中国骨质疏松诊治精品.ppt

* * Sometimes T scores can be misleading, and one instance when they can be misleading is when a patient has a previous fracture. * Consider this case. Suppose that an 80-year-old Caucasian woman presents to your office with a DXA scan demonstrating that she has a T score at her femoral neck that is -2.5. She is accompanied by her 50-year-old daughter, who is approximately the same height, approximately the same weight, and also has a T score of her femoral neck that is -2.5. * Which woman do you think has a higher lifetime risk of fracturing her hip: the mother or the daughter, or do they have similar lifetime risks for fracturing -- 2 women, Caucasian, same height, same weight, same T score, different age? It turns out that in this example, the daughter has a higher lifetime risk for fracturing. Why? Well, if her T score is -2.5 when shes 50 years old, what do you think her T score is going to be when shes 80 years old? Its going to be -3.5 or -4 if shes untreated. * Suppose I asked you the question this way. Suppose that we were studying cadaveric bone from a 50-year-old woman and cadaveric bone from an 80-year-old woman, and we subjected them to a stress force in the laboratory until the bones broke. Now, each of these bones has a T score of -2.5. Which femur will require less force to break, the 50-year-old femur, the 80-year-old femur, or do you think that they will both fracture with a similar force? You see, in this example, Im taking away the cataracts. Im taking away the risk of falling. Im taking away the orthostatic hypotension. Were just looking at bone. It turns out the 80-year-old bone fractures sooner every single time. * Id like to introduce you to 2 women that I recently saw in my practice who illustrate a couple of questions that Id like to raise. Of these 2 women, who do you think is at a greater risk for fracturing in the next 12 months? Neither woman has fractured in the past. You have a 50-year-old woman with a T score of -2.5 at her spin