、对照研究。153例类固醇性骨质疏松症患者,随机分为埘照组(C组,49例)、伊班膦酸钠治疗组(Ⅰ组,52例)和阿法骨化醇治疗组(R组,52例)。3组患者均每天补充碳酸钙600mg/d。Ⅰ组:应用伊班膦酸钠注射液静脉点滴,3个月1次,每次2mg。R组:罗钙全0.25μg/d,口服。疗程6个月。观察伊班膦酸钠治疗后患者腰椎骨密度、股骨颈骨密度、全段甲状旁腺激素(iPTH)、血钙、血磷、血清碱性磷酸酶(AKP)等骨代谢指标的变化及不良反应发生情况。结果(1)治疗6个月后,Ⅰ组、R组腰椎及股骨颈骨密度均较C组明显上升[腰椎骨密度(g/cm2):Ⅰ组比C组,1.28±0.04比0.82±0.04,P<0.01;R组比C组,1.14±0.03比0.82±0.04,P<0.05;股骨颈骨密度(g/cm2):Ⅰ组比C组、1.29±0.04比0.90±0.04,P<0.05;R组比C组,1.21±0.06比0.90±0.04,P<0.05]。(2)治疗6个月后,Ⅰ组和R组血iPTH水平均较C组下降[Ⅰ组比C组,39.02±1.28比90.67±10.02(pg/ml),P<0.01;R组比C组,52.43±1.42比90.67±10.02(pg/ml),P<0.05]。(3)伊班膦酸钠治疗后,患者无严重不良反应发生。结论伊班膦酸钠是一种治疗类固醇性骨质疏松症的有效而安全的药物,其升高骨密度的作用比阿法骨化醇明显,且静脉应用患者依从     

The near absence of osteoporosis treatment in older men with fractures

The burden of osteoporotic fractures in older men is significant. The objectives of our study were to: (1) characterize older men with fractures associated with osteoporosis, (2) determine if medication treatment rates for osteoporosis are improving and (3) identify patient, healthcare benefit and utilization, and clinician characteristics that are significantly associated with treatment. This retrospective cohort study assessed 1,171 men aged 65 or older with any new fracture associated with osteoporosis between 1 January 1998 and 30 June 2001 in a non-profit health maintenance organization in the United States. Multiple logistic regression was used to evaluate pre-fracture factors for their association with osteoporosis treatment in the 6-month post-fracture period. The main outcome measure was pharmacologic treatment for osteoporosis in the 6 months after the index fracture. Subjects average age was 76.7 years; 3.3% had a diagnosis of osteoporosis and 15.2% a diagnosis or medication associated with secondary osteoporosis. Only 7.1% of the study population and 16.0% of those with a hip or vertebral fracture received a medication for osteoporosis following the index fracture, and treatment rates did not improve over time. In the multivariate model, factors significantly associated with drug treatment were a higher value on the Charlson Comorbidity Index (odds ratio 1.26, 95% confidence interval 1.05–1.51), having an osteoporosis diagnosis (odds ratio 8.11, 95% confidence interval 3.08–21.3), chronic glucocorticoid use (odds ratio 5.37, 95% confidence interval 2.37–12.2) and a vertebral fracture (odds ratio 16.6, 95% confidence interval 7.8–31.4). Bone mineral density measurement was rare ( n =13, 1.1%). Our findings suggest that there is under-ascertainment and under-treatment of osteoporosis and modifiable secondary causes in older men with fractures. Information systems merging diagnostic and treatment information can help delineate gaps in patient management. Interventions showing promise in other conditions should be evaluated to improve care for osteoporosis.     

