醫療聚焦年齡層及發生機率骨質的流失, 平均是以每年 0.5% 到 1% 的速度在進行, 而停經後的婦女更可以 3% 到 5% 的速度流失其中男性約會流失所有骨質的 20% ~30%, 而女性更可高達 40% ~50% 國內衛生署統計 65 歲以上人口, 女性患有骨質疏鬆症約佔 1/4 左

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第 195 期現代文明下的隱形殺手漫談骨質疏鬆症文 / 朱唯廉 ( 骨科部主治醫師 ) 於生活方式由飲食習慣的改變再加上人口急速老化, 使得所謂的文明病更提早浮現而骨質疏鬆便是目前較為大家所熟悉, 卻是很容易被忽略的疾病骨質疏鬆顧名思義, 就是指骨質因加速的流失而導致骨質含量減少, 使得骨頭本身變得脆弱疏鬆, 因而容易造成骨頭斷裂擠壓變形

1 第 195 期現代文明下的隱形殺手漫談骨質疏鬆症文 / 朱唯廉 ( 骨科部主治醫師 ) 於生活方式由飲食習慣的改變再加上人口急速老化, 使得所謂的文明病更提早浮現而骨質疏鬆便是目前較為大家所熟悉, 卻是很容易被忽略的疾病骨質疏鬆顧名思義, 就是指骨質因加速的流失而導致骨質含量減少, 使得骨頭本身變得脆弱疏鬆, 因而容易造成骨頭斷裂擠壓變形其中最主要的原因是骨內的鈣質從骨髓內流失則骨頭內的破骨細胞, 便會加速工作, 以便將骨內的鈣質釋放到血液中, 維持細胞正常功能;相反的, 若是血液中的鈣質偏高, 則又會將過多的鈣質儲存回骨頭內在青少年及兒童時期, 造骨細胞較為活躍, 因此可以大量累積鈣質, 使得骨骼系統增大增強, 這就是所謂的骨本的累積到了 35 歲左右, 骨本達到最高峰, 然而過了骨本高峰期之後, 破骨細胞便開始逐漸佔上風, 骨質疏鬆就可能會發生骨骼生理要了解骨質疏鬆症, 我們應先要知道骨頭本身的結構人體骨骼系是由 206 塊骨頭所組成, 其中鈣質約有 99% 是儲存在骨頭之中人體骨骼中有所謂的造骨細胞及破骨細胞當血液中的鈣質降低時, 上圖左為正常的骨骼組織, 右則為骨質疏鬆症之骨骼切面 2 第 195 期

2 醫療聚焦年齡層及發生機率骨質的流失, 平均是以每年 0.5% 到 1% 的速度在進行, 而停經後的婦女更可以 3% 到 5% 的速度流失其中男性約會流失所有骨質的 20% ~30%, 而女性更可高達 40% ~50% 國內衛生署統計 65 歲以上人口, 女性患有骨質疏鬆症約佔 1/4 左右骨折好發部位因骨質疏鬆所造成的骨折, 常好發在脊椎手腕髖關節及肩部等處往往骨折治療很簡單, 但其併發症卻是十分可怕的根據統計, 因髖關節骨折的病人, 約有 10% ~20% 的病人在第一年內會死亡, 而有 50% 的病患, 在日後的生活會行動不便, 甚至需要他人長期照顧最常見的腰椎壓迫性骨折, 也是造成個人及家庭沈重的負擔此種問題, 已對國內預防醫學造成很大的壓力高危險群一般所謂的高危險群可以大致分為下列幾種, 種族的差異 ( 白種人及黃種人的骨質密度較其他種族為低 ) 女性提早停經或是荷爾蒙分泌失調愈瘦小的人長期減肥及營養失調抽菸過量飲酒咖啡因過量缺乏運動長期使用類固醇利尿劑化學治療等病患腎臟病糖尿病人體骨骼關節處最易發生骨折, 併發症更是可怕甲狀腺功能亢進性腺功能不足者以上種種, 只是反映有許多原因會導致骨質疏鬆如何診斷骨質疏鬆要瞭解是否有骨質疏鬆, 我們一般最常用的是以 X 光來判讀但 X 光檢驗是不太靈敏的, 往往判斷有骨質疏鬆時, 骨質早已流失 30% 以上因此陸續發展出骨骼代謝指標 (Bone Markers) 電腦定量斷層檢查超音波骨質密度檢查中子活化分析全身骨骼鈣量磁振攝影以及本院所使用的雙光子能量 X 光吸收儀等方法來測量骨質密度如何自我檢查正因為骨質疏鬆症是無聲無息的, 所以我們更應該提高警覺, 若有下列症狀則 March

