Ex-smokers can regain BMD; primary care docs fail to track osteoporosis
1/31/2007
By: Shalmali Pal
Research has shown that women who smoke have a greater risk for developing osteoporosis. However, smokers who quit could actually see an increase in bone mineral density (BMD), according to Connecticut-based researchers.
On the other hand, any benefits derived from choosing a cigarette-free lifestyle may be for naught if primary care providers don't fully understand BMD test results and steer their patients in the right direction toward maintaining optimum bone health, said another team from the Cleveland Clinic Foundation.
First, Dr. Cheryl Oncken and colleagues looked at the impact of smoking cessation on BMD in postmenopausal women. "We hypothesized that women who quit smoking for one year would have a slower decline in BMD of the hip compared with those who continued smoking," wrote Oncken, who is from the Center on Aging at the University of Connecticut's School of Medicine in Farmington. Her co-authors are from the university's Storrs campus, as well as the VA Connecticut Healthcare System in Newington (Journal of Women's Health, December 2006, Vol. 15:10, pp. 1141-1150).
The study population consisted of 152 postmenopausal women who smoked at least 10 cigarettes a day. BMD of the hip, spine, wrist, and total body was measured by bone densitometry (Lunar DPX-IQ, GE Healthcare, Chalfont St. Giles, U.K.) at baseline and again one year after the women completed a smoking-cessation treatment program.
According to the results, smokers who had quit saw a 1.52% increase in hip BMD versus women who continued to smoke (0.43% increase). BMD improvement was seen in those who quit at the femoral trochanter -- 2.9% versus 0.6% for smokers. BMD changes at the femoral neck, radius, spine, and total body did not differ significantly between the two groups, Oncken's group stated.
Weight change was one of the main factors leading to increased BMD in women who gave up smoking, the researchers added, with the effects of cessation mediated by weight gain. Also, cessation was associated with an increase in bone alkaline phosphatase (BAP), which is a marker for bone remodeling, they stated.
The increase in hip BMD was particularly good news as decreased density in that area is a risk factor for fracture, the group concluded.
Secondary osteoporosis recognition
The word may be out that women of a certain age should undergo regular bone densitometry scans, yet healthcare providers are still not meeting the screening recommendations laid out by the National Osteoporosis Foundation (NOH) or the International Society for Clinical Densitometry (ISCD), according to Dr. Andrea Sikon and colleagues.
In this study, Sikon's group sought to determine the percentage of patients with DEXA scans who were referred for secondary testing by a primary care physician.
"Women with osteoporosis often are found to have secondary causes, most commonly including hypoestrogenemia, steroid use, excess thyroid hormone, and anticonvulsant use.... Low T-scores (≤ -2.5) do not necessary define primary osteoporosis, as this is only one possible diagnosis in a long differential of other potential causes of low BMD," wrote Sikon, who is from the Women's Health Center at the Cleveland Clinic Foundation in Ohio. Other contributors are from the departments of rheumatic and immunologic diseases and endocrinology (Journal of Women's Health, December 2006, Vol. 15:10, pp. 1174-1183).
All DEXA scans performed at the Women's Health Center from July 2002 to August 2003 were collected. These scans were assessed for abnormal results of low bone density/osteopenia (T-score of -1.1. to -2.4) or osteoporosis (T- score ≤ -2/5). In addition, the Z-score had to be -1.5 or less.
Referring physicians were categorized as a primary care provider (PCP) or specialist (internist, ob/gyn). A total of 31 providers (21 PCPs, 10 specialists) ordered DEXA scans in the study period. Possible secondary bone evaluations included conducting a complete blood count (CBC) and testing for thyroid-stimulating hormone (TSH) and blood urea nitrogen (BUN).
According to the results, of the 712 abnormal DEXA scans, 77 had low Z-scores and were recommended for secondary evaluation by the bone scan reader. However, only 49 of these 77 (63.6%) underwent additional evaluation at the behest of the referring physician. A woman was more likely to be sent on for additional tests by a specialist (95.1%) than by a primary care physician (27.8%), the study authors found.
