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?????????S?. ???s?????????? ?????a - S??pt??at?????a??????s?Te?ape?a - T??. ???S???. ???????????S: ???a? ? ??????? pe???d?? p?? s??at?d?te? t? ?et??as? ap? t?? a?apa?a?????? st? ?? pa?a?????? f?s? t?? ???? t?? ???a??a?. ??a??e? p???? ?????a (45-65 et??) ?a? ?p?d?

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. , MSc

/ & /


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    .

    (45-65 ) .


  • :

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  • :

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2.

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(, , 2-8 , )


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    (, -)

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  • / (FSH, E2)

  • FSH-test


()


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    ... ..


: -

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4.

5.

6.

/

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Source:

:

,

.WHO 1994

Review:

Reviewer Memo:

, .

.

ational Osteoporosis Foundation 2000

IH Consensus Development Panel on Osteoporosis JAMA 285:785-95; 2001

Slide Modified:

Memo:


, () () , () .


4 :

:-1 SD

: -1 SD -2.5 SD

: >2.5 SD

: 1 .

2 :

( I)

( II)

&


:

200.000.000

  • 40 50 % 50

  • 30% 65

  • :

    • 20% 1

    • 20% ,

    • 50%

    • ,


:

35%

20,4 % >>

1977 : 5100 ( 22,49 % > 80 )

  • : 10953 >> >> ( 50 % > 80 )

    1997 : 13870 >> >> ( 54 % > 80 )

    24 % .

    60 %

    50 %

    . . 1994, 1999


4000

3000

/100,000 /

2000

1000

20

3539

> 85

3539

> 85

O

13 %

40 %

Cooper et al., J Bone Min Res1992


1,000,000

2,000,000

1,500,000

1,200,0001

513,0002

500,000

228,0002

184,3003

0

National Osteoporosis Foundation, 2002. Available at: http://www.nof.org.

2 American Heart Association. Heart & Stroke Facts: 1999 Statistical Supplement.

3 American Cancer Society. Breast Cancer Facts & Figures 1999-2000.

1


(kg)

50

40

30

20

10

0

01020304050607080

o


Finkelstein JS. Cecil Textbook of Medicine. 21st ed. 1999;1366-73

Riggs BL, Melton LJ III. N Engl J Med. 1986;314:1676-86.


  • 1% - 2% 10

  • 3-6


  • > 30%

  • (50% , 25% , 25% Colles)


Source:

Review:

  • (, )

Reviewer Memo:

Papaioannou P et al. Am J Med 113:220-228,2002

Slide Modified:

Memo:


,

&

&

Heaney RP. Bone 33:457-465, 2003


, ,

.


  • BMD


  • (.. , Ca, P, , / )

  • DEXA

  • (TSH, PTH, Ca, Vit D )

Baldor RA, Update on Osteoporosis, American Academy of Family Physicians 2003 Scientific Assembly


- .

Marshall et al. BMJ 1996; 312: 1254-9

.


  • (DEXA)

  • CT

  • US


DEXA

( 2 )

.

X-ray

( 2 )


DEXA

  • BMD = g/cm2

  • 2-5

  • 2-3 mrem

  • (2 4)

  • ( Ward)


(BMD)

  • ( Bone mass density BMD)

  • T-score:

    BMD BMD

  • Z-score:

    SD BMD BMD ,

Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1-129.


()


B

  • -

    -

    -

    -PICP, PINP ( )

  • -Ca 2

    -OH - 2

    - (Pyr)

    -CTX, NTX ( -- 2)


  • , ,

  • . ,

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SERMs

D

ranelate


META THN MELETH W H I .

.. .

... , .

SERMs.

... . ... .

, .

ACOG Statement for the prevention and treatment of postmenopausal osteoporosis. October 7, 2003


:

1.

2. ..


Hendlund 1983, Bonucci 1995

Farley 1992, Wallach 1993

H

( ...

b )

Azria 1995

H

( ,

.. )

1996


SERMs (Evista)


(Livial)

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  • : 2.5mg/


-

H

G

-


FORSTEO

  • T (rDNA)

  • 20 g

    18

    3.


Strontium ranelate:

Marie PJ et al. Calcif Tissue Int. 2001;69:121-129.


Strontium ranelate:

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-D

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  • : 1)

    (, , )

    2)

    ( , )

  • SERMs

  • E


  • ( , & )

  • DEXA gold standard

  • T-score

  • 2

  • ( )

  • 2



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