北美-NAMS关于绝经后妇女骨质疏松症诊治指南 2010 节选

Meta-analyses have also suggested the risk of hip fracture may be markedly increased in current smokers.182 In current smokers, the risk of hip fracture is similar in women up to age 50, but then increases with age with a risk ratio of 1.17 at age 60, increasing to 1.71 at age 80. The RR is only modestly adjusted downward when corrected for BMD. Current smoking is associated with significantly increased risk of any fracture, any osteoporotic fracture, and hip fracture in women.33 The mechanism is unclear: it may be related to lower levels of activity, morbidity, risk of falls, or changes in microarchitecture.33 The WHO findings indicate that a history of smoking confers a substantial risk for future fracture, largely independent of BMD.178 Smoking cessation and avoidance of secondhand smoke for nonsmokers is important as a general health measure because of the numerous health problems associated with smoking. Lower BMD and increased fracture risk are two of these health problems.156,178 A wide array of smoking cessation aids are available, including prescription products (with and without nicotine) and behavior-modification programs. Alcohol consumption Data suggest an association between moderate alcohol intake and increased BMD in postmenopausal women.183,184 Nevertheless, this observation must be tempered by the increased risk of falling and osteoporotic fracture associated with alcohol consumption. The level of alcohol consumption associated with an increased risk of falls is more than seven units a week, as established by the Framingham Heart Study.185 Two or more units of alcohol within 6 hours is estimated to account for approximately 20% of falls at home among working-age adults.186 Data from more than 11,000 women from three different cohorts suggest that alcohol consumption of more than two units a day is associated with an increased risk of osteoporotic fracture.187 Therefore, postmenopausal women who drink should be advised to drink moderately and not exceed seven units of alcohol a week, with preferably no more than two in any one 6-hour period. One unit is considered to be 12 oz (360 mL) of beer, 4 oz (120 mL) of wine, or 1 oz (30 mL) of liquor.