英文 第五节 老年性骨质疏松症.ppt

Section5Osteoporosis Definition OsteoporosisisasystemicskeletaldiseasecharacterizedbyLowbonemassMicroarchitecturaldeteriorationofbonetissue LeadingtoincreasedbonefragilityAndgreatersusceptibilitytofracture 原发性骨疏松是一种以骨量低下 骨微结构破坏 导致骨脆性增加 易发生骨折为特征的全身性骨病 Epidemiology Incidence 100 000personyear Women 85 35 39 Epidemiologyofvertebral hip Colles fractureswithage Incidenceoffracture fracturesper1000patientyears IIPathophysiology Remodeling 骨重建过程 Mechanismofboneremodeling 破骨细胞 成骨细胞 MenopauseAging OtherriskFactors Hormonalcontrolofboneresorption Clinicalcharacteritics Osteoporosisoftenstartssilentlyandmaynotbefounduntilabonefractures Fragilityfractureisatypeofpathologicfracturethatoccursasresultofnormalactivities suchasafallfromstandingheightorless theNationalOsteoporosisFoundation NOF 1 5millionfracturesoccureachyearinUSasaconsequenceofosteoporosis700 000vertebralcrushfracutres300 000hipfractures250 000wristfractures300 000otherfractures Pain Only25 30 ofvertebralcompressionfracturespresentwithsuddenonsetbackpainChronicpain Lossofheight Humpback kyphosis humpback Kyphosisismoreseverewithage24VertebralbodyVertebralbodyheight2cmShort2mm total3 6cm Fractures FracturesarethemostdangerousaspectofosteoporosisMultiplevertebralfracturesleadtoastoopedposture lossofheight andchronicpainwithresultantreductioninmobilityHipfracture inparticular usuallyrequirespromptsurgery asthereareseriousrisksassociatedwithahipfracture suchasdeepveinthrombosisandapulmonaryembolism andincreasedmortality Aclassicalcaseofosteoporosismaystartinawomanabout55yearsofagewithawristfracture ThoracicfractureareassociatedwithrestrictivelungdiseasesLumbarfractureareassociatedwithabdominalsymptomincludingdistension earlysatietyandconstipation Diagnosisanddifferentialdiagnosis Bonemineraldensity 骨密度测定 Measurementofbonemass Dual energyx rayabsorptiometry DXA 双能X线吸收法 Thegoldstandardformeasuringbonedensity MeasurementsofanysiteClinicaldeterminationsaremadeofthespineandhipBonespurs whicharefrequentlyinosteoarthritis tendtofalselyincreasebonedensityofthespineandareaparticularprobleminmaesuringthespineofolderindividualsStandardx raysshowchangesinbonedensityafterabout40 ofbonelossDEXAscancandetectchangesafterabouta1 change TscorescompareindividualresultstothoseinyongpopulationthatismatchedforraceandgenderZscorescompareindividualresultstothoseofanage matchedpopulationthatismatchedforraceandgender WHOdefinition BasedonBoneDensityLevels NormalBonedensityiswithin1SD 1or 1 oftheyoungadultmean LowbonemassBonedensityisbetween1and2 5SDbelowtheyoungadultmean 1to 2 5SD OsteoporosisBonedensityis2 5SDormorebelowtheyoungadultmean 2 5SDorlower Severe established osteoporosisBonedensityismorethan2 5SDbelowtheyoungadultmean andtherehavebeenoneormoreosteoporoticfractures 正常骨密度在年轻成人均值1个SD 1或 1 以内低骨量骨密度在年轻成人均值1到2 5SD之间骨质疏松骨密度等于或低于年轻成人均值2 5SD严重 已确立 骨质疏松骨密度等于或低于年轻成人均值2 5SD 而且有一处或多处骨质疏松性骨折 Treatment Arecentlydevelopedtechniqueinvolvespercutaneousinjectionofartificialcement ploymethymethacrylate intothevertebralbody Vertebroplasty kyphoplasty ThisofferssignificantimmediatepainreliefinthemajorityofpatientsLongtermeffectsareunknown Vertebroplasty kyphoplasty NutritionalRecommendation 营养治疗的建议 AdequateCalciumIntakeLifestageGroupEtsimatedAdequateDailyCalciumIntake mg d Youngchildren 1 3years 500Olderchildren 4 8years 800Adolescentsandyoungadults 9 18years 1300Menandwomen 19 50years 1000Menandwomen 51andolder 1200 Note Pregnancyandlactationneedsarethesameasfornonpregnantwomen e g 1300mg dforadolescents youngadultand1000mg dfor 19years ElementalCalciumContentofVariousOralCalciumPreparation各种口服钙剂的元素钙的含量 CalciumPreparationElementalCalcium 钙制剂 元素钙含量 Calciumcitrate柠檬酸钙60mg 300mgCalciumlactate乳酸钙80mg 600mgCalciumgluconate葡萄糖酸钙40mg 500mgCalciumcarbonate碳酸钙400mg gCalciumcarbonate 5ugvitaminD2 OsCal250 碳酸钙250mg 片Calciumcarbonate Turns500 碳酸钙500mg 片Source AdaptedfromSMKraneandMFHolick Chap 355inHPIM 14ed 1998 VitaminD VitaminDgoal Serum25 hydroxyvitaminD 75 mol L 30ng mL 70yearsofage 600IU dayTheelderlyandchronicallyill 1000IU daySerum25 hydroxyvitaminD 75 mol L 30ng mL Inadequatedosage Estrogens 雌激素 SelectiveEstrogenReceptorModulators SERMs 选择性雌激素受体调节剂 Bisphosphonate 双磷酸盐 Calcium 降钙素 Parathyroidhormone 甲状旁腺激素PTH Fluoride 氟化物 PharmacologicTherapy 药物治疗 Estrogens Resultsofhormonetherapyregimensonbonemineraldensity BMD ofthespine A andhip B Effectsofhormonetherapyoneventrates SERMs 选择性雌激素受体调节剂 TwoSERMsarecurrentlybeingusedinpostmenopausalwomenRaloxifeneisapprovedforprenventionandtreatmentofosteoporosisTamoxifeneisapprovedforprenventionandtreatmentofbreastcancerThereisnodataconfirmingthatraloxifenecanreducetheriskofnonvertebralfractures Alendronate risedronate andibandronateareapprovedforthepreventionandtreatmentofpostmenopausalosteoporosis RisedronateandAlendronateareapprovedfortreatmentofsteroidinducedosteoporosis Risedronateisapprovedforthepreventionofsteroidinducedosteoporosis RisedronateandAlendronateareapprovedfortreatmentofosteoporosisinmen Bisphosphonate Cumulativeproportionsofwomenwithosteoporosiswhosufferedclinicalfracture vertebral hip orwrist duri