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骨质疏松症筛查和诊断方法的研究进展
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Abstract:
骨质疏松是一种常见的骨骼疾病，其发病率逐年上升且危害严重，易引发脆性骨折等不良后果，极大影响患者生活质量并加重医疗负担。早期进行骨质疏松筛查，有助于及时发现病情、采取干预措施，降低骨折等不良后果的发生风险。目前骨质疏松诊断依然依靠双能X线骨密度仪(DXA)，但作为筛查方式，骨密度的检查费用高，可及性差，因此在本综述中，我们总结了骨质疏松的筛查方法，以期为骨质疏松的早期发现与防治提供参考。
Osteoporosis is a common bone disease with an increasing incidence rate and severe consequences, such as an increased risk of fragility fractures. It can significantly impair the quality of life of patients and increase the burden on the healthcare system. Early screening for osteoporosis helps to detect the condition in a timely manner and take intervention measures to reduce the risk of fractures and other adverse outcomes. Currently, dual-energy X-ray absorptiometry (DXA) remains the mainstay for diagnosing osteoporosis. However, as a screening method, bone density testing is expensive and not readily accessible. Therefore, in this review, we summarize the screening methods for osteoporosis in the hope of providing references for the early detection and prevention of osteoporosis.
| [1] | (1993) Consensus Development Conference: Diagnosis, Prophylaxis, and Treatment of Osteoporosis. The American Journal of Medicine, 94, 646-650. https://doi.org/10.1016/0002-9343(93)90218-e |
| [2] | 王晓燕, 金晖, 韩晶, 邓春花, 孙美娟. 社区骨质疏松症高危人群筛查与预防的研究进展[J]. 中国骨质疏松杂志, 2019, 25(10): 1498-1501. |
| [3] | Mabuchi, S., Ohta, R. and Sano, C. (2024) Osteoporosis Management in a Rural Community Hospital in Japan: A Cross-Sectional Retrospective Study. BMJ Open, 14, e086845. https://doi.org/10.1136/bmjopen-2024-086845 |
| [4] | Wright, N.C., Looker, A.C., Saag, K.G., Curtis, J.R., Delzell, E.S., Randall, S., et al. (2014) The Recent Prevalence of Osteoporosis and Low Bone Mass in the United States Based on Bone Mineral Density at the Femoral Neck or Lumbar Spine. Journal of Bone and Mineral Research, 29, 2520-2526. https://doi.org/10.1002/jbmr.2269 |
| [5] | 国家卫生健康委员会官网. 国家卫生健康委发布首个中国骨质疏松症流行病学调查结果[J]. 人口文摘, 2018(11): 55-56. |
| [6] | Wang, Y., Tao, Y., Hyman, M.E., Li, J. and Chen, Y. (2009) Osteoporosis in China. Osteoporosis International, 20, 1651-1662. https://doi.org/10.1007/s00198-009-0925-y |
| [7] | 中华医学会骨质疏松和骨矿盐疾病分会. 中国骨质疏松症流行病学调查及“健康骨骼”专项行动结果发布[J]. 中华骨质疏松和骨矿盐疾病杂志, 2019, 12(4): 317-318. |
| [8] | Kanis, J.A., Oden, A., Johnell, O., De Laet, C., Jonsson, B. and Oglesby, A.K. (2003) The Components of Excess Mortality after Hip Fracture. Bone, 32, 468-473. https://doi.org/10.1016/s8756-3282(03)00061-9 |
| [9] | 杨永碧. 绝经期女性骨质疏松及其影响因素[J]. 中国老年学杂志, 2014(11): 3176-3178. |
| [10] | Peeters, C.M.M., Visser, E., Van de Ree, C.L.P., Gosens, T., Den Oudsten, B.L. and De Vries, J. (2016) Quality of Life after Hip Fracture in the Elderly: A Systematic Literature Review. Injury, 47, 1369-1382. https://doi.org/10.1016/j.injury.2016.04.018 |
| [11] | Alexiou, K., Roushias, A., Varitimidis, S. and Malizos, K. (2018) Quality of Life and Psychological Consequences in Elderly Patients after a Hip Fracture: A Review. Clinical Interventions in Aging, 13, 143-150. https://doi.org/10.2147/cia.s150067 |
