Prevention of the trauma and accident in exercise of elderly people with osteoporosis

It is the important thing that osteoporotic patient is checked by internal and orthopaedic medical check before starting exercise. If a patient with mal-alignment you may reduce the alignment by foot insole. To count unilateral foot standing time is available the motor assessment. The falling school or unilateral standing of one minute is useful to prevent the accident like a fracture in exercise for osteoporosis.     

老年男性骨质疏松与动脉粥样硬化相关性的研究

目的 探讨老年男性人群中骨质疏松与动脉粥样硬化之间的相关性. 方法 以93例老年医学科住院男性患者为研究对象,采用双能X线吸收法(dual-energy X-ray absorptiometry,DXA)测定腰椎骨和股骨区的骨密度(BMD);同时采用超声探查颈动脉内中膜厚度(intima-media thickness,IMT)及粥样斑块的情况. 结果 在骨质疏松组(46例)中,存在内膜增厚者38例(82.61%),粥样斑块34例(73.91%),与非骨质疏松组比较,骨质疏松组在动脉内中膜增厚(IMT≥0.9 mm)及粥样斑块的发生率上均明显升高(P<0.05);而内中膜增厚组(67例)及斑块组(57例)的BMD分别较其对照组低,并在NECK、WARDs三角、TORCH等部位具有统计学差异(P<0.05). 结论 老年男性骨质疏松人群较非骨质疏松人群更易发生动脉粥样硬化病变,同时存在动脉粥样硬化病变的人群也易致骨量的丢失.提示骨质疏松与动脉粥样硬化之间可能存在着共同危险因素.     

老年男性骨质疏松症患者口服阿仑膦酸钠的依从性分析

  目的 调查老年男性骨质疏松症患者口服阿仑膦酸钠的依从性,探讨影响服药依从性的相关因素。方法 入选2011年1—6月在解放军总医院门诊确诊骨质疏松症并开始口服阿仑膦酸钠治疗的老年男性患者145例,调查其服该药1年的依从性,根据药物占有率（MPR）分为依从性好组（MPR≥80%）和差组（MPR<80%）,比较两组差异,分析影响依从性的因素。结果 随访到139例患者,其中依从性好者32例（23.02％),依从性差者107例（76.98％);对筛选出的影响服药依从性的因素进行logistic回归分析,结果显示,骨痛(OR值0.69,P=0.043)、无人提醒用药（OR值1.37,P=0.025）、担心药物副作用(OR值1.49,P=0.018)、服药种类＞7种(OR值1.30,P=0.036)、不清楚远期疗效(OR值1.39,P=0.021)为影响服药依从性的因素。结论 老年男性骨质疏松症患者口服阿仑膦酸钠治疗的依从性差;降低服药依从性的因素有：无人提醒服药、担心药物副作用、服药种类＞7种和不清楚远期疗效;骨痛可提高患者服药依从性。     

老年医学与衰弱老年人的医疗服务

目的 随着年龄的增长.人们发生多种健康问题的可能性增大.这些问题可被称作健康缺陷.健康缺陷越多.越容易引发健康方面的不良后果,例如健康状况恶化,甚至死亡.所渭衰弱,是指能够增加不良健康后果的危险的身体状态.健康缺陷度越高,身体衰弱度就越大.在临床上,通过临床衰弱量表-09的使用,可以对衰弱度进行逐级描述(此量表是加拿大健康与衰老研究课题所设计使用的临床衰弱量表的修订版).衰弱导致了健康问题的复杂化.由于老年人的健康问题较为复杂,而临床服务一般只侧重于诊治单一的问题,造成对老年患者的服务不够全面.老年专科医生应该是能够综合处理复杂问题的专家,应擅长诊治并存多种健康问题的老年患者.充分了解和认真研究健康需求的复杂性问题,老年专科医生才能最有效地帮助那些身体衰弱的老年患者.模式识别就是对付老年疾病复杂性的一种重要手段,它借助于老年综合性评估和对实际发病的衰弱老年人所表现出的症状特征的识别而加以实现.     

