中國大陸地區(qū)早期診斷骨質(zhì)疏松癥及干預(yù)閾值探討

人口平均預(yù)期壽命達到74.83歲男性為72.38歲；女性為77.37歲60歲及以上的人口占總?cè)丝?3.26％總數(shù)1.79億至2050年，我國預(yù)計老齡人口將達人口總數(shù)的1/3面臨老年社會壓力

更需要關(guān)注骨質(zhì)疏松癥國家統(tǒng)計局人口和就業(yè)統(tǒng)計司.中國人口和就業(yè)統(tǒng)計年鑒——2014[M].北京:中國統(tǒng)計出版社,2015當(dāng)前1頁，總共26頁。北京等地區(qū)50歲以上女性脊椎骨折患病率為15%

相當(dāng)于每7名（50歲以上）女性中就有1名發(fā)生

脊椎骨折2013年國際骨質(zhì)疏松基金會(InternationalOsteoporosisFoundation，IOF)

年鑒顯示

全世界1/3女性和1/5男性會發(fā)生

一次骨質(zhì)疏松性骨折XuL,JBoneMinerRes,2000,15(10):2019-2025InternationalOsteoporosisFoundation．

Epidemiology，

costs＆

burdenofosteoporosisin2013當(dāng)前2頁，總共26頁。骨質(zhì)疏松性骨折105歲骨質(zhì)疏松性骨折+PKP60歲-2.0SD當(dāng)前3頁，總共26頁。當(dāng)前4頁，總共26頁。WHO骨質(zhì)疏松癥診斷標(biāo)準(zhǔn)測量方法：DXA股骨頸正常:T-scoregreaterthanorequalto?1SD低骨量(osteopenia):T-score<?1and>?2.5SD.骨質(zhì)疏松:T-scorelessthanorequalto?2.5SD重度骨質(zhì)疏松(establishedosteoporosis):T-scorelessthanorequalto?2.5SDinthepresenceof1ormorefragilityfractures當(dāng)前5頁，總共26頁。為什么測量骨密度?預(yù)測未來

發(fā)生骨折

的可能性當(dāng)前6頁，總共26頁。骨密度值能準(zhǔn)確預(yù)測未來發(fā)生骨折的可能性嗎?當(dāng)前7頁，總共26頁。哪些因素會產(chǎn)生影響呢?年齡性別7種風(fēng)險因子（即往骨折史吸煙父母的髖部骨折史皮質(zhì)激素使用史酗酒史體重指數(shù)類風(fēng)濕性關(guān)節(jié)炎

)WHO骨折風(fēng)險因子當(dāng)前8頁，總共26頁。WHO骨質(zhì)疏松癥診斷采用的是髖部或脊柱的骨密度值低于白人婦女峰值骨量的2.5SDbyDXA設(shè)備

峰值骨量5%—17%差異忽略差異?\改變標(biāo)準(zhǔn)?T<-2.5SD髖部骨折發(fā)病率T<-2SD當(dāng)前9頁，總共26頁。不同種族峰值骨量差異---腰椎COUNTRYRACECASEAGESLUMBAR2-4USACaucasian16422.1±0.051.136±0.011NetherlandsCaucasian97271.143±0.138NetherlandsCaucasian9827-291.143±0.013FinlandCaucasian3135-451.038±0.154BelgiumCaucasian3925-351.035±0.109Greece3730-391.044±0.10JapanYELLOW28335-391.051±0.115Hongkong[21]YELLOWYELLOW23621-400.994±0.126Hongkong[8]YELLOW17331-401.010±0.12Taipei42430-391.078±0.133TianjinChinaYELLOW2225-301.085±0.149China[26]3730-391.055±0.115LiuGY,《ChineseJournalofosteoporosis》2007,13(2):101-104-5.6%Caucasian當(dāng)前10頁，總共26頁。不同種族峰值骨量差異---股骨頸countryraceCaucasiancaseagesFemoralneckUSACaucasian16422.1±0.051.069±0.009FinlandYellow13225-300.943±0.104Greece3320-290.923±0.110Japan24315-190.849±0.099HongkongYellow14520-390.766±0.110HongkongYellow28921-400.832±0.118HongkongYellow23621-400.831±0.117HongkongYellow17331-400.840±0.120TaibeiYellow16317-290.873±0.101ChinaYellow8520-290.855±0.125-17.1%LiuGY,《ChineseJournalofosteoporosis》2007,13(2):101-104當(dāng)前11頁，總共26頁。CHINA

(HONGKONG)389100000Sweden739100000Norway737100000England603100000USA617100000劉明珠,從全球的角度看亞洲骨質(zhì)疏松癥的流行病學(xué),國外醫(yī)學(xué)內(nèi)分泌分冊，2004，24（4）：222-223白色人種亞洲≈40%

差異

當(dāng)前12頁，總共26頁。CHINA

(HONGKONG)劉明珠,從全球的角度看亞洲骨質(zhì)疏松癥的流行病學(xué),國外醫(yī)學(xué)內(nèi)分泌分冊，2004，24（4）：222-223Caucasianages(yrs)HipFrxhipFrxSpineFrxCollisFrxFemale白色人種亞洲≈28%

差異

當(dāng)前13頁，總共26頁。為何出現(xiàn)如此差異？-----主要是人種差異

A:峰值骨量B:髖部骨折發(fā)病率5%—40%差異忽略之?\改變之?T<-2.5SDT<-2SD白人亞洲人種當(dāng)前14頁，總共26頁。一項回顧性研究

采用診斷標(biāo)準(zhǔn)T值≤-2.5SD或-2.0SD數(shù)據(jù)薈萃分析來源于“萬方數(shù)據(jù)”+中國醫(yī)院知識數(shù)據(jù)庫(CHKD)

