卫小春-骨质疏松诊疗.ppt

,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,起 草 过 程,编写调查问卷，广泛征求意见,专家负责，分部撰写（脊柱骨折、髋部骨折、肱骨近端骨折、桡尺骨远端骨折、药物治疗）,邱贵兴教授任组长，专家组集体讨论（关节、脊柱、创伤、内分泌、老年病等专家）,衷心感谢各位专家的辛勤劳动,一,、,概述,特点：属于脆性骨折 好发于老年人,好发部位：脊柱、髋部、肱骨近端、桡尺骨远端,面临问题：内固定松动 再次骨折 致残率及,致死率高,治疗措施：骨折和骨质疏松同时治疗,二,、,临床表现,一般表现：出现压痛、疼痛或原有疼痛加重,特有表现：出现畸形、骨擦感、反常活动、功能障碍,脊柱变形：身高变矮或驼背畸形,三,、,诊断与鉴别诊断,1.,性别：女性多见，也可见于男性,2.,年龄：多见于,60,岁以上老年人,3.,外伤史：仅为轻微外伤或无明显外伤史,4.,临床表现：疼痛、畸形、功能障碍,三,、,诊断与鉴别诊断,5.,影像学检查：一般要求拍摄正、侧位,X,片合理应用,CT,、,MRI,、,CT,三维成像技术,6.,骨密度检查：双能,X,线吸收法,(DXA),7.,实验室检查：血、尿常规，肝肾功能，血糖、钙、磷、碱性磷酸酶、,25(OH)D,和甲状旁腺激素等,三、诊断与鉴别诊断,8.,鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导致的骨折,9.,危险因素：,(1),主要危险因素：低骨密度、脆性骨折史、高龄,65,岁、骨折家族病史,(2),次要危险因素：跌倒、抽烟、酗酒；性腺机能减退、早期绝经（,20,，同时,-2.5SDT50,岁男性,2.T-2.5SD,者,3.,骨质疏松性骨折（髋部、脊柱）患者,4.,继发性骨质疏松症伴有骨折高危因素者,5.,有骨折史伴有低骨密度（,-2.5SDT65,岁女性、,70,岁男性，需进行骨密度检测,2.,绝经后妇女、,50,70,岁男性，依临床危险因素程度每两年进行一次骨密度检测,3.,经期过渡期伴有危险因素者（如低体重、脆性骨折史、服用某些药物史）,4.50,岁成人且有骨折史者,六,.,预 防,（二）哪些人员需要进行风险评估,5.,继发性骨质疏松症患者（如类风湿性关节炎、服用激素史、低骨量）,6.,接受骨质疏松症治疗或正在观察疗效者,7.,显示骨丢失而需接受治疗者,8.,经期后妇女如停止雌激素治疗者,六,.,预 防,（三）患者的自我管理,1.,坚持预防,2.,戒烟限酒,3.,减肥,4.,增加肌力运动,5.,预防跌倒,参 考 文 献,Cummings SR,，,Kelsey JL.Epidemiology of osteoporosis and osteoporotic fractures.Epidemiol Rev,1985,7:178-208,Camero S.Care of older people.Falls in late life and their consequences implementing effective services.Br Med J,2001,322(7290):855-857.,Hoesel LM,Pausch M,Schnettler R,Heiss C,.The impact of osteoporosis on the classification of hip and wrist fractures.Med Sci Monit.2008,14(3):HY1-8.,Tuck SP,Datta HK,.Osteoporosis in the aging male:treatment options.Clin Interv Aging.2007,2(4):521-36,参 考 文 献,Tuck SP,Datta HK,.Osteoporosis in the aging male:treatment options.Clin Interv Aging.2007,2(4):521-36Lyritis GP,Paspati,et al.Pain relief from nasal salmon calcitonin in osteoporotic vertebral crush fractures.A double blind,placebo-controlled clinical study.Acta Orthop Scand Suppl.1997 Oct;275:112-4.,Charles H Chesnut,et al.Effects of salmon calcitonin on trabecular microarchitecture as determined by magnetic resonance imaging:results from the quest study.J Bone Miner Res 2005;20:1548-1561,Chesnut CH 3rd,Silverman S,Andriano K,et al.A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis:the prevent recurrence of osteoporotic fractures study.Am J Med,2000,109:267-276.,参 考 文 献,Scott A.et al,What,s New in Orthopaedic Research,J Bone Joint Surg Am.,2004;86:2085-2095.,Scott A.Rodeo,Suzanne A.Maher and Chisa Hidaka,What,s New in Orthopaedic Research,J Bone Joint Surg Am.,2004;86:2085-2095.,中华医学会骨质疏松和骨矿盐疾病分会,原发性骨质疏松症诊治指南,Brown JP,et al.2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada.CMAJ.2002;167:sl-s34,www.emea.europa.eu/dfs/human/referral/calcitonin/086704en.pdf,参 考 文 献,Meunier PJ,et al.The effects of Strontium Ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis(SOTI),N Engl J Med 2004;350:459-68,J.-Y.Reginster,E.Seeman,et al.Strontium Ranelate Reduces the Risk of Nonvertebral Fractures in Postmenopausal Women with Osteoporosis:Treatment of Peripheral Osteoporosis(TROPOS)Study.Journal of Clinical Endocrinology and Metabolism 2005;90:2816-2822,Huusko TM,et al.Randomized double blind clinically controlled trial of intranasal calcitonin treatment in patients with hip fracture.Calcif Tissre Int 2002,71:478-484,