骨质疏松骨折

骨质疏松骨折Osteoporosis fracture,骨质疏松症是一种以骨量降低、骨微结构破坏、骨脆性增加、骨强度下降、骨折风险增大为特征的全身性、代谢性骨骼系统疾病Osteoporosis is a systemic, metabolic skeletal system characterized by decreased bone mass, bone microstructural damage, increased bone fragility, decreased bone strength, and increased risk of fracture,骨质疏松骨折的特点及治疗难点：Characteristics and Treatment Difficulties of Osteoporosis fracture：,1、骨质疏松骨折患者卧床制动后骨丢失加快，骨质疏松会加重；Osteoporosis fractures in patients with bed pressure after bone loss accelerated ，osteoporosis will increase2、骨折多为粉碎性，难以获得满意的固定；Fractures are mostly comminuted , it is difficult to obtain a satisfactory fixation3、内固定易松动，植骨易被吸收；Internal fixation easy to loose,bone graft easily absorbed,4、骨折愈合时间长，易发生延迟愈合、不愈合；Fracture healing time is long, prone to delayed healing or nonunion5、再骨折风险大；Easy to recur fracture again6、多为老年人，常合并多器官疾病，全身状况差；Patients are mostly elderly , often associated with multiple organ diseases, poor overall condition7、致残率、致死率较高，严重影响生活质量和寿命。disability rate and fatality rate are higher, seriously affecting the quality of life and life.,骨质疏松症的诊断标准：Diagnostic criteria for osteoporosis：,双能X线吸收法（DXA）是目前国际公认的骨密度检查方法。DXA is the internationally recognized method of bone mineral density .,根据中国人骨质疏松症诊断标准专家共识（第三稿2014版），年轻白人女性峰值骨量减少2.5标准差（-2.5SD）作为骨质疏松症的诊断标准。由于黄种人峰值骨量低于白种人等原因，国内推荐使用低于峰值骨量2标准差（-2.0SD），或者骨量下降25%作为诊断标准。According to the Chinese osteoporosis diagnostic criteria expert consensus (third edition 2014 version), young white female peak bone mass reduction of 2.5 standard deviation (-2.5SD) as the diagnostic criteria for osteoporosis. As the yellow population of bone mass below the white and other reasons, the domestic recommended lower than the peak bone mass 2 standard deviation (-2.0SD), or bone loss of 25% as a diagnostic standard.,骨折后抗骨质疏松用药建议：Prevention of osteoporosis after fracture:,根据中华医师学会骨科分会骨质疏松骨质诊疗指南，重要有如下几个要点：According to the Chinese Physicians Society Orthopedic Branch osteoporosis bone diagnosis and treatment guide, The main points are as follows:,1、合理使用钙剂：Rational use of calcium钙需要量为800-1200mg，骨折后补钙剂量应酌情适当加量。建议分次服用Calcium requirements for the 800-1200mg, After the fracture, the dosage of calcium should be appropriately added. Suggested fract. dos.2、推荐活性维生素D3Recommended use of vitamin D3建议用法为0.25-0.5ug/d，不仅能够增进肠钙吸收，促进骨形成和骨矿化，而且有助于增强肌力，增强神经肌肉协调性，防止跌倒倾向。Suggested usage is 0.25-0.5ug / d, not only can enhance intestinal calcium absorption, promote bone formation and bone mineralization, but also help to enhance muscle strength, enhance neuromuscular coordination, to prevent the tendency to fall.,3、降钙素（Calcitonin）如鲑鱼降钙素皮下或肌肉内注射50IU/d，鼻喷剂200IU/d。能够提高骨密度、改善骨质量、增强骨的生物力学性能、降低椎体骨质疏松骨折发生率，还有止痛作用。Such as salmon calcitonin subcutaneous or intramuscular injection of 50IU / d, nasal spray 200IU / d. Can improve bone density, improve bone mass, enhance bone biomechanical properties, Reduce the incidence of osteoporotic vertebral fractures, as well as analgesic effect.但少数患者可有面部潮红、恶心等不良反应，其中多数患者症状可在数小时内自行缓解，有明显药物过敏史者禁用。But may have facial flushing, nausea and other adverse reactions, most of which patients can be self-mitigation within a few hours, there are obvious history of drug allergy disabled.,如阿伦磷酸钠、利赛磷酸钠、唑来磷酸钠等，可提高腰椎和髋部骨密度，降低骨折风险及再骨折发生率。阿伦磷酸钠有口服70mg/w和10mg/d两种用法，应当日首次就餐前30min以一杯白开水送服，矿泉水不可用。为减轻药物对胃与食管的刺激，服药后至少30分钟内避免躺卧。双磷酸盐类药物主要不良反应是胃肠道反应，如恶心、呕吐、腹痛、腹泻等。Such as sodium alendate, sodium phosphate, sodium azole phosphate, etc., can improve the lumbar and hip bone density, reduce the risk of fracture and fracture rate. Alan sodium phosphate oral administration of 70mg / w and 10mg / d two kinds of usage, should be the first day before dinner 30min to a cup of boiled water delivery service, mineral water is not available. To reduce the stimulation of the stomach and esophagus, medication at least 30 minutes after the avoidance of lying. The main adverse effects of bisphosphonates are gastrointestinal reactions, such as nausea, vomiting, abdominal pain, diarrhea and so on.,4、双磷酸盐（Bisphosphonates）,5、选择性雌激素受体调节剂（SERMs）,6、锶盐（Strontium salt）如雷耐酸锶2g/d，睡前服用。具有双重作用机制，可提高骨强度、降低椎体及髋部骨折风险。Such as strontium strontium 2g / d, taken before going to bed. Has a dual mechanism of action, can improve bone strength, reduce the risk of vertebral and hip fractures.,如雷洛昔芬60mg/d，服药时间不受饮食影响。在提高骨密度、降低绝经后骨质疏松骨折发生率方面有良好疗效。Such as raloxifene 60mg / d, medication time from diet. In improving bone density, reduce the incidence of postmenopausal osteoporotic fractures have a good effect.,骨质疏松骨折危险因素：Risk factors for osteoporosis fracture:,1，主要危险因素Major risk factors跌倒，低骨密度，脆性骨折史，年龄大于65岁，有骨折家族病史Fall, low bone density, brittle brtl fracture history, older than 65 years old, with a history of fracture family2、次要危险因素Secondary risk factors嗜烟，酗酒，低体重指数，性腺机能减退，早期绝经（45岁），长期营养不良，影响骨代谢药物使用史（糖皮质激素、肝素），类风湿性关节炎、甲状腺功能亢进、甲状旁腺功能亢进患者。Smoking, alcoholism, low body mass index , hypogonadismhapgndzm,Early menopause (45 years), long-term malnutrition, the history of bone metabolism used drugs (glucocorticoid, heparin), rheumatoid arthritis, hyperthyroidism, hyperparathyroidism patients.,如何预防How to prevent,1、戒烟戒酒，均衡膳食；Quit smok