骨质疏松症达标治疗研究进展

Research progress of treat-to-target of osteoporosis

基于在其他慢性病上的成功,达标治疗现在被认为是一种治疗骨质疏松症的有效策略。然而,选择并设定便捷有效的目标是实施骨质疏松症达标治疗的一大难点,目前可供选择的治疗目标均各有特点和利弊,如骨密度作为诊断骨质疏松症的金标准,达到目前建议的目标参数所需时间也很长甚至长期没有明显变化,进而无法判断早期治疗是否失败和有效解决治疗依从性差的问题。同时不少文献显示握力、疼痛评分与骨密度紧密相关,可以作为衡量治疗的指标,而作为不依赖于骨密度的评价腰椎骨小梁微结构的一种新替代指标,骨小梁评分不仅可用于调整FRAX评分,还可以改善骨折风险预测能力,为达标治疗效果评估提供了新选择。笔者针对当前骨质疏松症达标治疗的研究进展进行综述。

Based on its success in other chronic diseases,treat-to-target is now considered to be an effective strategy for the treatment of osteoporosis.However,selecting and setting convenient and effective targets are major difficulty in the implementation of treat-to-target of osteoporosis.At present,the treatment targets available for selection have their own characteristics,advantages,and disadvantages.For example,bone mineral density,as the gold standard for the diagnosis of osteoporosis,takes a long time to reach the currently recommended target parameter,or even has not changed significantly for a long time.Furthermore,it is impossible to judge whether early treatment fails and to effectively solve the problem of poor treatment compliance.At the same time,many literature show that grip strength and pain score are closely related to bone mineral density,which can be used as an index to measure treatment.As a new alternative index to evaluate the microstructure of lumbar trabecular bone independent of bone mineral density,trabecular bone score can not only be used to adjust FRAX score,but also improve the ability of fracture risk prediction,which provides a new choice for the evaluation of treat-to-target effect.This paper reviews the current research progress of treat-to-target of osteoporosis.