老年髋部骨折骨质疏松管理课件

1、老年髋部骨折骨质疏松管理Auguste Rodin(18401917）走自己的路让别人说去道德常常能填补智慧的缺陷智慧却填补不了道德的缺陷Dante Alighieri（12651321）Laura L. Tosi M.DJoseph M. Lane M.DTosi LL, Lane JM.Osteoporosis Prevention and the Orthopaedic Surgeon:When Fracture Care is Not Enough.J Bone Joint Surg Am. 1998 Nov;80(11):1567-9.Richard M. Dell,Osteopor

2、osis Disease Management: What Every Orthopaedic Surgeon Should Know.J Bone Joint Surg Am, 2009 Nov 01; 91 (Supplement 6): 79 -86 . Richard M. DellKaiser Permanente Downey Medical CenterDowney, California春晓唐孟浩然春眠不觉晓，处处闻啼鸟。夜来风雨声，花落知多少。原发性骨质疏松症 90%I 型女性绝经后骨质疏松症II型老年退化性骨质疏松症继发性骨质疏松症特发性青少年骨质疏松症分型Dowagers

3、 hump=Kyphosis=圆形驼背=贵妇背50岁每日钙需求Source: The 2004 Surgeon Generals Report on Bone Health and Osteoporosis: What It Means to You at /library/bonehealth 超过50岁后1,200 mg/天目标常用钙剂选择钙剂XXXDXXXXXX钙(X力)XX钙(XX钙)XX钙(XX力)XXX钙(XX钙)XXXX冲剂XX力(新)元素钙含量600mg/片275mg/片50mg/包25mg/片80mg/片35mg/包150mg/片规格30片/瓶30片/瓶20包/盒30片/瓶4

4、8片/瓶40包/盒48/盒价格/元33.836.89.813.54626.726元素价格比/元:0.1g0.190.590.981.131.231.91每天服600mg元素钙需要量1片2.18片12包24片7.5片17包4片月费用/元33.879.6176.4203.4220.8343.865防治骨质疏松药物抑制骨吸收药物 促进骨形成双重机制药物双膦酸盐SERMs降钙素雌激素类PTH（类甲状旁腺激素） 锶盐维生素K活性维生素D双膦酸药物的发现R. GRAHAM G. RUSSELL, Bisphosphonates, From Bench to Beside Ann. N.Y. Acad. S

5、ci. 1068: 367401 (2006). R. GRAHAM G. RUSSELL, Bisphosphonates，An Update on Mechanisms of Action and How These Relate to Clinical EfficacyR. GRAHAM G. RUSSELL, Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int (20

6、08) 19:7337591960年，Fleisch提出，焦磷酸盐存在于体内，可以与羟基磷灰石的结合，抑制矿化过程，是体内“除垢剂”，可以防止组织钙化，调节骨组织矿化。焦磷酸盐双磷酸盐AO Dialogue.2007(2):22-23Herbert Andre Fleisch(19332007)唑来膦酸是作用最强的双膦酸盐MA-32Green JR, et al. J Bone Miner Res. 1994;9:745-751.高钙血症小鼠体内相对抑制强度体外相对抑制强度，骨培养100101102103104105106100101102103唑来膦酸利塞膦酸盐伊班膦酸盐阿仑膦酸盐奥帕膦酸盐

7、帕米膦酸Neridronate氯屈膦酸盐（氯膦酸二钠）羟乙双膦酸盐（依替膦酸钠）R = 0.97动物研究证实：唑来膦酸的骨吸收抑制强度是帕米膦酸盐的100850倍MA-3739%24小时内排出61%骨组织结合100%生物利用度39%不经过体内代谢以原型经肾脏排出1) Aclasta SmPC; 2) Fosamax weekly tablets SmPC; 3) Fosavance tablets SmPC; 4) Actonel weekly tablets SmPC; 5) Bonviva tablets SmPC 唑来膦酸药代特性 George Wilhelm Herman Emanue

8、l Merck (美18941957) 永远铭记，药物是为人类而生产，不是为追求利润而制造的。只要坚守这一信念，利润必将随之而来。 仅仅发明了一种新药，并非已经大功告成，还要探索有效途径。乔治默克密盖息镇痛：显著降低止痛药用量Lyritis GP et al. Analgesic effect of salmon calcitonin suppositories in patients with acute pain due to recent osterporotic vertebral crush fractures: a prospective double-blind randomized placebo controlled clinical study. The Clinical Journal of Pain. 1999; 15: 284-289. 0123456基线第一周第二周第三周第四周*P=0.0005 v