骨质疏松症病人健康知识知晓情况宣教及相关行为调查研究

骨质疏松症是一种因骨量低下,骨的显微结构破坏导致骨脆性增加,从而导致骨骼发生骨折的危险性升高为特征的一种全身性疾病。随着人类进入老龄化社会,骨质疏松所致骨折的发病率逐年上升,给患者的生活质量及家庭造成很大的影响,其主要病理改变为骨质明显缺钙,临床症状常表现周身骨痛、骨形改变,易发骨折、牙齿松动。     

骨质疏松症的发生机制与治疗进展

骨质疏松以骨丢失和易发生骨折为特征,最常见的原发性骨质疏松主要是老年性骨质疏松和绝经后骨质疏松。６５岁以上的人群中女性有２０％～３０％,男性有１２％～２０％发生骨质疏松。一旦发生髋部骨折,１２％～２０％的人死亡,５０％的人需要他人终生护理,没有人能恢复到骨折前的功能水平。此外骨质疏松还可以引起桡骨及椎骨骨折,造成腰背畸形、疼痛,导致心理上的压力。随着社会老龄化进程,骨质疏松已成为日益突出的公共健康问题。１　骨质疏松症的发生机制骨骼是一个代谢惰性的系统,但人的一生中一直存在骨重建,在骨重建的过程中…     

骨质疏松性骨盆环骨折的研究进展

骨质疏松症是一种常见的疾病,是由骨量减少、骨骼微结构发生破坏导致骨骼脆弱而易发生骨折的疾病［1］。骨质疏松性骨折可发生在身体的任何部位,主要为髋部骨折、椎体骨折、桡骨远端骨折、肱骨外科颈骨折和胫骨平台骨折。骨质疏松性骨盆环骨折比较少见,根据受伤时所受外力的大小可分为高能量骨折和低能量骨折。因其常不伴有韧带结构损伤,其治疗方式与正常人骨盆环骨折有很大区别。现对骨质疏松性骨盆环骨折的研究进展综述如下。     

新型骨折风险综合评估模型在骨量减少患者针灸治疗中的应用

<正>骨质疏松症(osteoporosis,OP)是一种以骨量低,骨组织微结构损坏,导致骨脆性增加,易发生骨折为特征的全身性骨病~([1])。骨质疏松症最大的危害是容易引起骨折。骨质疏松导致骨折的发生率为7.31%～12.2%,而将近一半的脆性骨折发生在骨量减少者中~([2])。由于骨量丢失通常在无症状的情况下发生~([3]),常     

加压螺钉内固定治疗骨质疏松性股骨颈骨折临床分析

内固定术是骨质疏松性骨折的一种重要方法,股骨颈骨折发生基础是骨质疏松,骨质疏松症是一种以低骨量和骨组织的微细结构破坏为特征,能导致骨的脆性和骨折危险性增加的一种疾病.骨质疏松降低了骨密度和弹性,同时也改变了骨的微细结构,使之易发生骨折.股骨颈骨折是老年人常见的骨折,是骨质疏松性骨折中症状最重、治疗最棘手、预后最差的骨折.股骨颈骨折早期治疗,有利于尽快恢复骨折后血管扭曲、受压或痉挛,消除疼痛,早期活动,减少卧床所致的各种并发症,改善生活质量,降低病死率.     

骨质疏松骨折及其治疗

骨质疏松（OP）是全身性骨骼退化,表现为骨量降低,骨微结构破坏,导致骨脆性增加,骨折危险性提高。OP引起的脆性骨折是老年人最主要的骨折原因,骨折是OP的重要并发症。常见的骨折部位有脊柱、髋部、桡骨远端及肱骨近端。OP及其导致的骨折已成为日常临床工作的常见病及多发病。OP骨折愈合慢,并发症高,其治疗较一般骨折尤应引起我们重视。     

糖尿病患者骨矿物含量的测定及意义

糖尿病患者骨矿物含量的测定及意义（２５００２２）山东煤矿总医院王晶糖尿病患者由于体内内分泌代谢紊乱．易造成骨丢失，导致骨质疏松。本文通过对糖尿病患者骨矿物含量的测定，分析和研究糖尿病并发骨质疏松的原因和影响因素，为预防并发骨质疏松和骨折的发生提供有价...     

