骨质疏松in_SCI4-15讲稿.pptVIP

Osteoporosis in Spinal Cord Injury Outline Basic Terminology Mechanism of Osteoporosis Osteoporosis in the General Population Special Issues in SCI Prevention Treatment Disclaimer I have no financial, personal, or business interest in any of the medications or treatments mentioned in this lecture. Lecture Overview The incidence and treatment of osteoporosis varies with age, sex, type, and level of spinal cord injury. SCI physicians take care of a wide range of patients (ASIA A to E). Osteoporosis in the general population (applicable to our incomplete patients and aging population) Specific issues in para/tetraplegic patients. Incidence Prevention Treatment Clinical Definitions Osteopenia- reduction in bone mass below the theoretical fracture threshold. Osteoporosis- reduction in the bone mass to a level where there is increased risk of fracture in the absence of trauma. Or a fracture has already occurred. 影响骨代谢的激素 甲状腺激素：促进生长发育 缺乏：呆小病 甲状旁腺激素： 促进骨钙入血， 刺激破骨细胞的活动，激活肾内的1-ɑ羟化酶,促使25-OH-D3转化为有高度活性的1-25-OH-D3.促进对钙和磷的吸收 降钙素 甲状腺C细胞分泌,降低血钙和血磷,抑制破骨细胞的活动,使溶骨过程减弱,同时使成骨过程增强,促进骨组织钙\磷沉积. 1-25-二羟维生素D3: 维生素D3是胆固醇衍生物,可从肝\乳\鱼肝油等食物中摄取,也可在体内由皮肤合成. VD-肝内25-羟化酶租用下形成25-OH-D3,在肾近曲小管1-ɑ羟化酶催化下形成1-25-OH-D3.对动员骨钙入血和钙在骨中沉积都有作用.总效应是血钙升高. 肾上腺皮质激素 抑制骨生成 雌激素: 增强成骨细胞活动和钙\磷沉积,促进骨的成熟及骨骺愈合. The parathyroid glands secrete parathyroid hormone (PTH) when serum calcium levels are too low PTH stimulates the activity of the 1-hydroxylase enzyme in the kidney, resulting in increased production of calcitriol, the biologically active form of vitamin D3. Increased calcitriol production increases serum calcium levels by: activating the vitamin D-dependent transport system in the small intestine to increase absorption of dietary calcium increasing the reabsorption of calcium by the kidneys. increasing the mobilization of calcium from bone into the circulation *stimulating bone reabsorption. Classification:National Osteoporosis Foundation (NOF) Primary Type 1- post menopausal Type 2- senil