中國醫(yī)學(xué)期刊雜志文獻from1994to2015and檢測骨密度設(shè)備DXA,pDXA,SPA,RA測量位置:腰椎、股骨頸等(From:OCCGS,OsteoporosisCommitteeofChinaGerontologicalSociety)當(dāng)前15頁，總共26頁。AretrospectiveliteraturestudyofosteoporosisprevalencerateinmainlandChinawhenthediagnosiscriterionis-2.5SDor-2.0SD數(shù)據(jù)來源：112全文文獻

包括男性42882例次、女性樣本51264例次摘取年齡、測量部位、骨質(zhì)疏松發(fā)病率等、設(shè)備型號、其中30片文獻有完整數(shù)據(jù)表SPSS17.0軟件作為統(tǒng)計(From:OCCGS,OsteoporosisCommitteeofChinaGerontologicalSociety)當(dāng)前16頁，總共26頁。40歲以上中國大陸地區(qū)骨質(zhì)疏松發(fā)病率女性骨質(zhì)疏松癥發(fā)病率Referances4527113Average+/-SD40-9.6%5.6%5.65%9%4.7%3.65%6.37%±2.39%50-21%25%25%10%24.8%24.7%21.75%±5.96%60-44%48.5%48.5%25.7%63%48.6%46.38%±12.03%70-55.6%70%70.4%49%67%73.9%64.32%±9.79%80-67.7%78%78.7%--77.7%81.6%76.74%±5.28%男性骨質(zhì)疏松癥發(fā)病率

Referances4527113Average+/-SD40-1.6%5.3%5.3%2.3%4.8%5.35%4.11%±1.70%50-12.3%18%18%2.5%8.8%17.8%12.90%±6.35%60-20.6%26.5%26.5%8.2%11.1%26.5%19.90%±8.31%70-22.3%31.7%29.1%37.6%17.8%35.3%28.97%±7.63%80-24%43.6%43.6%60%20%47.5%39.78%±15.09%OP診斷標(biāo)準(zhǔn)T≤-2.5SD當(dāng)前17頁，總共26頁。女性O(shè)Prate男性O(shè)Prate每10年男性骨質(zhì)疏松癥增加9%，女性增加18%40-50-60-70-80-（yrs）OP診斷標(biāo)準(zhǔn)T≤-2.5SD當(dāng)前18頁，總共26頁。Ages(yrs)Male(people）MaleprevalencerateMaleOPPEOPLEFemale(people）FemaleprevalencerateFemaleOPPEOPLETotleOPpeople40-1173850964.11%48245271129634216.37%71957691202029650-8144617212.90%105065567861947321.75%170997352760629160-5058289719.90%100659964919766746.38%228178773288387370-2768231228.97%80195652914221864.32%1874427526763840≥80-877475239.78%34905961221459476.74%937348012864076Totleosteoporosispeople:11213837640歲以上OP發(fā)病率：112138376/（男285871229+女282137373）=0.1974骨質(zhì)疏松發(fā)病率約約1.12億人男女比例約1:220%OP診斷標(biāo)準(zhǔn)T≤-2.5SD當(dāng)前19頁，總共26頁。5%—40%差異T≤-2.5SDT≤-2.0SD高加索人種亞洲人種OP診斷標(biāo)準(zhǔn)當(dāng)前20頁，總共26頁。

女性O(shè)P發(fā)病率%

男性O(shè)P發(fā)病率%

REFERENCE40-50-60-70-80-REFERENCE40-50-60-70-80-(4)28.834.35990(17)09.328.133.650.2腰椎(4)3.39.338.762.591(4)1.75.219.45085.7(6)9.88538.262.8179.8289.06(5)

6.621.6241.36(12)8.121.353.373.1

(5)14.7451.2574.42(4)26.6215388.9股骨頸(7)7.843.754.985.189.5(6)8.44523.9930.8138.8647.22(8)7.142.65586.188.2(7)5.725.330.138.964(9)2.1224.3566.16(8)5.124.829.239.561.1(10)21.7154.0965.1475.14(9)5.08524.0252.97(11)22.945.1565.9(10)20.3931.941.7252.42T-test

P>0.05P>0.05P>0.05P>0.05

P>0.05P<0.05P>0.05P>0.05P>0.05X7.7528.0052.6773.4589.55

4.0015.7330.5543.4666.19SD6.3815.7210.769.531.04

2.909.4910.797.3017.56OP診斷標(biāo)準(zhǔn)T≤-2.0SD當(dāng)前21頁，總共26頁。Ages(yrs)Male(people）Maleprevalencerate

MaleOPPEOPLEFemale(people）FemaleprevalencerateFemaleOPPEOPLETotleOPpeople40-1173850964.00%47004351129634217.75%87567831345721850-8144617215.73%128089387861947328.00%220122733482121160-5058289730.55%154516704919766752.67%259131494136481970-2768231243.46%120295222914221873.45%2140593133435452≥80-877475266.19%58077161221459489.55%1093853516746251Totleosteoporosispeople以上OP發(fā)病率：139824951/（男285871229+女282137373）=0.2462骨質(zhì)疏松發(fā)病率大約

約1.4億人

25%OP診斷標(biāo)準(zhǔn)T≤-2.0SD當(dāng)前22頁，總共26頁。男性和女性O(shè)P發(fā)病率比較(40歲以上)40-50-60-70-80-（yrs）FemaleOPrateMaleOPrate

OP診斷標(biāo)準(zhǔn)T≤-2.0SD每10年男性骨質(zhì)疏松癥增加15%，女性增加21%當(dāng)前23頁，總共26頁。6.37%89.55%66.19%76.74%39.78%73.45%43.46