骨质疏松诊疗.ppt

骨质疏松诊疗骨质疏松诊疗现在学习的是第1页，共43页起起 草草 过过 程程n n编写调查问卷，广泛征求意见编写调查问卷，广泛征求意见n n专家负责，分部撰写（脊柱骨折、髋部骨折、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）肱骨近端骨折、桡尺骨远端骨折、药物治疗）n n邱贵兴教授任组长，专家组集体讨论（关节、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）脊柱、创伤、内分泌、老年病等专家）n n衷心感谢各位专家的辛勤劳动衷心感谢各位专家的辛勤劳动现在学习的是第2页，共43页一一、概述概述1.1.特点：属于脆性骨折特点：属于脆性骨折特点：属于脆性骨折特点：属于脆性骨折 好发于老年人好发于老年人好发于老年人好发于老年人2.2.好发部位：脊柱、髋部、肱骨近端、桡尺骨远端好发部位：脊柱、髋部、肱骨近端、桡尺骨远端好发部位：脊柱、髋部、肱骨近端、桡尺骨远端好发部位：脊柱、髋部、肱骨近端、桡尺骨远端3.3.面临问题：内固定松动面临问题：内固定松动面临问题：内固定松动面临问题：内固定松动 再次骨折再次骨折再次骨折再次骨折 致残率及致残率及致残率及致残率及 致死率高致死率高致死率高致死率高4.4.治疗措施：骨折和骨质疏松同时治疗治疗措施：骨折和骨质疏松同时治疗治疗措施：骨折和骨质疏松同时治疗治疗措施：骨折和骨质疏松同时治疗现在学习的是第3页，共43页二二、临床表现临床表现一般表现：出现压痛、疼痛或原有疼痛加重一般表现：出现压痛、疼痛或原有疼痛加重一般表现：出现压痛、疼痛或原有疼痛加重一般表现：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、功能障碍特有表现：出现畸形、骨擦感、反常活动、功能障碍特有表现：出现畸形、骨擦感、反常活动、功能障碍特有表现：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脊柱变形：身高变矮或驼背畸形脊柱变形：身高变矮或驼背畸形脊柱变形：身高变矮或驼背畸形现在学习的是第4页，共43页三三、诊断与鉴别诊断诊断与鉴别诊断1.1.性别：女性多见，也可见于男性性别：女性多见，也可见于男性性别：女性多见，也可见于男性性别：女性多见，也可见于男性 2.2.年龄：多见于年龄：多见于年龄：多见于年龄：多见于6060岁以上老年人岁以上老年人岁以上老年人岁以上老年人 3.3.外伤史：仅为轻微外伤或无明显外伤史外伤史：仅为轻微外伤或无明显外伤史外伤史：仅为轻微外伤或无明显外伤史外伤史：仅为轻微外伤或无明显外伤史4.4.临床表现：疼痛、畸形、功能障碍临床表现：疼痛、畸形、功能障碍临床表现：疼痛、畸形、功能障碍临床表现：疼痛、畸形、功能障碍现在学习的是第5页，共43页三三、诊断与鉴别诊断诊断与鉴别诊断5.5.影像学检查影像学检查影像学检查影像学检查 ：一般要求拍摄正、侧位：一般要求拍摄正、侧位：一般要求拍摄正、侧位：一般要求拍摄正、侧位X X片合理应用片合理应用片合理应用片合理应用CTCT、MRIMRI、CTCT三维成像技术三维成像技术三维成像技术三维成像技术 6.6.骨密度检查骨密度检查骨密度检查骨密度检查 ：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(DXA)(DXA)7.7.实验室检查：血、尿常规，肝肾功能，血糖、钙、磷、实验室检查：血、尿常规，肝肾功能，血糖、钙、磷、实验室检查：血、尿常规，肝肾功能，血糖、钙、磷、实验室检查：血、尿常规，肝肾功能，血糖、钙、磷、碱性磷酸酶、碱性磷酸酶、碱性磷酸酶、碱性磷酸酶、25(OH)D25(OH)D和甲状旁腺激素等和甲状旁腺激素等和甲状旁腺激素等和甲状旁腺激素等现在学习的是第6页，共43页三、三、诊断与鉴别诊断诊断与鉴别诊断8.8.8.8.鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导致的骨鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导致的骨鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导致的骨鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导致的骨折折折折9.9.9.9.危险因素：危险因素：危险因素：危险因素：(1)(1)(1)(1)主要危险因素：低骨密度、脆性骨折史、高龄主要危险因素：低骨密度、脆性骨折史、高龄主要危险因素：低骨密度、脆性骨折史、高龄主要危险因素：低骨密度、脆性骨折史、高龄65656565岁、岁、岁、岁、骨折家族病史骨折家族病史骨折家族病史骨折家族病史(2)(2)(2)(2)次要危险因素：跌倒、抽烟、酗酒；性腺机能减退、次要危险因素：跌倒、抽烟、酗酒；性腺机能减退、次要危险因素：跌倒、抽烟、酗酒；性腺机能减退、次要危险因素：跌倒、抽烟、酗酒；性腺机能减退、早期绝经（早期绝经（早期绝经（早期绝经（45454520202020，同时，同时，同时，同时-2.5SDT-1.0SD2.5SDT-1.0SD2.5SDT-1.0SD2.5SDT50505050岁男性岁男性岁男性岁男性2.T-2.5SD2.T-2.5SD2.T-2.5SD2.T-2.5SD者者者者3.3.3.3.骨质疏松性骨折（髋部、脊柱）患者骨质疏松性骨折（髋部、脊柱）患者骨质疏松性骨折（髋部、脊柱）患者骨质疏松性骨折（髋部、脊柱）患者4.4.4.4.继发性骨质疏松症伴有骨折高危因素者继发性骨质疏松症伴有骨折高危因素者继发性骨质疏松症伴有骨折高危因素者继发性骨质疏松症伴有骨折高危因素者5.5.5.5.