复旦大学：《内科学》课程教学资源（PPT课件讲稿）（谢瑞满）Chapter 28 Osteoporosis

Chapter 28 Osteoporosis Presentation: 2005 谢瑞满Rui- man xie,Ph.D,MD Professor of Neurology Gerontology ZhongShan Hospital, Fudan University rmxie@zshospital.netxieruiman@yahoo.com

Chapter 28 Osteoporosis Presentation: 2005 谢瑞满 Rui-man Xie，Ph.D., M.D. Professor of Neurology & Gerontology ZhongShan Hospital, Fudan University rmxie@zshospital.net, xieruiman@yahoo.com

Obiective 1 Definition, types and mechanism of osteoporosis 2, Diagnosis, prevention and treatment of osteoporosis 3 Etiology and Epidemiology of osteoporosis times-45 minutes×2

Objective 1、Definition、types and mechanism of osteoporosis 2、 Diagnosis、prevention and treatment of osteoporosis 3 、Etiology and Epidemiology of osteoporosis times – 45 minutes×2

Overview Definition: Osteoporosis is a bone disease in which the amount of bone is decreased and the structural integrity of trabecular bone is impaired. Cortical bone becomes more porous and thinner. This makes the bone weaker and more likely to fracture

Overview Definition : Osteoporosis is a bone disease in which the amount of bone is decreased and the structural integrity of trabecular bone is impaired. Cortical bone becomes more porous and thinner. This makes the bone weaker and more likely to fracture

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ASsociated changes in body shape and vertebra deleted 6 pictures norma 50yrs above 55yrs above kyphosis 75yrs S

Associated changes in body shape and vertebra （deleted 6 pictures） norma l 50yrs above 55yrs above 75yrs kyphosi s

F Patients with risk factors or conditions that cause osteoporosis a* Postmenopausal woman with family history of hip fractures or kyphosis Medications: corticosteroids, dilantin, gonadotropin releasing hormone agonists, loop diuretics, methotrexate, thyroid, heparin, cyclosporin, depot- medroxyprogesterone acetate + Hereditary skeletal diseases: osteogenesis imperfecta rickets, hypophosphatasia Endocrine and metabolic: hypogonadism, hyperparathyroidism, hyperthyroidism, Cushing syndrome, acidosis, Gaucher's disease Marrow diseases: myeloma, mastocytosis, thalassemia Others: Anorexia, Malabsorption, Cystic fibrosis, Renal insufficiency, Hypercalciuria, Hepatic disease, Depression, Spinal cord injury, Systemic Lupus, Weight below healthy range, Cigarette smoking

Patients with risk factors or conditions that cause osteoporosis  Postmenopausal woman with family history of hip fractures or kyphosis  Medications: corticosteroids, dilantin, gonadotropin releasing hormone agonists, loop diuretics, methotrexate, thyroid, heparin, cyclosporin, depot￾medroxyprogesterone acetate  Hereditary skeletal diseases: osteogenesis imperfecta, rickets, hypophosphatasia  Endocrine and metabolic: hypogonadism, hyperparathyroidism, hyperthyroidism, Cushing syndrome, acidosis, Gaucher's disease  Marrow diseases: myeloma, mastocytosis, thalassemia  Others: Anorexia, Malabsorption, Cystic fibrosis, Renal insufficiency, Hypercalciuria, Hepatic disease, Depression, Spinal cord injury, Systemic Lupus, Weight below healthy range, Cigarette smoking

Epidemiology The population of older men and women has been increasing, and therefore the number of people with osteoporosis is increasing. t In the USA, about 21% of postmenopausal women have osteoporosis(low bone density ), and about 16% have had a fracture In women older than 80, about 40% have experienced a fracture of the hip, vertebra, arm, or pelvIs. t Women have more osteoporotic fractures than men. Age is one of the most important risks in all groups. + The decreased physical activi ity may be playing a role in increased hip fractures

