男性骨质疏松症的病因和治疗

Osteoporosis in men: incidence, etiology and treatment

目的 男性骨质疏松(OP)的发生率虽然不如女性高,但男性OP性髋部骨折的发生率与女性接近。因此男性OP应引起人们重视。男性OP的发生率目前尚无确切的统计数据。最近北京、江苏、辽宁等地区利用DXA检测男性OP的发生率分别是26.6％、27.7％于27％。OP的分类为原发性与继发性,其中以原发性老年OP较多,继发性较少。男性老年OP的原因:不合理的营养、体重低、缺少运动、过度烟酒、内分泌激素水平下降、局部细胞因子等因素。男性OP的治疗:一,一般治疗:食物中足够钙的摄入、改变生活方式,戒烟少酒、运动锻炼与日光照射等。二,药物:钙的补充,65岁以上应1500mg/;VD代谢产物的补充,对肝肾功能不良,应用a-D3等药;降钙素(CT)可抑制破骨细胞活性,减少破骨细胞量,能有效减轻OP性脊柱骨折引起骨痛;双膦酸盐的第三代产物阿仑膦酸钠(alendronate)药效大,其作用是抑制破骨细胞活性,缩短其存活时间,加速细胞凋亡等,最适用男性煌治疗;生长激素虽有用,尚未得到临床验证;氟化物对OP治疗尚有争论。关于男性激素治疗,对已证实雄性激素减退(缺乏)引起男性OP是有效,但有心血管病的副作用与引起前列腺癌的危险,应慎重选择,定期查前列腺与血PSA。

The incidence of osteoporosis in men is not so high as women but the rate of hip fracture in male elderly is approximately equal to female so we must emphasized the importance of osteoporosis in men. The literature reviews showed that the incidence of osteoporosis in elderly men reported from Beijing, Jiangsu and Liaon-ing was 26. 6% ,27. 7% and 27% , respectively. The etiologies of osteoporosis in men were as following; calcium deficiency in diet, low body weight, poor activity, heavy tobacco, alcoholism , hypogonadism, gene and growth factors, etc. Treatment of osteoporosis in men indicated as following: adequate calcium diet, abstaining smoke , drinking with red wine, exercise and sun exposure. Drugs may be used calcium and Vitamine D, supplementing calcitonin, bisphosphonate ( alendronate) , growth hormone , fluoride and aandrogen therapy.