Osteoporosis骨质疏松 · 老年第一致残

Place · Level 3 · Condition

DXA T + FRAX · 髋骨折 1 年死亡 20-30% · 钙+D+蛋白+力量 · 双膦/Denos/Romo · 围绝经窗口

The silent killer

Stop 1/5

骨质疏松 · 沉默的杀手

Osteoporosis = progressive decline in bone mineral density and microarchitecture → ↑ risk of fragility fracture.

Epidemiology (China 2018 survey):

32% of 65+ y/o women + 6% of men have osteoporosis~ 19% of 50+ y/o women + 6% of men~ 2 million fragility fractures per yearHip-fracture 1-year mortality 20-30%, residual disability 40-50%One of the leading causes of disability in older adults
WHO osteoporosis definition (DXA T-score):

Normal: T ≥ -1.0Osteopenia: -2.5 < T < -1.0Osteoporosis: T ≤ -2.5Severe osteoporosis: T ≤ -2.5 + any fragility fracture
DXA:

Lumbar spine + hip + femoral neck standard sitesScreening: women 65+, men 70+ (any) / 60+ (with risk)
Risk factors:

Non-modifiable: female + older age + family history + early menopause + Caucasian / Asian + small frameModifiable:Insufficient calcium / D / protein intakeSedentary lifestyleSmoking + heavy alcoholLow body weight (BMI < 18.5)Long-term steroids (≥ 5 mg prednisone-equivalent ≥ 3 months)Hypogonadism (low T / low E2)Hyperthyroidism / hyperparathyroidism / Cushing'sEstrogen blockers (aromatase inhibitors for breast cancer)Long-term PPI / anticonvulsants / SSRI / chemotherapy
FRAX assessment (Kanis 2008):

10-year major + hip-fracture probabilityIntegrates age / sex / BMI / risk factors / DXAOnline tool: FRAX.shef.ac.uk (China model available)DXA + FRAX combined drives treatment
Common osteoporotic fracture sites:

Vertebral compression (most common, 50%+ of patients): sudden back pain; some asymptomatic and only found on X-ray → height loss + kyphosisHip fractures (femoral neck / intertrochanteric): the most serious in older adultsDistal radius (Colles' fracture): from a fall onto an outstretched hand; common first presentation in middle-aged womenProximal humerus / ribs / pelvis: other fragility sites
"The postmenopausal window" (atlas perimenopause L4):

Bone loss is fastest in the first 5-10 years post-menopause (-2-5%/year)Building reserve at 35-50 + early intervention at menopause = the key to lifelong bone health

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本站提供科普与一般性建议，不替代医师诊断或处方；有症状或正在服药请咨询合格医师。 Educational content, not medical advice — consult a clinician for diagnosis or treatment.

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