靶向破骨细胞的骨质疏松治疗药物研究进展

<正>骨质疏松是由多种因素造成的以骨量减少、骨小梁显微结构退化导致骨强度降低为特征的全身性骨骼退行变化,患者常有腰背部或者全身无特征性疼痛,脆性骨折及呼吸系统受影响等症状。骨质疏松是全球性的慢性病。2014年美国休斯敦美国骨矿盐研究会年会报道,美国将会有1/2的老年女性以及1/3的老年男性将会发生骨质疏松性骨折。据调查,巴西绝经后骨质疏松患病率为15%-33%,我国人群40岁以上骨质疏松患病率约20%。骨质疏松患病率高,骨折率高,严重影响了中老年人的生活质量。目前骨质疏松的治     

4142例健康体检者跟骨定量超声骨密度检测结果分析

骨质疏松（osteoporosis,OP）是以骨量减少和骨组织显微结构退行性改变为特征,骨脆性增加,易发生骨折的一种全身性代谢性骨病。然而骨质丢失的过程较为隐匿,自觉症状感觉不明显,一般在发生骨折时才能意识到。骨质疏松及其导致的并发症严重影响人们生活质量,其高发病率、高致残率和所花费的高额医疗费用,已成为世界性公共问题。本研究对健康体检人群骨密度进行检测,了解人群骨质疏松症发生情况,为有针对性地采取干预措施,及早预防和治疗骨质疏松提供科学依据。     

骨质疏松诊断与骨密度检查报告的解读

由骨质疏松导致髋部或脊柱骨折的致残率和致死率非常高,目前已经成为全球公共健康问题。为预防骨质疏松性骨折的发生,骨质疏松早期诊断尤其重要,可以及早进行有效的干预,从而降低发生骨折的风险性。世界卫生组织（WHO）和中华医学会骨质疏松和骨矿盐疾病分会制定的骨质疏松诊断标准如下。     

Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 9. Calcitonin in the treatment of osteoporosis.

OBJECTIVE: To describe potential therapeutic uses of calcitonin in the prevention and treatment of osteoporosis. OPTIONS: Parenterally and intranasally administered calcitonin (eel, salmon or human). OUTCOMES: Fracture, fracture pain and loss of bone mineral density in osteoporosis; increased bone mass, prevention of fractures, reduction of pain and improved quality of life associated with calcitonin treatment. EVIDENCE: Relevant clinical studies and reports were examined, with an emphasis on recent randomized, placebo-controlled trials. In vitro and in vivo studies of osteoclast activity were also considered. VALUES: Reducing fractures and fracture pain, increasing bone mineral density and minimizing side effects of treatment were given a high value. BENEFITS, HARMS AND COSTS: Calcitonin reduces acute pain associated with osteoporotic fractures and has been found useful in treating chronic back pain following vertebral fractures in spinal osteoporosis. It can prevent bone loss and may be effective in preventing fractures. Side effects are dose related and generally mild; they include gastrointestinal, vascular and dermatologic conditions that can be treated symptomatically or by varying the dosage. Side effects are much rarer with nasal administration than with injection. True allergic reactions are rare. RECOMMENDATIONS: Calcitonin in both intramuscular and intranasal forms can reduce the pain of acute osteoporotic vertebral fractures and may be effective in treating that associated with chronic vertebral osteoporotic fractures. Calcitonin may also prevent postmenopausal bone loss and increase bone density in those with established osteoporosis. Current evidence for long-term prevention of fractures is limited and does not support the use of calcitonin as a first-line treatment for established osteoporosis. Most side effects can be avoided with nasal administration. Further trials are needed to assess fracture prevention and effective dose ranges for treating pain and increasing bone mineral density and to determine the long-term efficacy of calcitonin in secondary osteoporosis, in premenopausal women, in men and in elderly people.     

Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 6. Use of bisphosphonates in the treatment of osteoporosis.

OBJECTIVE: To describe the mechanisms of action of bisphosphonates in the treatment of osteoporosis and compare bisphosphonate therapy with other treatments. OPTIONS: The bisphosphonates, etidronate, alendronate, clodronate, pamidronate, tiludronate, ibandronate and risedronate; combined bisphosphonates and estrogen; combined bisphosphonates and calcium supplements. OUTCOMES: Fracture and loss of bone mineral density in osteoporosis; increased bone mass, prevention of fractures and improved quality of life associated with bisphosphonate treatment. EVIDENCE: Relevant clinical studies and reports were examined with emphasis on recent controlled trials. The availability of treatment products in Canada was also considered. VALUES: Reducing fractures, increasing bone mineral density and minimizing side effects of treatment were given a high value. BENEFITS, HARMS AND COSTS: Treatment with bisphosphonates may be an acceptable alternative to ovarian hormone therapy in increasing bone mass and decreasing fractures associated with osteoporosis. Compared with estrogens, bisphosphonates are bone-tissue specific, have equal or greater antiresorptive effect and have few side effects and no known risk for carcinogenesis. They also hold promise in treating male osteoporosis and steroid-induced bone loss. Prolonged, continuous treatment with etidronate may lead to impaired calcification of newly formed bone; therefore, etidronate is administered cyclically. This risk is not present in newer generations of bisphosphonates. RECOMMENDATIONS: Bisphosphonate therapies may be considered as an alternative to ovarian hormone therapy in postmenopausal osteopenic or osteoporotic women who cannot or will not tolerate ovarian hormone therapy. They should also be considered in treating male osteoporosis and steroid-induced bone loss. Combination therapy with estrogen may be effective, although more research is needed. Combination therapy with calcium supplements is recommended. Bisphosphonate therapies should be restricted to postmenopausal patients with osteopenia or established osteoporosis and are not yet recommended for younger perimenopausal women as prophylaxis.     

Osteoporosis, calcium and physical activity.

Sales of calcium supplements have increased dramatically since 1983, as middle-aged women seek to prevent or treat bone loss due to osteoporosis. However, epidemiologic studies have failed to support the hypothesis that larger amounts of calcium are associated with increased bone density or a decreased incidence of fractures. The authors examine the evidence from controlled trials on the effects of calcium supplementation and physical activity on bone loss and find that weight-bearing activity, if undertaken early in life and on a regular basis, can increase the peak bone mass of early adulthood, delay the onset of bone loss and reduce the rate of loss. All of these factors will delay the onset of fractures. Carefully planned and supervised physical activity programs can also provide a safe, effective therapy for people who have osteoporosis.     

'Senile' osteoporosis reconsidered

Osteoporosis is a devastating, morbid, and costly condition whose ravages are felt most profoundly by women over age 70 years. Yet most research on its prevention and treatment has focused on perimenopausal women, although there are significant differences between perimenopausal and older women in factors related to bone mineral metabolism, rates of bone loss, the structural integrity of remaining bone, risk factors for fractures, and the types of fractures sustained. Currently recommended therapies, which slow bone loss in perimenopausal women, may be of less benefit for older women whose loss of bone has already slowed or ceased and whose remaining bone may be of inadequate quantity and quality to prevent fracture. Thus, the application of currently available modalities is unlikely to mitigate significantly the consequences of osteoporosis in this population. Further research is urgently needed, and some directions for future investigation are suggested.     

