米国HIV治疗伴课题.pptVIP

* 15,000 participants in Third National Health and Nutrition Examination Survey (NHANES III), performed between 1988-1994 by the National Center for Health Statistics Determination of CKD prevalence predicated on accurate prediction of GFR from serum creatinine values 8-11 million people with CKD * * * * * * * * BACKGROUND Osteoporosis has long been considered a disease of women Orwoll et al sought to compare the physiology and pathophysiology of bone and osteoporosis in men versus women MAIN MESSAGES The figure illustrates the effects of age on trabecular bone volume in men and women Bone volume increases at different rates in men and women until peak bone mass is achieved in early adulthood Bone loss begins in early adulthood in both men and women, underscoring for clinicians the need to evaluate risk factors for bone loss in both genders The relative influences on peak bone mass in men are estimated to be 40–83% heritable or genetic and the remainder environmental Following acquisition of peak bone mass, bone loss occurs relatively slowly (0.5–1.0% per year) with age in both men and women, but women are additionally exposed to accelerated bone loss after the menopause TRANSITION Diagnostic criteria have been developed by the WHO to characterize the degree of bone loss, and the definitions used are shown on the next slide. * BACKGROUND It is unclear the individual role of traditional versus non-traditional risk factors for bone loss in HIV infected patients. Glesby et al attempted to summarize the multitude of factors that may contribute to decreased BMD in HIV-infected patients based upon available data MAIN MESSAGES HIV infected patients have risk factors traditionally associated with bone loss HIV infected patients have additional risk factors for decreased BMD, including HIV itself and certain ARVs HIV can affect bone density by activating T-cells, causing a permanent inflammatory state and release of cytokines that disrupt normal bone formation and reso