104例骨质疏松性病理骨折的临床分析

Clinical analysis of 104 cases with pathologic osteoporostic fractures

本文回顾性分析了１０４例骨质疏松性病理骨折的资料。女性２５例，６０岁以上占８０％。男性７９例，７０岁以上占７７％。女性骨折类型中髋和椎体骨折占９２％，而男性则占８５％。在１４例骨Ｘ线片所证实的脊椎骨折中，ＢＭＤ达－３．０ＳＤ者１例，－１．１～－２．４ＳＤ者７例，－１．０～＋１．０ＳＤ者６例。因此ＢＭＤ－１．０ＳＤ或更严重者，有必要对骨质疏松作治疗。对骨质疏松的诊断来说，既要用双能Ｘ线骨密度仪测定ＢＭＤ，又要拍脊柱Ｘ线平片。测定尿中脱氧吡啶啉和羟脯氨酸，以及血骨钙素来决定骨转换率时，１４例老年男性骨质疏松性骨折资料显示，骨转换率正常者６例，增加者５例，降低者３例。本组骨质疏松的独立病因如下：９３％为原发性退化性，７％为继发性，包括原发性甲旁亢、肾小管酸中毒和多发性骨髓瘤。促进骨质疏松发生发展的因素有：钙和ＶｉｔＤ缺乏（４８％），肾小管酸中毒（１７％），以及心、肺、神经。

Abstract The paper analyzed retrospectively the data of 104 cases of pathologic osteoporotic fractures (POF) and gave the following results.In this series,females being 25 cases over the age of 60 accounted for 80%,and males being 79 cases over 70 made up 77%.The totals of hip and spinal fractures comprised 92% in females and 85% in males.In 14 cases with X ray documented spinal fractures,-3.0 SD of BMD was in 1 case,-1.1～-2.4 SD in 7 cases,and -1.0～+1.0 SD in 6 cases.Therefore,-1.0 SD or more of BMD indicated a necessity for osteoporosis therapy.Also both BMD assay by DEXA and X ray plain film of spines are necessary for the diagnosis of osteoporosis.Among 14 elderly male cases of POF,the bone turnover rate,which was checked by urine Dpd and HOP as well as serum BGP,was normal in 6 cases,increased in 5 cases,and decreased in 3 cases.The independent causes for the series were as follows:93% for primary involutional and 7% for secondary osteoporosis which included primary hyperparathyroidism,renal tubular acidosis,and multiple myeloma.The precipitating factors included the deficiency of calcium and /or vit.D(29/61),renal tubular acidosis (10/59),and chronic geriatric deseases of heart,lungs,and neurological and digestive systems.