老性骨质疏松症英文版ppt课件

文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Definition Osteoporosis is a systemic skeletal disease characterized byvLow bone mass vMicroarchitectural deterioration of bone tissue,v Leading to increased bone fragility vAnd greater susceptibility to fracture 原发性骨疏松是原发性骨疏松是原发性骨疏松是原发性骨疏松是一种以骨量低下，骨一种以骨量低下，骨一种以骨量低下，骨一种以骨量低下，骨微结构破坏，导致骨微结构破坏，导致骨微结构破坏，导致骨微结构破坏，导致骨脆性增加，易发生骨脆性增加，易发生骨脆性增加，易发生骨脆性增加，易发生骨折为特征的折为特征的折为特征的折为特征的全身性全身性全身性全身性骨骨骨骨病病病病 Definition Osteoporosis is a1文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Epidemiology Epidemiology 2文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。老性骨质疏松症英文版ppt课件3文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。老性骨质疏松症英文版ppt课件4文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。老性骨质疏松症英文版ppt课件5文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。老性骨质疏松症英文版ppt课件6文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Incidence/100,000 person yearIncidence/100,000 person yearIncidence/100,000 person yearIncidence/100,000 person year WomenWomen =85=85=85=8535-3935-3935-3935-39Incidence/100,000 person year7文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Incidence of fracture8文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。老性骨质疏松症英文版ppt课件9文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。II PathophysiologyII Pathophysiology10文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Remodeling(骨重建过程骨重建过程)Remodeling(骨重建过程)11文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Mechanism of bone remodeling.Mechanism of bone remodeling.12文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。破骨细胞破骨细胞成骨细胞成骨细胞Menopause Menopause AgingAgingOther risk Other risk FactorsFactors 破骨细胞成骨细胞Menopause Other risk 13文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Hormonal control of bone resorption.Hormonal control of bone resor14文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。老性骨质疏松症英文版ppt课件15文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Clinical characteritics Clinical characteritics16文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。v Osteoporosis often starts silently and may not be found until a bone fractures.v Fragility fracture is a type of pathologic fracture that occurs as result of normal activities,such as a fall from standing height or less(the National Osteoporosis Foundation,NOF)17文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。1.5 million fractures occur each year in US as a 1.5 million fractures occur each year in US as a consequence of osteoporosisconsequence of osteoporosis 700,000700,000 vertebral crush fracutres vertebral crush fracutres 300,000300,000 hip fractures hip fractures 250.000 250.000 wrist fractures wrist fractures 300,000 other fractures300,000 other fractures 老性骨质疏松症英文版ppt课件18文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Pain Only 25-30%of vertebral compression Only 25-30%of vertebral compression fractures present with sudden onset back painfractures present with sudden onset back pain Chronic pain Chronic pain Pain 19文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Loss of height,Humpback n nkyphosiskyphosis（humpbackhumpback）n nKyphosis is more severe with Kyphosis is more severe with age age n n24 Vertebral body 24 Vertebral body Vertebral body height Vertebral body height 2 cm 2 cm Short 2mm Short 2mm，total 3-6cm total 3-6cm Loss of height,Humpback 20文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。FracturesppFractures are the most dangerous aspect of osteoporosisFractures are the most dangerous aspect of osteoporosisp Multiple vertebral fractures lead to a stooped posture,loss of height,Multiple vertebral fractures lead to a stooped posture,loss of height,and chronic pain with resultant reduction in mobilityand chronic pain with resultant reduction in mobilityppHip fracture,in particular,usually requires prompt surgery,as there Hip fracture,in particular,usually requires prompt surgery,as there are serious risks associated with a hip fracture,such as are serious risks associated with a hip fracture,such as deep vein deep vein thrombosisthrombosis and a and a pulmonary embolismpulmonary embolism,and,and increased mortalityincreased mortality.FracturesFractures are the mos21文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。A classical case of osteoporosis may start in a woman about 55 years of age with a wrist fractureA classical case of osteoporos22文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。