Fracture Reduction Affects Medicare Economics (FRAME): Impact of increased osteoporosis diagnosis and treatment

Osteoporosis is a common, debilitating disease affecting US Medicare beneficiaries, yet diagnosis and treatment lag behind medical advances. We estimated the cost of fractures to the Medicare program and the impact of increasing osteoporosis diagnosis and treatment. A Markov model was used to predict fracture incidence and costs in postmenopausal women aged 65 years and older, over 3 years (2001–2003). Only 1.80 million women were estimated to receive a Medicare-reimbursed bone mineral density (BMD) test in 2001. We evaluated the budget impact of testing an additional 1 million women from Medicare and patient perspectives. These women were stratified into high-risk (osteoporotic with prevalent vertebral fracture) and moderate-risk (without prevalent vertebral fracture) groups. During 2001–2003, an estimated 2.39 million fractures occurred among the 5.11 million women aged 65+ with osteoporosis, at a cost to Medicare of $12.96 billion. We projected that BMD testing of an additional 1 million women in 2001 would result in treatment of 440,000 new patients with a bone-specific medication, preventing over 35,000 fractures over the 3 years. The decrease in fractures would produce a net discounted savings to the Medicare budget of $77.86 million. Medicares hospital inpatient cost would decrease by $115.41 million and long-term care cost by $43.51 million, more than offsetting incremental outpatient cost of $81.07 million. Patients would benefit from fracture avoidance, but their out-of-pocket medical costs would increase by $63.49 million during 2001–2003, or $1,771 per fracture avoided. Sensitivity analyses showed that savings to the Medicare program varied in proportion to the unit cost of fractures, fracture risk of the populations tested, treatment rate, and adherence to therapy. Increased osteoporosis diagnosis may produce savings for the Medicare program if interventions are targeted to women at elevated risk for fracture and may be budget neutral if all older women are screened.A related study, which employed the same economic model but evaluated current BMD testing rates in the Medicare program, was presented at the ACR Annual Meeting on October 28, 2002. An abstract of that study was published in the Abstract Supplement for the meeting (Arthritis Rheum 46 [Supplement 9]:S583, abstract 1,567)     

5mg唑来膦酸治疗绝经后骨质疏松及其骨折

目的 探讨5mg唑来膦酸每年1次在干预绝经后妇女不同原因所致骨质疏松及其骨折的作用. 方法 2009年10月至2009年12月收治且符合纳入标准的绝经后妇女骨质疏松患者89例,根据病情分为两组:A组(原发性骨质疏松)47例,年龄47～83岁,平均63.7岁;其中骨折患者27例,6个月内均未服用影响骨代谢的药物.B组(继发性骨质疏松)44例,年龄45 ～78岁,平均62.5岁;其中骨折患者28例;同时伴有类风湿关节炎(6例)、乳腺癌术后(9例)、子宫内膜癌术后(3例)、消化系统溃疡(7例)、溃疡性结肠炎(3例).所有患者均接受5 mg唑来膦酸,30 min静脉注射治疗,每年1次,骨化三醇0.25 μg和钙剂600 mg及维生素D125 IU,1次/d.分别比较两组患者治疗前和治疗后12个月时腰椎和髋部骨密度及跌倒风险指数(FI),观察患者治疗依从性和药物不良反应. 结果 所有新鲜骨折患者在治疗3个月后随访,骨折愈合良好,未出现骨折延迟愈合或不愈合.治疗12个月后,A、B组分别有43例、42例患者获得随访.A组骨密度增加:腰椎5.8％、股骨颈2.9％、Words区5 2％、大转子5.3％和髋部总量3.9％,FI降低26.1％;B组骨密度增加:腰椎3.4％、股骨颈2.1％、Words区3.2％、大转子3.0％和髋部总量2.5％,FI降低21.8％.与治疗前自身比较差异均有统计学意义(P＜0 05).A、B组各有1例发生骨折,均行保守治疗.两组患者血钙、血磷测定均在正常范围内,部分患者有不良反应.结论 每年1次5 mg唑来膦酸治疗绝经后骨质疏松可显著提高腰椎、髋部及股骨颈的骨密度,降低跌倒风险,是一种方便高效的临床骨质疏松治疗手段.     

