Osteoporosis UNC School of Medicine（骨质疏松症北卡罗来纳大学医学院）.pptVIP

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Osteoporosis UNC School of Medicine（骨质疏松症北卡罗来纳大学医学院）.ppt

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Osteoporosis UNC School of Medicine（骨质疏松症北卡罗来纳大学医学院）

Osteoporosis An Inpatient Topic? July 2006 Background The problem Osteoporosis is common Over 50% of women and 30-45% of men over age 50 have osteopenia/osteoporosis White woman over age 50: 50 % lifetime risk of osteoporotic fracture, 25% risk vertebral fracture, 15% risk of hip fracture Man over age 60 has 25% risk osteoporotic fracture 70% over age 80 have osteoporosis Background Hip fractures are bad 20% patients with hip fracture die within the year 25-30% need placement in skilled nursing facility Why is this an inpatient topic? Older patients have frequent admissions and increased length of stay, increasing possible points of contact Patients from nursing facilities, those at greatest risk, may have little continuity Discharge medications for patients going to skilled nursing facilities can have LARGE impact Study: Only 6% of patients admitted with hip fracture to a tertiary care hospital were adequately treated for osteoporosis at discharge, only 12% at 5 years! Another study: only 21% medicare beneficiaries with hip fracture had any prescription treatment; patients older than 74 and those with other comorbidities were least likely to receive treatment What is Osteoporosis? Loss in total mineralized bone Disruption of normal balance of bone breakdown and build up Osteoclasts: bone resorption, stimulated by PTH Calcitonin: inhibits osteoclastic bone resorption Major mechanisms: Slow down of bone build up: osteoporosis seen in older women and men (men after age 70) Accelerated bone breakdown: postmenopausal Normal loss .5% per year after peak in 20s Up to 5% loss/year during first 5 years after menopause Defining Osteoporosis “systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk” True Definition: bone with lower density and higher fracture risk WHO: utilizes Bone Mineral Density as definition (T score -2.5); surrogate marker W