vvThoracic fracture are associated with restrictive lung Thoracic fracture are associated with restrictive lung diseases diseases vvLumbar fracture are associated with abdominal symptom Lumbar fracture are associated with abdominal symptom including distension,early satiety and constipationincluding distension,early satiety and constipationThoracic fracture are associat23文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Diagnosis and differential diagnosis Diagnosis and 24文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。老性骨质疏松症英文版ppt课件25文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Bone mineral density（骨密度测定（骨密度测定）Bone mineral density（骨密度测定）26文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Measurement of bone mass Dual-energy x-ray absorptiometry(Dual-energy x-ray absorptiometry(DXADXA,双能双能双能双能X X线吸收法）线吸收法）线吸收法）线吸收法）The gold standard for measuring bone density The gold standard for measuring bone density Measurement of bone mass Dual-27文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。l lMeasurements of any site Measurements of any site l lClinical determinations are made of theClinical determinations are made of the spine spine andand hip hip l lBone spursBone spurs,which are frequently in osteoarthritis,tend to ,which are frequently in osteoarthritis,tend to falsely falsely increase bone densityincrease bone density of the spine and are a particular problem in of the spine and are a particular problem in maesuring the spine of older individuals maesuring the spine of older individuals l lStandard x-rays show changes in bone density after about Standard x-rays show changes in bone density after about 40%40%of of bone lossbone lossl lDEXA scan can detect changes after about a DEXA scan can detect changes after about a 1%1%change changeMeasurements of any site 28文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。T scores compare individual results to those in yong population that is compare individual results to those in yong population that is matched for race and gender matched for race and gender Z scores compare individual results to those of an age-matched compare individual results to those of an age-matched population population that is matched for race and genderthat is matched for race and genderT scores compare individual re29文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。WHO definitionWHO definition （Based on Bone Density LevelsBased on Bone Density Levels）vNormal Bone density is within 1 SD(+1 or 1)of the young adult mean.vLow bone mass Bone density is between 1 and 2.5 SD below the young adult mean(1 to 2.5 SD).vOsteoporosis Bone density is 2.5 SD or more below the young adult mean(2.5 SD or lower).vSevere(established)osteoporosis Bone density is more than 2.5 SD below the young adult mean,and there have been one or more osteoporotic fractures.vv正常正常正常正常 骨密度在年轻成人均值1个SD(+1或1)以内vv低骨量低骨量低骨量低骨量 骨密度在年轻成人均值1 到2.5 SD之间 vv骨质疏松骨质疏松骨质疏松骨质疏松 骨密度等于或低于年轻成人均值 2.5 SD vv严重严重严重严重(已确立已确立已确立已确立)骨质疏松骨质疏松骨质疏松骨质疏松 骨密度等于或低于年轻成人均值 2.5 SD，而且有一处或多处骨质疏松性骨折WHO definition（Based on Bon30文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Treatment Treatment31文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。vvA recently developed technique involves percutaneous injection of A recently developed technique involves percutaneous injection of artificial cement(ploymethymethacrylate)into the vertebral body artificial cement(ploymethymethacrylate)into the vertebral body(Vertebroplasty,Vertebroplasty,kyphoplasty)vThis offers significant immediate pain relief in the majority of patientsv Long term effects are unknown.VertebroplastyVertebroplasty kyphoplasty A recently developed technique32文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Nutritional Recommendation(营养治疗的建议营养治疗的建议)Adequate Adequate Calcium IntakeCalcium Intake Life stage Group Etsimated Adequate Daily Life stage Group Etsimated Adequate Daily Calcium Intake.mg/d Calcium Intake.mg/d Young children(1-3 years)Young children(1-3 years)500 500Older children(4-8 years)800Older children(4-8 years)800Adolescents and young adults(9-18 years)Adolescents and young adults(9-18 years)1300 1300Men and women(19-50 years)Men and women(19-50 years)1000 1000Men and women(51 and older)Men and women(51 and older)1200 1200Note:Pregnancy and lactation needs are the same as for nonpregnant women(e.g.,1300 mg/d for adolescents/young adult and 1000 mg/d for 19 years).Nutritional Recommendation(营33文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Elemental Calcium Content of Various Oral Calcium Preparation 各种口服钙剂的元素钙的含量各种口服钙剂的元素钙的含量 Calcium Preparation Elemental CalciumCalcium Preparation Elemental Calcium (钙制剂钙制剂钙制剂钙制剂 )()(元素钙含量元素钙含量元素钙含量元素钙含量)Calcium citrate Calcium citrate 柠檬酸钙柠檬酸钙柠檬酸钙柠檬酸钙 60 mg/300 mg60 mg/300 mg Calcium lactateCalcium lactate乳酸钙乳酸钙乳酸钙乳酸钙 80 mg/600 mg80 mg/600 mg