英文第五節(jié)老年性骨質(zhì)疏松癥詳解演示文稿本文檔共43頁(yè)；當(dāng)前第1頁(yè)；編輯于星期一\20點(diǎn)11分（優(yōu)選）英文第五節(jié)老年性骨質(zhì)疏松癥本文檔共43頁(yè)；當(dāng)前第2頁(yè)；編輯于星期一\20點(diǎn)11分本文檔共43頁(yè)；當(dāng)前第3頁(yè)；編輯于星期一\20點(diǎn)11分本文檔共43頁(yè)；當(dāng)前第4頁(yè)；編輯于星期一\20點(diǎn)11分本文檔共43頁(yè)；當(dāng)前第5頁(yè)；編輯于星期一\20點(diǎn)11分本文檔共43頁(yè)；當(dāng)前第6頁(yè)；編輯于星期一\20點(diǎn)11分Incidence/100,000personyear

Women

>=8535-39Epidemiologyofvertebral,hip,Colles'fractureswithage本文檔共43頁(yè)；當(dāng)前第7頁(yè)；編輯于星期一\20點(diǎn)11分Incidenceoffracture(fracturesper1000patientyears)本文檔共43頁(yè)；當(dāng)前第8頁(yè)；編輯于星期一\20點(diǎn)11分IIPathophysiology本文檔共43頁(yè)；當(dāng)前第9頁(yè)；編輯于星期一\20點(diǎn)11分Remodeling(骨重建過(guò)程)本文檔共43頁(yè)；當(dāng)前第10頁(yè)；編輯于星期一\20點(diǎn)11分Mechanismofboneremodeling.本文檔共43頁(yè)；當(dāng)前第11頁(yè)；編輯于星期一\20點(diǎn)11分破骨細(xì)胞成骨細(xì)胞MenopauseAgingOtherriskFactors

本文檔共43頁(yè)；當(dāng)前第12頁(yè)；編輯于星期一\20點(diǎn)11分Hormonalcontrolofboneresorption.本文檔共43頁(yè)；當(dāng)前第13頁(yè)；編輯于星期一\20點(diǎn)11分本文檔共43頁(yè)；當(dāng)前第14頁(yè)；編輯于星期一\20點(diǎn)11分ⅢClinicalcharacteritics

本文檔共43頁(yè)；當(dāng)前第15頁(yè)；編輯于星期一\20點(diǎn)11分

Osteoporosisoftenstartssilentlyandmaynotbefounduntilabonefractures.

Fragilityfractureisatypeofpathologicfracturethatoccursasresultofnormalactivities,suchasafallfromstandingheightorless

(theNationalOsteoporosisFoundation,NOF)本文檔共43頁(yè)；當(dāng)前第16頁(yè)；編輯于星期一\20點(diǎn)11分

1.5millionfracturesoccureachyearinUSasaconsequenceofosteoporosis

700,000vertebralcrushfracutres

300,000hipfractures

250.000wristfractures

300,000otherfractures

本文檔共43頁(yè)；當(dāng)前第17頁(yè)；編輯于星期一\20點(diǎn)11分Pain

Only25-30%ofvertebralcompressionfracturespresentwithsuddenonsetbackpainChronicpain本文檔共43頁(yè)；當(dāng)前第18頁(yè)；編輯于星期一\20點(diǎn)11分

Lossofheight,Humpback

kyphosis（humpback）Kyphosisismoreseverewithage24VertebralbodyVertebralbodyheight

2cmShort2mm，total3-6cm

本文檔共43頁(yè)；當(dāng)前第19頁(yè)；編輯于星期一\20點(diǎn)11分FracturesFracturesarethemostdangerousaspectofosteoporosis

Multiplevertebralfracturesleadtoastoopedposture,lossofheight,andchronicpainwithresultantreductioninmobilityHipfracture,inparticular,usuallyrequirespromptsurgery,asthereareseriousrisksassociatedwithahipfracture,suchasdeepveinthrombosisandapulmonaryembolism,andincreasedmortality.本文檔共43頁(yè)；當(dāng)前第20頁(yè)；編輯于星期一\20點(diǎn)11分Aclassicalcaseofosteoporosismaystartinawomanabout55yearsofagewithawristfracture本文檔共43頁(yè)；當(dāng)前第21頁(yè)；編輯于星期一\20點(diǎn)11分ThoracicfractureareassociatedwithrestrictivelungdiseasesLumbarfractureareassociatedwithabdominalsymptomincludingdistension,earlysatietyandconstipation本文檔共43頁(yè)；當(dāng)前第22頁(yè)；編輯于星期一\20點(diǎn)11分Ⅳ

