中国人骨质疏松症诊断标准专家共识(第三稿·2014版)

Expert consensus on the diagnosis of osteoporosis in Chinese Population

中国老年学学会骨质疏松委员会组织专家在2000年第二稿的基础上,复习了近年来国际国内在骨质疏松症诊断方面的研究进展,结合中国人群特点和中国骨质疏松症防治实际情况,制定本共识为各级医疗机构开展骨质疏松症诊疗工作提供参考。骨密度测量在骨质疏松症诊断中有重要作用,可以参照WHO-2.5 SD的标准,也可以根据中国人群的实际情况采用中国老年学学会骨质疏松委员会(OCCGS)建议的-2.0SD或者骨量下降25%作为诊断标准。并提出了在使用DXA骨密度诊断时需要注意DXA的局限性,避免漏诊。根据近年来定量CT研究的成果,首次在共识中建议采用国际临床骨密度学会(ISCD)和美国放射学院(ACR)推荐的腰椎QCT骨密度低于80 mg/cm3作为骨质疏松的诊断标准。首次建议在骨质疏松诊断中的FRAX应用。脆性骨折作为骨质疏松症诊断标准的重要性,并推荐综合影像检查诊断脆性骨折和鉴别诊断。强调了骨生化检查的作用。

Based on the year 2000 the 2nd version of the diagnosis of osteoporosis, the Osteoporosis Committee of China Gerontological Society （ OCCGS） has organized experts to learn the research advance in recent years all over the world, to consider the characteristics of Chinese population and the medical practice in the prevention and treatment of osteoporosis in China, and to make the following consensus of the diagnosis of osteoporosis for guidelines of osteoporosis management in all levels of medical center.Detection of the bone mineral density （BMD） is still the most important measurement in the diagnosis of osteoporosis.The DXA -2.5 SD criteria recommended by WHO is widely used.Also the diagnose standard can be set as -2.0 SD or 25%reduce of BMD recommended by OCCGS according to real status of Chinese population.Attention needs to be paid to the limitation of DXA in the diagnosis of osteoporosis, in order to avoid misdiagnosis.With the advance in QCT BMD measurement in recent years, the 80 mg/cm3 QCT criteria proposed by ISCD and ACR is also recommended in the consensus.The application of FRAX in the diagnosis of osteoporosis is suggested for the first time.The fragility fracture is an important diagnosis in osteoporosis.It should be diagnosed and differentially diagnosed combining with image examination.The clinical use of bone biochemical examination is emphasized.