The group suggested several possible reasons that PCPs, and specialists to some degree, were either missing or ignoring recommendations for workup, including a lack of understanding as to what constitutes appropriate secondary evaluation.
"At our facility, we have made efforts to unify report content and flow to simplify interpretation for the ordering physicians," the authors explained. "Outcomes of this change have not yet been assessed."
The group also found that referring physicians were often prescribing antiresorptive agents for osteoporosis without taking into consideration other mitigating factors, such as the patient's vitamin D levels.
By Shalmali Pal
AuntMinnie.com staff writer
January 31, 2007
本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领
红字部分可能翻得不对，烦请高手指教，谢谢！
初译：
Ex-smokers can regain BMD; primary care docs fail to track osteoporosis
1/31/2007
By: Shalmali Pal
吸烟可以导致骨质疏松，戒烟后骨密度可以恢复
Research has shown that women who smoke have a greater risk for developing osteoporosis. However, smokers who quit could actually see an increase in bone mineral density (BMD), according to Connecticut-based researchers.
以前的研究告诉我们，吸烟女性更易罹患骨质疏松症。而来自康乃狄格大学的最新研究发现，吸烟女性在戒烟后骨密度（BMD）可以恢复。
On the other hand, any benefits derived from choosing a cigarette-free lifestyle may be for naught if primary care providers don't fully understand BMD test results and steer their patients in the right direction toward maintaining optimum bone health, said another team from the Cleveland Clinic Foundation.
另据俄亥俄州克利夫兰市临床基金会的研究显示，如果初级护理医师不完全了解病人的骨密度测试结果，无法正确指导病人如何保持最佳骨密度，那么这些吸烟的骨质疏松症患者在戒烟后可能身体状况也未见得会有任何起色。
First, Dr. Cheryl Oncken and colleagues looked at the impact of smoking cessation on BMD in postmenopausal women. "We hypothesized that women who quit smoking for one year would have a slower decline in BMD of the hip compared with those who continued smoking," wrote Oncken, who is from the Center on Aging at the University of Connecticut's School of Medicine in Farmington. Her co-authors are from the university's Storrs campus, as well as the VA Connecticut Healthcare System in Newington (Journal of Women's Health, December 2006, Vol. 15:10, pp. 1141-1150).
首先，谢丽.奥肯及其同事研究了戒烟对绝经期后女性骨密度的影响。“我们假设，戒烟1年的女性其髋骨的骨质流失要比持续吸烟的女性少”奥肯在其研究报告中写道。奥肯供职于位于法明顿镇的康乃狄格大学医学院的衰老研究中心。参与该研究的同时还有来自该大学斯托思校区的专家以及来自位于纽因顿镇的VA康乃狄格医疗保健系统的专家。（《妇女健康杂志》，2006年12月，卷.15:10,页.1141－1150）
The study population consisted of 152 postmenopausal women who smoked at least 10 cigarettes a day. BMD of the hip, spine, wrist, and total body was measured by bone densitometry (Lunar DPX-IQ, GE Healthcare, Chalfont St. Giles, U.K.) at baseline and again one year after the women completed a smoking-cessation treatment program.
该研究的研究对象是每天吸烟至少10支的绝经后女性。通过骨密度测定法分别测定这些女性基线时的髋骨、脊柱、腕骨和全身的骨密度，并在她们戒烟1年之后，再次测定骨密度。
According to the results, smokers who had quit saw a 1.52% increase in hip BMD versus women who continued to smoke (0.43% increase). BMD improvement was seen in those who quit at the femoral trochanter -- 2.9% versus 0.6% for smokers. BMD changes at the femoral neck, radius, spine, and total body did not differ significantly between the two groups, Oncken's group stated.
研究结果显示，戒烟女性的髋骨骨密度增加了1.52％，股骨大转子骨密度增加2.9％，而持续吸烟者的髋骨骨密度只增加了0.43％，股骨大转子骨密度增加0.6%。在股骨颈、桡骨、脊柱和全身骨密度的改变方面，两组女性无显著差异。
Weight change was one of the main factors leading to increased BMD in women who gave up smoking, the researchers added, with the effects of cessation mediated by weight gain. Also, cessation was associated with an increase in bone alkaline phosphatase (BAP), which is a marker for bone remodeling, they stated.
