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1、Section 5 Osteoporosis,Definition,Osteoporosis is a systemic skeletal disease characterized byLow bone mass Microarchitectural deterioration of bone tissue,Leading to increased bone fragility And greater susceptibility to fracture,原发性骨疏松是一种以骨量低下，骨微结构破坏，导致骨脆性增加，易发生骨折为特征的全身性骨病,Epidemiology,Incidence/1
2、00,000 person year,Women,=85,35-39,Epidemiology of vertebral,hip,Collesfractures with age,Incidence of fracture(fractures per 1000 patient years),II Pathophysiology,Remodeling(骨重建过程),Mechanism of bone remodeling.,破骨细胞,成骨细胞,Menopause Aging,Other risk Factors,Hormonal control of bone resorption.,Clini
3、cal characteritics,Osteoporosis often starts silently and may not be found until a bone fractures.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),1.5 million fractures
4、 occur each year in US as a consequence of osteoporosis 700,000 vertebral crush fracutres 300,000 hip fractures 250.000 wrist fractures 300,000 other fractures,Pain,Only 25-30%of vertebral compression fractures present with sudden onset back pain Chronic pain,Loss of height,Humpback,kyphosis（humpbac
5、k）Kyphosis is more severe with age 24 Vertebral body Vertebral body height 2 cm Short 2mm，total 3-6cm,Fractures,Fractures are the most dangerous aspect of osteoporosis Multiple vertebral fractures lead to a stooped posture,loss of height,and chronic pain with resultant reduction in mobilityHip fract
6、ure,in particular,usually requires prompt surgery,as there are serious risks associated with a hip fracture,such as deep vein thrombosis and a pulmonary embolism,and increased mortality.,A classical case of osteoporosis may start in a woman about 55 years of age with a wrist fracture,Thoracic fractu
7、re are associated with restrictive lung diseases Lumbar fracture are associated with abdominal symptom including distension,early satiety and constipation,Diagnosis and differential diagnosis,Bone mineral density（骨密度测定）,Measurement of bone mass,Dual-energy x-ray absorptiometry(DXA,双能X线吸收法）The gold s
8、tandard for measuring bone density,Measurements of any site Clinical determinations are made of the spine and hip Bone spurs,which are frequently in osteoarthritis,tend to falsely increase bone density of the spine and are a particular problem in maesuring the spine of older individuals Standard x-r
9、ays show changes in bone density after about 40%of bone lossDEXA scan can detect changes after about a 1%change,T scores compare individual results to those in yong population that is matched for race and gender Z scores compare individual results to those of an age-matched population that is matche
10、d for race and gender,WHO definition（Based on Bone Density Levels）,Normal Bone density is within 1 SD(+1 or 1)of the young adult mean.Low bone mass Bone density is between 1 and 2.5 SD below the young adult mean(1 to 2.5 SD).Osteoporosis Bone density is 2.5 SD or more below the young adult mean(2.5
11、SD or lower).Severe(established)osteoporosis Bone density is more than 2.5 SD below the young adult mean,and there have been one or more osteoporotic fractures.,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2.5 SD之间 骨质疏松 骨密度等于或低于年轻成人均值 2.5 SD 严重(已确立)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,Treatment,A
12、 recently developed technique involves percutaneous injection of artificial cement(ploymethymethacrylate)into the vertebral body(Vertebroplasty,kyphoplasty)This offers significant immediate pain relief in the majority of patients Long term effects are unknown.,Vertebroplasty,kyphoplasty,Nutritional
13、Recommendation(营养治疗的建议),Adequate Calcium Intake Life stage Group Etsimated Adequate Daily Calcium Intake.mg/d,Young children(1-3 years)500Older children(4-8 years)800Adolescents and young adults(9-18 years)1300Men and women(19-50 years)1000Men and women(51 and older)1200,Note:Pregnancy and lactation
14、 needs are the same as for nonpregnant women(e.g.,1300 mg/d for adolescents/young adult and 1000 mg/d for 19 years).,Elemental Calcium Content of Various Oral Calcium Preparation 各种口服钙剂的元素钙的含量,Calcium Preparation Elemental Calcium(钙制剂)(元素钙含量)Calcium citrate 柠檬酸钙 60 mg/300 mg Calcium lactate乳酸钙 80 mg
15、/600 mg Calcium gluconate 葡萄糖酸钙 40 mg/500 mg Calcium carbonate 碳酸钙 400 mg/g Calcium carbonate+5 ug vitamin D2(OsCal250)碳酸钙 250 mg/片 Calcium carbonate(Turns 500)碳酸钙 500 mg/片Source:Adapted from SM Krane and MF Holick,Chap.355 in HPIM,14 ed,1998.,Vitamin D,Vitamin D goal:Serum 25-hydroxyvitamin D75 mol
16、/L(30 ng/mL)70 years of age:600 IU/day The elderly and chronically ill:1000 IU/daySerum 25-hydroxyvitamin D 75 mol/L(30 ng/mL).Inadequate dosage,Estrogens(雌激素)Selective Estrogen Receptor Modulators(SERMs,选择性雌激素受体调节剂)Bisphosphonate(双磷酸盐)Calcium(降钙素)Parathyroid hormone（甲状旁腺激素PTH）Fluoride(氟化物),Pharmaco
17、logic Therapy(药物治疗),Estrogens,Results of hormone therapy regimens on bone mineral density(BMD)of the spine(A)and hip(B,Effects of hormone therapy on event rates,SERMs(选择性雌激素受体调节剂),Two SERMs are currently being used in postmenopausal women Raloxifene is approved for prenvention and treatment of osteo
18、porosisTamoxifene is approved for prenvention and treatment of breast cancer There is no data confirming that raloxifene can reduce the risk of nonvertebral fractures,Alendronate,risedronate,and ibandronate are approved for the prevention and treatment of postmenopausal osteoporosis.Risedronate and
19、Alendronate are approved for treatment of steroid induced osteoporosis.Risedronate is approved for the prevention of steroid induced osteoporosis.Risedronate and Alendronate are approved for treatment of osteoporosis in men,Bisphosphonate,Cumulative proportions of women with osteoporosis who suffere
20、d clinical fracture(vertebral,hip,or wrist)during 3 years of treatment with alendronate or placebo,Calcium(降钙素),Parathyroid hormone（甲状旁腺激素PTH）,Teriparatide(立特帕 肽),Effect of parathyroid hormone(PTH)treatment on bone microarchitecture,Number of incident vertebral deformities,Summary,Question,What are WHO definitions based on bone density levels？,