有骨折史伴有低骨密度（有骨折史伴有低骨密度（有骨折史伴有低骨密度（有骨折史伴有低骨密度（-2.5SDT-1.0SD-2.5SDT-1.0SD-2.5SDT-1.0SD-2.5SDT651.651.651.65岁女性、岁女性、岁女性、岁女性、70707070岁男性，需进行骨密度检测岁男性，需进行骨密度检测岁男性，需进行骨密度检测岁男性，需进行骨密度检测2.2.2.2.绝经后妇女、绝经后妇女、绝经后妇女、绝经后妇女、5050505070707070岁男性，依临床危险因素程度岁男性，依临床危险因素程度岁男性，依临床危险因素程度岁男性，依临床危险因素程度每两年进行一次骨密度检测每两年进行一次骨密度检测每两年进行一次骨密度检测每两年进行一次骨密度检测3.3.3.3.经期过渡期伴有危险因素者（如低体重、脆性骨折经期过渡期伴有危险因素者（如低体重、脆性骨折经期过渡期伴有危险因素者（如低体重、脆性骨折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）史、服用某些药物史）史、服用某些药物史）史、服用某些药物史）4.504.504.504.50岁成人且有骨折史者岁成人且有骨折史者岁成人且有骨折史者岁成人且有骨折史者现在学习的是第37页，共43页六六.预预 防防（二）哪些人员需要进行风险评估（二）哪些人员需要进行风险评估（二）哪些人员需要进行风险评估（二）哪些人员需要进行风险评估5.5.5.5.继发性骨质疏松症患者（如类风湿性关节炎、服用激继发性骨质疏松症患者（如类风湿性关节炎、服用激继发性骨质疏松症患者（如类风湿性关节炎、服用激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）素史、低骨量）素史、低骨量）素史、低骨量）6.6.6.6.接受骨质疏松症治疗或正在观察疗效者接受骨质疏松症治疗或正在观察疗效者接受骨质疏松症治疗或正在观察疗效者接受骨质疏松症治疗或正在观察疗效者7.7.7.7.显示骨丢失而需接受治疗者显示骨丢失而需接受治疗者显示骨丢失而需接受治疗者显示骨丢失而需接受治疗者8.8.8.8.经期后妇女如停止雌激素治疗者经期后妇女如停止雌激素治疗者经期后妇女如停止雌激素治疗者经期后妇女如停止雌激素治疗者现在学习的是第38页，共43页六六.预预 防防（三）患者的自我管理（三）患者的自我管理（三）患者的自我管理（三）患者的自我管理1.1.1.1.坚持预防坚持预防坚持预防坚持预防2.2.2.2.戒烟限酒戒烟限酒戒烟限酒戒烟限酒3.3.3.3.减肥减肥减肥减肥4.4.4.4.增加肌力运动增加肌力运动增加肌力运动增加肌力运动5.5.5.5.预防跌倒预防跌倒预防跌倒预防跌倒现在学习的是第39页，共43页参参 考考 文文 献献Cummings SRCummings SRCummings SRCummings SR，Kelsey JL.Epidemiology of osteoporosis and Kelsey JL.Epidemiology of osteoporosis and Kelsey JL.Epidemiology of osteoporosis and Kelsey JL.Epidemiology of osteoporosis and osteoporotic fractures.Epidemiol Rev,1985,7:178-208osteoporotic fractures.Epidemiol Rev,1985,7:178-208osteoporotic fractures.Epidemiol Rev,1985,7:178-208osteoporotic fractures.Epidemiol Rev,1985,7:178-208Camero S.Care of older people.Falls in late life and their Camero S.Care of older people.Falls in late life and their Camero S.Care of older people.Falls in late life and their Camero S.Care of older people.Falls in late life and their consequences implementing effective services.Br Med consequences implementing effective services.Br Med consequences implementing effective services.Br Med consequences implementing effective services.Br Med J,2001,322(7290):855-857.J,2001,322(7290):855-857.J,2001,322(7290):855-857.J,2001,322(7290):855-857.Hoesel LMHoesel LMHoesel LMHoesel LM,Pausch MPausch MPausch MPausch M,Schnettler RSchnettler RSchnettler RSchnettler R,Heiss CHeiss CHeiss CHeiss C.The impact of.The impact of.The impact of.The impact of osteoporosis on the classification of hip and wrist osteoporosis on the classification of hip and wrist osteoporosis on the classification of hip and wrist osteoporosis on the classification