2014.06.05骨质疏松诊治与中医药.ppt

具有中医特色的干预措施 一级预防：“未病先防” (1)调摄精神，(2)调节饮食 (3)科学健身 如五禽戏、太极拳、气功、散步、八段锦、慢跑、游泳等 (4)起居有常：顺应四时气候变化 6)积极的中医药防治：补肾健骨，调 补后天脾胃，补气活血 二级预防：有病早治、既病防变 通过调查和骨密度筛查，早发现，早诊断，早治疗 通过药物与非药物手段，缓解骨痛，增进健康，延缓衰老，提高生活质量。 在治疗中，积极应用行之有效的补肝肾以及补气活血中药，积极的中医康复治疗 抑制骨转换率：适用于骨转换率增高者，常选用骨吸收抑制剂以防止骨量进一步丢失，主要的药物有雌激素类、降钙素和氨基二磷酸盐等。 增加骨量：可选用骨形成刺激剂。临床上可用的有氟化物等 抑制继发性甲状旁腺功能亢进症的发生，常选用骨矿化促进剂以纠正低钙血症。 治疗原则 1．抗骨吸收药物 雌激素替代疗法(HRT 选择性雌激素受体调节剂(SERM) 降钙素 双膦酸盐类药物 2．促进骨形成药物 甲状旁腺激素（PTH） 氟化物 他汀类药物 成骨生长肽(OGP) 骨髓基质干细胞治疗 3．其它药物 植物雌激素 常用的药物及应用 防治骨质疏松药物作用机制 Ca2+ 维生素D 骨 转换、塑型 Ca2+ 代谢 摄取 骨吸收 骨形成 雌激素 SERMS 双膦酸盐 鲑鱼降钙素 PTH 氟化物制剂 Definition of Osteoporosis The definition of osteoporosis continues to evolve as we gain a better understanding of the underlying changes in bone and the mechanisms for these changes that lead to the disease. At a National Institutes of Health Consensus Development Conference held in 2000, osteoporosis was defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture, and states that bone strength is a reflection of both bone density and bone quality.1 ? These photographs compare the structure of normal versus osteoporotic bone, illustrating the point that osteoporosis is characterized not only by loss of bone mineral density, but is also associated with a decline in bone quality, including architectural abnormalities, trabecular thinning and loss of trabecular connectivity. This microarchitectural deterioration may particularly increase the risk of vertebral fracture, since trabecular bone dominates in the vertebra. ? 1. NIH Consensus Development Panel. JAMA 2001;285:785-95 According to the NIH Consensus Statement, bone strength reflects the integration of bone quality and bone density. Bone density is expressed as grams