骨科急性骨丢失防治专家共识

Expert consensus on prevention and treatment of acute bone loss in orthopaedics

因病情需要制动数日至数周,甚至更长时间的患者,当某部位或全身活动功能受限时,破骨细胞活性增加,溶骨速度大于成骨速度,出现局部和全身急性骨丢失现象。急性骨丢失一般发生在急性制动后的6~8周,这个阶段患者的骨量将急剧下降至最低水平,是预期骨折风险最高的时期,之后会出现骨量的逐步恢复,但骨形成和骨吸收的速率仍不平衡,恢复到一定水平后骨量将继续丢失,这个时期持续2~24个月,称为进行性骨丢失。患者经历急性和进行性骨丢失后,大量骨质流失,骨骼强度降低,且往往多年无法完全恢复到骨折前的骨量水平,增加骨质疏松、骨折固定、关节置换失败等风险。针对临床常见的急性骨丢失现象,国内外骨科医师的认知各有不同,治疗差异也很大,且国际上尚未有急性骨丢失方面的共识和指南规范。本共识结合已有研究及临床经验,对急性骨丢失研究历史、现状、病因、评估以及防治等进行归纳总结,以期加强临床医师对急性骨丢失的认识和管理,有效提升骨科急性骨丢失的防治效果,防止骨折,加速康复,改善患者远期预后。

Osteoclast activity is stimulated,the rate of osteolysis is higher than that of osteogenesis,and acute bone loss occurs once patients need to be immobilized for days to weeks or even longer.Acute bone loss usually occurs in 6-8 weeks after immobilization.During the period,bone mass will drop sharply to the lowest level,and patients have the highest risk of fracture.Then the bone mass will gradually recover,but continue to lose because of the imbalance between bone formation and resorption.This period lasts for 2 to 24 months,and is called progressive bone loss.Massive bone loss occurs after acute bone loss and progressive bone loss,bone strength is reduced,and bone mass often does not recover to the normal,which increases the risk of osteoporosis,fracture,joint replacement failure.There is no international consensus or guideline for the treatment of acute bone loss.In this paper,the history,current status,etiology,evaluation,prevention,and treatment of bone loss were summarized.It is hoped that clinicians’understanding and management of acute bone loss can be strengthened so as to effectively improve the prevention and treatment of acute bone loss in orthopedics patients,prevent related fractures,accelerate rehabilitation,and ameliorate long-term prognosis of patients.