老性骨質(zhì)疏松癥英文版專家講座

Section5老性骨質(zhì)疏松癥英文版第1頁Definition

OsteoporosisisasystemicskeletaldiseasecharacterizedbyLowbonemassMicroarchitecturaldeteriorationofbonetissue,LeadingtoincreasedbonefragilityAndgreatersusceptibilitytofracture

原發(fā)性骨疏松是一個以骨量低下，骨微結(jié)構(gòu)破壞，造成骨脆性增加，易發(fā)生骨折為特征全身性骨病老性骨質(zhì)疏松癥英文版第2頁ⅠEpidemiology老性骨質(zhì)疏松癥英文版第3頁老性骨質(zhì)疏松癥英文版第4頁老性骨質(zhì)疏松癥英文版第5頁老性骨質(zhì)疏松癥英文版第6頁老性骨質(zhì)疏松癥英文版第7頁Incidence/100,000personyear

Women

>=8535-39Epidemiologyofvertebral,hip,Colles'fractureswithage老性骨質(zhì)疏松癥英文版第8頁Incidenceoffracture老性骨質(zhì)疏松癥英文版第9頁老性骨質(zhì)疏松癥英文版第10頁IIPathophysiology老性骨質(zhì)疏松癥英文版第11頁Remodeling(骨重建過程)老性骨質(zhì)疏松癥英文版第12頁Mechanismofboneremodeling.老性骨質(zhì)疏松癥英文版第13頁破骨細胞成骨細胞MenopauseAgingOtherriskFactors

老性骨質(zhì)疏松癥英文版第14頁Hormonalcontrolofboneresorption.老性骨質(zhì)疏松癥英文版第15頁老性骨質(zhì)疏松癥英文版第16頁ⅢClinicalcharacteritics

老性骨質(zhì)疏松癥英文版第17頁

Osteoporosisoftenstartssilentlyandmaynotbefounduntilabonefractures.

Fragilityfractureisatypeofpathologicfracturethatoccursasresultofnormalactivities,suchasafallfromstandingheightorless

(theNationalOsteoporosisFoundation,NOF)老性骨質(zhì)疏松癥英文版第18頁

1.5millionfracturesoccureachyearinUSasaconsequenceofosteoporosis

700,000vertebralcrushfracutres

300,000hipfractures

250.000wristfractures

300,000otherfractures

老性骨質(zhì)疏松癥英文版第19頁Pain

Only25-30%ofvertebralcompressionfracturespresentwithsuddenonsetbackpainChronicpain老性骨質(zhì)疏松癥英文版第20頁

Lossofheight,Humpback

kyphosis（humpback）Kyphosisismoreseverewithage24VertebralbodyVertebralbodyheight

2cmShort2mm，total3-6cm

老性骨質(zhì)疏松癥英文版第21頁FracturesFracturesarethemostdangerousaspectofosteoporosis

Multiplevertebralfracturesleadtoastoopedposture,lossofheight,andchronicpainwithresultantreductioninmobilityHipfracture,inparticular,usuallyrequirespromptsurgery,asthereareseriousrisksassociatedwithahipfracture,suchasdeepveinthrombosisandapulmonaryembolism,andincreasedmortality.老性骨質(zhì)疏松癥英文版第22頁Aclassicalcaseofosteoporosismaystartinawomanabout55yearsofagewithawristfracture老性骨質(zhì)疏松癥英文版第23頁ThoracicfractureareassociatedwithrestrictivelungdiseasesLumbarfractureareassociatedwithabdominalsymptomincludingdistension,earlysatietyandconstipation老性骨質(zhì)疏松癥英文版第24頁Ⅳ

Diagnosisanddifferentialdiagnosis老性骨質(zhì)疏松癥英文版第25頁老性骨質(zhì)疏松癥英文版第26頁Bonemineraldensity（骨密度測定）

老性骨質(zhì)疏松癥英文版第27頁Measurementofbonemass

Dual-energyx-rayabsorptiometry(DXA,雙能X線吸收法）Thegoldstandardformeasuringbonedensity老性骨質(zhì)疏松癥英文版第28頁MeasurementsofanysiteClinicaldeterminationsaremadeofthespineandhip

