老年性骨质疏松症英文版培训课件

1、老年性骨质疏松症英文版老年性骨质疏松症英文版Definition Osteoporosis is a systemic skeletal disease characterized byLow bone mass Microarchitectural deterioration of bone tissue, Leading to increased bone fragility And greater susceptibility to fracture 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 2老年性骨质疏松症英文版Definition O

2、steoporosis is aEpidemiology 3老年性骨质疏松症英文版Epidemiology 3老年性骨质疏松症英文版4老年性骨质疏松症英文版4老年性骨质疏松症英文版5老年性骨质疏松症英文版5老年性骨质疏松症英文版6老年性骨质疏松症英文版6老年性骨质疏松症英文版7老年性骨质疏松症英文版7老年性骨质疏松症英文版Incidence /100,000 person year Women =8535-39Epidemiology of vertebral,hip,Collesfractures with age8老年性骨质疏松症英文版Incidence /100,000 person y

3、earIncidence of fracture9老年性骨质疏松症英文版Incidence of fracture9老年性骨质疏松症10老年性骨质疏松症英文版10老年性骨质疏松症英文版II Pathophysiology11老年性骨质疏松症英文版II Pathophysiology11老年性骨质疏松症英Remodeling (骨重建过程)12老年性骨质疏松症英文版Remodeling (骨重建过程)12老年性骨质疏松症英文Mechanism of bone remodeling.13老年性骨质疏松症英文版Mechanism of bone remodeling.1破骨细胞成骨细胞Menopau

4、se AgingOther risk Factors 14老年性骨质疏松症英文版破骨细胞成骨细胞Menopause Other risk 1Hormonal control of bone resorption.15老年性骨质疏松症英文版Hormonal control of bone resor16老年性骨质疏松症英文版16老年性骨质疏松症英文版 Clinical characteritics17老年性骨质疏松症英文版 Clinical characteritics17老年 Osteoporosis often starts silently and may not be found unt

5、il a bone fractures. Fragility fracture is a type of pathologic fracture that occurs as result of normal activities, such as a fall from standing height or less ( the National Osteoporosis Foundation ,NOF)18老年性骨质疏松症英文版 18老年性骨质疏松症英文版 1.5 million fractures occur each year in US as a consequence of ost

6、eoporosis 700,000 vertebral crush fracutres 300,000 hip fractures 250.000 wrist fractures 300,000 other fractures 19老年性骨质疏松症英文版19老年性骨质疏松症英文版Pain Only 25-30% of vertebral compression fractures present with sudden onset back pain Chronic pain 20老年性骨质疏松症英文版Pain 20老年性骨质疏松症英文版Loss of height , Humpback ky

7、phosis（humpback）Kyphosis is more severe with age 24 Vertebral body Vertebral body height 2 cm Short 2mm，total 3-6cm 21老年性骨质疏松症英文版Loss of height , Humpback 21老FracturesFractures are the most dangerous aspect of osteoporosis Multiple vertebral fractures lead to a stooped posture, loss of height, and c

8、hronic pain with resultant reduction in mobilityHip fracture, in particular, usually requires prompt surgery, as there are serious risks associated with a hip fracture, such as deep vein thrombosis and a pulmonary embolism, and increased mortality.22老年性骨质疏松症英文版FracturesFractures are the mosA classic

9、al case of osteoporosis may start in a woman about 55 years of age with a wrist fracture23老年性骨质疏松症英文版A classical case of osteoporosThoracic fracture are associated with restrictive lung diseases Lumbar fracture are associated with abdominal symptom including distension ,early satiety and constipatio

10、n24老年性骨质疏松症英文版Thoracic fracture are associat Diagnosis and differential diagnosis25老年性骨质疏松症英文版 Diagnosis and 25老年性骨质疏松症英文版26老年性骨质疏松症英文版26老年性骨质疏松症英文版Bone mineral density（骨密度测定） 27老年性骨质疏松症英文版Bone mineral density（骨密度测定） 27Measurement of bone mass Dual-energy x-ray absorptiometry (DXA, 双能X线吸收法）The gold

11、standard for measuring bone density 28老年性骨质疏松症英文版Measurement of bone mass Dual-Measurements of any site Clinical determinations are made of the spine and hip Bone spurs ,which are frequently in osteoarthritis ,tend to falsely increase bone density of the spine and are a particular problem in maesuri

