英文 第五节 老年性骨质疏松症 高建苑

Section5ⅠEpidemiologyIncidence/100,000personyear

Women

>=8535-39Epidemiologyofvertebral,hip,Colles'fractureswithageIncidenceoffractureIIPathophysiologyRemodeling(骨重建过程)Mechanismofboneremodeling.破骨细胞成骨细胞MenopauseAgingOtherriskFactors

Hormonalcontrolofboneresorption.ⅢClinicalcharacteritics

Osteoporosisoftenstartssilentlyandmaynotbefounduntilabonefractures.

Fragilityfractureisatypeofpathologicfracturethatoccursasresultofnormalactivities,suchasafallfromstandingheightorless

(theNationalOsteoporosisFoundation,NOF)

1.5millionfracturesoccureachyearinUSasaconsequenceofosteoporosis

700,000vertebralcrushfracutres

300,000hipfractures

250.000wristfractures

300,000otherfractures

Pain

Only25-30%ofvertebralcompressionfracturespresentwithsuddenonsetbackpainChronicpain

Lossofheight,Humpback

kyphosis（humpback）Kyphosisismoreseverewithage24VertebralbodyVertebralbodyheight

2cmShort2mm，total3-6cm

FracturesFracturesarethemostdangerousaspectofosteoporosis

Multiplevertebralfracturesleadtoastoopedposture,lossofheight,andchronicpainwithresultantreductioninmobilityHipfracture,inparticular,usuallyrequirespromptsurgery,asthereareseriousrisksassociatedwithahipfracture,suchasdeepveinthrombosis

andapulmonaryembolism,andincreasedmortality.Aclassicalcaseofosteoporosismaystartinawomanabout55yearsofagewithawristfractureThoracicfractureareassociatedwithrestrictivelungdiseasesLumbarfractureareassociatedwithabdominalsymptomincludingdistension,earlysatietyandconstipationⅣ

DiagnosisanddifferentialdiagnosisBonemineraldensity（骨密度测定）

Measurementofbonemass

Dual-energyx-rayabsorptiometry(DXA,双能X线吸收法）ThegoldstandardformeasuringbonedensityMeasurementsofanysiteClinicaldeterminationsaremadeofthespineandhip

Bonespurs,whicharefrequentlyinosteoarthritis,tendtofalselyincreasebonedensityofthespineandareaparticularprobleminmaesuringthespineofolderindividualsStandardx-raysshowchangesinbonedensityafterabout40%ofbonelossDEXAscancandetectchangesafterabouta1%changeTscorescompareindividualresultstothoseinyongpopulationthatismatchedforraceandgenderZscorescompareindividualresultstothoseofanage-matchedpopulation

thatismatchedforraceandgenderWHOdefinition

（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ⅤTreatmentArecentlydevelopedtechniqueinvolvespercutaneousinjectionofartificialcement(ploymethymethacrylate)intothevertebralbody(Vertebroplasty,kyphoplasty)ThisofferssignificantimmediatepainreliefinthemajorityofpatientsLongtermeffectsareunknown.Vertebroplasty

kyphoplasty

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).

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.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

Estrogens(雌激素)SelectiveEstrogenReceptorModulators

(SERMs,选择性雌