老年性骨質(zhì)疏松癥英文版培訓課件

1、老年性骨質(zhì)疏松癥英文版老年性骨質(zhì)疏松癥英文版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 原發(fā)性骨疏松是一種以骨量低下，骨微結構破壞，導致骨脆性增加，易發(fā)生骨折為特征的全身性骨病 2老年性骨質(zhì)疏松癥英文版Definition O

2、steoporosis is aEpidemiology 3老年性骨質(zhì)疏松癥英文版Epidemiology 3老年性骨質(zhì)疏松癥英文版4老年性骨質(zhì)疏松癥英文版4老年性骨質(zhì)疏松癥英文版5老年性骨質(zhì)疏松癥英文版5老年性骨質(zhì)疏松癥英文版6老年性骨質(zhì)疏松癥英文版6老年性骨質(zhì)疏松癥英文版7老年性骨質(zhì)疏松癥英文版7老年性骨質(zhì)疏松癥英文版Incidence /100,000 person year Women =8535-39Epidemiology of vertebral,hip,Collesfractures with age8老年性骨質(zhì)疏松癥英文版Incidence /100,000 person y

3、earIncidence of fracture9老年性骨質(zhì)疏松癥英文版Incidence of fracture9老年性骨質(zhì)疏松癥10老年性骨質(zhì)疏松癥英文版10老年性骨質(zhì)疏松癥英文版II Pathophysiology11老年性骨質(zhì)疏松癥英文版II Pathophysiology11老年性骨質(zhì)疏松癥英Remodeling (骨重建過程)12老年性骨質(zhì)疏松癥英文版Remodeling (骨重建過程)12老年性骨質(zhì)疏松癥英文Mechanism of bone remodeling.13老年性骨質(zhì)疏松癥英文版Mechanism of bone remodeling.1破骨細胞成骨細胞Menopau

4、se AgingOther risk Factors 14老年性骨質(zhì)疏松癥英文版破骨細胞成骨細胞Menopause Other risk 1Hormonal control of bone resorption.15老年性骨質(zhì)疏松癥英文版Hormonal control of bone resor16老年性骨質(zhì)疏松癥英文版16老年性骨質(zhì)疏松癥英文版 Clinical characteritics17老年性骨質(zhì)疏松癥英文版 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老年性骨質(zhì)疏松癥英文版 18老年性骨質(zhì)疏松癥英文版 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老年性骨質(zhì)疏松癥英文版19老年性骨質(zhì)疏松癥英文版Pain Only 25-30% of vertebral compression fractures present with sudden onset back pain Chronic pain 20老年性骨質(zhì)疏松癥英文版Pain 20老年性骨質(zhì)疏松癥英文版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老年性骨質(zhì)疏松癥英文版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老年性骨質(zhì)疏松癥英文版FracturesFractures are the mosA classic

9、al case of osteoporosis may start in a woman about 55 years of age with a wrist fracture23老年性骨質(zhì)疏松癥英文版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老年性骨質(zhì)疏松癥英文版Thoracic fracture are associat Diagnosis and differential diagnosis25老年性骨質(zhì)疏松癥英文版 Diagnosis and 25老年性骨質(zhì)疏松癥英文版26老年性骨質(zhì)疏松癥英文版26老年性骨質(zhì)疏松癥英文版Bone mineral density（骨密度測定） 27老年性骨質(zhì)疏松癥英文版Bone mineral density（骨密度測定） 27Measurement of bone mass Dual-energy x-ray absorptiometry (DXA, 雙能X線吸收法）The gold

11、standard for measuring bone density 28老年性骨質(zhì)疏松癥英文版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老年性骨質(zhì)疏松癥英文版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老年性骨質(zhì)疏松癥英文版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 骨密度在年輕成人均值1個SD (+1或1) 以內(nèi)低骨量 骨密度在年輕成人均值1 到2.5 SD之間 骨質(zhì)疏松 骨密度等于或低于年輕成人均值 2.5 SD 嚴重(已確立)骨質(zhì)疏松 骨密度等于或低于年輕成人均值 2.5 SD ，而且有一處或多處骨質(zhì)疏松性骨折31老年性骨質(zhì)疏松癥英文版WHO definition （Based on Bon Treatment32老年性骨質(zhì)疏松癥英文版 Treatment32老年性骨質(zhì)疏松癥英文版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老年性骨質(zhì)疏松癥英文版A recently developed techniqueNutritional Recommendation (營養(yǎng)治療的建議 ) 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老年性骨質(zhì)疏松癥英文版Nutritional Recommendation (營 Elemental Calcium Content of Various Oral Calcium Preparation 各種口服鈣劑的元素鈣的含量 Calcium Preparation Elemental Calcium (鈣制劑 ) (元素鈣含量) Calcium citrate 檸檬酸鈣 60 mg/300 mg

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

20、al Calcium Content of 老年性骨質(zhì)疏松癥英文版培訓課件Estrogens(雌激素)Selective Estrogen Receptor Modulators (SERMs,選擇性雌激素受體調(diào)節(jié)劑)Bisphosphonate(雙磷酸鹽) Calcium(降鈣素) Parathyroid hormone （甲狀旁腺激素PTH）Fluoride(氟化物)Pharmacologic Therapy (藥物治療) 37老年性骨質(zhì)疏松癥英文版Estrogens(雌激素)Pharmacologic ThEstrogens38老年性骨質(zhì)疏松癥英文版Estrogens38老年性骨質(zhì)疏松癥

21、英文版Results of hormone therapy regimens on bone mineral density (BMD) of the spine (A) and hip (B39老年性骨質(zhì)疏松癥英文版Results of hormone therapy regEffects of hormone therapy on event rates40老年性骨質(zhì)疏松癥英文版Effects of hormone therapy on SERMs(選擇性雌激素受體調(diào)節(jié)劑) 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老年性骨質(zhì)疏松癥英文版SERMs(選擇性雌激素受體調(diào)節(jié)劑) 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