20xx年醫(yī)學(xué)專題—類固醇誘發(fā)的骨質(zhì)疏松-文庫吧資料
2024-11-13 23:52本頁面
【正文】 ed vertebral fracture rates from 518 patients on steroid therapy. *P=0.016 vs. control. Reid D, et al, 1998.,*,第三十九頁，共四十九頁。,Effect of Risedronate on BMD inPatients Initiating Corticosteroid Therapy,*P0.05 vs control. Cohen S, et al, 1998.,*,*,*,*,*,*,4.0,2.0,0.0,2.0,4.0,Lumbar spine,Femoral neck,Trochanter,Change in BMD from baseline (%),at 12 months,Control,Risedronate 2.5 mg,Risedronate 5 mg,第三十七頁，共四十九頁。 **P0.01 vs. control。 Saag KG, et al, 1998.,*?,*?,*?,*?,?,**?,*?,**?,第三十五頁，共四十九頁。 **P 0.01 vs. control。,Efficacy of Pamidronate in the Prevention of Bone Loss,Boutsen Y, et al, 1997.,6,4,2,0,2,4,6,6 months,12 months,6 months,12 months,Changes in BMD from baseline (%),Pamidronate + calcium,Calcium only,第三十四頁，共四十九頁。,Cyclical Etidronate and Prevention of CorticosteroidInduced Bone Loss,*P0.05 betweengroup difference. Adachi JD, et al, 1997. Roux C, et al,1998.,*,*,4,3,2,1,0,1,2,Lumbar,spine,Femoral,neck,Trochanter,Lumbar,spine,Femoral,neck,Trochanter,Changes in BMD from baseline (%) at 1 year,Etidronate,Control,第三十二頁，共四十九頁。,Testosterone Replacement Therapy in the Treatment of CIO,*P=0.005 vs control。,0.06,0.04,0.02,0,0.02,0.04,0.06,Group 1,Prednisone,only,Group 2,Prednisone,+ ERT,Group 3,Control,Group 4,ERT only,Changes in lumbar spine BMD (g/cm,2,),at 1 year,Estrogen Replacement Therapy in the Treatment of CIO,*P=0.008 vs. baseline。,Pharmacologic treatment of CIO,Thiazide diuretics increase calcium absorption from GI tract decrease urinary calcium excretion Fluorides stimulate osteoblast activity Anabolic steroids increase bone formation,第二十八頁，共四十九頁。 calcium,Placebo,第二十六頁，共四十九頁。,Management of CIO: Goals of Treatment,Reduce fracture risk Maintain current BMD, prevent additional bone loss Alleviate pain associated with existing fracture(s) Maintain/increase muscle strength Initiate lifestyle changes as needed,第二十五頁，共四十九頁。 SD=standard deviation.,WHO Criteria for Assessing Disease Severity,第二十三頁，共四十九頁。,Patient Evaluation,Complete blood count and erythrocyte sedimentation rate ( ESR ) Serum calcium, phosphate, creatinine, electrolyte, alkaline phosphatase, 25hydroxyvitamin D, estradiol, testosterone ( male ) 24 hrUrinary calcium and creatinine BMD of spine and hip Xrays of appropriate areas,laboratory,第二十二頁，共四十九頁。,Patient Evaluation,History Documentation of height , weight , muscle strength , balance , vision Documentation of medical history Documentation of menstrual history, infertility in men Fracture history and Family history of fractures Other risk factors for osteoporosis : Lifestyles influences : calcium and vitamin D intake, smoking, alcohol intake, medications, prevention of falling Patient education : prevention of falling , exercise General health and prognosis,第二十頁，共四十九頁。,Osteoblast proliferation Apoptosis OB number Protein synthesis Bone formation Differentiation Bone mass Fracture Risk Androgen Osteoclast apoptosis Bone resorption Osteoclast formation PTH Calcium and phosphate absorption ( gut and ki
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