英文 第五節(jié) 老年性骨質(zhì)疏松癥 高建苑

Section5ⅠEpidemiologyIncidence/100,000personyear

Women

>=8535-39Epidemiologyofvertebral,hip,Colles'fractureswithageIncidenceoffractureIIPathophysiologyRemodeling(骨重建過程)Mechanismofboneremodeling.破骨細(xì)胞成骨細(xì)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（骨密度測定）

Measurementofbonemass

Dual-energyx-rayabsorptiometry(DXA,雙能X線吸收法）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

骨密度在年輕成人均值1個(gè)SD(+1或?1)以內(nèi)低骨量骨密度在年輕成人均值1到2.5SD之間骨質(zhì)疏松骨密度等于或低于年輕成人均值

2.5SD嚴(yán)重(已確立)骨質(zhì)疏松骨密度等于或低于年輕成人均值

2.5SD，而且有一處或多處骨質(zhì)疏松性骨折ⅤTreatmentArecentlydevelopedtechniqueinvolvespercutaneousinjectionofartificialcement(ploymethymethacrylate)intothevertebralbody(Vertebroplasty,kyphoplasty)ThisofferssignificantimmediatepainreliefinthemajorityofpatientsLongtermeffectsareunknown.Vertebroplasty

kyphoplasty

NutritionalRecommendation

(營養(yǎng)治療的建議

)

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

各種口服鈣劑的元素鈣的含量

CalciumPreparationElementalCalcium

(鈣制劑)(元素鈣含量)

Calciumcitrate檸檬酸鈣60mg/300mg

Calciumlactate乳酸鈣80mg/600mgCalciumgluconate葡萄糖酸鈣40mg/500mgCalciumcarbonate碳酸鈣 400mg/gCalciumcarbonate+5ugvitaminD2(OsCal250)碳酸鈣250mg/片Calciumcarbonate(Turns500) 碳酸鈣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,選擇性雌