第 195 期表示您可能已經中獎了, 包括經常腰酸背痛走路無力偶而會有劇痛 ; 駝背走路背部漸漸彎曲, 甚至愈來愈矮如何預防及治療預防重於治療這句話對於骨質疏鬆症是十分貼切的, 雖然醫學科技如此進步的今日, 仍無法完全阻止骨質疏鬆的發生, 甚至要強化骨本都是非常的困難因此預防骨質疏鬆的發生及減緩發生的速度是相當重要的兩件事, 以下所列則是預防的方法, 供您參考 1.

3 第 195 期表示您可能已經中獎了, 包括經常腰酸背痛走路無力偶而會有劇痛 ; 駝背走路背部漸漸彎曲, 甚至愈來愈矮如何預防及治療預防重於治療這句話對於骨質疏鬆症是十分貼切的, 雖然醫學科技如此進步的今日, 仍無法完全阻止骨質疏鬆的發生, 甚至要強化骨本都是非常的困難因此預防骨質疏鬆的發生及減緩發生的速度是相當重要的兩件事, 以下所列則是預防的方法, 供您參考 1. 鈣質及充足的營養補充 : 根據衛生署推薦, 國人每日攝取鈣質量, 在青少年時期, 男性為 800mg, 女性為 700mg, 成年婦女則每日以 1000mg 的鈣質補充為準, 孕婦及停經過後的婦女則要增加到每日 1500mg 的鈣質量但是鈣質的補充一定要按醫師指定劑量服用, 切忌自行調高劑量, 以免造成腎臟負擔過重而導致成腎衰竭的悲劇 2. 適當的運動保健 : 許多的研究指出, 適度的戶外運動可以增加骨骼肌肉系統的強度, 尤其是負荷重量訓練接受適當的陽光照射更可生成維生素 D, 以助於鈣質的吸收 3. 荷爾蒙的補充:因為顧及可能引發乳癌子宮內膜癌等, 故雌性激素治療骨質疏鬆目前已少為醫師之首選藥物 4. 抑鈣素製劑藥物:此類藥物主要功能是抑制骨內破骨細胞, 對於骨質疏鬆症的急性疼痛治療有功效, 但增加骨質效果不佳 5. 雙磷酸鹽類製劑藥物:例如 Etidrorate Alendronate 等藥物, 其功能也是抑制破骨細胞的活性, 而此類藥物仍要配合鈣片的使用, 如此不但可以避免骨質疏鬆惡化, 更可增強其骨質密度但此類藥物對腸胃道的影響頗大, 因此必須要按醫師指示使用 6. 其他藥物:例如氟化物副甲狀腺素製劑 (Forteo) Protos Prolia 維生素 K2 等藥物每日攝取足夠的鈣質, 對於預防骨質疏鬆有一定效果骨質疏鬆症之所以可怕, 是因為有許多人不瞭解它, 甚至有錯誤的認知也因為它在不知不覺中就侵蝕每一個人的骨本, 因此希望每個人都能正視此一問題, 並且真正能預防因為骨質疏鬆而造成的併發症 4 第 195 期

4 News in Medicine Invisible Killer of Modern Civilization ----Random Talk about Osteoporosis Author/ Dr. William Chu(Attending Surgeon of Orthopedics) Ow i n g t o t h e c h a n g e s o f l i f e style and eating habits plus the rapid aging population, the so-called Diseases of Civilization emerge early. Osteoporosis" is one of the most familiar but easily neglected diseases by the public. Osteoporosis" by the definition indicates the bone density decrease due to the fast loss of bony compositions resulting in friable and loose, which can easily lead to broken bones, compression and deformation. Among them, one of the most common causes is the loss of marrow calcium from bone. Bone Physiology In order to understand osteoporosis, first we should know the structure of bone itself. Human skeletal system is consisted of 206 bones; about 99% of the calcium is deposited in the bones. There are osteoblast and osteoclast cells in the skeleton. When the level of the blood calcium is low, ostesclasts of bone will work harder to release bony calcium into the blood stream to maintain normal cellular functions. On the contrary, if blood calcium level is high, then the surplus calcium will be stored back into bones. During adolescent and children stages, osteoblast cells are more active thus much calcium deposition in bone to strengthen and augment the skeletal system which is called the accumulation of bone base" reaching the plateau until the age of 35. However, after the stage of plateau of bone base, osteoclasts begin to predominate then osteoporosis may occur. Age Distribution and Incidence The bone loss rate average is about 0.5% to 1% per year, while it is 3% to 5% in postmenopausal women. Among them, men will lose 20% to 30 % of bone while women may reach the figures of 40% to 50%. According to the statistics of DOH (Department of Health) Taiwan, about 1/4 of women has osteoporosis in the population over 65 years old. March