跳跃性脊柱骨折的诊断和治疗

两个或两个以上不相邻的椎体或其附件同时发生骨折,为脊柱跳跃性骨折。跳跃性脊柱骨折义称多节段非相邻型脊柱骨折（multiple—level noncontiguous spinal fractures,MNSF）。临床上所见约占全部脊柱损伤的1．6％～23．8％,常为较强暴力沿脊柱纵轴传导及多种暴力同时或重复作用于脊柱所致,常并发其他损伤,易漏诊或延迟诊断。若不能早期正确诊断,不仅会影响脊柱运动功能及残存脊髓神经功能的恢复,严重者可因继发性损伤引起迟发性截瘫甚至死亡。自2000年1月至2008年6月共收治44例,其中27例获得6个月以上的随访,现总结报告如下。     

国产羟乙膦酸二钠治疗骨质疏松症180例临床验证报告

对国产的羟乙膦酸二钠（康骨片）进行治疗骨质疏松症的临床验证，考察其疗效和安全性。方法三家医院共观察骨质疏松患者１８０例，将病例接随机双盲法分组，其中羟乙膦酸二钠治疗组１０１例，安慰剂对照组７９例。通过治疗前后腰椎和髋部骨密度值变化和临床症状缓解情况判断疗效。数据经配对ｔ检验和Ｘ２检验处理。结果经两个疗程共６个月的治疗，骨质疏松患者治疗前后的比较，治疗组２～４、股骨颈、大转子和Ｗａｒｄｓ三角区等部位治疗后骨密度增加显著，对照组均无显著变化。两组间比较，Ｌ２～４、大转子和Ｗａｒｄｓ三角区骨密度指标差异有显著性。羟乙膦酸二钠还可缓解因骨质疏松引起的腰背痛等症状，增加关节活动度。治疗期间未见明显的副作用。治疗组晨尿ＨＯＰ／Ｃｒ下降显著，表明羟乙膦酸二钠能抑制骨吸收。结论以上结果表明，羟乙膦酸二钠（康骨片）是骨质疏松症安全有效的治疗药物。     

588例骨盆骨折的流行病学特征与临床分析

目的探讨骨盆骨折的流行病学特征及临床特点,以提高对骨盆骨折的防治水平,进一步减少骨盆骨折的死亡率及伤残率。方法总结2007年11月-2009年5月收治的588例骨盆骨折患者的临床资料,统计分析患者性别、年龄、致伤原因及合并伤等情况。结果588例患者中,男326例,女262例,男女比例为1．24：1,年龄为8～90岁。主要致伤原因为交通伤363例（61．7％）及高处坠落伤153例（26．0％）。AO／ASIF分型：61—A型340例（57．8％）,61-B型95例（15．7％）,61-C型33例（5．1％）;62-A型54例（9．0％）,62-B型38例（6．3％）,62-C型14例（2．4％）;61＋62型14例（2．4％）。219例（37．2％）患者合并其它部位的损伤,其中腹部损伤、脑外伤、脊柱损伤等为骨盆骨折的常见合并伤。本组病例共发生休克31例,死亡8例,死亡率1．4％,抢救成功率74．2％。急诊行骨盆外固定支架固定31例,DSA25例,栓塞18例。二期行切开复位内固定术207例,术后恢复良好。结论骨盆骨折以男性中青年居多,绝大多数由高能量损伤所致,合并伤发生率较高,易发生休克。需要对高危人群加强安全教育和培训,从而有利于提高创伤救治水平和医疗质量,降低骨盆骨折的发生率,进一步减少伤残率和死亡率。     

