© 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

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

正常 骨質疏鬆症

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

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)

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

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

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

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。

What food and drink are

high in calcium and

vitamin D ?

什麼食物富含鈣和維生素D？

Graphic 79375 Version 3.0

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

EXERCISE運動

30 MIN/ DAY1 天 30 分鐘

3 DAYS/WEEK1 周 3 天

WHEN TO START

TAKING MEDICATIONS?

何時開始服用藥物？

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

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

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。

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

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

THANK

YOU!