英文第五節(jié)老性骨質(zhì)疏松癥詳解演示文稿

英文第五節(jié)老年性骨質(zhì)疏松癥詳解演示文稿現(xiàn)在是1頁\一共有43頁\編輯于星期二（優(yōu)選）英文第五節(jié)老年性骨質(zhì)疏松癥現(xiàn)在是2頁\一共有43頁\編輯于星期二現(xiàn)在是3頁\一共有43頁\編輯于星期二現(xiàn)在是4頁\一共有43頁\編輯于星期二現(xiàn)在是5頁\一共有43頁\編輯于星期二現(xiàn)在是6頁\一共有43頁\編輯于星期二Incidence/100,000personyear

Women

>=8535-39Epidemiologyofvertebral,hip,Colles'fractureswithage現(xiàn)在是7頁\一共有43頁\編輯于星期二Incidenceoffracture(fracturesper1000patientyears)現(xiàn)在是8頁\一共有43頁\編輯于星期二IIPathophysiology現(xiàn)在是9頁\一共有43頁\編輯于星期二Remodeling(骨重建過程)現(xiàn)在是10頁\一共有43頁\編輯于星期二Mechanismofboneremodeling.現(xiàn)在是11頁\一共有43頁\編輯于星期二破骨細(xì)胞成骨細(xì)胞MenopauseAgingOtherriskFactors

現(xiàn)在是12頁\一共有43頁\編輯于星期二Hormonalcontrolofboneresorption.現(xiàn)在是13頁\一共有43頁\編輯于星期二現(xiàn)在是14頁\一共有43頁\編輯于星期二ⅢClinicalcharacteritics

現(xiàn)在是15頁\一共有43頁\編輯于星期二

Osteoporosisoftenstartssilentlyandmaynotbefounduntilabonefractures.

Fragilityfractureisatypeofpathologicfracturethatoccursasresultofnormalactivities,suchasafallfromstandingheightorless

(theNationalOsteoporosisFoundation,NOF)現(xiàn)在是16頁\一共有43頁\編輯于星期二

1.5millionfracturesoccureachyearinUSasaconsequenceofosteoporosis

700,000vertebralcrushfracutres

300,000hipfractures

250.000wristfractures

300,000otherfractures

現(xiàn)在是17頁\一共有43頁\編輯于星期二Pain

Only25-30%ofvertebralcompressionfracturespresentwithsuddenonsetbackpainChronicpain現(xiàn)在是18頁\一共有43頁\編輯于星期二

Lossofheight,Humpback

kyphosis（humpback）Kyphosisismoreseverewithage24VertebralbodyVertebralbodyheight

2cmShort2mm，total3-6cm

現(xiàn)在是19頁\一共有43頁\編輯于星期二FracturesFracturesarethemostdangerousaspectofosteoporosis

Multiplevertebralfracturesleadtoastoopedposture,lossofheight,andchronicpainwithresultantreductioninmobilityHipfracture,inparticular,usuallyrequirespromptsurgery,asthereareseriousrisksassociatedwithahipfracture,suchasdeepveinthrombosisandapulmonaryembolism,andincreasedmortality.現(xiàn)在是20頁\一共有43頁\編輯于星期二Aclassicalcaseofosteoporosismaystartinawomanabout55yearsofagewithawristfracture現(xiàn)在是21頁\一共有43頁\編輯于星期二ThoracicfractureareassociatedwithrestrictivelungdiseasesLumbarfractureareassociatedwithabdominalsymptomincludingdistension,earlysatietyandconstipation現(xiàn)在是22頁\一共有43頁\編輯于星期二Ⅳ

Diagnosisanddifferentialdiagnosis現(xiàn)在是23頁\一共有43頁\編輯于星期二現(xiàn)在是24頁\一共有43頁\編輯于星期二Bonemineraldensity（骨密度測(cè)定）

現(xiàn)在是25頁\一共有43頁\編輯于星期二Measurementofbonemass

Dual-energyx-rayabsorptiometry(DXA,雙能X線吸收法）Thegoldstandardformeasuringbonedensity現(xiàn)在是26頁\一共有43頁\編輯于星期二MeasurementsofanysiteClinicaldeterminationsaremadeofthespineandhip

Bonespurs,whicharefrequentlyinosteoarthritis,tendtofalselyincreasebonedensityofthespineandareaparticularprobleminmaesuringthespineofolderindividualsStandardx-raysshowchangesinbonedensityafterabout40%ofbonelossDEXAscancandetectchangesafterabouta1%change現(xiàn)在是27頁\一共有43頁\編輯于星期二TscorescompareindividualresultstothoseinyongpopulationthatismatchedforraceandgenderZscorescompareindividualresultstothoseofanage-matchedpopulation

thatismatchedforraceandgender現(xiàn)在是28頁\一共有43頁\編輯于星期二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(gè)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(yán)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)疏松性骨折現(xiàn)在是29頁\一共有43頁\編輯于星期二ⅤTreatment現(xiàn)在是30頁\一共有43頁\編輯于星期二Arecentlydevelopedtechniqueinvolvespercutaneousinjectionofartificialcement(ploymethymethacrylate)intothevertebralbody(Vertebroplasty,kyphoplasty)ThisofferssignificantimmediatepainreliefinthemajorityofpatientsLongtermeffectsareunknown.Vertebroplasty

kyphoplasty

現(xiàn)在是31頁\一共有43頁\編輯于星期二NutritionalRecommendation

(營(yíng)養(yǎng)治療的建議

)

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).現(xiàn)在是32頁\一共有43頁\編輯于星期二

ElementalCalcium

ContentofVariousOralCalciumPreparation

各種口服鈣劑的元素鈣的含量

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.現(xiàn)在是33頁\一共有43頁\編輯于星期二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

現(xiàn)在是34頁\一共有43頁\編輯于星期二Estrogens(雌激素)SelectiveEstrogenReceptorModulators

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

（甲狀旁腺激素PTH）Fluoride(氟化物)PharmacologicTherapy(藥物治療)

現(xiàn)在是35頁\一共有43頁\編輯于星期二Estrogens現(xiàn)在是36頁\一共有43頁\編輯于星期二Resultsofhormonetherapyregimensonbonemineraldensity(BMD)ofthespine(A)andhip(B現(xiàn)在是37頁\一共有43頁\編輯于星期二Effectsofhormonetherapyoneventrates現(xiàn)在是38頁\一共有43頁\編輯于星期二SERMs(選擇性雌激素受體調(diào)節(jié)劑)

TwoSERMsarecurrentlybeingusedinpostmenopausalwomenRaloxifeneisapprovedforprenventionandtreatmentofosteoporosisTamoxifeneisapprovedforprenventionandtreatmentofbreastcancerT