1、 OsteoporosisLi MeiLi Mei2015.10.82015.10.8Osteoporosis 8 million Osteoporotic Women and 2.5 million Osteoporotic Men in USA Expected to increase by about 40%by 2020 Mortality increased 2-3 fold in women and women after all types of Osteoporotic fractures1 Surgeon-Generals Report2 Canadian and US ce
2、nsus data3 Access Economics,4 Center 1999Impact of osteoporosis on the quality offragile fractureWhat is the status of diagnose and treat?In study of 4 Midwestern health systems:1/8 1/4 of hip fracture pts received BMD testing were given calcium/D supplements 1/10 treated with antiresorptive medicat
3、ionsUS Department of Health and Human Services:Bone Health and Osteoporosis:A Report of the Surgeon General,Office of the Surgeon General,2004.Definition Signs and Symptoms Mechanism Risk Factors Diagnosis Importance of BMD testing Who should be tested?BMD testing and interpretation Who should be tr
4、eated?How to treatmentOutlineWhat is the definition?A condition of skeletal fragility characterized by compromised bone strength predisposing to an increased risk of fractureNormal BoneOsteoporosisWhat are the signs and symptoms?Back pain Loss of height over time FractureWhat is the mechanism?Imbala
5、nce in bone remodeling as a result of:i)bone breakdown by osteoclastsii)bone formation by osteblastsBiochemical Markers of Bone TurnoverFormationosteoblastsResorptionosteoclastsFormation Markers Osteocalcin(OC)Bone-specific alkaline phosphatase(BAP)Amino terminal propeptide of type I collagen(PINP)C
6、arboxyl terminal propeptide of type I collagen(PICP)Resorption Markers Pyridinoline(Pyr)Deoxypyridinoline(dPyr)Amino terminal telopeptide of type I collagen(NTX)Carboxyl terminal telopeptide of type I collagen(CTX)How to measure bone mass?FemurWorld Health Organization.Guidelines for Preclinical Eva
7、luation and Clinical Trials in Osteoporosis.Geneva,Switzerland:World Health Organization;1998.T Score What is the diagnosis criteria?MIBI ScanningMultiple MyolemaBone Biopsy可见大量、增殖的浆细胞可见大量、增殖的浆细胞MetastasesMetastasesMetastasisType I Collagen,Osteogenesis Imperfectacollagen“blue”eyes in OIfractures in
8、 OICollagen is the major protein of bone encoded by COLIA1 and COLIA2 genes Collagen genes produce alpha 1 and alpha 2 chains Chains assemble to form collagen fibresMutations cause extreme bone fragility and severeOsteoporosis“brittle bone disease”osteogenesis imperfecta(OI)Antiresorptive Bisphospho
9、nates alendronate,risedronate,ibandronate,etidronate SERMs(Selective estrogen receptor modulators)raloxifene Estrogen Calcitonin Anabolic PTH Both:Renalate strontiumWhat is the treatments for Osteoporosis?Lifestyle AdviceDietBalanced diet containing adequate calcium1000 mg/dayExerciseRegular weight
10、bearing exercise 3 times a week for 20 minutes minimumSmokingStop smokingAlcoholWithin safe limits2u/day women3u/day menSunlight Exposure15-20 minutes on face,hands and forearms twice weekly form April to October 基础用药基础用药 骨吸收抑制剂骨吸收抑制剂 骨形成促进剂骨形成促进剂钙剂钙剂 双膦酸盐双膦酸盐 维生素维生素D D 降钙素降钙素 甲状旁腺素片段甲状旁腺素片段 雌激素雌激素
11、合成类固醇合成类固醇雷尼酸锶盐雷尼酸锶盐 雷尼酸锶盐雷尼酸锶盐 选择性雌激素受体调节剂选择性雌激素受体调节剂 维生素维生素K K骨质疏松防骨质疏松防治药物治药物AgeHormonal ReplacementBisphosphonates StrontiumSERM20406080Vitamin DPTHLife StyleTreatmentchoiceAntifracture efficacy of antiosteoporotic agents 0.61.00.2Incident nonvertebral fractures Relative risk RLX 60,120(MORE)*CT
12、 200(PROOF)*Teriparatide 20g*ALN 5/10(FIT1)*ALN 5/10(FIT2)*RIS 5(VERT-NA)*RIS 5(VERT-MN)*Incident vertebral fractures Relative risk RLX 60(MORE)*RLX 60(MORE)*CT 200(PROOF)*Teriparatide 20g*ALN 5/10(FIT1)*ALN 5/10(FIT2)*RIS 5(VERT-NA)*RIS 5(VERT-MN)*Strontium ranelate(SOTI)*Strontium ranelate(SOTI+TR
13、OPOS)*Strontium ranelate(TROPOS)*Strontium ranelate(SOTI)*Updated from Delmas,Lancet 2002RR 95%CI骨质疏松症治疗新药骨质疏松症治疗新药抗骨吸收药物抗骨吸收药物DenosumabDenosumabOdanacatibOdanacatibLasofoxifeneLasofoxifeneBazedoxifeneBazedoxifene口服鲑鱼降钙素口服鲑鱼降钙素 促进骨形成药物促进骨形成药物骨硬化素抑制剂骨硬化素抑制剂PTHPTH制剂制剂 经皮经皮PTHPTH内源性内源性PTHPTH刺激剂刺激剂 钙敏感受体拮抗剂钙敏感受体拮抗剂复方制剂复方制剂 Definition Signs and Symptoms Mechanism Risk Factors Diagnosis Importance of BMD testing Who should be tested?BMD testing and interpretation Who should be treated?How to treatmentMassage to take home谢谢！谢谢！