12、ng the spine of older individuals Standard x-rays show changes in bone density after about 40% of bone lossDEXA scan can detect changes after about a 1% change29老年性骨质疏松症英文版Measurements of any site 29老年性T scores compare individual results to those in yong population that is matched for race and gende

13、r Z scores compare individual results to those of an age-matched population that is matched for race and gender30老年性骨质疏松症英文版T scores compare individual reWHO definition （Based on Bone Density Levels） Normal Bone density is within 1 SD (+1 or 1) of the young adult mean.Low bone mass Bone density is b

14、etween 1 and 2.5 SD below the young adult mean (1 to 2.5 SD).Osteoporosis Bone density is 2.5 SD or more below the young adult mean (2.5 SD or lower).Severe (established) osteoporosis Bone density is more than 2.5 SD below the young adult mean, and there have been one or more osteoporotic fractures.

15、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2.5 SD之间 骨质疏松 骨密度等于或低于年轻成人均值 2.5 SD 严重(已确立)骨质疏松 骨密度等于或低于年轻成人均值 2.5 SD ，而且有一处或多处骨质疏松性骨折31老年性骨质疏松症英文版WHO definition （Based on Bon Treatment32老年性骨质疏松症英文版 Treatment32老年性骨质疏松症英文版A recently developed technique involves percutaneous injection of artificial cement

16、 (ploymethymethacrylate)into the vertebral body (Vertebroplasty, kyphoplasty)This offers significant immediate pain relief in the majority of patients Long term effects are unknown. Vertebroplasty kyphoplasty 33老年性骨质疏松症英文版A recently developed techniqueNutritional Recommendation (营养治疗的建议 ) Adequate C

17、alcium Intake Life stage Group Etsimated Adequate Daily Calcium Intake. mg/d Young children (1-3 years) 500Older children (4-8 years) 800Adolescents and young adults (9-18 years) 1300Men and women (19-50 years) 1000Men and women (51 and older) 1200Note: Pregnancy and lactation needs are the same as

18、for nonpregnant women (e.g., 1300 mg/d for adolescents/young adult and 1000 mg/d for 19 years).34老年性骨质疏松症英文版Nutritional Recommendation (营 Elemental Calcium Content of Various Oral Calcium Preparation 各种口服钙剂的元素钙的含量 Calcium Preparation Elemental Calcium (钙制剂 ) (元素钙含量) Calcium citrate 柠檬酸钙 60 mg/300 mg

19、 Calcium lactate乳酸钙 80 mg/600 mg Calcium gluconate 葡萄糖酸钙 40 mg/500 mg Calcium carbonate 碳酸钙 400 mg/g Calcium carbonate + 5 ug vitamin D2 (OsCal250) 碳酸钙 250 mg/片 Calcium carbonate (Turns 500)碳酸钙 500 mg/片Source: Adapted from SM Krane and MF Holick, Chap. 355 in HPIM, 14 ed, 1998. 35老年性骨质疏松症英文版 Element

20、al Calcium Content of 老年性骨质疏松症英文版培训课件Estrogens(雌激素)Selective Estrogen Receptor Modulators (SERMs,选择性雌激素受体调节剂)Bisphosphonate(双磷酸盐) Calcium(降钙素) Parathyroid hormone （甲状旁腺激素PTH）Fluoride(氟化物)Pharmacologic Therapy (药物治疗) 37老年性骨质疏松症英文版Estrogens(雌激素)Pharmacologic ThEstrogens38老年性骨质疏松症英文版Estrogens38老年性骨质疏松症

21、英文版Results of hormone therapy regimens on bone mineral density (BMD) of the spine (A) and hip (B39老年性骨质疏松症英文版Results of hormone therapy regEffects of hormone therapy on event rates40老年性骨质疏松症英文版Effects of hormone therapy on SERMs(选择性雌激素受体调节剂) Two SERMs are currently being used in postmenopausal women

22、 Raloxifene is approved for prenvention and treatment of osteoporosisTamoxifene is approved for prenvention and treatment of breast cancer There is no data confirming that raloxifene can reduce the risk of nonvertebral fractures 41老年性骨质疏松症英文版SERMs(选择性雌激素受体调节剂) Two SERMs aAlendronate ,risedronate ,an

23、d ibandronate are approved for the prevention and treatment of postmenopausal osteoporosis. Risedronate and Alendronate are approved for treatment of steroid induced osteoporosis. Risedronate is approved for the prevention of steroid induced osteoporosis. Risedronate and Alendronate are approved for treatment of osteoporosis