摘要骨质疏松性骨折因级联效应（cascade effect）发生再骨折的风险极高，再骨折后内固定或关节假体松动、移位是临床治疗的难题。传统以抗破骨细胞为核心的治疗策略可提升骨密度，却在促进骨折愈合、修复骨微结构方面存在明显局限。基于骨质疏松是"骨骼组成成分等比例损害"这一病理认知，"成骨先行"理念应运而生。"成骨先行"指在骨质疏松性骨折的临床干预中将促进成骨细胞活性、加速新骨形成的治疗措施置于优先和主导地位。与传统的抗骨吸收药物治疗策略相比，"成骨先行"策略在快速提升骨密度、促进骨折愈合、预防内固定松动以及降低再骨折风险方面具有优势。新鲜骨质疏松性骨折患者是实施"成骨先行"策略的优先人群。促成骨应用应遵循尽早使用、连续使用、足疗程使用的原则。"成骨先行"策略有望带来更全面的骨骼修复疗效，为骨质疏松性骨折术后远期疗效的维持提供保障。

abstractsOsteoporotic fractures are associated with an exceedingly elevated risk of subsequent fracture due to cascade effect. Loosening and migration of internal fixations or joint prostheses following refracture constitute a major clinical therapeutic challenge. Traditional therapies focused on the inhibition of osteoclast activity to increase bone mineral density (BMD), yet they exhibit notable limitations in facilitating fracture healing and restoring bone microarchitecture. Based on the pathological understanding that osteoporosis is characterized by proportional deterioration of skeletal components, the concept of "anabolic first" has been proposed. This concept posits that, in clinical management of osteoporotic fractures, therapeutic interventions enhencing osteoblast activity and accelerating new bone formation should be prioritized and adopted as the primary approach. Compared with conventional antiresorptive medications, the "anabolic first" strategy demonstrates superior efficacy in rapidly elevating BMD, facilitating fracture healing, preventing internal fixation loosening, and reducing the risk of refracture. Patients exhibiting fresh osteoporotic fractures represent the primary candidates for this strategy. The administration of anabolic medication should follow the principles of early initiation, continuous management, and full-course treatment. The "anabolic first" strategy is expected to yield more comprehensive bone repair outcomes, and provide robust support for maintaining the long-term efficacy of surgical treatment for such cases.