Calcium gluconate Calcium gluconate 葡萄糖酸钙葡萄糖酸钙葡萄糖酸钙葡萄糖酸钙 40 mg/500 mg40 mg/500 mg Calcium carbonate Calcium carbonate 碳酸钙碳酸钙碳酸钙碳酸钙 400 mg/g 400 mg/g Calcium carbonate+5 ug Calcium carbonate+5 ug vitamin D2(OsCal250)vitamin D2(OsCal250)碳酸钙碳酸钙碳酸钙碳酸钙 250 mg/250 mg/片片片片 Calcium carbonate Calcium carbonate (Turns 500)(Turns 500)碳酸钙碳酸钙碳酸钙碳酸钙 500 mg/500 mg/片片片片Source:Adapted from SM Krane and MF Holick,Chap.355 in HPIM,14 ed,1998.Elemental Calcium Content of 34文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Vitamin D vvVitamin D goal :Serum 25-hydroxyvitaminVitamin D goal :Serum 25-hydroxyvitamin D75 mol/L D75 mol/L(30 ng/mL)(30 ng/mL)vv 70 years of age:600 70 years of age:600 IUIU/day/day The elderly and chronically ill:The elderly and chronically ill:1000 1000 IUIU/day/dayvvSerum 25-hydroxyvitaminSerum 25-hydroxyvitamin D D 75 mol/L(30 75 mol/L(30 75 mol/L(30 75 mol/L(30 ng/mL).ng/mL).ng/mL).ng/mL).Inadequate dosageInadequate dosage Vitamin D Vitamin D goal :Se35文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。vvEstrogensEstrogens(雌激素雌激素雌激素雌激素)vvSelective Estrogen Receptor ModulatorsSelective Estrogen Receptor Modulators (SERMs,(SERMs,选择性雌激素受体调节剂选择性雌激素受体调节剂选择性雌激素受体调节剂选择性雌激素受体调节剂)vvBisphosphonateBisphosphonate(双磷酸盐双磷酸盐双磷酸盐双磷酸盐)vvCalciumCalcium(降钙素降钙素降钙素降钙素)vvParathyroid hormoneParathyroid hormone （甲状旁腺激素（甲状旁腺激素（甲状旁腺激素（甲状旁腺激素PTHPTH）vvFluorideFluoride(氟化物氟化物氟化物氟化物)Pharmacologic Therapy(药物治疗药物治疗)Estrogens(雌激素)Pharmacologic Th36文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。EstrogensEstrogens37文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Results of hormone therapy regimens on bone mineral Results of hormone therapy regimens on bone mineral density(BMD)of the spine(density(BMD)of the spine(A A)and hip()and hip(B BResults of hormone therapy reg38文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Effects of hormone therapy on event ratesEffects of hormone therapy on 39文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。SERMs(SERMs(选择性雌激素受体调节剂选择性雌激素受体调节剂选择性雌激素受体调节剂选择性雌激素受体调节剂)vvTwo SERMs are currently being used in postmenopausal women Two SERMs are currently being used in postmenopausal women vvRaloxifene is approved for prenvention and treatment of osteoporosisRaloxifene is approved for prenvention and treatment of osteoporosisvvTamoxifene is approved for prenvention and treatment of breast Tamoxifene is approved for prenvention and treatment of breast cancer cancer vvThere is no data confirming that raloxifene can reduce the risk of There is no data confirming that raloxifene can reduce the risk of nonvertebral fractures nonvertebral fractures SERMs(选择性雌激素受体调节剂)Two SERMs a40文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。vvAlendronate,risedronate,and ibandronateAlendronate,risedronate,and ibandronate are approved for the are approved for the prevention and treatment of prevention and treatment of postmenopausal osteoporosispostmenopausal osteoporosis.vvRisedronate and Alendronate are approved Risedronate and Alendronate are approved for treatmentfor treatment of steroid of steroid induced osteoporosis.induced osteoporosis.vvRisedronate is approved for Risedronate is approved for the preventionthe prevention of steroid induced of steroid induced osteoporosis.osteoporosis.vvRisedronate and Alendronate are approved for treatment of Risedronate and Alendronate are approved for treatment of osteoporosis in menosteoporosis in men BisphosphonateAlendronate,risedronate,and 41文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Cumulative Cumulative proportions of proportions of women with women with osteoporosis who osteoporosis who suffered clinical suffered clinical fracture(vertebral,fracture(vertebral,hip,or wrist)hip,or wrist)during 3 years of during 3 years of treatment with treatment with alendronate or alendronate or placeboplacebo Cumulative proportions of 42文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。老性骨质疏松症英文版ppt课件43文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Calcium(降钙素降钙素)Calcium(降钙素)44文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Parathyroid hormone （甲状旁腺激素（甲状旁腺激素PTH）Teriparatide(立特帕立特帕 肽肽)Parathyroid hormone （甲45文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Effect of parathyroid hormone(PTH)treatment on bone microarchitectureEffect of parathyroid hormone 46文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Number of incident vertebral deformitiesNumber of incident vertebral d47文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Summary Summary 48文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Question What are WHO definitions based on bone density levels？Question What are WHO 49