卫小春骨质疏松诊疗 .ppt

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片合理应片合理应片合理应片合理应用用用用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、实验室检查：血、尿常规，肝肾功能，血糖、钙、实验室检查：血、尿常规，肝肾功能，血糖、钙、实验室检查：血、尿常规，肝肾功能，血糖、钙、磷、碱性磷酸酶、磷、碱性磷酸酶、磷、碱性磷酸酶、磷、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鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导致的骨折致的骨折致的骨折致的骨折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、骨折家族病史岁、骨折家族病史岁、骨折家族病史岁、骨折家族病史(2)(2)(2)(2)次要危险因素：跌倒、抽烟、酗酒；性腺机能次要危险因素：跌倒、抽烟、酗酒；性腺机能次要危险因素：跌倒、抽烟、酗酒；性腺机能次要危险因素：跌倒、抽烟、酗酒；性腺机能减退、早期绝经（减退、早期绝经（减退、早期绝经（减退、早期绝经（45454520202020，同时同时同时同时-2.5SDT-1.0SD-2.5SDT-1.0SD-2.5SDT-1.0SD-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3.3.3.3.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，依临床危险因素程岁男性，依临床危险因素程岁男性，依临床危险因素程岁男性，依临床危险因素程度每两年进行一次骨密度检测度每两年进行一次骨密度检测度每两年进行一次骨密度检测度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）折史、服用某些药物史）折史、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、服继发性骨质疏松症患者（如类风湿性关节炎、服继发性骨质疏松症患者（如类风湿性关节炎、服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）用激素史、低骨量）用激素史、低骨量）用激素史、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参参 考考 文文 献献Cummings SRCummings SRCummings SRCummings SR，Kelsey JL.Epidemiology of osteoporosis Kelsey JL.Epidemiology of osteoporosis Kelsey JL.Epidemiology of osteoporosis Kelsey JL.Epidemiology of osteoporosis and osteoporotic fractures.Epidemiol and osteoporotic fractures.Epidemiol and osteoporotic fractures.Epidemiol and osteoporotic fractures.Epidemiol Rev,1985,7:178-208Rev,1985,7:178-208Rev,1985,7:178-208Rev,1985,7:178-208Camero S.Care 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