骨质疏松症的诊断标准和治疗阈值的相关问题

Related Issues in the Diagnostic Criteria and Intervention Thresholds of Osteoporosis

根据骨质疏松症的定义,用于骨质疏松症临床评估的理想指标应全面反映骨强度且能最好地预测骨折风险。目前,骨质疏松症的诊断和治疗主要基于能部分反映骨强度的骨密度、脆性骨折史和骨折风险预测简易工具(FRAX~)等。然而上述方法在确定骨质疏松症的诊断标准和治疗阈值方面存在诸多问题和广泛的争议。本文回顾了骨密度、脆性骨折史、FRAX~分别在骨质疏松症的诊断标准和治疗阈值中的优势和局限性,并且就目前各指南对骨质疏松症诊断标准和治疗阈值的变迁进行综述。

Osteoporosis was defined as " a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture ". This definition emphasized that the decline in bone strength is characteristic of osteoporosis and fracture is the final consequence. Thus the ideal clinical evaluation for osteoporosis should be comprehensively reflect the bone strength and can optimally predict the fracture risk. Recently,the diagnosis and treatment of osteoporosis are mainly based on three methods, which contain bone mineral density( BMD) detected by dual X-ray absorptiometry( DXA) and quantitative computer tomography( QCT),fragility fractures and FRAX~ fracture risk assessment tool. However,there are many problems and extensive controversies over the three methods in determining the diagnostic criteria and intervention thresholds of osteoporosis. We reviewed the merits and demerits of BMD,fragility fracture and FRAX~ in the evaluation field of osteoporosis respectively,and evolutions in current guidelines.