Bone biology in the elderly: clinical importance for fracture treatment
Bone biology in the elderly: clinical importance for fracture treatment
复制标题
老年人骨生物学：骨折治疗的临床重要性
DOI：
10.1515/iss-2016-0025
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发表时间：
2016
影响因子：
1.3
通讯作者：
M. Amling
中科院分区：
文献类型：
--
作者：
T. Rolvien;M. Amling
摘要老年人骨质疏松常导致脆性骨折。尽管广泛提供了良好的手术治疗，但对潜在骨疾病的诊断和治疗往往没有考虑在内。三种主要骨细胞-成骨细胞、破骨细胞和骨细胞-的相互作用通常通过信使的分泌来控制骨重塑。老年人可能发生的可能的失衡部分是由于年龄，遗传风险因素和不良的生活方式因素，但重要的是也由于钙稳态的失衡（主要是由于维生素D缺乏或低氯血症），必须消除。因此，创伤外科医生和骨科医生之间的合作对于诊断和治疗处于风险中的相应患者至关重要。我们建议任何患有脆性骨折的患者都要严格筛查骨质疏松症和代谢性骨病。这包括通过双能X射线吸收法测量骨密度，钙，磷酸盐，维生素D和骨转换标志物的实验室检查，以及必要时的其他诊断方法。因此，大多数风险因素，包括维生素D缺乏症，可以确定和治疗，而符合特定治疗标准的患者（即抗吸收和骨合成代谢）接受这种治疗。如果当地卫生系统成功地管理这一二级骨折预防过程，脆性骨折的发病率和死亡率将降至最低水平。
Abstract Age-related bone impairment often leads to fragility fractures in the elderly. Although excellent surgical care is widely provided, diagnosis and treatment of the underlying bone disorder are often not kept in mind. The interplay of the three major bone cells – osteoblasts, osteoclasts, and osteocytes – is normally well regulated via the secretion of messengers to control bone remodeling. Possible imbalances that might occur in the elderly are partly due to age, genetic risk factors, and adverse lifestyle factors but importantly also due to imbalances in calcium homeostasis (mostly due to vitamin D deficiency or hypochlorhydria), which have to be eliminated. Therefore, the cooperation between the trauma surgeon and the osteologist is of major importance to diagnose and treat the respective patients at risk. We propose that any patient suffering from fragility fractures is rigorously screened for osteoporosis and metabolic bone diseases. This includes bone density measurement by dual-energy X-ray absorptiometry, laboratory tests for calcium, phosphate, vitamin D, and bone turnover markers, as well as additional diagnostic modalities if needed. Thereby, most risk factors, including vitamin D deficiency, can be identified and treated while patients who meet the criteria for a specific therapy (i.e. antiresorptive and osteoanabolic) receive such. If local health systems succeed to manage this process of secondary fracture prevention, morbidity and mortality of fragility fractures will decline to a minimum level.
影响因子：
17.1
作者：
Milovanovic, Petar;Zimmermann, Elizabeth A.;Busse, Bjoern
通讯作者：
Busse, Bjoern
影响因子：
4.1
作者：
Wang J;Stein EM;Zhou B;Nishiyama KK;Yu YE;Shane E;Guo XE
通讯作者：
Guo XE
影响因子：
168.9
作者：
Rachner, Tilman D.;Khosla, Sundeep;Hofbauer, Lorenz C.
通讯作者：
Hofbauer, Lorenz C.