of hip and wrist fractures.Med Sci Monit.2008,14(3):HY1-8.fractures.Med Sci Monit.2008,14(3):HY1-8.fractures.Med Sci Monit.2008,14(3):HY1-8.fractures.Med Sci Monit.2008,14(3):HY1-8.Tuck SPTuck SPTuck SPTuck SP,Datta HKDatta HKDatta HKDatta HK.Osteoporosis in the aging male:treatment.Osteoporosis in the aging male:treatment.Osteoporosis in the aging male:treatment.Osteoporosis in the aging male:treatment options.Clin Interv Aging.2007,2(4):521-36options.Clin Interv Aging.2007,2(4):521-36options.Clin Interv Aging.2007,2(4):521-36options.Clin Interv Aging.2007,2(4):521-36现在学习的是第40页，共43页参参 考考 文文 献献Tuck SPTuck SPTuck SPTuck SP,Datta HKDatta HKDatta HKDatta HK.Osteoporosis in the aging male:treatment.Osteoporosis in the aging male:treatment.Osteoporosis in the aging male:treatment.Osteoporosis in the aging male:treatment options.Clin Interv Aging.2007,2(4):521-36Lyritis GP,options.Clin Interv Aging.2007,2(4):521-36Lyritis GP,options.Clin Interv Aging.2007,2(4):521-36Lyritis GP,options.Clin Interv Aging.2007,2(4):521-36Lyritis GP,Paspati,et al.Pain relief from nasal salmon calcitonin in Paspati,et al.Pain relief from nasal salmon calcitonin in Paspati,et al.Pain relief from nasal salmon calcitonin in Paspati,et al.Pain relief from nasal salmon calcitonin in osteoporotic vertebral crush fractures.A double blind,placebo-osteoporotic vertebral crush fractures.A double blind,placebo-osteoporotic vertebral crush fractures.A double blind,placebo-osteoporotic vertebral crush fractures.A double blind,placebo-controlled clinical study.Acta Orthop Scand Suppl.1997 Oct;controlled clinical study.Acta Orthop Scand Suppl.1997 Oct;controlled clinical study.Acta Orthop Scand Suppl.1997 Oct;controlled clinical study.Acta Orthop Scand Suppl.1997 Oct;275:112-4.275:112-4.275:112-4.275:112-4.Charles H Chesnut,et al.Effects of salmon calcitonin on Charles H Chesnut,et al.Effects of salmon calcitonin on Charles H Chesnut,et al.Effects of salmon calcitonin on Charles H Chesnut,et al.Effects of salmon calcitonin on trabecular microarchitecture as determined by magnetic trabecular microarchitecture as determined by magnetic trabecular microarchitecture as determined by magnetic trabecular microarchitecture as determined by magnetic resonance imaging:results from the quest study.J Bone resonance imaging:results from the quest study.J Bone resonance imaging:results from the quest study.J Bone resonance imaging:results from the quest study.J Bone Miner Res 2005;20:1548-1561Miner Res 2005;20:1548-1561Miner