研究人员补充道，戒烟后可见体重增加，而体重改变是导致戒烟女性骨密度增高的一大因素。同样，骨再造的标记－骨碱性磷酸酶的增高与戒烟也存在着联系。
The increase in hip BMD was particularly good news as decreased density in that area is a risk factor for fracture, the group concluded.
研究人员总结道，髋骨的骨密度低容易引发骨折，而此次发现髋骨骨密度可在戒烟后得以增高无疑是个令人兴奋的消息。
Secondary osteoporosis recognition
认识继发性骨质疏松症
The word may be out that women of a certain age should undergo regular bone densitometry scans, yet healthcare providers are still not meeting the screening recommendations laid out by the National Osteoporosis Foundation (NOH) or the International Society for Clinical Densitometry (ISCD), according to Dr. Andrea Sikon and colleagues.
另据来自安德拉.西贡博士及其同事所开展的研究显示，虽然美国国家骨质疏松症基金会(NOH)和国际临床骨密度测定学会(ISCD)建议医疗工作者为特定年龄的女性进行定期的骨密度测定，但医疗工作者对这一建议尚未引起足够重视，从而未能有效减少继发性骨质疏松症的发病率。
In this study, Sikon's group sought to determine the percentage of patients with DEXA scans who were referred for secondary testing by a primary care physician.
在该研究中，研究人员试图确定在初级护理医师的建议下而接受二次检查－双能X-线吸收仪（DEXA）扫描的病人比例。
"Women with osteoporosis often are found to have secondary causes, most commonly including hypoestrogenemia, steroid use, excess thyroid hormone, and anticonvulsant use.... Low T-scores (≤ -2.5) do not necessary define primary osteoporosis, as this is only one possible diagnosis in a long differential of other potential causes of low BMD," wrote Sikon, who is from the Women's Health Center at the Cleveland Clinic Foundation in Ohio. Other contributors are from the departments of rheumatic and immunologic diseases and endocrinology (Journal of Women's Health, December 2006, Vol. 15:10, pp. 1174-1183).
“女性继发性骨质疏松症的最常见病因包括：血雌激素过少、类固醇药物的使用、甲状腺激素分泌过多和抗惊厥剂的使用.... 低T-score值(≤ -2.5)还不足以诊断原发性骨质疏松，因为这只是用于鉴别长期低骨密度的其他潜在病因的一个诊断参考指数” 来自俄亥俄州克利夫兰临床基金会的妇女健康中心的西贡博士在其研究报告中写道。另外，参与该研究的还有来自风湿病免疫疾病和内分泌学部门的研究人员。（《妇女健康杂志》，2006年12月，卷.15:10,页.1174-1183）
All DEXA scans performed at the Women's Health Center from July 2002 to August 2003 were collected. These scans were assessed for abnormal results of low bone density/osteopenia (T-score of -1.1. to -2.4) or osteoporosis (T- score ≤ -2/5). In addition, the Z-score had to be -1.5 or less.
研究人员收集了2002年7月至2003年8月在妇女健康中心接受DEXA扫描的病人的全部数据，然后进行低骨密度/骨质减少(T-score值-1.1. 至-2.4)评估和骨质疏松(T- score 值≤ -2/5)评估。此外，另一评估值－Z-score值为≤ 1.5。
Referring physicians were categorized as a primary care provider (PCP) or specialist (internist, ob/gyn). A total of 31 providers (21 PCPs, 10 specialists) ordered DEXA scans in the study period. Possible secondary bone evaluations included conducting a complete blood count (CBC) and testing for thyroid-stimulating hormone (TSH) and blood urea nitrogen (BUN).
