NOF骨质疏松指南解读.ppt
《NOF骨质疏松指南解读.ppt》由会员分享,可在线阅读,更多相关《NOF骨质疏松指南解读.ppt(49页珍藏版)》请在三一文库上搜索。
1、2014NOF骨质疏松指南解读,江苏省中西医结合医院 内分泌代谢病院区,epidemiology,Since NOF first published the Guide in 1999, it has become increasingly clear that many patients are not being given appropriate information about prevention and many patients are not receiving appropriate testing to diagnose osteoporosis or establish
2、 osteoporosis risk. Most importantly, many patients who have osteoporosis-related fractures are not being diagnosed with osteoporosis and are not receiving any of the FDA-approved, effective therapies.,Medical Impact,Fractures and their complications are the relevant clinical sequelae of osteoporosi
3、s. Fractures may be followed by full recovery or by chronic pain, disability and death Hip fractures are associated with an 8.4 to 36 percent excess mortality within one year, and followed by a 2.5-fold increased risk of future fractures.,Pathogenesis of Osteoporosis-Related Fractures,Risk Assessmen
4、t,All postmenopausal women and men age 50 and older should be evaluated for osteoporosis risk in order to determine the need for BMD testing and/or vertebral imaging. In general, the more risk factors that are present, the greater the risk of fracture. Osteoporosis is preventable and treatable, but
5、because there are no warning signs prior to a fracture, many people are not being diagnosed in time to receive effective therapy during the early phase of the disease.,Others,Gastrointestinal disorders Hematologic disorders Rheumatologic and autoimmune disease Neurological and musculoskeletal risk f
6、actors Miscellaneous conditions and diseases Medications,T-Score,World Health Organization (WHO) 骨质疏松诊断标准,indication,椎体成像,UNIVERSAL RECOMMENDATIONS FOR ALL PATIENTS,Adequate Intake of Calcium,Men 50-70 1000mg,71 1200mg women 51 1200 mg There is no evidence that calcium intake in excess of these amou
7、nts confers additional bone strength. Intakes in excess of 1,200 to 1,500 mg per day may increase the risk of developing kidney stones, cardiovascular disease and stroke. The scientific literature is highly controversial in this area,Adequate Intake of Vitamin D,Bring the serum 25(OH)D level to 30 n
8、g/ml (75 nmol/L) and a maintenance dose to maintain this level, particularly for individuals with osteoporosis. Many patients with osteoporosis will need more than the general recommendation of 800-1,000 IU per day. The safe upper limit for vitamin D intake for the general adult population was incre
9、ased to 4,000 IU per day,Treatment of Vitamin D Deficiency,Adults who are vitamin D deficient may be treated with 50,000 IU of vitamin D2 or vitamin D3 once a week or the equivalent daily dose (7,000 IU vitamin D2 or vitamin D3) for 8-12 wks to achieve a 25(OH)D blood level of approximately 30 ng/ml
10、. This regimen should be followed by maintenance therapy of 1,5002,000 IU/d or whatever dose is needed to maintain the target blood level.,Regular Weight-Bearing and Muscle-Strengthening Exercise,Weight-bearing exercise includes walking, jogging, Tai-Chi, stair climbing, dancing and tennis. Muscle-s
11、trengthening exercise includes weight training and other resistive exercises, such as yoga, Pilates and boot camp programs. Before an individual with osteoporosis initiates a new vigorous exercise program, such as running or heavy weight-lifting, a clinicians evaluation is appropriate.,Fall Preventi
12、on,maintaining adequate vitamin D levels and physical activity home safety assessment and modification especially when done by an occupational therapist and gradual withdrawal of psychotropic medication if possible. Appropriate correction of visual impairment may improve mobility and reduce risk of
13、falls. Hip protectors may protect an individual from injuring the hip in the event of a fall,Cessation of Tobacco Use and Avoidance of Excessive Alcohol Intake,Advise patients to stop tobacco smoking Recognize and treat patients with excessive alcohol intake,PHARMACOLOGIC THERAPY,Pharmacologic treat
14、ment recommendations,After appropriate evaluation: Initiate pharmacologic treatment in those with hip or vertebral (clinical or asymptomatic) fractures. Initiate therapy in those with T-scores 3 percent or a 10-year major osteoporosis-related fracture probability 20 percent based on the U.S.-adapted
15、 WHO absolute fracture risk model (FRAX; www.NOF.org and www.shef.ac.uk/FRAX).,U.S. FDA-Approved Drugs for Osteoporosis,bisphosphonates (alendronate, alendronate plus D, ibandronate, risedronate and zoledronic acid) calcitonin estrogens (estrogen and/or hormone therapy), estrogen agonist/antagonist
16、(raloxifene), tissue-selective estrogen complex (conjugated estrogens/bazedoxifene) parathyroid hormone (PTH1-34, teriparatide) the RANKL inhibitor denosumab.,Bisphosphonates,双膦酸盐,Drug safety,Side effects are similar for all oral bisphosphonate medications and include gastrointestinal problems such
17、as difficulty swallowing, inflammation of the esophagus and stomach. All bisphosphonates can affect renal function and are contraindicated in patients with estimated GFR below 30-35 ml/min. Eye inflammation can also occur.,Drug safety,There have been rare reports of osteonecrosis of the jaw (ONJ) wi
18、th long term use of bisphosphonates for osteoporosis, though ONJ is much more common following high dose intravenous bisphosphonate treatment for patients with cancer. The risk of ONJ appears to increase with duration of treatment beyond five years.,Drug safety,Although rare, low trauma atypical fem
19、ur fractures may be associated with the long-term use of bisphosphonates (e.g. 5 years of use). Pain in the thigh or groin area, which can be bilateral, often precedes these unusual fractures. For patients with thigh and groin pain, a stress fracture in the subtrochanteric region or femoral shaft of
20、 the femur may be present. Bilateral x-ray of the femurs should be ordered when an atypical femur fracture is suspected, followed by an MRI or a radionuclide bone scan when clinical suspicion is high enough. Surgical fixation is required in some cases whereas medical conservative treatment is approp
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- NOF 骨质 疏松 指南 解读
链接地址:https://www.31doc.com/p-5033200.html