| [12] | Shepstone, L., Lenaghan, E., Cooper, C., Clarke, S., Fong-Soe-Khioe, R., Fordham, R., et al. (2018) Screening in the Community to Reduce Fractures in Older Women (SCOOP): A Randomised Controlled Trial. The Lancet, 391, 741-747. https://doi.org/10.1016/s0140-6736(17)32640-5 |
| [13] | Curry, S.J., Krist, A.H., Owens, D.K., Barry, M.J., Caughey, A.B., Davidson, K.W., et al. (2018) Screening for Osteoporosis to Prevent Fractures. Journal of the American Medical Association, 319, 2521-2531. https://doi.org/10.1001/jama.2018.7498 |
| [14] | Viswanathan, M., Reddy, S., Berkman, N., Cullen, K., Middleton, J.C., Nicholson, W.K., et al. (2018) Screening to Prevent Osteoporotic Fractures. Journal of the American Medical Association, 319, 2532-2551. https://doi.org/10.1001/jama.2018.6537 |
| [15] | Koh, L.K.H., Ben Sedrine, W., Torralba, T.P., Kung, A., Fujiwara, S., Chan, S.P., et al. (2001) A Simple Tool to Identify Asian Women at Increased Risk of Osteoporosis. Osteoporosis International, 12, 699-705. https://doi.org/10.1007/s001980170070 |
| [16] | Fan, Z., Li, X., Zhang, X., Yang, Y., Fei, Q. and Guo, A. (2020) Comparison of OSTA, FRAX and BMI for Predicting Postmenopausal Osteoporosis in a Han Population in Beijing: A Cross Sectional Study. Clinical Interventions in Aging, 15, 1171-1180. https://doi.org/10.2147/CIA.S257166 |
| [17] | 郭勇, 栗敏, 张颖, 贺丹丹, 张智海. 3253例围绝经及绝经后女性骨质疏松风险评估工具的应用[J]. 中国骨质疏松杂志, 2023, 29(10): 1420-1424+1436. |
| [18] | Liu, Y., Wang, C., Wang, G., Sun, Y., Deng, Z., Chen, L., et al. (2019) Loureirin B Suppresses Rankl-Induced Osteoclastogenesis and Ovariectomized Osteoporosis via Attenuating Nfatc1 and ROS Activities. Theranostics, 9, 4648-4662. https://doi.org/10.7150/thno.35414 |
| [19] | Iantomasi, T., Romagnoli, C., Palmini, G., Donati, S., Falsetti, I., Miglietta, F., et al. (2023) Oxidative Stress and Inflammation in Osteoporosis: Molecular Mechanisms Involved and the Relationship with Micrornas. International Journal of Molecular Sciences, 24, Article 3772. https://doi.org/10.3390/ijms24043772 |
| [20] | Agarwal, K., Cherian, K.E., Kapoor, N. and Paul, T.V. (2022) OSTA as a Screening Tool to Predict Osteoporosis in Indian Postmenopausal Women—A Nationwide Study. Archives of Osteoporosis, 17, Article No. 121. https://doi.org/10.1007/s11657-022-01159-w |
| [21] | Lu, C., Chen, D., Cai, Y. and Wei, S. (2006) Concordane of OSTA and Lumbar Spine BMD by DXA in Identifying Risk of Osteoporosis. Journal of Orthopaedic Surgery and Research, 1, Article No. 14. https://doi.org/10.1186/1749-799x-1-14 |
| [22] | IOF One-Minute OSTE Oporosis Risk Test. https://www.iofbonehealth.org/ |
| [23] | Sheng, Y., Wu, T., Liaw, C., Hsiao, S., Kuo, K. and Tsai, C. (2024) Real World Fracture Prediction of Fracture Risk Assessment Tool (FRAX), Osteoporosis Self-Assessment Tool for Asians (OSTA) and One-Minute Osteoporosis Risk Test: An 11-Year Longitudinal Study. Bone Reports, 20, Article 101742. https://doi.org/10.1016/j.bonr.2024.101742 |
| [24] | Kanis, J.A. (2008) Assessment of Osteoporosis at the Primary Health Care Level. Technical Report. WHO Collaborating Centre, University of Sheffield, UK. |
| [25] | Kanis, J.A., Harvey, N.C., Johansson, H., Liu, E., Vandenput, L., Lorentzon, M., et al. (2020) A Decade of FRAX: How Has It Changed the Management of Osteoporosis? Aging Clinical and Experimental Research, 32, 187-196. https://doi.org/10.1007/s40520-019-01432-y |