多发骨质疏松椎体压缩骨折的相关因素研究

目的 :探讨发生多发骨质疏松椎体压缩骨折的相关因素。方法 :回顾性分析2011年3月至2015年3月收治的199例骨质疏松性椎体压缩骨折患者病史及影像学资料,根据骨折椎体的数量分为单椎体骨折组与多椎体骨折组,采用非条件Logistic回归分析可能影响发生多椎体骨折的危险因素。结果:多椎体骨折组(71例)与单椎体骨折组(128例)的年龄、性别、体重质量指数(BMI)、既往高血压、糖尿病史差异均无统计学意义,而两组骨密度T值与脊柱畸形指数差异有统计学意义,多椎体骨折组骨密度较单椎体骨折组降低,而SDI评分高于单椎体骨折组。非条件Logistic回归分析发现脊柱畸形指数与多椎体骨折明显相关,其中脊柱畸形指数[2≤脊柱畸形指数4,OR=2.587,95%CI(1.148,5.828);脊柱畸形指数≥-4,OR=7.775,95%CI(3.272,18.478)]及骨密度T值-4.5SD,OR=2.608,95%CI(1.038,6.551)]差异有统计学意义。结论 :骨密度越低,脊柱畸形指数评分越高,发生多椎体骨折的危险性越高。     

Treatment of osteoporosis in men

Osteoporosis in men is recognised worldwide as an important and increasing public health problem. The causes are more heterogeneous than those in women. About 50% are diagnosed as secondary cases. In some secondary forms of osteoporosis the specific diagnosis results in additional therapeutic options (e.g. androgen therapy in proven hypogonadism). The basic therapy for osteoporosis in men is no different to that in postmenopausal women, namely recommendations for counteracting modifiable risk factors, especially with regard to diet, physical exercise, and calcium and vitamin D supplementation. Concerning specific drug medications, however, even today there is still a therapeutic dilemma in male osteoporosis. While older substances (e.g. calcitonin, fluoride, alfacalcidol) are approved for both sexes, all newer medications have primarily been approved for the treatment of postmenopausal osteoporosis. Health authorities request studies in purely male populations. For new drugs, fracture data are necessary while for new substances within a class (e.g. bisphosphonates), at the very least consistent effects on bone mineral density (BMD) and bone turnover markers are requested. Due to these regulatory rules, ibandronate, teriparatide and strontium ranelate are not approved in the European Union. Some years ago, alendronate was the first bisphosphonate that was approved for the treatment of men with osteoporosis, based on consistent results from two independent male studies using a daily 10 mg dosage. Very recently risedronate was approved by the FDA and EMEA. A randomised, placebo-controlled multicentre trial of 285 male patients showed, after 2 years, a 5.8% increase in lumbar spine BMD in the risedronate 35 mg once weekly group vs 1.2% in the placebo group. In a prospective controlled study on 316 men with primary or secondary osteoporosis we found, after 12 months, a lumbar spine BMD of +4.7% vs +1.0% in controls. The number of patients with one or more new vertebral fractures was 8 in the risedronate group and 20 in the placebo group (a fracture reduction of 60%). Furthermore, we found a significantly smaller decrease in height and a steeper decrease in back pain in the risedronate group. Risedronate is the first oral bisphosphonate available for men with the more comfortable once weekly dosage.     

Spinal fractures during fluoride therapy for osteoporosis: Relationship to spinal bone density

Recent studies report that fluoride therapy for osteoporosis increases spinal bone density without improving vertebral fracture rate, challenging the notion that restoration of bone mass improves bone fragility. To further evaluate this issue, the relationship between spinal bone density and vertebral fracture rate was examined in a large number of fluoride-treated, osteoporotic patients. A retrospective assessment was made of clinical data collected from our observations of 389 osteoporotics treated with fluoride 30±8 mg/day (mean±SD) (equivalent to 66±17 mg NaF/day) and calcium 1500 mg/day for 28±18 months. Fracture rate and bone density were assessed in the same region of the spine (i.e., T12 through L4) using quantitative computed tomography (QCT).Spinal bone density increased with time on fluoride, but the relationship was hyperbolic (r=0.99,p<0.0001; asymptote=167 mg/cc on double-reciprocal plot), suggesting a plateau in the response. The spinal fracture rate decreased as a function of time on therapy (r=–0.83,p<0.01), and was inversely related to spinal bone density during fluoride therapy (r=0.70,p<0.001 on arithmetic plot;r=–0.79,p<0.001 on semi-log plot). The subgroup of patients who responded to treatment with a significant increase in spinal bone density had a 48% reduction in spinal fracture rate compared with non-responders (p<0.001). The subgroup of patients who sustained a fracture during fluoride therapy not only had a slower rate of increase in spinal bone density in response to fluoride therapy, but were also significantly older, had more fractures prior to fluoride therapy, and had a lower pretreatment spinal bone density; consequently, spinal bone density after treatment with fluoride was also lower in this subgroup of patients compared with those who did not sustain a fracture (p<0.001). These findings are consistent with both the general hypothesis that bone density is an important determinant of fracture risk in osteoporosis, and the specific hypothesis that an increase in spinal bone density in response to fluoride treatment is associated with a decrease in the risk for vertebral fractures.     

