英文 第五节 老年性骨质疏松症 高建苑

ⅠEpidemiology0500100015002000250030003500hipfracturevertebralfractureCollesfractureIncidence/100,000personyearWomen=8535-39Exponetialrelationshipbetweendecreasingbonemassandincreasingincidenceoffractures01020304050BonemassCalcaneousfracturevertebralfractureColles'fractureIIPathophysiologyRemodeling(骨重建过程)Mechanismofboneremodeling.破骨细胞成骨细胞MenopauseAgingOtherriskFactorsHormonalcontrolofboneresorption.ⅢClinicalcharacteriticsOsteoporosisoftenstartssilentlyandmaynotbefounduntilabonefractures.Fragilityfractureisatypeofpathologicfracturethatoccursasresultofnormalactivities,suchasafallfromstandingheightorless(theNationalOsteoporosisFoundation,NOF)1.5millionfracturesoccureachyearinUSasaconsequenceofosteoporosis700,000vertebralcrushfracutres300,000hipfractures250.000wristfractures300,000otherfracturesPainOnly25-30%ofvertebralcompressionfracturespresentwithsuddenonsetbackpainChronicpainLossofheight,Humpbackkyphosis（humpback）Kyphosisismoreseverewithage24VertebralbodyVertebralbodyheight2cmShort2mm，total3-6cmFracturesFracturesarethemostdangerousaspectofosteoporosisMultiplevertebralfracturesleadtoastoopedposture,lossofheight,andchronicpainwithresultantreductioninmobilityHipfracture,inparticular,usuallyrequirespromptsurgery,asthereareseriousrisksassociatedwithahipfracture,suchasdeepveinthrombosisandapulmonaryembolism,andincreasedmortality.Aclassicalcaseofosteoporosismaystartinawomanabout55yearsofagewithawristfractureThoracicfractureareassociatedwithrestrictivelungdiseasesLumbarfractureareassociatedwithabdominalsymptomincludingdistension,earlysatietyandconstipationⅣDiagnosisanddifferentialdiagnosisBonemineraldensity（骨密度测定）MeasurementofbonemassDual-energyx-rayabsorptiometry(DXA,双能X线吸收法）ThegoldstandardformeasuringbonedensityMeasurementsofanysiteClinicaldeterminationsaremadeofthespineandhipBonespurs,whicharefrequentlyinosteoarthritis,tendtofalselyincreasebonedensityofthespineandareaparticularprobleminmaesuringthespineofolderindividualsStandardx-raysshowchangesinbonedensityafterabout40%ofbonelossDEXAscancandetectchangesafterabouta1%changeTscorescompareindividualresultstothoseinyongpopulationthatismatchedforraceandgenderZscorescompareindividualresultstothoseofanage-matchedpopulationthatismatchedforraceandgenderWHOdefinition（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ⅤTreatmentArecentlydevelopedtechniqueinvolvespercutaneousinjectionofartificialcement(ploymethymethacrylate)intothevertebralbody(Vertebroplasty,kyphoplasty)ThisofferssignificantimmediatepainreliefinthemajorityofpatientsLongtermeffectsareunknown.VertebroplastykyphoplastyNutritionalRecommendation(营养治疗的建议)AdequateCalciumIntakeLifestageGroupEtsimatedAdequateDailyCalciumIntake.mg/dYoungchildren(1-3years)500Olderchildren(4-8years)800Adolescentsandyoungadults(9-18years)1300Menandwomen(19-50years)1000Menandwomen(51andolder)1200Note: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-hydroxyvitaminD75μmol/L(30ng/mL)50yearsofage:200IU/day50–70yearsofage:400IU/day70yearsofage:600IU/dayTheelderlyandchronicallyill:1000IU/daySerum25-hydroxyvitaminD75μmol/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)EstrogensResultsofhormonetherapyregimensonbonemineraldensity(BMD)ofthespine(A)andhip(BEffectsofhormonetherapyoneventratesSERMs(选择性雌激素受体调节剂)TwoSERMsarecurrentlybeingusedinpostmenopausalwomenRaloxifeneisapprovedforprenventionandtreatmentofosteoporosisTamoxifeneisapprovedforprenventionandtreatmentofbreastcancerThereisnodataconfirmingthatraloxifenecanreducetheriskofnonvertebralfracturesAlendronate,risedronate,andibandronateareapprovedforthepreventionandtreatmentofpostmenopausalosteoporosis.RisedronateandAlendronateareapprovedfortreatmentofsteroidinducedosteoporosis.Risedronateisapprovedforthepreventionofsteroidinducedosteoporosis.RisedronateandAlendronateareapprovedfortreatmentofosteoporosisinmenBisphosphonateCumulativeproportionsofwomenwithosteoporosiswhosufferedclinicalfracture(vertebral,hip,orwrist)during3year