| [26] | 郭培栋, 吴炯林, 丁悦. 骨质疏松症筛查方法的研究进展[J]. 中华内分泌代谢杂志, 2023, 39(4): 372-376. |
| [27] | Chen, J., Yu, S., Hsu, C., Chiu, W., Wu, C., Lai, H., et al. (2019) The Role of Bone Mineral Density in Therapeutic Decision-Making Using the Fracture Risk Assessment Tool (FRAX): A Sub-Study of the Taiwan Osteoporosis Survey (Tops). Archives of Osteoporosis, 14, Article No. 101. https://doi.org/10.1007/s11657-019-0653-7 |
| [28] | Kharroubi, A., Saba, E., Ghannam, I. and Darwish, H. (2016) Evaluation of the Validity of Osteoporosis and Fracture Risk Assessment Tools (IOF One Minute Test, SCORE, and FRAX) in Postmenopausal Palestinian Women. Archives of Osteoporosis, 12, Article No. 6. https://doi.org/10.1007/s11657-016-0298-8 |
| [29] | Hoff, M., Meyer, H.E., Skurtveit, S., Langhammer, A., Søgaard, A.J., Syversen, U., et al. (2017) Validation of FRAX and the Impact of Self-Reported Falls among Elderly in a General Population: The HUNT Study, Norway. Osteoporosis International, 28, 2935-2944. https://doi.org/10.1007/s00198-017-4134-9 |
| [30] | Leslie, W.D., Lix, L.M., Johansson, H., Oden, A., McCloskey, E. and Kanis, J.A. (2017) Manitoba Bone Density Program. Independent Clinical Validation of a Canadian FRAX Tool: Fracture Prediction and Model Calibration. Journal of Bone and Mineral Research, 25, 2350-2358. https://doi.org/10.1002/jbmr.123 |
| [31] | 中华医学会骨质疏松和骨矿盐疾病分会, 章振林. 原发性骨质疏松症诊疗指南(2022) [J]. 中国全科医学, 2023, 26(14): 1671-1691. |
| [32] | Gregson, C.L., Armstrong, D.J., Bowden, J., Cooper, C., Edwards, J., Gittoes, N.J.L., et al. (2022) Correction: UK Clinical Guideline for the Prevention and Treatment of Osteoporosis. Archives of Osteoporosis, 17, Article No. 80. https://doi.org/10.1007/s11657-022-01115-8 |
| [33] | Fu, Y., Li, C., Luo, W., Chen, Z., Liu, Z. and Ding, Y. (2020) Fragility Fracture Discriminative Ability of Radius Quantitative Ultrasound: A Systematic Review and Meta-Analysis. Osteoporosis International, 32, 23-38. https://doi.org/10.1007/s00198-020-05559-x |
| [34] | Langton, C. (1996) Prediction of Mechanical Properties of the Human Calcaneus by Broadband Ultrasonic Attenuation. Bone, 18, 495-503. https://doi.org/10.1016/8756-3282(96)00086-5 |
| [35] | Schultz, K. and Wolf, J.M. (2019) Emerging Technologies in Osteoporosis Diagnosis. The Journal of Hand Surgery, 44, 240-243. https://doi.org/10.1016/j.jhsa.2018.07.006 |
| [36] | 苏其昌, 梁江声. 超声骨密度检测在骨质疏松症诊断中的应用[J]. 中国骨科临床与基础研究杂志, 2024(2): 121-125. |
| [37] | 陈明月, 张雪丽, 汤光宇. 基于CT的机会性筛查评估骨质疏松症的研究进展[J]. 国际医学放射学杂志, 2022, 45(4): 459-465. |
| [38] | Lenchik, L., Weaver, A.A., Ward, R.J., Boone, J.M. and Boutin, R.D. (2018) Opportunistic Screening for Osteoporosis Using Computed Tomography: State of the Art and Argument for Paradigm Shift. Current Rheumatology Reports, 20, Article No. 74. https://doi.org/10.1007/s11926-018-0784-7 |
| [39] | Gausden, E.B., Nwachukwu, B.U., Schreiber, J.J., Lorich, D.G. and Lane, J.M. (2017) Opportunistic Use of CT Imaging for Osteoporosis Screening and Bone Density Assessment. Journal of Bone and Joint Surgery, 99, 1580-1590. https://doi.org/10.2106/jbjs.16.00749 |
