1、骨质疏松性骨折诊疗指南（讨论稿）,中华医学会骨科学分会骨质疏松学组卫 小 春,起 草 过 程,2006.11，北京，首届COA大会，指南启动2007.4，广东东莞，骨科精英论坛，指南初稿 2007.7，吉林长春，2007国际骨质疏松高层论坛，指南二稿 2007.11，河南郑州，第二届COA大会，指南三稿,起 草 过 程,编写调查问卷，广泛征求意见专家负责，分部撰写（脊柱骨折、髋部骨折、肱骨近端骨折、桡尺骨远端骨折、药物治疗）邱贵兴教授任组长，专家组集体讨论（关节、脊柱、创伤、内分泌、老年病等专家）衷心感谢各位专家的辛勤劳动,一、 概述,特点：属于脆性骨折 好发于老年人好发部位：脊柱、髋部、肱骨
2、近端、桡尺骨远端面临问题：内固定松动 再次骨折 致残率及 致死率高治疗措施：骨折和骨质疏松同时治疗,二、 临床表现,一般表现：出现压痛、疼痛或原有疼痛加重特有表现：出现畸形、骨擦感、反常活动、功能障碍脊柱变形：身高变矮或驼背畸形,三、 诊断与鉴别诊断,1. 性别：女性多见，也可见于男性 2. 年龄：多见于60岁以上老年人 3. 外伤史：仅为轻微外伤或无明显外伤史4. 临床表现：疼痛、畸形、功能障碍,三、 诊断与鉴别诊断,5. 影像学检查 ：一般要求拍摄正、侧位X片合理应用CT、MRI、CT三维成像技术 6. 骨密度检查 ：双能X线吸收法(DXA) 7. 实验室检查：血、尿常规，肝肾功能，血糖、
3、钙、磷、碱性磷酸酶、25(OH)D和甲状旁腺激素等,三、 诊断与鉴别诊断,8. 鉴别诊断：骨肿瘤、继发性骨质疏松症和骨病导致的骨折9. 危险因素：(1) 主要危险因素：低骨密度、脆性骨折史、高龄65岁、骨折家族病史(2) 次要危险因素：跌倒、抽烟、酗酒；性腺机能减退、早期绝经（20，同时-2.5SD50岁男性2. T-2.5SD者3. 骨质疏松性骨折（髋部、脊柱）患者4. 继发性骨质疏松症伴有骨折高危因素者5. 有骨折史伴有低骨密度（-2.5SDT65岁女性、70岁男性，需进行骨密度检测2. 绝经后妇女、5070岁男性，依临床危险因素程度每两年进行一次骨密度检测3. 经期过渡期伴有危险因素者（
4、如低体重、脆性骨折史、服用某些药物史）4. 50岁成人且有骨折史者,六. 预 防,（二）哪些人员需要进行风险评估5. 继发性骨质疏松症患者（如类风湿性关节炎、服用激素史、低骨量）6. 接受骨质疏松症治疗或正在观察疗效者7. 显示骨丢失而需接受治疗者8. 经期后妇女如停止雌激素治疗者,六. 预 防,（三）患者的自我管理1. 坚持预防2. 戒烟限酒3. 减肥4. 增加肌力运动5. 预防跌倒,参 考 文 献,Cummings SR，Kelsey JL.Epidemiology of osteoporosis and osteoporotic fractures.Epidemiol Rev,1985,
5、7:178-208Camero S.Care of older people.Falls in late life and their consequences implementing effective services.Br Med J,2001,322(7290):855-857.Hoesel LM, Pausch M, Schnettler R, Heiss C.The impact of osteoporosis on the classification of hip and wrist fractures. Med Sci Monit. 2008 ,14(3):HY1-8.Tu
6、ck SP, Datta HK. Osteoporosis in the aging male: treatment options. Clin Interv Aging. 2007,2(4):521-36,参 考 文 献,Tuck SP, Datta HK. Osteoporosis in the aging male: treatment options. Clin Interv Aging. 2007,2(4):521-36Lyritis GP, Paspati, et al. Pain relief from nasal salmon calcitonin in osteoporoti
7、c vertebral crush fractures.A double blind, placebo-controlled clinical study. Acta Orthop Scand Suppl. 1997 Oct; 275: 112-4.Charles H Chesnut , et al. Effects of salmon calcitonin on trabecular microarchitecture as determined by magnetic resonance imaging: results from the quest study. J Bone Miner
8、 Res 2005; 20: 1548-1561Chesnut CH 3rd , Silverman S, Andriano K, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. Am J Med, 2000, 109:267-276.,参 考 文 献,Scott A. et al, Whats New i
9、n Orthopaedic Research, J Bone Joint Surg Am. ,2004; 86:2085-2095.Scott A. Rodeo, Suzanne A. Maher and Chisa Hidaka, Whats New in Orthopaedic Research, J Bone Joint Surg Am. ,2004; 86:2085-2095.中华医学会骨质疏松和骨矿盐疾病分会原发性骨质疏松症诊治指南 Brown JP, et al. 2002 clinical practice guidelines for the diagnosis and man
10、agement of osteoporosis in Canada. CMAJ. 2002;167:sl-s34www.emea.europa.eu/dfs/human/referral/calcitonin/086704en.pdf,参 考 文 献,Meunier PJ, et al.The effects of Strontium Ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis ( SOTI), N Engl J Med 2004; 350: 459-68J.- Y.
11、Reginster, E. Seeman, et al. Strontium Ranelate Reduces the Risk of Nonvertebral Fractures in Postmenopausal Women with Osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) Study. Journal of Clinical Endocrinology and Metabolism 2005;90: 2816-2822 Huusko TM, et al. Randomized double blind cli
12、nically controlled trial of intranasal calcitonin treatment in patients with hip fracture. Calcif Tissre Int 2002, 71:478-484,参 考 文 献,Marie JP, et al. An uncoupling agent containing Strontium prevents bone loss by depressing bone resorption and maintaining bone formation in estrogen deficient rats.
13、J Bone Min Res. 1993; 8 (5): 607Lyritis GP, Paspati, et al. Pain relief from nasal salmon calcitonin in osteoporotic vertebral crush fractures.A double blind, placebo-controlled clinical study. Acta Orthop Scand Suppl. 1997 Oct; 275: 112-4.CLINICIANS GUIDE TO PREVENTION AND TREATMENT OF OSTEOPOROSIS.NATIONAL OSTEOPOROSIS FOUNDATION.2008,讨 论 问 题,稳定性问题：COBB角度、症状、影像学单节段和多节段问题合并神经症状的问题 药物用名问题用药时间问题严重桡骨远端粉碎性骨折，双侧钢板内固定问题,谢谢,