5 第 195 期 Most Common Fracture Sites Fractures induced by osteoporosis usually occur in sites of spine, wrist, hip joints and shoulder etc. Though the fracture treatment is easy but the complication is very dreadful. According to the statistics, in patients with hip joint fracture, about 10-20% dies in the first year while about 50% patients may have disability in daily activity or even depend on others long-term care. The most common lumbar spine compression fracture is the main cause of heavy burden on individuals and families. Such problems have created great pressure to the domestic preventive medicine. High Risk Group The general so-called high risk groups may be divided into the following types: racial differences (Caucasian and Yellow skin people have lower bone density than other races), women premature menopause or hormonal imbalance, thinner and smaller people, chronic weight reduction and nutritional imbalance, smoking, over drinking, caffeine overdose, lack of exercise, long term steroid use, diuretics, chemotherapy etc. patients; renal disease, diabetes, hyperthyroidism, and gonadal hypo functions. All these instances are just the reflection of various causes of osteoporosis. How to Diagnose Osteoporosis We usually utilize x-ray examination to diagnose the osteoporosis. But the x-ray instruments are not quite sensitive, frequently the bone loss already over 30% when osteoporosis is diagnosed. Hence bone markers, quantitative CT scan, ultrasound bone density examination, Tbca-NAA (Total body calcium-neutron Activation Analysis), MRI (Magnetic Resonance Imaging) and our hospital ś Dual-energy x-ray absorptiometry" etc. methods are being developed consecutively to measure the bone density. How to Self Examine? Because osteoporosis is soundless and motionless, high alertness is mandatory. If there are following symptoms: frequent wait soreness and back pain, weak walking with occasional severe pain; kyphosis, progressive back bending while walking or even associated with more and more short statue, then you probably have osteoporosis. How to Prevent and Treat? Prevention is better than treatment" 6 第 195 期

6 News in Medicine this sentence is very appropriate to osteoporosis. Although the medical technology is more advanced nowadays, total prevention of the occurrence of osteoporosis is impossible. Even the strengthening of bone base is very difficult. Thus prevention of the osteoporosis occurrence and slow down the pace of incidence are two very important things. The followings are the methods of prevention and just for your reference. 1. Calcium and adequate nutritional supplements: According to DOH ś recommendations, the daily intake of calcium is 800mg for male adolescents and 700 mg for female adolescents, 1000mg for adult women, 1500mg for pregnant women and postmenopausal ladies. But the calcium supplement must follow the specified dosage instruction of doctor, do not increase the dosage privately; otherwise the kidney may be overloaded and result in renal failure tragedy. 2. Appropriate exercise: Many researches demonstrate that proper exercise can increase the strength of musculoskeletal system especially the weight bearing training. Receiving moderate sunlight can synthesize vitamin D which is helpful for calcium absorption. 3. Hormonal supplement: Due to the risks of breast and endometrial cancer, presently the treatment of osteoporosis with estrogen is rarely the first choice by doctors. 4. Calcitonin formulated drugs: This kind of drugs mainly inhibit the osteoclasts and is effective for the treatment of acute pain from osteoporosis, but an increase in bone is ineffective. 5. Bisphosphonate formulated drugs: Drugs like Etidrorate Alendronate function as to suppress the activity of osteoclasts and should be taken with calcium tablet in order to avoid the worsening of osteoporosis and to strength the bone density. However these drugs are harmful to the gastrointestinal tract and must be applied under the doctors instruction. 6. Other drugs: e.g. Fluorides, parathyroid medication (Forteo), Protos, Prolia, Vitamin K2 etc. The fear of osteoporosis is due to ignorance of most people or even wrong recognition. Because osteoporosis is corroding the bone base sneakily, everybody should pay attention to it, then genuinely to avoid the complications of osteoporosis. (Translated by General Surgeon: Dr. Menglun Liu) March

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