Guidelines for diagnosis and treatment of secondary osteoporosisSecondary osteoporosis is a metabolic bone disease due to reduced, caused by
Guidelines for diagnosis and treatment of secondary osteoporosis
Secondary osteoporosis is a metabolic bone disease due to reduced, caused by disease or drugs cause bone damage, bone microstructure and bone fragility fracture easily. There are many causes of secondary osteoporosis, which are mostly caused by endocrine and metabolic diseases, connective tissue diseases, kidney diseases, gastrointestinal diseases and drugs.
A common cause
1 endocrine and metabolic diseases: hyperparathyroidism, Cushing syndrome, hypogonadism, hyperthyroidism, pituitary prolactinoma, diabetes (mainly in type 1 diabetes mellitus), hypopituitarism.
2 connective tissue disease: systemic lupus erythematosus, rheumatoid arthritis, Sjogren syndrome, dermatomyositis, mixed connective tissue disease.
3 kinds of chronic kidney disease cause renal bone dystrophy.
4 gastrointestinal diseases and nutritional disorders: malabsorption syndrome, gastrointestinal tract after gastrectomy, chronic pancreatic disease, chronic liver disease, protein calorie malnutrition, long-term parenteral nutrition support treatment.
5 hematological disorders: leukemia, lymphoma, multiple myeloma, Gaucher disease and myelodysplastic syndrome.
6 neuromuscular disease caused by a variety of reasons: hemiplegia, paraplegia, motor dysfunction, muscular dystrophy, stiff man syndrome and myoclonus syndrome.
7 long term braking or space travel.
8 after organ transplantation.
9 drugs: glucocorticoid and immunosuppressants, heparin, anticonvulsant, anticancer drugs, aluminum containing antacids, thyroid hormone, GnRH-a or dialysate etc..
Two, clinical manifestation
1 symptoms depending on the degree of osteoporosis and the nature of the primary disease. Most of the symptoms are more hidden, no diagnostic specificity, often masked by the performance of the original disease, many patients in the X film was found to have been complicated by osteoporosis. Some patients complained of low back pain, weakness, limb twitching or difficulty in movement. Serious illness can have obvious bone pain, slight injury is prone to hip or spine, ribs, bone fracture, rib fracture in secondary osteoporosis in primary osteoporosis is more common.
The 2 main signs and primary osteoporosis is similar, can have serious height, kyphosis, kyphosis or chest deformity.
3 clinical manifestations of primary diseases.
Three, diagnostic points
At present, there is no direct method to measure bone strength, so it is often used in clinical diagnosis of bone mineral density (BMD) and fragile fracture. For secondary osteoporosis, but also need to have a clear cause of osteoporosis.
1 brittle fracture: is the final result of the decline in bone strength, so there is a clear disease or drug caused by brittle fracture can be diagnosed with secondary osteoporosis.
Determination of bone mineral density: 2 in primary osteoporosis guidelines.
3 bone mineral density measurement: see the guidelines for diagnosis and treatment of primary osteoporosis. More attention should be paid to the Z value when analyzing the results
4 diagnostic criteria: refer to the diagnostic criteria recommended by WHO (WHO). Refer to the guidelines for diagnosis and treatment of primary osteoporosis.
5 x ray plain film: the sensitivity and accuracy of the diagnosis of osteoporosis is low, so it is not helpful for the early diagnosis of osteoporosis. However, it is of great value in the diagnosis of bone fracture and joint lesions.
6 biochemical markers of bone turnover: at present, there is not a biochemical index for the diagnosis of osteoporosis. It is mainly used in the classification of bone turnover, the rate of bone loss, the monitoring of disease and the evaluation of drug efficacy. Clinical guidelines for the diagnosis and treatment of primary osteoporosis with common biochemical markers of bone turnover.
7 causes of osteoporosis related to the detection of the original disease: such as liver and kidney function, autoimmune indicators, thyroid function, parathyroid function, gonadal function, tumor related checks, etc..
Four, treatment principles and programs
1 the treatment of primary diseases: actively looking for the cause of osteoporosis, for the effective treatment of secondary osteoporosis, is of great significance. Once the cause is clear, should be timely treatment of the original disease.
2 general measures: pay attention to eating a balanced diet rich in calcium, low salt and the amount of protein. In the premise of no influence on the treatment of primary disease, appropriate outdoor activities, to increase the sunlight, increase the body coordination ability, prevent wrestling, avoid alcohol and tobacco, with other drugs may affect bone health.
3 basic drug treatment: including the appropriate supplement of calcium, vitamin D or its active metabolites, etc.. Guidelines for the diagnosis and treatment of primary osteoporosis. Special attention is required, if the patients with hypercalcemia, such as tumor or hyperparathyroidism, it should be a contraindication to the use of calcium and vitamin D preparations. Patients with renal stones and hypercalciuria displacement, should be used with caution in calcium and vitamin D preparations.
4 drug treatment: effective inhibitors of bone resorption when necessary (such as bisphosphonates and calcitonin) treatment. Notes and instructions for use of drugs in the treatment of primary osteoporosis. Bone formation promoting agent (such as parathyroid hormone N-terminal fragment) is suitable for secondary osteoporosis, which needs to be accumulated in the future.
Five, the treatment of several special secondary osteoporosis
1 sex hormone deficiency osteoporosis: active treatment of primary disease. The young female patients need to add the right amount of estrogen or estrogen, progesterone, male patients should be supplemented with androgen. If necessary, use other types of anti osteoporosis drugs.
2 glucocorticoid induced osteoporosis: physiological dose of glucocorticoid can also cause bone loss, the bone loss was most obvious in the medication for 6 to 12 months. Some diseases need long-term use of corticosteroids, such as the conditions allow, should use the lowest effective dose. Where appropriate, calcium supplement, vitamin D preparation and bisphosphonates anti osteoporosis drug helps prevent glucocorticoid induced osteoporosis. For obvious pain patients, can be combined with calcitonin drugs.
3 brake (disuse) osteoporosis: general treatment and drug treatment with primary osteoporosis, but should pay special attention to the functional exercise and rehabilitation treatment of the braking position.
4 osteoporosis caused by long term parenteral nutrition: general therapy and drug therapy in patients with primary osteoporosis. Because of this disease associated with rickets (or osteomalacia), in addition to the use of aluminum free nutrition liquid, to supplement vitamin D preparations.
5 diabetic osteoporosis: mainly to strictly control high blood sugar, while the use of anti osteoporosis drugs.
6 osteoporosis after organ transplantation: primary osteoporosis.
7 hemodialysis osteoporosis: prevention and treatment of primary osteoporosis. Avoid the use of aluminum containing dialysate and low phosphorus dialysate.