骨质疏松的健康管理发展现状及挑战

骨质疏松是引起老年人骨质疏松性骨折的主要原因,严重影响患者的生活质量、增加经济负担。引起骨质疏松的主要原因包括骨密度下降、骨组织显微结构的破坏及骨强度减弱等。目前针对骨密度下降这一原因的主要治疗手段是使用抗骨吸收药物(如双膦酸盐类药物、降钙素)、促进骨形成药物(甲状旁腺激素)以及某些中药等,然而药物治疗效果并不理想。尽管可以通过手术进行干预,但依旧存在诸多术后并发症。近年来随着三级预防思想的树立,从一级预防的角度针对高危人群来进行骨质疏松的健康管理成为当前预防骨质疏松症及相关骨折的主流方法。本文主要从骨质疏松健康管理的来源与患者和医务人员的相互关系2个方面简要介绍骨质疏松健康管理的一些措施及其在当前发展中所遇到的挑战。此外,绝经后女性的骨质疏松症主要是由于雌激素减少导致骨密度下降,因而在预防措施上与老年性骨质疏松有所不同,予以分开阐述。进一步的发展目前需要解决我国三级诊疗体系尚不完善的现状并制定出更科学的骨质疏松评定标准以及加强患者对健康管理方案中饮食和生活习惯的依从性等。此外,从雌激素的类型、剂量、持续使用时间以及个体情况等方面改善并发展雌激素在围绝经期女性骨质疏松健康管理中的应用,最终发挥健康管理在骨质疏松症及相关骨折中的一级预防作用。      

Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 4. Calcium nutrition and osteoporosis.

OBJECTIVE: To recommend appropriate levels of calcium intake in light of the most recent studies. OPTIONS: Dietary calcium intake, calcium supplementation, calcium and vitamin D supplementation; ovarian hormone therapy in postmenopausal women. OUTCOMES: Fracture and loss of bone mineral density in osteoporosis; increased bone mass, prevention of fractures and improved quality of life associated with osteoporosis prevention. EVIDENCE: Relevant clinical studies and reports were examined, in particular those published since the 1988 Osteoporosis Society of Canada position paper on calcium nutrition. Only studies in humans were considered, including controlled, randomized trials and prospective studies, using bone mass and fractures as end-points. Studies in early and later phases of skeletal growth were noted. The analysis was designed to eliminate menopause as a confounding variable. VALUES: Preventing osteoporosis and maximizing quality of life were given a high value. BENEFITS, HARMS AND COSTS: Adequate calcium nutrition increases bone mineral density during skeletal growth and prevents bone loss and osteoporotic fractures in the elderly. Risks associated with high dietary calcium intake are low, and a recent study extends this conclusion to the risk of kidney stones. Lactase-deficient patients may substitute yogurt and lactase-treated milk for cow's milk. True milk allergy is probably rare; its promotion of diabetes mellitus in susceptible people is being studied. RECOMMENDATIONS: Current recommended intakes of calcium are too low. Revised intake guidelines designed to reduce bone loss and protect against osteoporotic fractures are suggested. Canadians should attempt to meet their calcium requirements principally through food sources. Pharmaceutical calcium supplements and a dietician's advice should be considered where dietary preferences or lactase deficiency restrict consumption of dairy foods. Further research is necessary before recommending the general use of calcium supplements by adolescents. Calcium supplementation cannot substitute for hormone therapy in the prevention of postmenopausal bone loss and fractures. Adequate amounts of vitamin D are necessary for optimal calcium absorption and bone health. Elderly people and those who use heavy sun screens should have a dietary intake of 400 to 800 IU of vitamin D per day.     