Lower extremity stress fractures during intermittent cyclical etidronate treatment for osteoporosis

During intermittent cyclical etidronate treatment, a lower extremity pain syndrome associated with stress fractures was observed in three osteoporotic patients. This report describes the development of stress fractures during initial cycles of treatment, with recurrence of symptoms in two patients when etidronate therapy was resumed. Further studies are needed to confirm whether stress fractures are associated with cyclic etidronate treatment and if so, the incidence and pathophysiology need to be determined.     

Alendronate treatment for osteoporosis: A review of the clinical evidence

Bisphosphonates have recently gained an increasing role in the management of osteoporosis. The aminobisphosphonate, alendronate has recently been introduced as a new agent for the treatment of post-menopausal osteoporosis. This paper reviews the clinical evidence for the use of this agent and seeks to assess its place in osteoporosis management.     

French recommendations on the prevention and treatment of osteoporosis secondary to bariatric surgery

IntroductionThis article presents the initial recommendations of the Groupe de Recherche et d’Information sur les Ostéoporoses (Osteoporosis Research and Information Group [GRIO]) and the Société Française de Rhumatologie (French Rheumatology Society [SFR]) on the prevention and treatment of osteoporosis secondary to bariatric surgery.MethodsThe recommendations were produced by a working group comprising 4 expert rheumatologists, 3 medically qualified nutritionists, 2 obesity surgeons, 1 physical activity specialist, and 1 patient-association representative.ResultsThe following generally recommended measures apply to all patients with an indication for bariatric surgery or who have already undergone bariatric surgery: normalize calcium and protein intake, attain a 25(OH) vitamin D concentration of between 30 and 60 ng/mL; prevent the risk of falls, and introduce a suitable regimen of physical activity. An initial assessment of fracture risk should be routinely performed – ideally before the first bariatric surgery procedure – (i) in the case of RYGB and biliopancreatic diversion, regardless of age, (ii) in patients at high risk of fracture, regardless of age, and (iii) in all menopausal women and all men ≥ 50 years old, regardless of the type of bariatric surgical procedure. The fracture risk assessment is based on a determination of osteoporosis risk factors and bone mineral density measurements. Anti-osteoporosis treatment – zoledronic acid as the first line of treatment – is indicated for menopausal women and men ≥ 50 years old with (i) a history of severe fracture, regardless of T-score, (ii) a history of non-severe fracture and a T-score ≤ ?1, and (iii) no history of fracture and a T-score ≤ ?2.ConclusionsThere is an increased risk of fracture after bariatric surgery. Clinicians should focus their attention on patients at high fracture risk such as postmenopausal women and men older than 50 years. More research is necessary to direct and support guidelines.     

