osteoporosis - ladiamondlionsclub.org · osteoporosis 骨質疏鬆症 presenter: katherine lin, d.o...
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© 2018 Southern California Permanente Medical Group August 17, 2019
Osteoporosis骨質疏鬆症
Presenter:
KATHERINE LIN, D.O
OSTEOPATHIC DOCTOR
KAISER FONTANA MEDICAL CENTER
INTERNAL MEDICINE
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What is Osteoporosis?
什麼是骨質疏鬆症?
Thinning of bones 骨骼變薄
Postmenopausal women is at risk
because female hormone helps to
maintain bone mass.
絕經後婦女處於危險之中,因為女性荷爾蒙有助於維持骨量。
Increased risk of fractures 骨折風險增加
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正常 骨質疏鬆症
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Each year in the US, osteoporosis
leads to approximately 2.0 million
fractures在美國,骨質疏鬆症每年導致約200萬次骨折
Vertebrae fractures
椎骨骨折 550,000 cases
Wrist fractures
手腕骨折 400,000 cases
Hip fractures
髖部骨折 300,000 cases
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How Do I know if I have
osteoporosis? 如何知道我是否患有骨質疏鬆症?
DEXA SCAN (Dual-energy x-ray absorptiometry) 雙能X射線吸收
SCREENING women 篩選測試女性 > 65 yo
Men or women < 65 yo with high risks
(past fracture, cigarette,
Alcohol, on medications)
男性或高風險
(過去骨折,香煙,
酒精,藥物)
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T- Score :
NORMAL 正常: +1 TO -1
OSTEOPENIA
低骨密度 (LOW BONE
MASS) :
-1 TO -2.5
OSTEOPOROSIS
骨質 疏鬆症: < -2.5
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FRAX – FRACTURE RISK
ASSESSMENT TOOL
骨折風險評估工具
The formula for measuring your risk uses factors such as: 衡量風險的公式使用以下因素:
Age 年齡
Weight 重量
Gender 性別
Smoking history 吸煙
Alcohol use 飲酒
fracture history 骨折病史
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PREVENTION 預防
CALCIUM + VITAMIN D 鈣 和維生素 D
REDUCE ALCOHOL AND SMOKING TOBACCO 減少酒精和吸煙
EXERCISE – RESISTANCE TRAINING
運動 + 阻力訓練
AVOID FALLS – ( RUGS, ELECTRICAL CORDS) 避免地毯, 電線
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CALCIUM + VITAMIN D
鈣 和 維生素 D
Postmenopausal women:
Calcium 鈣: 1200mg DAILY
Building block for bones 骨骼的基本材料
VITAMIN D 維生素 D : 800 IU DAILY
Human skin can make large amounts of vitamin D when lots of
skin is exposed and the sun is high in the sky.
當皮膚暴露在陽光下時,人類皮膚可以產生大量的維生素D。
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What food and drink are
high in calcium and
vitamin D ?
什麼食物富含鈣和維生素D?
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Graphic 79375 Version 3.0
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Food Calcium, milligrams
Milk (skim, 2 percent, or whole, 8 oz [240 mL]) 300
Yogurt (6 oz [168 g]) 250
Orange juice (with calcium, 8 oz [240 mL]) 300
Tofu with calcium (1/2 cup [113 g]) 435
Cheese (1 oz [28 g]) 195 to 335 (hard cheese = higher calcium)
Cottage cheese (1/2 cup [113 g]) 130
Ice cream or frozen yogurt (1/2 cup [113 g]) 100
Soy milk (8 oz [240 mL]) 300
Beans (1/2 cup cooked [113 g]) 60 to 80
Dark, leafy green vegetables (1/2 cup cooked [113 g]) 50 to 135
Almonds (24 whole) 70
Orange (1 medium) 60
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EXERCISE運動
30 MIN/ DAY1 天 30 分鐘
3 DAYS/WEEK1 周 3 天
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WHEN TO START
TAKING MEDICATIONS?
何時開始服用藥物?
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Indications for medications
History of hip or vertebral fracture
髖關節或椎骨骨折史
DEXA scan shows T score of < -2.5
DEXA 掃描顯示 T < -2.5
T score -1 to -2.5 with a higher risk of fracture
defined by FRAX score for
Major osteoporotic fracture 10-year
probability of 20% or higher OR
Hip fracture 10-year probability 3% or higher
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MEDICATIONS -BISPHOSPHONATES
SLOW THE BREAKDOWN AND REMOVAL OF
BONE 減緩骨骼的分解
Alendronate ( brand name: Fosamax) – once
weekly
Risedronate ( Actonel, Atelvia) – can be taking
daily, weekly, or monthly
Ibandronate (Boniva) – oral or IV every 3
months
ZOLEDRONIC ACID (RECLAST) – once a year
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Side effects of bisphosphonates 雙磷酸鹽副作用
Upset stomach 胃酸
Osteonecrosis of the jaw in patients undergoing invasive dental work : 下巴骨壞死
In general, very low risk 風險極低
higher risk when higher dose of IV bisphosphonates are given during cancer treatment 在癌症治療期間給予更高劑量的IV雙磷酸鹽時,風險較高
Long term use ( > 7years) : increase risk of unusual type of femur (thigh bone) fracture.
長期使用增加大腿骨折的風險。
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SUMMARY 總結
SCREEN WITH BONE DENSITY SCAN
骨密度掃描
SUPPLEMENTS:
CALCIUM 鈣 1200mg + VITAMIN D 維生素D 800 IU
EXERCISE 運動 – 30 min/day, 3 days /week
MEDICATIONS 藥物
Follow up with bone density scan every 2 years 每2年進行骨密度掃描
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REFERENCE
https://www.uptodate.com/contents/overview-of-the-
management-of-osteoporosis-in-postmenopausal-
women?search=OSTEOPOROSIS&source=search_result&s
electedTitle=1~150&usage_type=default&display_rank=
1
Burge R, Dawson-Hughes B, Solomon DH, et al.
Incidence and economic burden of osteoporosis-related
fractures in the United States, 2005-2025. J Bone Miner
Res 2007; 22:465.
http://www.osteoporosisinstitute.org/wp-
content/uploads/DXA-example.jpg
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THANK
YOU!