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首页> 外文期刊>International journal of clinical rheumatology. >Clinical fractures beyond low BMD
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Clinical fractures beyond low BMD

机译：低BMD以外的临床骨折

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The risk of fractures is multifactorial and is related to the ability of bone to resist fracturing, which depends on its material and structural properties, and on the intensity, frequency and impact of trauma. Low BMD is a major determinant of bone strength and fracture risk. However, most patients with a fracture have no osteoporosis and BMD explains <50% of bone strength and fracture risk. Beyond BMD, bone strength can be calculated by analysis of 2D and 3D structural images of the bone, but this is not yet part of daily clinical practice. Fracture risk can be evaluated by integrating BMD with systematic evaluation of clinical risk factors, such as in the fracture risk assessment tool (FRAX) case finding algorithm (age, personal and family history of clinical fractures, life style, diseases and medications). Clinical risk factors, not included in FRAX, are fall risks, the number and timing of previous clinical fractures, the presence, number and severity of morphometric vertebral fractures and the dose of glucocorticoids. These have been included in other case finding tools, such as the Garvan Fracture Risk Calculator, the Fracture Risk in Glucocorticosteroid Users and the Maastricht Fracture Risk Nomogram. Further refinement of case finding algorithms will be needed to integrate BMD, bone strength calculations and clinical risk factors into a single algorithm for fracture risk prediction, that can be used in daily practice.
机译：骨折的风险是多因素的，并且与骨头抵抗骨折的能力有关，这取决于骨头的材料和结构特性，以及创伤的强度，频率和影响。低骨密度是骨强度和骨折风险的主要决定因素。但是，大多数骨折患者没有骨质疏松症，BMD解释了<50％的骨强度和骨折风险。除BMD以外，还可以通过分析骨骼的2D和3D结构图像来计算骨骼强度，但这还不是日常临床实践的一部分。骨折风险可以通过将BMD与临床风险因素的系统评估集成在一起进行评估，例如在骨折风险评估工具（FRAX）病例查找算法（年龄，临床骨折的个人和家族史，生活方式，疾病和药物治疗）中进行评估。 FRAX中未包括的临床风险因素包括跌倒风险，以前的临床骨折的数量和时机，形态学椎骨骨折的存在，数量和严重程度以及糖皮质激素的剂量。这些已包含在其他案例发现工具中，例如Garvan骨折风险计算器，糖皮质激素使用者的骨折风险和Maastricht骨折风险Nomogram。需要进一步完善病例发现算法，以将BMD，骨强度计算和临床危险因素集成到单个骨折风险预测算法中，该算法可用于日常实践。

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