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,Collesfractureswithage,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(+1or1)oftheyoungadultmean.LowbonemassBonedensityisbetween1and2.5SDbelowtheyoungadultmean(1to2.5SD).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/dfor19years).,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-hydroxyvitaminD75mol/L(30ng/mL)70yearsofage:600IU/dayTheelderlyandchronicallyill:1000IU/daySerum25-hydroxyvitaminD75mol/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)during3y