研究人员将咨询医生分成两类：初级护理医师(PCP)和专业医师（内科医师：产科医师/妇科医师）。在研究期间，为病人开出DEXA扫描治疗单的有31位医师（21位初级护理医师，10位专业医师）。二次骨密度检查时包括的检查项目可能还有全血细胞计数(CBC)、促甲状腺激素(TSH)和血液尿素氮(BUN)测定。
According to the results, of the 712 abnormal DEXA scans, 77 had low Z-scores and were recommended for secondary evaluation by the bone scan reader. However, only 49 of these 77 (63.6%) underwent additional evaluation at the behest of the referring physician. A woman was more likely to be sent on for additional tests by a specialist (95.1%) than by a primary care physician (27.8%), the study authors found.
在712位DEXA扫描结果显示异常的病人中，有77位Z-score值低的病人被自己的咨询医师建议接受二次检查。然而，这77位病人中，只有49位（63.3％）听从咨询医师的劝告。研究负责人发现，在接受二次检查的妇女中，听从专业医师劝告的比例占到了95.1％，而接受初级护理医师建议的则只有27.8％，显然专业医师的话更有说服力。
The group suggested several possible reasons that PCPs, and specialists to some degree, were either missing or ignoring recommendations for workup, including a lack of understanding as to what constitutes appropriate secondary evaluation.
研究人员指出，可能是由于不清楚二次检查的正确检查项目，无论是初级护理医师还是专业医师都在一定程度上忘记或者疏忽了对患者提出接受二次检查的建议。
"At our facility, we have made efforts to unify report content and flow to simplify interpretation for the ordering physicians," the authors explained. "Outcomes of this change have not yet been assessed."
“在我们部门，我们尽力简化检查报告的递送流程，为的是方便主治医师进行诊断”该研究报告的作者解释道。“而评估时尚未将这方面改变所带来的影响加以考虑。”
The group also found that referring physicians were often prescribing antiresorptive agents for osteoporosis without taking into consideration other mitigating factors, such as the patient's vitamin D levels.
研究人员还发现，咨询医师经常在不考虑其他缓解因素，诸如维生素D水平的情况下，就为骨质疏松症患者开出抗再吸收剂的处方。
编译投稿：
吸烟可以导致骨质疏松，戒烟后骨密度可以恢复
以前的研究告诉我们，吸烟女性更易罹患骨质疏松症。而来自康乃狄格大学的最新研究发现，吸烟女性在戒烟后骨密度（BMD）可以恢复。
另据俄亥俄州克利夫兰市临床基金会的研究显示，如果初级护理医师不完全了解病人的骨密度测试结果，无法正确指导病人如何保持最佳骨密度，那么这些吸烟的骨质疏松症患者在戒烟后可能身体状况也未见得会有任何起色。
在康乃狄格大学开展的研究中，谢丽.奥肯及其同事研究了戒烟对绝经期后女性骨密度的影响。“我们假设，戒烟1年的女性其髋骨的骨质流失要比持续吸烟的女性少”奥肯在其研究报告中写道。奥肯供职于位于法明顿镇的康乃狄格大学医学院的衰老研究中心。参与该研究的同时还有来自该大学斯托思校区的专家以及来自位于纽因顿镇的VA康乃狄格医疗保健系统的专家。（《妇女健康杂志》，2006年12月，卷.15:10,页.1141－1150）
该研究的研究对象是每天吸烟至少10支的绝经后女性。通过骨密度测定法分别测定这些女性基线时的髋骨、脊柱、腕骨和全身的骨密度，并在她们戒烟1年之后，再次测定骨密度。