中药内服治疗原发性骨质疏松的系统评价

目的探讨内服中药治疗原发性骨质疏松的疗效。方法计算机检索Cochrane Library、MEDLINE、EMbase、CBM、CNKI、VIP等数据库,人工检索相关临床随机对照研究文献,依据统一的纳入排除标准,对纳入研究的文献质量进行评估。采用Rev Man5.3进行Meta分析,对患者用药后总体疗效、腰椎、股骨颈、股骨大粗隆、ward三角、跟骨骨密度以及肝肾功能、血液流变学指标进行评价。结果纳入9篇文献,共计1 372例原发性骨质疏松患者。内服中药治疗组较对照组总体有效率高(P<0.01);内服中药能够显著提高患者腰椎和股骨颈骨密度(P<0.01),但股骨粗隆、ward三角以及跟骨密度无统计学差异(P>0.05)。此外,中药能够增加患者血清中骨钙素、1,25(OH)2D3含量,同时改善血液流变学相关指标。结论内服中药对原发性骨质疏松具有一定疗效。     

伴有合并症的结直肠癌治疗的药物选择

结直肠癌是我国及世界范围内最常见的肿瘤之一,结直肠癌合并特殊功能状态或疾病如肝肾功能不全、肝炎、心血管疾病、老年、体弱等的患者并不少见。合并特殊功能状态或疾病的结直肠癌患者的治疗,既要考虑伴随疾病对结直肠癌治疗选择的影响,又要考虑结直肠癌治疗对既有疾病的影响。本文将主要从伴随疾病对结直肠癌治疗药物药动学和药效学的影响方面,系统回顾现有资料,探讨伴有合并症的结直肠癌的治疗选择。     

Effect of oral health dental state and risk of malnutrition in elderly people

Aim: To determine the risk of malnutrition in both institutionalized and non‐institutionalized elderly people of the region of Murcia in Spain. Methods: A cross‐sectional study was carried out on 465 participants (213 men and 252 women) aged 65 years or older, and representative of the population of the region of Murcia in Spain. The nutritional condition was determined with the Mini Nutritional Assessment screening tool. The following clinical oral health variables were recorded: number of teeth in the mouth, use of removable dentures and hygiene. Results: The prevalence of malnutrition was 7% in the study population, whereas the risk of malnutrition was 49%. A greater prevalence was recorded in the older and in the institutionalized participants. There were no significant differences in terms of malnutrition or the risk of malnutrition between the participants with or without dentures or between the dentate or edentulous participants. Conclusions: Age and institutionalization are parameters to be taken into account for detecting the risk of malnutrition in elderly people. Geriatr Gerontol Int 2013; 13: 43–49 .     

Bone complications during the treatment of osteoporosis with fluor

Fourteen osteoporotic women who had been under treatment with fluoride (23 mg/day of fluorine ions) for 12 months on average developed periarticular pain in the lower limbs or pelvis, corresponding to 21 fractures due to bone insufficiency. Six of these fractures were revealed only by radionuclide uptake in the painful areas, whereas the remaining 15 fractures, including 2 of the sacrum, were visible at radiography. Four patients had a past history of hyperthyroidism or were in a state of active hyperthyroidism detected by hormonal assays and iliac bone biopsy when the fractures were diagnosed. The decalcification associated with hyperthyroidism facilitates the occurrence of bone insufficiency fractures, as do treatments with high doses of fluoride, inadequate calcium supplement intake (observed in 5 cases) or the presence before treatment of renal impairment or disorders of bone mineralization, sometimes detected only by iliac bone biopsy. Repeated measurements of blood and urinary fluoride levels during treatment make it possible to adjust fluoride dosage, and lower doses (14 mg/day of fluorine ions) might reduce the incidence of the adverse effects of fluoride on bone.     

C-peptide response to oral glucose and its clinical role in elderly people.

