课件：第四章骨健康的临床评价.ppt

53% of the 664 patients had known risk factors by medical history alone:Glucocorticoids, premature ovarian failure, weight loss, malnutrition, alcoholism, liver disease, immobility, chemotherapy, hyperthyroidism, anticonvulsants, RA, SLE, hyperparathyroidism, malabsorption, metabolic or bone disorders, other meds affecting bone. 173 healthy women ages 46-87 without prior laboratory abnormalities or history of secondary etiologies underwent a comprehensive laboratory review that included a CBC, chemistry, 24 hour urine calcium, PTH, 25 OH vitamin D, TSH, SPEP. The authors found hypercalciuria, malabsorption, hyperparathyroidism, vitamin D deficiency, Exogenous hyperthyroidism, Cushings, Hypocaliuric hypercalcemia in 32% (post publication personal communication from Tannenbaum and Luckey disclosed laboratory abnormalities in 44% of those completely tested when the normal vitamin D level was accepted 20). Most common etiologies found included: Glucocorticoids, premature ovarian failure, vitamin D deficiency, and hypercalciuria. In other studies hyperthyroidism is commonly found. Frequency of laboratory abnormalities in 173 women extensively tested for secondary etiologies. Note: 25 additional cases found when abnormal 25 hydroxyvitamin D was changed from less than 12.5 ng/ml to 20 ng/ml. Malabsorption from gluten sensitive enteropathy discovered by low BMD hip. The value of a urine calcium is illustrated here. General tests useful – CBC High calcium level may indicate hyperparathyroidism Alk phos -non-specific but if elevated, can point to a bone problem (Paget’s, new fracture, cancer, osteomalacia) Very underutilized: 24-hour urine calcium - If over 4 mg/kg (300 mg in men and 250 mg in women) must consider primary hyperparathyroidism/idiopathic hypercalciuria etc. or under 50 mg/24 hours (malabsorption/insufficient intake/etc.) is of concern. More involved tests are used in case finding strategy if history and exam indicate a problem. If SPEP or UPEP abnorma