英文第五节老性骨质疏松症幻灯片.ppt
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1、英文第五英文第五节老性骨老性骨质疏松症疏松症第1页,共50页,编辑于2022年,星期二Definition Osteoporosis is a systemic skeletal disease characterized byvLow bone mass vMicroarchitectural deterioration of bone tissue,v Leading to increased bone fragility vAnd greater susceptibility to fracture 原发性骨疏松是一原发性骨疏松是一种以骨量低下,骨微种以骨量低下,骨微结构破坏,导致骨脆结
2、构破坏,导致骨脆性增加,易发生骨折性增加,易发生骨折为特征的为特征的全身性全身性骨病骨病骨病骨病 第2页,共50页,编辑于2022年,星期二Epidemiology 第3页,共50页,编辑于2022年,星期二第4页,共50页,编辑于2022年,星期二第5页,共50页,编辑于2022年,星期二第6页,共50页,编辑于2022年,星期二第7页,共50页,编辑于2022年,星期二Incidence/100,000 person yearIncidence/100,000 person yearIncidence/100,000 person yearIncidence/100,000 person
3、year WomenWomen =85=85=85=8535-3935-3935-3935-39第8页,共50页,编辑于2022年,星期二第9页,共50页,编辑于2022年,星期二第10页,共50页,编辑于2022年,星期二II Pathophysiology第11页,共50页,编辑于2022年,星期二Remodeling(骨重建过程骨重建过程)第12页,共50页,编辑于2022年,星期二Mechanism of bone remodeling.第13页,共50页,编辑于2022年,星期二破骨细胞破骨细胞成骨细胞成骨细胞Menopause AgingOther risk Other risk
4、FactorsFactors 第14页,共50页,编辑于2022年,星期二Hormonal control of bone resorption.第15页,共50页,编辑于2022年,星期二第16页,共50页,编辑于2022年,星期二 Clinical characteritics第17页,共50页,编辑于2022年,星期二 v Osteoporosis often starts silently and may not be found until a bone fractures.v Fragility fracture is a type of pathologic fracture t
5、hat occurs as result of normal activities,such as a fall from standing height or less(the National Osteoporosis Foundation,NOF)第18页,共50页,编辑于2022年,星期二 1.5 million fractures occur each year in US as a consequence of osteoporosis 700,000700,000 vertebral crush fracutres vertebral crush fracutres 300,00
6、0300,000 hip fractures hip fractures 250.000 250.000 wrist fractures wrist fractures 300,000 other fractures300,000 other fractures 第19页,共50页,编辑于2022年,星期二Pain Only 25-30%of vertebral compression fractures present with sudden onset back pain Chronic pain 第20页,共50页,编辑于2022年,星期二Loss of height,Humpback
7、n nkyphosiskyphosis(humpbackhumpback)n nKyphosis is more severe with age Kyphosis is more severe with age n n24 Vertebral body 24 Vertebral body Vertebral body height Vertebral body height 2 cm 2 cm Short 2mm Short 2mm,total 3-6cm total 3-6cm 第21页,共50页,编辑于2022年,星期二FracturesppFractures are the most d
8、angerous aspect of osteoporosisFractures are the most dangerous aspect of osteoporosisp Multiple vertebral fractures lead to a stooped posture,loss of height,and Multiple vertebral fractures lead to a stooped posture,loss of height,and chronic pain with resultant reduction in mobilitychronic pain wi
9、th resultant reduction in mobilityppHip fracture,in particular,usually requires prompt surgery,as there are Hip fracture,in particular,usually requires prompt surgery,as there are serious risks associated with a hip fracture,such as serious risks associated with a hip fracture,such as deep vein thro
10、mbosisdeep vein thrombosis and a and a pulmonary embolismpulmonary embolism,and,and increased mortalityincreased mortality.第22页,共50页,编辑于2022年,星期二A classical case of osteoporosis may start in a woman about 55 years of age with a wrist fracture第23页,共50页,编辑于2022年,星期二vvThoracic fracture are associated w
11、ith restrictive lung diseases Thoracic fracture are associated with restrictive lung diseases vvLumbar fracture are associated with abdominal symptom including Lumbar fracture are associated with abdominal symptom including distension,early satiety and constipationdistension,early satiety and consti
12、pation第24页,共50页,编辑于2022年,星期二 Diagnosis and differential diagnosis第25页,共50页,编辑于2022年,星期二第26页,共50页,编辑于2022年,星期二Bone mineral density(骨密度测定(骨密度测定)第27页,共50页,编辑于2022年,星期二Measurement of bone mass Dual-energy x-ray absorptiometry(Dual-energy x-ray absorptiometry(DXADXA,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)The gol
13、d standard for measuring bone density The gold standard for measuring bone density 第28页,共50页,编辑于2022年,星期二l lMeasurements of any site Measurements of any site l lClinical determinations are made of theClinical determinations are made of the spine spine andand hip hip l lBone spursBone spurs,which are
14、 frequently in osteoarthritis,tend to ,which are frequently in osteoarthritis,tend to falsely increase bone falsely increase bone densitydensity of the spine and are a particular problem in maesuring the spine of the spine and are a particular problem in maesuring the spine of older individuals of o
15、lder individuals l lStandard x-rays show changes in bone density after about Standard x-rays show changes in bone density after about 40%40%of bone loss of bone lossl lDEXA scan can detect changes after about a DEXA scan can detect changes after about a 1%1%change change第29页,共50页,编辑于2022年,星期二T score
16、s compare individual results to those in yong population that is compare individual results to those in yong population that is matched for race and gender matched for race and gender Z scores compare individual results to those of an age-matched compare individual results to those of an age-matched
17、 population population that is matched for race and genderthat is matched for race and gender第30页,共50页,编辑于2022年,星期二WHO definitionWHO definition (Based on Bone Density LevelsBased on Bone Density Levels)vNormal Bone density is within 1 SD(+1 or 1)of the young adult mean.vLow bone mass Bone density is
18、 between 1 and 2.5 SD below the young adult mean(1 to 2.5 SD).vOsteoporosis Bone density is 2.5 SD or more below the young adult mean(2.5 SD or lower).vSevere(established)osteoporosis Bone density is more than 2.5 SD below the young adult mean,and there have been one or more osteoporotic fractures.v
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