C-Peptide response to oral glucose was measured in 45 elderly diabetics, in whom final treatment was established on clinical grounds during a 16-18 months follow-up. The diabetic patients comprised 19 ultimately classified as insulin-dependent (IDD) (group 1) and 26 regarded as non-insulin-dependent (NIDD) (group 2). Fifteen matched controls (group 3) and 15 young controls (group 4) were similarly studied. Fasting C-peptide values were lower in groups 1 and 2 (1.48 +/- 0.39 and 2.14 +/- 0.22 ng/ml; mean +/- SEM, respectively) compared with groups 3 and 4 (2.51 +/- 0.16 and 2.71 +/- 0.20 ng/ml, respectively) (p less than 0.001). Peak C-peptide levels were reached at 30 min in healthy young and at 60 min in healthy elderly. All non-diabetic control subjects showed a peak of at least 6.5 ng/ml and an increment of at least 4 ng/ml. The ratio of C-peptide increment/blood glucose increment (100 delta CP/delta BG) at 60 min derived to assess beta-cell function was at least 90 in all healthy subjects. The ratio was less than 10 in 68% of IDD but in only 27% of NIDD patients (p less than 0.01). The 100 delta CP/delta BG was inversely related to the prevailing fasting blood glucose (FBG) (p less than 0.001). These findings suggest that C-peptide response to oral glucose may be a useful test in certain elderly diabetic patients whose insulin dependence is in question.     

Cardio-cerebrovascular complications in elderly with diabetes

Authors have considered the prevalence of hypertension (HT), myocardial infarction (MI) and stroke (S), in elderly subjects with diabetes, impaired fasting glucose (IFG) and normal fasting glucose (NFG), respectively. A high occurrence of diabetes in elderly subjects has been found. MI and S were more frequent in diabetic group than in IFG and NFG ones. HT proved to be elevated in the total pool, especially in older olds, and with a higher prevalence among those with diabetes. A 5-year follow-up has been carried out. The index of survival for MI and S was lower in subjects with diabetes. The subjects affected by both MI and S displayed the worst index of survival in all the three categories considered, therefore, it can be stated that such an association is a determinant factor of mortality.     

The management of osteoporosis in the elderly

In the elderly, the clinical features of osteoporosis are characterized by the variety among patients. For the purpose of the fracture prevention, it is important that the managements are suitable for the personal pathophysiological status, and coordinated by both the treatment of osteoporosis and the reduction of fall risks. In addition, the management plan should be immediately modified when the difficulties are observed.     

Osteopenia and osteoporosis among treatment-experienced people living with HIV

IntroductionLife expectancy of people living with human immunodeficiency (PLHIV) has increased mainly due to the accessibility and effectiveness of antiretroviral therapy (ART). However, adverse effects from long-term use of antiretrovirals, and the physiological changes associated with aging, may compromise the quality of life of PLHIV, in addition to causing new demands on the healthcare system.ObjectivesEstimate the frequency of osteoporosis and osteopenia in patients on prolonged ART and to verify their associated factors.MethodsA cross-sectional study was conducted in Belo Horizonte, Minas Gerais, Brazil, from August 2017 to June 2018, in a sample of PLHIV (age ≥ 18 years) who started ART between 2001 and 2005. Data were collected through face-to-face interviews, physical evaluation, laboratory tests, and Dual-Energy X-Ray Absorptiometry Screening (DEXA). The outcome of interest was presence of bone alteration, defined as presence of osteopenia or osteoporosis in DEXA. The association between the explanatory variables and the event was assessed through odds ratio (OR) estimate, with 95% confidence interval (CI). Multiple logistic regression was performed to evaluate factors independently associated with bone alteration.ResultsAmong 92 participants, 47.8% presented bone alteration (19.6% osteoporosis and 28.2% osteopenia). The variables that remained in the final logistic regression model were age ≥ 50 years (OR: 12.53; 95% CI: 4.37–35.90) and current alcohol use (OR: 2.63; 95% CI: 0.94–7.37).ConclusionsThis study showed a high frequency of bone changes, especially in PLHIV older than 50 years. This information is useful to stimulate the screening and timely intervention of this comorbidity of PLHIV on prolonged use of ART in order to prevent or minimize complications and new demands on the healthcare system.     

Knowledge of medicine required for the exercise cure for prevention of fall and fracture in elderly people

The typical medicine constituting elderly people cause of a fall is the anxiolytic and hypnotic drugs of Benzodiazepines. The danger of the fall by the prolonged action type or the medicine with a strong line relaxation action is suggested especially. Moreover, anti-depressant drugs and anti-hypertensive drugs with alpha-adrenaline interception action also causes orthostatic hypotention, and induces a fall. In elderly, there are many complications and there is a tendency for combined use medicine to increase in number. Since the danger of fall increases in proportion to the number of medicines, much more cautions are required of the elderly people who have taken two or more medicines.