卫小春-骨质疏松诊疗9843.pptx

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第一页，共四十三页。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.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第二页，共四十三页。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第三页，共四十三页。三三、诊断与鉴别诊断诊断与鉴别诊断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 2.年龄：多见于年龄：多见于6060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.临床表现：疼痛、畸形、功能障碍临床表现：疼痛、畸形、功能障碍第四页，共四十三页。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：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CT、MRI、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线吸收法线吸收法(DXA)(DXA)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、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第五页，共四十三页。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鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导致的鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导致的鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导致的骨折骨折骨折骨折9.9.9.9.危险因素：危险因素：危险因素：危险因素：(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6565岁、骨折家族病史岁、骨折家族病史(2)(2)次要危险因素：跌倒、抽烟、酗酒；性腺机能减次要危险因素：跌倒、抽烟、酗酒；性腺机能减退、早期绝经退、早期绝经4520202020，同时，同时，同时，同时-2.5SDT-2.5SDT-2.5SDT-2.5SDT50505050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.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-2.5SDT651.65岁女性、岁女性、7070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每两岁男性，依临床危险因素程度每两岁男性，依临床危险因素程度每两岁男性，依临床危险因素程度每两年进行一次骨密度检测年进行一次骨密度检测年进行一次骨密度检测年进行一次骨密度检测3.3.经期过渡期伴有危险因素者如低体重、脆性骨经期过渡期伴有危险因素者如低体重、脆性骨折史、服用某些药物史折史、服用某些药物史4.504.50岁成人且有骨折史者岁成人且有骨折史者第三十六页，共四十三页。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、服用激素继发性骨质疏松症患者如类风湿性关节炎、服用激素继发性骨质疏松症患者如类风湿性关节炎、服用激素继发性骨质疏松症患者如类风湿性关节炎、服用激素史、低骨量史、低骨量史、低骨量史、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.显示骨丧失而需接受治疗者显示骨丧失而需接受治疗者显示骨丧失而需接受治疗者显示骨丧失而需接受治疗者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第三十七页，共四十三页。六六.预预 防防三患者的自我管理三患者的自我管理1.1.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.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第三十八页，共四十三页。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 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Hidaka,Whats New in Orthopaedic Research,J Bone Joint Surg Am.,2004;New in Orthopaedic Research,J Bone Joint Surg Am.,2004;New in Orthopaedic Research,J Bone Joint Surg Am.,2004;New in Orthopaedic Research,J Bone Joint Surg Am.,2004;86:2085-2095.86:2085-2095.86:2085-2095.86:2085-2095.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原发性骨质疏松症诊治原发性骨质疏松症诊治原发性骨质疏松症诊治指南指南指南指南?Brown JP,et al.2002 clinical practice guidelines for Brown JP,et al.2002 clinical practice guidelines for Brown JP,et al.2002 clinical practice guidelines for Brown JP,et al.2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada.the diagnosis and management of osteoporosis in Canada.the diagnosis and management of osteoporosis in Canada.the diagnosis and management of osteoporosis in Canada.CMAJ.2002;167:sl-s34CMAJ.2002;167:sl-s34CMAJ.2002;167:sl-s34CMAJ.2002;167:sl-s34 emea.europa.eu/dfs/human/referral/calcitonin/086704en.pdf 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