Res 2005;20:1548-1561Miner Res 2005;20:1548-1561Chesnut CH 3rd,Silverman S,Andriano K,et al.A Chesnut CH 3rd,Silverman S,Andriano K,et al.A Chesnut CH 3rd,Silverman S,Andriano K,et al.A Chesnut CH 3rd,Silverman S,Andriano K,et al.A randomized trial of nasal spray salmon calcitonin in randomized trial of nasal spray salmon calcitonin in randomized trial of nasal spray salmon calcitonin in randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis:the postmenopausal women with established osteoporosis:the postmenopausal women with established osteoporosis:the postmenopausal women with established osteoporosis:the prevent recurrence of osteoporotic fractures study.Am J prevent recurrence of osteoporotic fractures study.Am J prevent recurrence of osteoporotic fractures study.Am J prevent recurrence of osteoporotic fractures study.Am J Med,2000,109:267-276.Med,2000,109:267-276.Med,2000,109:267-276.Med,2000,109:267-276.现在学习的是第41页，共43页参参 考考 文文 献献Scott A.et al,Whats New in Orthopaedic Research,J Scott A.et al,Whats New in Orthopaedic Research,J Scott A.et al,Whats New in Orthopaedic Research,J Scott A.et al,Whats New in Orthopaedic Research,J Bone Joint Surg Am.,2004;86:2085-2095.Bone Joint Surg Am.,2004;86:2085-2095.Bone Joint Surg Am.,2004;86:2085-2095.Bone Joint Surg Am.,2004;86:2085-2095.Scott A.Rodeo,Suzanne A.Maher and Chisa Hidaka,Scott A.Rodeo,Suzanne A.Maher and Chisa Hidaka,Scott A.Rodeo,Suzanne A.Maher and Chisa Hidaka,Scott A.Rodeo,Suzanne A.Maher and Chisa Hidaka,Whats New in Orthopaedic Research,J Bone Joint Surg Whats New in Orthopaedic Research,J Bone Joint Surg Whats New in Orthopaedic Research,J Bone Joint Surg Whats New in Orthopaedic Research,J Bone Joint Surg Am.,2004;86:2085-2095.Am.,2004;86:2085-2095.Am.,2004;86:2085-2095.Am.,2004;86:2085-2095.中华医学会骨质疏松和骨矿盐疾病分会中华医学会骨质疏松和骨矿盐疾病分会中华医学会骨质疏松和骨矿盐疾病分会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原发性骨质疏松症诊治指南原发性骨质疏松症诊治指南原发性骨质疏松症诊治指南 Brown JP,et al.2002 clinical practice guidelines for the Brown JP,et al.2002 clinical practice guidelines for the Brown JP,et al.2002 clinical practice guidelines for the Brown JP,et al.2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada.CMAJ.diagnosis and management of osteoporosis in Canada.CMAJ.diagnosis and management of osteoporosis in Canada.CMAJ.diagnosis and management of osteoporosis in