167
Cơ - Xương - Kh p
Sơ đ 10.6 B nh xương chuy n hóa
OSTEOPOROSIS
What is osteoporosis?
This is a bone disorder that is characterised by loss of
trabecular bone and increased fracture risk. It is more common in
postmenopausal women due to ¯ oestrogen levels and
- bone resorption.
Causes
There is no single cause of osteoporosis but there are risk factors
that predispose patients to this condition. These include:
•
Loss of protective oestrogen in postmenopausal women.
•
Prolonged steroid use.
•
Increasing age.
•
Excessive alcohol intake.
•
Smoking.
•
Positive family history.
•
Diet deficient in calcium.
•
Endocrine disorders such as diabetes mellitus
and hyperthyroidism.
Signs and symptoms
This is often asymptomatic until the patient presents with
pathological fracture. Patients may report loss in height, back
pain and have a dowager’s hump (hyperkyphosis) on physical
examination.
C n lâm sàng
•
XN máu: TPT TB máu ngo i vi, ure, đi n gi i đ , creatinin,
XN ch c năng gan, tuy n giáp, glucose, calci máu, phosphat
máu, n ng đ alkaline phosphatase và hormon c n giáp.
•
Ch p X quang năng lư ng kép (DEXA) đ đo đ m đ
xương: ch n đoán khi T-score >-2,5.
•
CĐHA: X quang, CT và MRI đ đánh giá gãy xương.
Đi u tr
•
B o t n: giáo d c b nh nhân. Lo i b các y u t nguy cơ
như cai thu c lá, cai rư u. Khuy n khích các bài t p “ch u s c
n ng”. Đánh giá các ho t đ ng thư ng ngày.
•
N i khoa: tác nhân đi u hòa th th estrogen có ch n l c,
calcitonin và biphosphonate.
OSTEOMALACIA
What is osteomalacia?
This is a metabolic bone disorder characterised by low
mineral bone content and deficient vitamin D. This leads to
soft bones; however, the amount of bone is normal. In
children this condition is called rickets.
Causes
Remember REVOLT:
•
REsistance to vitamin D.
•
Vitamin D deficiency.
•
Osteodystrophy (renal).
•
Liver disease.
•
Tumour-induced osteomalacia.
Signs and symptoms
•
Bone pain.
•
Myalgia.
•
Pathological fracture.
Investigations
•
Bloods: FBC, U&Es, LFTs, TFTs, glucose, serum calcium,
serum phosphate, alkaline phosphatase, PTH and
vitamin D levels.
•
Radiology: X-ray to assess fractures.
Đi u tr
•
B o t n: giáo d c b nh nhân. Ch đ ăn tăng
cư ng calci và vitamin D.
•
N i khoa: b sung vitamin D như
cholecalciferol và calcitriol.
Bi n ch ng
•
Tăng nguy cơ gãy xương.
MAP 10.6 Metabolic Bone Disease
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