摘要
骨质疏松症已成为全球关注的公共卫生热点,骨质疏松症人群占中国总人口数的7.01%。骨质疏松症被称为“具有老年期影响的儿科疾病”。孕妇的营养状况直接影响胎儿的骨状况,从而影响人体一生的骨骼生长发育。佝偻病和骨软化症是儿童时期最常见的骨骼疾病。维生素D、钙、磷供给不足都可以导致佝偻病,影响骨量、骨强度,甚至导致骨骼畸形。一些慢性疾病和药物也可导致儿童骨质疏松症,如少年特发性骨质疏松症、类风湿性关节炎、糖皮质激素、甲状腺激素诱导的骨质疏松症等。妊娠期和哺乳期妇女也可发生特发性骨质疏松症。人体骨量从胎儿期、婴儿期到成年期前一直在聚集,此过程与人体的线性生长基本平行。胎儿期、婴儿期和青春期是人体骨骼生长发育最重要时期。骨量峰值在成年早期获得,它是成年人骨强度的重要决定因素,称为“成人期骨银行”。在儿童和青少年时期未达到合理骨量的个体,即使成年后无加速骨量流失现象发生,仍有可能患骨质疏松症。孕妇和儿童骨状况评估的物理方法包括X光片法、双能X线吸收法（DXA）、定量超声法（QUS）等。由于考虑到射线辐射、技术和价格等因素影响,X光片法和DXA的应用目前受到限制。定量超声设备测量宽波衰减值（BUA）和声波速度值（SOS）等参数来反映骨强度,显示出广泛的前景。常见的骨代谢生化指标包括碱性磷酸酶、骨碱性磷酸酶、骨钙素和钙调激素等。测量血液中1,25（OH）2D3水平可以反应人体维生素D状况,将在临床上不断普及应用。为了强壮骨骼预防骨质疏松症,应该设法创造理想的骨骼发育环境,最大限度的达到骨量或骨强度峰值,并定期进行骨状况评估,及时发现异常和早期干预,尽可能地减少骨折发生。营养和体力活动对骨骼发育有重要影响。妊娠期、哺乳期的妇女和儿童应保证合理营养、适当户外活动和日光照射,推广强化维生素D和钙的食品;并且,妊娠期、哺乳期妇女和儿童应该补充维生素D和钙。
Osteoporosis has globally become a hot spot of concern to Public Health. The number of osteoporosis accounts for 7.01% of total population in China. Osteoporosis is regarded as a pediatric disease with geriatric consequences. The nutritional status of pregnant women directly affects the bone status of the fetus,thus affecting life-long bone growth and development during the entire life. Rickets and osteomalacia are the most common childhood bone disorders. Insufficient supply of Vitamin D,calcium and phosphorus can lead to rickets,which influences bone mass,bone strength,and even leads to skeletal deformities. Some pediatric disorders associated with osteoporosis,such as idiopathic juvenile osteoporosis,rheumatoid arthritis and so on,and some drugs can induce osteoporosis including glucocorticoids,excessive thyroid hormones and so on. Idiopathic osteoporosis can also occur in pregnant and breast-feeding women. Bone mass is accumulated progressively from fetal period,infancy through the end of adolescence and beyond,in a process that generally parallels linear growth. Fetal period,infancy and adolescence are crucial periods for bone growth and development. Peak bone mass,which is reached by early adulthood,and an important contributor to bone strength during later life,serves as a bone reserve for the remainder of life. A reduced bone mass during childhood and adolescence is associated with osteoporosis and increased fracture risk in adults even if accelerated loss of bone mass won＇t happen in an individual. Physical technologies of assessing bone status in pregnant women and children include X-ray film,dual-energy X-ray absorptiometry （DXA）,quantitative ultrasound （QUS） and so on. Considering ray radiation,technical and price factors,X-ray and DXA are currently limited to pregnant women and children. QUS device measures the parameters such as broadband ultrasound attenuation （BUA） and speed of sound （SOS） to reflect bone strength,showing thriving prospects to these special populations. Common biochemical markers of bone turnover include alkaline phosphatase,bone alkaline phosphatase,osteocalcin and calcium-regulating hormones. Measurement of serum level of 1,25（OH）2D3 which responses to vitamin D status in human body is on the way of clinical generalization. For the purpose of strong bone and preventing osteoporosis,strategies should include ideal environment for bone development,optimization of bone mass and strength acquisition,as well as regular assessment of bone status to detect abnormalities and early intervention,and reduction of fracture as much as possible. Nutrition and physical activity have a significant effect on bone development. Pregnant,breast-feeding women and children should ensure that reasonable nutrition,appropriate outdoor activities and sunlight exposure. Meanwhile,foods fortified with vitamin D,calcium should be promoted,and vitamin D and calcium should be added particularly.
出处
《中国骨质疏松杂志》
CAS
CSCD
2009年第4期299-303,共5页
Chinese Journal of Osteoporosis
关键词
骨质疏松症
预防
妊娠
儿童
骨量
骨强度
维生素D
钙
佝偻病
Osteoporosis
Prevention
Pregnancy
Childhood
Bone mass
Bone strength
Vitamin D
Calcium
Rickets
