英文第五节老性骨质疏松症详解演示文稿

英文第五节老年性骨质疏松症详解演示文稿当前第1页\共有43页\编于星期四\11点（优选）英文第五节老年性骨质疏松症当前第2页\共有43页\编于星期四\11点当前第3页\共有43页\编于星期四\11点当前第4页\共有43页\编于星期四\11点当前第5页\共有43页\编于星期四\11点当前第6页\共有43页\编于星期四\11点Incidence/100,000personyear

Women

>=8535-39Epidemiologyofvertebral,hip,Colles'fractureswithage当前第7页\共有43页\编于星期四\11点Incidenceoffracture(fracturesper1000patientyears)当前第8页\共有43页\编于星期四\11点IIPathophysiology当前第9页\共有43页\编于星期四\11点Remodeling(骨重建过程)当前第10页\共有43页\编于星期四\11点Mechanismofboneremodeling.当前第11页\共有43页\编于星期四\11点破骨细胞成骨细胞MenopauseAgingOtherriskFactors

当前第12页\共有43页\编于星期四\11点Hormonalcontrolofboneresorption.当前第13页\共有43页\编于星期四\11点当前第14页\共有43页\编于星期四\11点ⅢClinicalcharacteritics

当前第15页\共有43页\编于星期四\11点

Osteoporosisoftenstartssilentlyandmaynotbefounduntilabonefractures.

Fragilityfractureisatypeofpathologicfracturethatoccursasresultofnormalactivities,suchasafallfromstandingheightorless

(theNationalOsteoporosisFoundation,NOF)当前第16页\共有43页\编于星期四\11点

1.5millionfracturesoccureachyearinUSasaconsequenceofosteoporosis

700,000vertebralcrushfracutres

300,000hipfractures

250.000wristfractures

300,000otherfractures

当前第17页\共有43页\编于星期四\11点Pain

Only25-30%ofvertebralcompressionfracturespresentwithsuddenonsetbackpainChronicpain当前第18页\共有43页\编于星期四\11点

Lossofheight,Humpback

kyphosis（humpback）Kyphosisismoreseverewithage24VertebralbodyVertebralbodyheight

2cmShort2mm，total3-6cm

当前第19页\共有43页\编于星期四\11点FracturesFracturesarethemostdangerousaspectofosteoporosis

Multiplevertebralfracturesleadtoastoopedposture,lossofheight,andchronicpainwithresultantreductioninmobilityHipfracture,inparticular,usuallyrequirespromptsurgery,asthereareseriousrisksassociatedwithahipfracture,suchasdeepveinthrombosisandapulmonaryembolism,andincreasedmortality.当前第20页\共有43页\编于星期四\11点Aclassicalcaseofosteoporosismaystartinawomanabout55yearsofagewithawristfracture当前第21页\共有43页\编于星期四\11点ThoracicfractureareassociatedwithrestrictivelungdiseasesLumbarfractureareassociatedwithabdominalsymptomincludingdistension,earlysatietyandconstipation当前第22页\共有43页\编于星期四\11点Ⅳ

Diagnosisanddifferentialdiagnosis当前第23页\共有43页\编于星期四\11点当前第24页\共有43页\编于星期四\11点Bonemineraldensity（骨密度测定）

当前第25页\共有43页\编于星期四\11点Measurementofbonemass

Dual-energyx-rayabsorptiometry(DXA,双能X线吸收法）Thegoldstandardformeasuringbonedensity当前第26页\共有43页\编于星期四\11点MeasurementsofanysiteClinicaldeterminationsaremadeofthespineandhip

Bonespurs,whicharefrequentlyinosteoarthritis,tendtofalselyincreasebonedensityofthespineandareaparticularprobleminmaesuringthespineofolderindividualsStandardx-raysshowchangesinbonedensityafterabout40%ofbonelossDEXAscancandetectchangesafterabouta1%change当前第27页\共有43页\编于星期四\11点TscorescompareindividualresultstothoseinyongpopulationthatismatchedforraceandgenderZscorescompareindividualresultstothoseofanage-matchedpopulation

thatismatchedforraceandgender当前第28页\共有43页\编于星期四\11点WHOdefinition

（BasedonBoneDensityLevels）

Normal

Bonedensityiswithin1SD(+1or−1)oftheyoungadultmean.Lowbonemass

Bonedensityisbetween1and2.5SDbelowtheyoungadultmean

(−1to−2.5SD).Osteoporosis

Bonedensityis2.5SDormorebelowtheyoungadultmean

(−2.5SDorlower).Severe(established)osteoporosis

Bonedensityismorethan2.5SDbelowtheyoungadultmean,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当前第29页\共有43页\编于星期四\11点ⅤTreatment当前第30页\共有43页\编于星期四\11点Arecentlydevelopedtechniqueinvolvespercutaneousinjectionofartificialcement(ploymethymethacrylate)intothevertebralbody(Vertebroplasty,kyphoplasty)ThisofferssignificantimmediatepainreliefinthemajorityofpatientsLongtermeffectsareunknown.Vertebroplasty

kyphoplasty

当前第31页\共有43页\编于星期四\11点NutritionalRecommendation

(营养治疗的建议

)

AdequateCalciumIntake

LifestageGroupEtsimatedAdequateDailyCalciumIntake.mg/d

Youngchildren(1-3years) 500Olderchildren(4-8years)800Adolescentsandyoungadults(9-18years) 1300Menandwomen(19-50years) 1000Menandwomen(51andolder) 1200Note:Pregnancyandlactationneedsarethesameasfornonpregnantwomen(e.g.,1300mg/dforadolescents/youngadultand1000mg/dfor≥19years).当前第32页\共有43页\编于星期四\11点

ElementalCalcium

ContentofVariousOralCalciumPreparation

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/300mg

Calciumlactate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.当前第33页\共有43页\编于星期四\11点VitaminD

VitaminDgoal:Serum25-hydroxyvitamin

D>75μmol/L(30ng/mL)

<50yearsofage:200IU/day50–70yearsofage:400IU/day>70yearsofage:600IU/day

Theelderlyandchronicallyill:>1000IU/daySerum25-hydroxyvitamin

D<75μmol/L(30ng/mL).Inadequatedosage

当前第34页\共有43页\编于星期四\11点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)

当前第35页\共有43页\编于星期四\11点Estrogens当前第36页\共有43页\编于星期四\11点Resultsofhormonetherapyregimensonbonemineraldensity(BMD)ofthespine(A)andhip(B当前第37页\共有43页\编于星期四\11点Effectsofhormonetherapyoneventrates当前第38页\共有43页\编于星期四\11点SERMs(选择性雌激素受体调节剂)

TwoSERMsarecurrentlybeingusedinpostmenopausalwomenRaloxifeneisapprovedforprenventionandtreatmentofosteoporosisTamoxifeneisapprovedforprenventionandtreatmentofbreastcancerThe