USPSTF修正其對骨質疏鬆症篩檢的建議


  2002年9月17日─9月17日的《Annals of Internal Medicine》雜誌報導,美國預防服務專門小組(USPSTF)修正其對骨質疏鬆症篩檢的建議。這些新的建議包括對年齡在65歲,或年齡60歲但發生骨質疏鬆性骨折的風險較高的女性,進行骨質密度檢查的B級建議。
  
  一旦診斷確認就無須再進一步篩檢。骨質密度的檢查頻率不應高於每兩年一次。骨質密度測定法,也被稱為雙倍能量X光吸收術(dual-energy x-ray absorptiometry,DEXA),目前是一種已被接受,且易於測量骨質密度的方法,但專門小組並未建議任何特異性的篩檢。
  
  Alfred O. Berg醫師及其USPSTF的同事認為,由於檢驗精確度問題,最少需要兩年才有可靠測量骨礦物質密度的變化,不過,對於重複篩檢而言,間隔更長的時間,也足以確認新的骨質疏鬆症病例。
  
  1996年,USPSTF沒有發現足夠的證據以建議或反對停經婦女進行例行的骨質疏鬆篩檢。目前,USPSTF對於年齡在60歲以下或年齡在60-64歲之間,發生骨質疏鬆骨折的風險不高的女性進行篩檢,既不贊同也不反對(C級建議)。
  
  目前,文獻中尚未研究進行篩檢的理想間隔時間,停止篩檢的適宜年齡,或對年齡在85歲以上的女性進行治療的效果等問題進行評估。專門小組因此考慮目前可得關於骨質疏鬆的機率,可用篩檢的精確度,以及治療有效性的資訊。
  
  臨床醫師應與患者一起考慮可供選擇的治療措施及其相關的益處與壞處,以及其效果與安全的不確定性,從而作出瞭解情況後的選擇。
  
  
  

USPSTF Revises Recommendations

By Laurie Barclay, MD
Medscape Medical News

Sept. 17, 2002 — The U.S. Preventive Services Task Force (USPSTF) has revised its recommendations for screening for osteoporosis, as reported in the Sept. 17 issue of the Annals of Internal Medicine. The new recommendations include a grade B recommendation for screening with a bone density test at age 65 or at age 60 for women at higher than average risk for osteoporotic fractures.

Once the diagnosis is made, there is no need to screen further. Bone densities should be obtained no more frequently than every two years. Bone densitometry, also known as dual-energy x-ray absorptiometry (DEXA), is currently an accepted and widely available method for measuring bone density, but the Task Force did not recommend any specific screening test.

"Because of limitations in the precision of testing, a minimum of two years may be needed to reliably measure a change in bone mineral density; however, longer intervals may be adequate for repeated screening to identify new cases of osteoporosis," write Alfred O. Berg, MD, MPH, and colleagues from the USPSTF.

In 1996, the USPSTF did not find enough evidence to recommend for or against routine osteoporosis screening in postmenopausal women. Currently, the USPSTF has no recommendation for or against screening postmenopausal women younger than age 60 or women age 60 to 64 who are not at increased risk of osteoporotic fractures (Grade C recommendation).

At present, there are still no studies in the literature evaluating the optimal intervals for screening, the appropriate age to stop screening, or the efficacy of treating women older than age 85. The Task Force therefore considered available information about the frequency of osteoporosis, the accuracy of available screening tests, and the effectiveness of treatments.

"Clinicians should review with patients the relative benefits and harms of available treatment options, and uncertainties about their efficacy and safety, to facilitate an informed choice," the authors write.

Ann Int Med. 2002;137(6):526-528, 529-541

Reviewed by Gary D. Vogin, MD

    
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