Diagnosisanddifferentialdiagnosis本文檔共43頁(yè)；當(dāng)前第23頁(yè)；編輯于星期一\20點(diǎn)11分本文檔共43頁(yè)；當(dāng)前第24頁(yè)；編輯于星期一\20點(diǎn)11分Bonemineraldensity（骨密度測(cè)定）

本文檔共43頁(yè)；當(dāng)前第25頁(yè)；編輯于星期一\20點(diǎn)11分Measurementofbonemass

Dual-energyx-rayabsorptiometry(DXA,雙能X線吸收法）Thegoldstandardformeasuringbonedensity本文檔共43頁(yè)；當(dāng)前第26頁(yè)；編輯于星期一\20點(diǎn)11分MeasurementsofanysiteClinicaldeterminationsaremadeofthespineandhip

Bonespurs,whicharefrequentlyinosteoarthritis,tendtofalselyincreasebonedensityofthespineandareaparticularprobleminmaesuringthespineofolderindividualsStandardx-raysshowchangesinbonedensityafterabout40%ofbonelossDEXAscancandetectchangesafterabouta1%change本文檔共43頁(yè)；當(dāng)前第27頁(yè)；編輯于星期一\20點(diǎn)11分TscorescompareindividualresultstothoseinyongpopulationthatismatchedforraceandgenderZscorescompareindividualresultstothoseofanage-matchedpopulation

thatismatchedforraceandgender本文檔共43頁(yè)；當(dāng)前第28頁(yè)；編輯于星期一\20點(diǎn)11分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)疏松性骨折本文檔共43頁(yè)；當(dāng)前第29頁(yè)；編輯于星期一\20點(diǎn)11分ⅤTreatment本文檔共43頁(yè)；當(dāng)前第30頁(yè)；編輯于星期一\20點(diǎn)11分Arecentlydevelopedtechniqueinvolvespercutaneousinjectionofartificialcement(ploymethymethacrylate)intothevertebralbody(Vertebroplasty,kyphoplasty)ThisofferssignificantimmediatepainreliefinthemajorityofpatientsLongtermeffectsareunknown.Vertebroplasty

kyphoplasty

本文檔共43頁(yè)；當(dāng)前第31頁(yè)；編輯于星期一\20點(diǎn)11分NutritionalRecommendation

(營(yíng)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).本文檔共43頁(yè)；當(dāng)前第32頁(yè)；編輯于星期一\20點(diǎn)11分

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.本文檔共43頁(yè)；當(dāng)前第33頁(yè)；編輯于星期一\20點(diǎn)11分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

本文檔共43頁(yè)；當(dāng)前第34頁(yè)；編輯于星期一\20點(diǎn)11分Estrogens(雌激素)SelectiveEstrogenReceptorModulators

(SERMs,選擇性雌激素受體調(diào)節(jié)劑)Bisphosphonate(雙磷酸鹽)Calcium(降鈣素)Parathyroidhormone

（甲狀旁腺激素PTH）Fluoride(氟化物)PharmacologicTherapy(藥物治療)

本文檔共43頁(yè)；當(dāng)前第35頁(yè)；編輯于星期一\20點(diǎn)11分Estrogens本文檔共43頁(yè)；當(dāng)前第36頁(yè)；編輯于星期一\20點(diǎn)11分Resultsofhormonetherapyregimensonbonemineraldensity(BMD)ofthespine(A)andhip(B本文檔共43頁(yè)；當(dāng)前第37頁(yè)；編輯于星期一\20點(diǎn)11分Effectsofhormonetherapyoneventrates本文檔共43頁(yè)；當(dāng)前第38頁(yè)；編輯于星期一\20點(diǎn)11分SERMs(選擇性雌激素受體調(diào)節(jié)劑)

TwoSERMsarecurrentlybeingusedinpostmenopausalwomenRaloxifeneisapprovedforprenventionandtreatmentofosteoporosisTamoxifeneisapprovedforprenventionandtreatmentofbreastcancerTherei