Osteoporosis prevention, diagnosis, and therapy.
Osteoporosis prevention, diagnosis, and therapy.
复制标题
DOI：
--
复制
发表时间：
2000
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
目的：本NIH共识声明的目的是告知生物医学研究和临床实践社区关于骨质疏松症预防、诊断和治疗的NIH共识发展会议的结果。该声明提供了最新信息，并提出了共识小组关于这些问题的结论和建议。此外，该声明确定了值得进一步调查的研究领域。本声明的临床医生目标受众包括但不限于家庭医生、内科医生、老年病学家、骨科医生、风湿病学家、产科医生和妇科医生以及预防医学专家。参与者一个非联邦，非倡导者，13名成员组成的小组，代表内科，家庭和社区医学，内分泌学，流行病学，矫形外科，老年学，风湿病学，妇产科，预防医学和细胞生物学领域。此外，来自这些领域的32名专家向小组和大约700名会议听众介绍了数据。证据使用MEDLINE检索文献，并向专家组提供广泛的参考文献目录。专家们为会议发言编写了摘要，并引用了相关文献。科学证据优先于临床经验。专家组回答预先确定的问题，根据公开论坛和科学文献中提出的科学证据得出结论。小组编写了一份声明草稿，全文宣读并分发给专家和听众征求意见。此后，专家组解决了相互矛盾的建议，并在会议结束时发布了一份修订后的声明。专家组在会议结束后几周内完成了修订。声明草案在会议上公布后立即在万维网上公布，并根据小组的最后修订稿进行了更新。结论：骨质疏松发生在所有人群和所有年龄段。虽然在绝经后的白色女性中更常见，但在其他人群中往往无法识别。骨质疏松症是一种严重的身体、心理和经济后果的破坏性疾病。骨质疏松症的风险，如低骨密度所反映的，和骨折的风险重叠，但不完全相同。应更多地关注已知与继发性骨质疏松症相关的患者的骨骼健康。临床风险因素在确定谁应该进行BMD测量、评估骨折风险和确定谁应该接受治疗方面具有重要作用，但尚未得到充分验证。充足的钙和维生素D摄入量对于形成最佳峰值骨量和终生保持骨量至关重要。补充这两种成分的生物可利用的形式可能是必要的个人谁没有达到推荐的摄入量从饮食来源。性腺类固醇是男性、女性和儿童峰值和终生骨量的重要决定因素。定期运动，特别是阻力和高冲击活动，有助于发展高峰骨量，并可能降低老年人福尔斯的风险。评估骨量，确定骨折风险，并确定谁应该接受治疗是评估骨质疏松症患者时的最佳目标。预防骨折是骨质疏松症患者治疗的主要目标。几种治疗方法已被证明可以降低骨质疏松性骨折的风险。这些包括增强骨量和降低福尔斯风险或后果的疗法。对于脊椎、肋骨、髋部或前臂远端骨折的成年人，应评估骨质疏松症的存在并给予适当的治疗。
OBJECTIVE The objective of this NIH Consensus Statement is to inform the biomedical research and clinical practice communities of the results of the NIH Consensus Development Conference on Osteoporosis Prevention, Diagnosis, and Therapy. The statement provides state-of-the-art information and presents the conclusions and recommendations of the consensus panel regarding these issues. In addition, the statement identifies those areas of study that deserve further investigation. The target audience of clinicians for this statement includes, but is not limited to, family practitioners, internists, gerontologists, orthopaedic surgeons, rheumatologists, obstetricians and gynecologists, and preventive medicine specialisits. PARTICIPANTS A nonfederal, nonadvocate, 13-member panel representing the fields of internal medicine, family and community medicine, endocrinology, epidemiology, orthopaedic surgery, gerontology, rheumatology, obstetrics and gynecology, preventive medicine, and cell biology. In addition, 32 experts from these same fields presented data to the panel and a conference audience of approximately 700. EVIDENCE The literature was searched using MEDLINE and an extensive bibliography of references was provided to the panel. Experts prepared abstracts for their conference presentations with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its release at the conference and was updated with the panel's final revisions. CONCLUSIONS Osteoporosis occurs in all populations and at all ages. Though more prevalent in white postmenopausal females, it often goes unrecognized in other populations. Osteoporosis is a devastating disorder with significant physical, psychosocial, and financial consequences. The risks for osteoporosis, as reflected by low bone density, and the risks for fracture overlap but are not identical. More attention should be paid to skeletal health in persons with conditions known to be associated with secondary osteoporosis. Clinical risk factors have an important, but as yet poorly validated, role in determining who should have BMD measurement, in assessing risk of fracture, and in determining who should be treated. Adequate calcium and vitamin D intake are crucial to develop optimal peak bone mass and to preserve bone mass throughout life. Supplementation of these two components in bioavailable forms may be necessary in individuals who do not achieve recommended intake from dietary sources. Gonadal steroids are important determinants of peak and lifetime bone mass in men, women, and children. Regular exercise, especially resistance and high-impact activities, contributes to development of high peak bone mass and may reduce the risk of falls in older individuals. Assessment of bone mass, identification of fracture risk, and determination of who should be treated are the optimal goals when evaluating patients for osteoporosis. Fracture prevention is the primary goal in the treatment of patients with osteoporosis. Several treatments have been shown to reduce the risk of osteoporotic fractures. These include therapies that enhance bone mass and reduce risk or consequences of falls. Adults with vertebral, rib, hip, or distal forearm fractures should be evaluated for the presence of osteoporosis and given appropriate therapy.