英文 第五节 老年性骨质疏松症.ppt
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1、Section 5 Osteoporosis,Definition,Osteoporosis is a systemic skeletal disease characterized by Low 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
2、 /100,000 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.,
3、 Clinical 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 millio
4、n fractures 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,ky
5、phosis(humpback) 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
6、mobility Hip fracture, 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 f
7、racture,Thoracic fracture 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 absorptiomet
8、ry (DXA, 双能X线吸收法) The gold standard 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
9、older individuals Standard x-rays show changes in bone density after about 40% of bone loss DEXA 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-
10、matched population that is matched 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
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