骨质疏松研究热点:骨髓间充质干细胞分化命运

骨质疏松症是一种常见的代谢性骨病,以骨量减少、骨密度降低和骨微结构破坏为特征,容易发生脆性骨折,其发病率逐年增高.骨质疏松症发病与骨平衡的破坏有关,一方面破骨细胞活性增强、骨吸收加快,另一方面成骨细胞功能衰减、骨形成不足,最终导致净骨量丢失.成骨不足与骨髓间充质干细胞分化方向密切相关.在骨质疏松症患者中,骨髓间充质干细胞向脂肪方向分化增多,向成骨方向分化减少,其分化命运受BMP/Smad、Wnt、Notch、Hedgehog等多条信号通路调控,并涉及转录调控、转录后调控和表观遗传等多种调控机制,是目前研究的热点与焦点.未来研究可集中于寻找决定骨髓间充质干细胞分化方向的关键因子和间充质干细胞移植,为骨质疏松症的治疗提供新思路.     

Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 3. Effects of ovarian hormone therapy on skeletal and extraskeletal tissues in women.

OBJECTIVE: To present recent evidence on the use of ovarian hormone therapy (OHT) for osteoporosis and outline safe and effective regimens. OPTIONS: Estrogen alone, estrogen and progestins, progestins alone; various treatment regimens. OUTCOMES: Fracture and loss of bone mineral density in osteoporosis; increased bone mass, prevention of fractures and improved quality of life associated with OHT. EVIDENCE: Relevant clinical studies and reports, including the Nurses' Health Study and the Post-menopausal Estrogen/Progestin Interventions (PEPI) Trial, were studied with emphasis on recent prospective, randomized, controlled trials. Current clinical practice was determined by survey. VALUES: Reducing fractures, increasing bone mineral density and minimizing side effects of treatment were given a high value. BENEFITS, HARMS AND COSTS: Proper management of osteoporosis minimizes injury and disability, improves quality of life and reduces the personal and social costs associated with the condition. OHT is the front-line pharmaceutical therapy for prevention and treatment of osteoporosis in post-menopausal women. In those who are able and willing to comply with therapy, OHT prevents bone loss and fractures. Hormone therapy may also decrease risk of coronary artery disease. Cyclic progestin protects against endometrial cancer in patients receiving estrogen. Potential harms include breast cancer and endometrial cancer related to dosage and duration of therapy. Mastalgia and especially resumption of menstrual bleeding affect compliance. RECOMMENDATIONS: Use of OHT should be considered as early as possible in the perimenopausal period for women at increased risk of osteoporosis. Guidelines are provided for assessment of osteoporosis risk. Physicians and their patients should take into account the absolute and relative contraindications to OHT. Women with a uterus should be given estrogen in combination with a progestin. Ideally, therapy would be continued for a minimum of 10 years beyond menopause for maximum bone protection. Women using OHT should be carefully monitored and evaluated for possible adverse events. This should include regular screening mammography, breast examination and, for some, endometrial surveillance. Specific dosages and treatment regimens are outlined.     

骨质疏松症物理治疗的研究进展

骨质疏松症是一种中老年人易患的骨骼性疾病,其特点是骨密度下降,骨微结构破坏,骨脆性增加,易发生骨折。药物疗法是有效防治骨质疏松、降低骨折的一个重要手段,但存在治疗周期长、药物不良反应等问题。而物理治疗兼具疗效突出且不良反应少的优点,现主要阐述物理治疗在骨质疏松治疗中的应用,旨在为临床制定出高质量的防治骨质疏松的康复策略提供依据。     

老年男性骨矿物含量变化的临床研究

为探讨男性骨质疏松的影响及危害,用双能X线骨密度测量仪（DEXA）对284例老年男性腰椎及股骨骨矿物含量进行测定,得出随着年龄的增长,骨矿物含量逐渐下降,其骨量丢失的变化规律为：股骨Wards三角＞股骨颈＞腰椎（L2～L4）＞股骨粗隆。骨质疏松发病率在70y以后明显增加,骨质疏松骨折发生率为18％。提示：男性骨质疏松发生率之高及其造成的危害应引起人们高度重视,骨密度（BMD）测量尤其是髋部骨量测定,对骨质疏松早期诊断及其骨折的预防有着重要的意义。