Canada.CMAJ.2002;167:sl-s342002;167:sl-s342002;167:sl-s342002;167:sl-s34www.emea.europa.eu/dfs/human/referral/calcitonin/086704en.pdfwww.emea.europa.eu/dfs/human/referral/calcitonin/086704en.pdfwww.emea.europa.eu/dfs/human/referral/calcitonin/086704en.pdfwww.emea.europa.eu/dfs/human/referral/calcitonin/086704en.pdf现在学习的是第42页，共43页参参 考考 文文 献献Meunier PJ,et al.The effects of Strontium Ranelate on the Meunier PJ,et al.The effects of Strontium Ranelate on the Meunier PJ,et al.The effects of Strontium Ranelate on the Meunier PJ,et al.The effects of Strontium Ranelate on the risk of vertebral fracture in women with postmenopausal risk of vertebral fracture in women with postmenopausal risk of vertebral fracture in women with postmenopausal risk of vertebral fracture in women with postmenopausal osteoporosis(SOTI),N Engl J Med 2004;350:459-68osteoporosis(SOTI),N Engl J Med 2004;350:459-68osteoporosis(SOTI),N Engl J Med 2004;350:459-68osteoporosis(SOTI),N Engl J Med 2004;350:459-68J.-Y.Reginster,E.Seeman,et al.Strontium Ranelate Reduces J.-Y.Reginster,E.Seeman,et al.Strontium Ranelate Reduces J.-Y.Reginster,E.Seeman,et al.Strontium Ranelate Reduces J.-Y.Reginster,E.Seeman,et al.Strontium Ranelate Reduces the Risk of Nonvertebral Fractures in Postmenopausal Women the Risk of Nonvertebral Fractures in Postmenopausal Women the Risk of Nonvertebral Fractures in Postmenopausal Women the Risk of Nonvertebral Fractures in Postmenopausal Women with Osteoporosis:Treatment of Peripheral Osteoporosis with Osteoporosis:Treatment of Peripheral Osteoporosis with Osteoporosis:Treatment of Peripheral Osteoporosis with Osteoporosis:Treatment of Peripheral Osteoporosis(TROPOS)Study.Journal of Clinical Endocrinology and(TROPOS)Study.Journal of Clinical Endocrinology and(TROPOS)Study.Journal of Clinical Endocrinology and(TROPOS)Study.Journal of Clinical Endocrinology and Metabolism 2005;90:2816-2822 Metabolism 2005;90:2816-2822 Metabolism 2005;90:2816-2822 Metabolism 2005;90:2816-2822 Huusko TM,et al.Randomized double blind clinically controlled Huusko TM,et al.Randomized double blind clinically controlled Huusko TM,et al.Randomized double blind clinically controlled Huusko TM,et al.Randomized double blind clinically controlled trial of intranasal calcitonin treatment in patients with hip trial of intranasal calcitonin treatment in patients with hip trial of intranasal calcitonin treatment in patients with hip trial of intranasal calcitonin treatment in patients with hip fracture.Calcif Tissre Int 2002,71:478-484fracture.Calcif Tissre Int 2002,71:478-484fracture.Calcif Tissre Int 2002,71:478-484fracture.Calcif Tissre Int 2002,71:478-484现在学习的是第43页，共43页