Bonespurs,whicharefrequentlyinosteoarthritis,tendtofalselyincreasebonedensityofthespineandareaparticularprobleminmaesuringthespineofolderindividualsStandardx-raysshowchangesinbonedensityafterabout40%ofbonelossDEXAscancandetectchangesafterabouta1%change老性骨質(zhì)疏松癥英文版第29頁TscorescompareindividualresultstothoseinyongpopulationthatismatchedforraceandgenderZscorescompareindividualresultstothoseofanage-matchedpopulation

thatismatchedforraceandgender老性骨質(zhì)疏松癥英文版第30頁WHOdefinition

（BasedonBoneDensityLevels）

Normal

Bonedensityiswithin1SD(+1or?1)oftheyoungadultmean.Lowbonemass

Bonedensityisbetween1and2.5SDbelowtheyoungadultmean

(?1to?2.5SD).Osteoporosis

Bonedensityis2.5SDormorebelowtheyoungadultmean

(?2.5SDorlower).Severe(established)osteoporosis

Bonedensityismorethan2.5SDbelowtheyoungadultmean,andtherehavebeenoneormoreosteoporoticfractures.正常

骨密度在年輕成人均值1個SD(+1或?1)以內(nèi)低骨量骨密度在年輕成人均值1到2.5SD之間骨質(zhì)疏松骨密度等于或低于年輕成人均值

2.5SD嚴重(已確立)骨質(zhì)疏松骨密度等于或低于年輕成人均值

2.5SD，而且有一處或多處骨質(zhì)疏松性骨折老性骨質(zhì)疏松癥英文版第31頁ⅤTreatment老性骨質(zhì)疏松癥英文版第32頁Arecentlydevelopedtechniqueinvolvespercutaneousinjectionofartificialcement(ploymethymethacrylate)intothevertebralbody(Vertebroplasty,kyphoplasty)ThisofferssignificantimmediatepainreliefinthemajorityofpatientsLongtermeffectsareunknown.Vertebroplasty

kyphoplasty

老性骨質(zhì)疏松癥英文版第33頁NutritionalRecommendation

(營養(yǎng)治療提議

)

AdequateCalciumIntake

LifestageGroupEtsimatedAdequateDailyCalciumIntake.mg/d

Youngchildren(1-3years) 500Olderchildren(4-8years)800Adolescentsandyoungadults(9-18years) 1300Menandwomen(19-50years) 1000Menandwomen(51andolder) 1200Note:Pregnancyandlactationneedsarethesameasfornonpregnantwomen(e.g.,1300mg/dforadolescents/youngadultand1000mg/dfor≥19years).老性骨質(zhì)疏松癥英文版第34頁

ElementalCalcium

ContentofVariousOralCalciumPreparation

各種口服鈣劑元素鈣含量

CalciumPreparationElementalCalcium

(鈣制劑)(元素鈣含量)

Calciumcitrate檸檬酸鈣60mg/300mg

Calciumlactate乳酸鈣80mg/600mgCalciumgluconate葡萄糖酸鈣40mg/500mgCalciumcarbonate碳酸鈣 400mg/gCalciumcarbonate+5ugvitaminD2(OsCal250)碳酸鈣250mg/片Calciumcarbonate(Turns500) 碳酸鈣500mg/片Source:AdaptedfromSMKraneandMFHolick,Chap.355inHPIM,14ed,1998.老性骨質(zhì)疏松癥英文版第35頁VitaminD

VitaminDgoal:Serum25-hydroxyvitamin

D>75μmol/L(30ng/mL)

<50yearsofage:200IU/day50–70yearsofage:400IU/day>70yearsofage:600IU/day

Theelderlyandchronicallyill:>1000IU/daySerum25-hydroxyvitamin

D<75μmol/L(30ng/mL).Inadequatedosage

老性骨質(zhì)疏松癥英文版第36頁Estrogens(雌激素)SelectiveEstrogenReceptorModulators

(SERMs,選擇性雌激素受體調(diào)整劑)Bisphosphonate(雙磷酸鹽)Calcium(降鈣素)Parathyroidhormone

（甲狀旁腺激素PTH）Fluoride(氟化物)PharmacologicTherapy(藥品治療)

老性骨質(zhì)疏松癥英文版第37頁Estrogens老性骨質(zhì)疏松癥英文版第38頁Resultsofhormonetherapyregimensonbonemineraldensity(BMD)ofthespine(A)andhip(B老性骨質(zhì)疏松癥英文版第39頁Effectsofhormonetherapyoneventrates老性骨質(zhì)疏松癥英文版第40頁SERMs(選擇性雌激素受體調(diào)整劑)

TwoSERMsarecurrentlybeingusedinpostmenopausalwomenRaloxifeneisapprovedforprenventionandtreatmentofosteoporosisTamoxifeneisapprovedforprenventionandtreatmentofbreastcancerThereisnodataconfirmingthatraloxifenecanreducetheriskofnonvertebralfractures老性骨質(zhì)疏松癥英文版第41頁Alendronate,risedronate,andibandronateareapprovedforthepreventionandtreatmentofpostmenopausalosteoporosis.RisedronateandAlendronateareapprovedfortreatm