鲑鱼降钙素联合口服钙剂治疗老年骨质疏松症的临床研究

目的：观察鲑鱼降钙素联合口服钙剂治疗老年骨质疏松症的治疗效果。方法将50例骨质疏松患者随机分为研究组和对照组,每组各25人,研究组用鲑鱼降钙素联合口服钙剂治疗,对照组单纯使用口服钙剂治疗。均为3个月的治疗期。两组治疗前后均记录患者骨痛、腰椎骨密度值。结果治疗3个月后,研究组骨痛改善明显高于对照组P＜0．01;而研究组腰椎骨密度均值在治疗后3个月有显著提高,P＜0．01,而对照组P＞0．05。结论鲑鱼降钙素联合口服钙剂治疗老年骨质疏松症能明显减轻患者疼痛、改善症状,提高患者骨密度,是一种疗效良好的安全方法。     

网袋成形术与椎体后凸成形术治疗骨质疏松性椎体压缩骨折的早期疗效比较

目的比较网袋成形术与椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩骨折（OVCFs）的早期疗效。 方法回顾性分析杭州师范大学附属医院骨科2015年6月至2016年12月接受PKP或网袋成形术治疗的OVCFs患者114例,依据手术方法分为PKP组（59例,68椎）和网袋成形术组（55例,66椎）。比较两组患者术前骨折椎体压缩度、术后椎体高度恢复率、骨水泥渗漏发生率、骨水泥形态、骨水泥容积率及手术前后疼痛视觉模拟评分（VAS）和功能障碍指数（ODI）。 结果所有患者均获得随访,随访时间为（3.7±0.9）个月。两组患者术后1 d VAS、ODI评分较术前均有改善,差异有统计学意义（PKP组：Z=-10.143,F=1768.418,P<0.05;网袋成形术组：Z=-10.027,F=2192.838,P<0.05）。两组患者末次随访VAS、ODI评分相较术后1 d均有改善,差异均有统计学意义（PKP组：Z=-5.708,F=204.339,P<0.05;网袋成形术组：Z=-5.691,F=147.729,P<0.05）。PKP组（27.9%）患者骨水泥渗漏率高于网袋成形术组（13.6%,χ²=4.146,P<0.05)。PKP组骨水泥容积率[（22±5）%]低于网袋成形术组[（24±4）%,t=-2.659,P<0.05]。骨水泥形态PKP组主要为混合型（60.3%）及骨小梁型（39.7%）,网袋成形术组主要为混合型（78.8%）及团块型（15.1%）,差异有统计学意义（χ²=34.271,P<0.05）。随访期间共发现4例椎体再骨折（PKP组1例,网袋成形术组3例）,两组差异无统计学意义。 结论网袋成形术治疗OVCFs可迅速缓解患者疼痛,提高活动能力,恢复椎体高度,相比PKP,能减少骨水泥渗漏的发生。     

骨密度测量技术诊断骨质疏松的评价

骨矿密度(BMD)是诊断骨量减少(低骨量,骨质疏松),评价骨丢失率和疗效的重要客观指标。被世界卫生组织(WHO)用来定义骨质疏松(OP)的诊断标准。目前非创伤性骨密度测量方法主要有以下几种:X线光密度法(RA),单光子吸收法(SPA),双光子吸收法(DPA),双能x线吸收测定(DEXA),定量CT(QCT)。不同的测量方法的优、缺点和临床意义不同,在此简要综述几种BMD测量方法和特点。     

Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Synopsis of a WHO report

The criteria required for an effective screening strategy for osteoporosis are largely met in Caucasian women. The disease is common and readily diagnosed by the measurement of bone mineral with single- or dual-energy absorptiometry. Such measurements have high specificity but lower sensitivity, so that the value of the technique is greater for those identified as being at higher risk. Against this background there is little evidence that osteoporosis can usefully be tackled by a public health policy to influence risk factors such as smoking, exercise and nutrition. This suggests that it is appropriate to consider targetting of treatment with agents affecting bone metabolism to susceptible individuals. Since the main benefits of the use of hormone replacement therapy (HRT) are probably on cardiovascular morbidity, the major role for selective screening is to direct non-HRT interventions. An appropriate time to consider screening and intervention is at the menopause, but screening at later ages is also worthy of consideration. Since the cost of screening is low and that of bone-active drugs is high, the selective use of screening techniques will improve the cost-benefit ratio of intervention.See Appendix for a list of members of the WHO Study Group.