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骨質疏鬆症

骨質疏鬆症. 骨質疏鬆症的危險因子. 雌激素缺乏. 缺乏運動. 鈣質攝取不足. 本人曾發生骨折. 體型瘦小. 日曬不足. 長期使用類固醇藥物. 家族老人曾發生骨折. 抽煙酗酒. Bone modeling and remodeling. Bone modeling Child and adolescent Non-coupling : bone formation and resorption occur on separate surfaces Bone remodeling

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骨質疏鬆症

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  1. 骨質疏鬆症

  2. 骨質疏鬆症的危險因子 雌激素缺乏 缺乏運動 鈣質攝取不足 本人曾發生骨折 體型瘦小 日曬不足 長期使用類固醇藥物 家族老人曾發生骨折 抽煙酗酒

  3. Bone modeling and remodeling Bone modeling • Child and adolescent • Non-coupling : bone formation and resorption occur on separate surfaces Bone remodeling • The replacement of old bone tissue by new bone tissue in the adult skeleton • Coupling

  4. Osteoporosis  imbalance in bone remodeling Results in thinning and eventual loss of trabecular connectivity

  5. Definition of Osteoporosis Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Bone strength primarily reflects the integration of bone density and bone quality. NIH Consensus Conference Normal bone Osteoporosis NIH Consensus Development Panel on Osteoporosis. JAMA 285:785-95, 2001

  6. Primary osteoporosis Older persons and women past menopause in which bone loss is accelerated over that predicted for age and sex. Secondary osteoporosis Metabolic bone disease hyperparathyroidism Neoplasia multiple myeloma or metastatic carcinoma Malnutrition Drug therapy with corticosteroids Prolonged immobilization Weightlessness with space travel Primary prevention Should provided all the people as comprehensive measures against other lifestyle-related diseases Secondary prevention Should target people at higher risk of osteoporotic fractures Tertiary prevention Should be provided the patients and at frail elderly people using medical or long-term care insurance Osteoporosis Osteoporosis Tutorial

  7. 雙能量X光骨密度檢查 超音波

  8. Factors affecting bone metabolism

  9. Anti-resorptive agent Estrogen SERM Raloxifene (Evista) Calcitonin Bisphosphonate Alendronate (Fosamax) Risedronate (Actonel) Ibandronate (Bonviva) (Bone resorption) Anabolic agent PTH (cyclic use) ( Bone formation) Strontium ranelate ( Bone formation) ( Bone resorption) Medical treatment for osteoporosis

  10. Protos OPG

  11. NEJM2004;350:459-468

  12. AEs of strontium ranelate (Protos) PROTOS Symptoms (%) Placebo p Gastritis 3.6 5.5 0.066 Gastric ulcer 1.0 1.1 NS Esophagitis 0.8 0.6 NS Diarrhea 6.1 3.6 0.019 • 2g of strontuim ranelate mix with a glass of water and drink immediately. • Taken before bedtime or 2-h before/after the meals 16

  13. Thank you for your attention!

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