the individual patients risk for osteoporotic fracture评估骨质疏松性骨折患者个体风险课件

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1、Selectingpatientsfortreatment:SelectingChoiceoftherapyWhatisbisphosphonatefailureandwhentochangecourseOsteoNecrosisoftheJawOsteoporosisC.R.Kannan.M.D.PretestQuestionsHowreliableistheDEXAtestforDxandofosteoporosis?A.HighlysensitiveB.HighlyspecificC.Nothelpfulinpeopleunder65yearsD.Serv

2、esasagoodfollowuptooltoassessresponsetoRx64yearoldwomanPostmenopausal12yearswasonERTfor4yearsC/oLowbackpainSmoker124lbMaternalhistoryofhipfracturePriorhistoryofvertebralfractureT-score–1.7inLST-score-1.5inhipOsteopeniaWasrecommendedcalciumandMVTcontainingDWHO.GuidelinesforPreclinical

3、EvaluationandClinicalTrialsinOsteoporosis;1998.T-ScoreOsteopeniaOsteoporosisNormal–2.5–2–10WHO=WorldHealthOrganization.WHODiagnosticCategoriesforOsteoporosisHowsensitiveistheDEXAtestforDxofosteoporosis?DefiningosteoporosisasaT-scorebelow–2.5doesnoteffectivelycapturemanypatientsatri

4、skforfractureTheProblem:FractureRiskScoreBlackDM,etal.OsteoporosInt.2001;12:519-528.T-score–1.0to–2.0–2.0to–2.5<–2.5NeedforarmstostandupCurrentsmokerWeight<125IbMaternalhipfracture>50yearsBrokenbones>50yearsAge65yearsParameterYesYesYesYesYesYesYesYes5-yearincrementsFeature234211111

5、–5PointValueFractureRiskAssessmentMrs.R64yearsofageT-score–1.7Smoker124lbMaternalhistoryofhipfracturePriorhistoryofvertebralfractureMrs.R(Patient2):RiskAssessmentBlackDM,etal.OsteoporosInt.2001;12:519-528.AgeClinicalParameter64yearsoldMrs.R0RiskScoreT-score–1.72WeightMaternalhipfract

6、ureSmokingFracturehistoryTotalScore124IbYesYesYes6points1111HowspecificistheDEXAtestforDxofosteoporosis?WhatisaZscore?Tscorecomparesthepatient’sBMDwiththatofa28yearoldatpeakbonemassZscorecomparesthepatient’sBMDwiththatofherownagematchedcohortTscore-2.8ZScore-160yearoldwomanTscore-2.8

7、ZScore-3Tscore-2.8ZScore-360yearoldwomanLookforsecondarycausesforLowBMDVitaminDdeficiencyMetastaticdiseasetospineMultiplemyelomaRenalosteodystrophyHyperthyroidism1.SirisES,etal.JAMA.2001;286:2815-2822.2.WainwrightSA,etal.JBoneMinerRes.2001;16:S155.SummaryTraditionalmodelofosteoporosi

8、slookstotrea