老年髖部骨折骨質疏松管理課件

1、老年髖部骨折骨質疏松管理Auguste Rodin(18401917）走自己的路讓別人說去道德常常能填補智慧的缺陷智慧卻填補不了道德的缺陷Dante Alighieri（12651321）Laura L. Tosi M.DJoseph M. Lane M.DTosi LL, Lane JM.Osteoporosis Prevention and the Orthopaedic Surgeon:When Fracture Care is Not Enough.J Bone Joint Surg Am. 1998 Nov;80(11):1567-9.Richard M. Dell,Osteopor

2、osis Disease Management: What Every Orthopaedic Surgeon Should Know.J Bone Joint Surg Am, 2009 Nov 01; 91 (Supplement 6): 79 -86 . Richard M. DellKaiser Permanente Downey Medical CenterDowney, California春曉唐孟浩然春眠不覺曉，處處聞啼鳥。夜來風雨聲，花落知多少。原發(fā)性骨質疏松癥 90%I 型女性絕經后骨質疏松癥II型老年退化性骨質疏松癥繼發(fā)性骨質疏松癥特發(fā)性青少年骨質疏松癥分型Dowagers

3、 hump=Kyphosis=圓形駝背=貴婦背50歲每日鈣需求Source: The 2004 Surgeon Generals Report on Bone Health and Osteoporosis: What It Means to You at /library/bonehealth 超過50歲后1,200 mg/天目標常用鈣劑選擇鈣劑XXXDXXXXXX鈣(X力)XX鈣(XX鈣)XX鈣(XX力)XXX鈣(XX鈣)XXXX沖劑XX力(新)元素鈣含量600mg/片275mg/片50mg/包25mg/片80mg/片35mg/包150mg/片規(guī)格30片/瓶30片/瓶20包/盒30片/瓶4

4、8片/瓶40包/盒48/盒價格/元33.836.89.813.54626.726元素價格比/元:0.1g0.190.590.981.131.231.91每天服600mg元素鈣需要量1片2.18片12包24片7.5片17包4片月費用/元33.879.6176.4203.4220.8343.865防治骨質疏松藥物抑制骨吸收藥物 促進骨形成雙重機制藥物雙膦酸鹽SERMs降鈣素雌激素類PTH（類甲狀旁腺激素） 鍶鹽維生素K活性維生素D雙膦酸藥物的發(fā)現(xiàn)R. GRAHAM G. RUSSELL, Bisphosphonates, From Bench to Beside Ann. N.Y. Acad. S

5、ci. 1068: 367401 (2006). R. GRAHAM G. RUSSELL, Bisphosphonates，An Update on Mechanisms of Action and How These Relate to Clinical EfficacyR. GRAHAM G. RUSSELL, Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int (20

6、08) 19:7337591960年，F(xiàn)leisch提出，焦磷酸鹽存在于體內，可以與羥基磷灰石的結合，抑制礦化過程，是體內“除垢劑”，可以防止組織鈣化，調節(jié)骨組織礦化。焦磷酸鹽雙磷酸鹽AO Dialogue.2007(2):22-23Herbert Andre Fleisch(19332007)唑來膦酸是作用最強的雙膦酸鹽MA-32Green JR, et al. J Bone Miner Res. 1994;9:745-751.高鈣血癥小鼠體內相對抑制強度體外相對抑制強度，骨培養(yǎng)100101102103104105106100101102103唑來膦酸利塞膦酸鹽伊班膦酸鹽阿侖膦酸鹽奧帕膦酸鹽

7、帕米膦酸Neridronate氯屈膦酸鹽（氯膦酸二鈉）羥乙雙膦酸鹽（依替膦酸鈉）R = 0.97動物研究證實：唑來膦酸的骨吸收抑制強度是帕米膦酸鹽的100850倍MA-3739%24小時內排出61%骨組織結合100%生物利用度39%不經過體內代謝以原型經腎臟排出1) Aclasta SmPC; 2) Fosamax weekly tablets SmPC; 3) Fosavance tablets SmPC; 4) Actonel weekly tablets SmPC; 5) Bonviva tablets SmPC 唑來膦酸藥代特性 George Wilhelm Herman Emanue

8、l Merck (美18941957) 永遠銘記，藥物是為人類而生產，不是為追求利潤而制造的。只要堅守這一信念，利潤必將隨之而來。 僅僅發(fā)明了一種新藥，并非已經大功告成，還要探索有效途徑。喬治默克密蓋息鎮(zhèn)痛：顯著降低止痛藥用量Lyritis GP et al. Analgesic effect of salmon calcitonin suppositories in patients with acute pain due to recent osterporotic vertebral crush fractures: a prospective double-blind randomized placebo controlled clinical study. The Clinical Journal of Pain. 1999; 15: 284-289. 0123456基線第一周第二周第三周第四周*P=0.0005 v