骨质疏松性骨折Osteoporotic-Fxs-培训课件.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Prevention and Treatment of Bone Fragility Fosmax Shown to increase the bone density in femoral neck in post menopausal women with osteoporosis (Lieberman et al. NEJM 1995) Reduced hip fracture rate by 50% in women who had sustained a previous vertebral fracture. (Black et al. Lancet 1996) Prevention and Treatment of Bone Fragility Calcium/Vitamin D Supplementation Recommended for most men and women 50 years Calcium Age 50 -- 1,000 mg/day Age 50 -- 1,200 mg/day Vitamin D Age 51-70 -- 400 IU/day Age 70 -- 600 IU/day Combining Vitamin D and calcium supplementation has been shown to increase bone mineral density and reduce the risk of fracture Prevention and Treatment of Bone Fragility Calcitonin Inhibits bone resorption by inhibiting osteoclast activity Approved for treatment of osteoporosis in women who have been post-menopausal for 5 years Daily intranasal spray of 200 IU Trial demonstrated 33% reduction of vertebral compression fractures with daily therapy (Chesnut Am J Med 2000) No effect on hip fractures demonstrated Prevention and Treatment of Bone Fragility Bisphosphonates Inhibits bone resorption by reducing osteoclast recruitment and activity Bone formed while on bisphosphonate therapy is histologically normal Available formulations Alendronate Risendronate Ibandronate Strongest evidence for rapid fracture risk reduction Decreasing the incidence of both vertebral and nonvertebral fractures Prevention and Treatment of Bone Fragility Teriparatide (Forteo) Recombinant formulation of parathyroid hormone Stimulates the formation of new bone by increasing the number and activity of osteoblasts Once daily subcutaneous injection of 20 ?g Study of 1637 post-menopausal women 65% reduction in the incidence of new vertebral fractures 53% reduction in the incidence of new nonvertebral fractures Conclusions Prevention is multifaceted Cost containment also a joint effort between orthop