Epidemiology  The population of older men and women has been increasing, and therefore the number of people with osteoporosis is increasing.  In the USA, about 21% of postmenopausal women have osteoporosis (low bone density), and about 16% have had a fracture. In women older than 80, about 40% have experienced a fracture of the hip, vertebra, arm, or pelvis.  Women have more osteoporotic fractures than men. Age is one of the most important risks in all groups.  The decreased physical activity may be playing a role in increased hip fractures

Mechanism Bone physiology The bone is continuously remodelling, and the bone surface moves in and out. The Basic Multicellular Unit(BMU) is a wandering team of cells that dissolves an area of the bone surface and then fills it with new bone The sequence is e Origination, Osteoclast recruitment, Resorption, Osteoblast recruitment. Osteoid formation Mineralization mineral maturation. Quiescence t Bone strength(Quality): In addition to bone porosity, the bone strength is determined by the trabecular microstructure Perforations of individual trabecula occur when resorption cavities are too deep. This, too, is seen with estrogen deficiency the remaining trabecula are not as well connected and are mechanically weaker

Mechanism : Bone physiology  The bone is continuously remodelling, and the bone surface moves in and out. The Basic Multicellular Unit (BMU) is a wandering team of cells that dissolves an area of the bone surface and then fills it with new bone. The sequence is Origination, Osteoclast recruitment, Resorption, Osteoblast recruitment, Osteoid formation, Mineralization, Mineral maturation, Quiescence.  Bone strength (Quality): In addition to bone porosity, the bone strength is determined by the trabecular microstructure. Perforations of individual trabecula occur when resorption cavities are too deep. This, too, is seen with estrogen deficiency. The remaining trabecula are not as well connected and are mechanically weaker

Mechanism Bone physiology o Microfracture healing is another aspect of bone strength that is not measured by bone density. Trabeculae inside the bone may fracture and microcalluses are formed that resemble the calluses seen on xrays of long bones after a macro-fracture. Osteoporotic bone is more susceptible to e these fractures because the individual trabeculae do not have as many reinforcing connections. The calluses may represent a method of repairing the bone and even connecting some of the trabecula. Bone which has lost the ability to form these calluses will be weaker The age of the bone mineral crystals may also play a role in the strength of bone. This is an area that needs further research. Studies suggest that older bone is more brittle, and that one purpose of bone remodelling is to remove the old bone and replace it with newer, more elastic bone

Mechanism : Bone physiology  Microfracture healing is another aspect of bone strength that is not measured by bone density. Trabeculae inside the bone may fracture and microcalluses are formed that resemble the calluses seen on xrays of long bones after a "macro-fracture". Osteoporotic bone is more susceptible to these fractures because the individual trabeculae do not have as many reinforcing connections. The calluses may represent a method of repairing the bone and even connecting some of the trabecula. Bone which has lost the ability to form these calluses will be weaker.  The age of the bone mineral crystals may also play a role in the strength of bone. This is an area that needs further research. Studies suggest that older bone is more brittle, and that one purpose of bone remodelling is to remove the old bone and replace it with newer, more elastic bone

Clinical manifestation and types Secondary osteoporosis: Mndocrine and metabolic: hypogonadism hyperparathyroidism, hyperthyroidism, Cushing syndrome, acidosis Gaucher's disease Marrow diseases: myeloma, mastocytosis, thalassemia Medications: corticosteroids, dilantin, gonadotropin releasing hormone agonists, loop diuretics, methotrexate, thyroid, heparin, cyclosporin, depot-medroxyprogesterone acetate Malabsorption, Hepatic disease, others Hereditary skeletal diseases osteogenesis imperfecta, rickets, hypophosphatasia t Primary osteoporosis

Clinical manifestation and types  Secondary osteoporosis： Mndocrine and metabolic: hypogonadism, hyperparathyroidism, hyperthyroidism, Cushing syndrome, acidosis, Gaucher's disease; Marrow diseases: myeloma, mastocytosis, thalassemia; Medications: corticosteroids, dilantin, gonadotropin releasing hormone agonists, loop diuretics, methotrexate, thyroid, heparin, cyclosporin, depot-medroxyprogesterone acetate; Malabsorption、Hepatic disease, others；  Hereditary skeletal diseases: osteogenesis imperfecta, rickets, hypophosphatasia;  Primary osteoporosis