研究结果显示，戒烟女性的髋骨骨密度增加了1.52％，股骨大转子骨密度增加2.9％，而持续吸烟者的髋骨骨密度只增加了0.43％，股骨大转子骨密度增加0.6%。在股骨颈、桡骨、脊柱和全身骨密度的改变方面，两组女性无显著差异。
研究人员补充道，戒烟后可见体重增加，而体重改变是导致戒烟女性骨密度增高的一大因素。同样，骨再造的标记－骨碱性磷酸酶的增高与戒烟也存在着联系。
研究人员总结道，髋骨的骨密度低容易引发骨折，而此次发现髋骨骨密度可在戒烟后得以增高无疑是个令人兴奋的消息。
认识继发性骨质疏松症
另据来自安德拉.西贡博士及其同事所开展的研究显示，虽然美国国家骨质疏松症基金会(NOH)和国际临床骨密度测定学会(ISCD)建议医疗工作者为特定年龄的女性进行定期的骨密度测定，但医疗工作者对这一建议尚未引起足够重视，从而未能有效减少继发性骨质疏松症的发病率。
在该研究中，研究人员试图确定在初级护理医师的建议下而接受二次检查－双能X-线吸收仪（DEXA）扫描的病人比例。
“女性继发性骨质疏松症的最常见病因包括：血雌激素过少、类固醇药物的使用、甲状腺激素分泌过多和抗惊厥剂的使用.... 低T-score值(≤ -2.5)还不足以诊断原发性骨质疏松，因为这只是用于鉴别长期低骨密度的其他潜在病因的一个诊断参考指数” 来自俄亥俄州克利夫兰临床基金会的妇女健康中心的西贡博士在其研究报告中写道。另外，参与该研究的还有来自风湿病免疫疾病和内分泌学部门的研究人员。（《妇女健康杂志》，2006年12月，卷.15:10,页.1174-1183）
研究人员收集了2002年7月至2003年8月在妇女健康中心接受DEXA扫描的病人的全部数据，然后进行低骨密度/骨质减少(T-score值-1.1. 至-2.4)评估和骨质疏松(T- score 值≤ -2/5)评估。此外，另一评估值－Z-score值为≤ 1.5。
研究人员将咨询医生分成两类：初级护理医师(PCP)和专业医师（内科医师：产科医师/妇科医师）。在研究期间，为病人开出DEXA扫描治疗单的有31位医师（21位初级护理医师，10位专业医师）。二次骨密度检查时包括的检查项目可能还有全血细胞计数(CBC)、促甲状腺激素(TSH)和血液尿素氮(BUN)测定。
在712位DEXA扫描结果显示异常的病人中，有77位Z-score值低的病人被自己的咨询医师建议接受二次检查。然而，这77位病人中，只有49位（63.3％）听从咨询医师的劝告。研究负责人发现，在接受二次检查的妇女中，听从专业医师劝告的比例占到了95.1％，而接受初级护理医师建议的则只有27.8％，显然专业医师的话更有说服力。
研究人员指出，可能是由于不清楚二次检查的正确检查项目，无论是初级护理医师还是专业医师都在一定程度上忘记或者疏忽了对患者提出接受二次检查的建议。
“在我们部门，我们尽力简化检查报告的递送流程，为的是方便主治医师进行诊断”该研究报告的作者解释道。“而评估时尚未将这方面改变所带来的影响加以考虑。”
研究人员还发现，咨询医师经常在不考虑其他缓解因素，诸如维生素D水平的情况下，就为骨质疏松症患者开出抗再吸收剂的处方。
个人意见，仅供参考：
Research has shown that
以前的研究告诉我们
既往研究表明
said another team from the Cleveland Clinic Foundation.
另据俄亥俄州克利夫兰市临床基金会的研究显示
而克利夫兰市临床医学基金会的另一个研究小组表示
postmenopausal women
绝经期后女性
绝经后妇女
We hypothesized that women who quit smoking for one year would have a slower decline in BMD of the hip compared with those who continued smoking
我们假设，戒烟1年的女性其髋骨的骨质流失要比持续吸烟的女性少”
我们假设，戒烟1年的女性与持续吸烟的女性相比，其髋骨的骨密度降低的速度减慢了。
The study population consisted of 152 postmenopausal women who smoked at least 10 cigarettes a day.
该研究的研究对象是每天吸烟至少10支的绝经后女性。
该研究的研究人群是152名每天吸烟至少10支的绝经后妇女。
marker for bone remodeling
骨再造的标记
骨重建的标记物
At our facility, we have made efforts to unify report content and flow to simplify interpretation for the ordering physicians
我们科努力使报告的内容和流程标准化，以便于预约的临床医生阅片。
这篇一定要给我老爸看看，呵呵
逼他戒烟
