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無聲無息的隱形殺手-骨質疏鬆

張貼日期
2020-09-18
張貼單位
本院
內  容

70歲張爺爺,年輕時工作忙碌,經常應酬喝酒、飲食不正常、缺乏運動,面對自己越來越矮的身高,也當作自然老化而不以為意。最近洗澡時不小心跌了一跤,就造成髖骨骨折,緊急入院開刀後,才知道自己早已患有骨質疏鬆症。

82歲王奶奶,曾經被診斷為骨質疏鬆卻拒絕就醫,認為多喝牛奶,多吃小魚乾,並服用鈣乳就已經足夠。早上起床時在家裡跌倒,頓覺腰部疼痛劇烈,像脊椎已經跌斷了似的,經過非常久時間無法自行站起來,趕緊電話通知正在上班的兒子回來,勉強攙扶至醫院骨科門診,醫師安排X光檢查,經診查發現腰椎壓迫性骨折,王奶奶從此生活品質更加下降。

衛福部新營醫院骨科林孝儒醫師說明,骨質流失是隨著年齡老化必然會面對的問題,根據世界衛生組織表示,骨質疏鬆已經是僅次於冠狀動脈心臟病的重要疾病。依照台灣平均壽命計算,約1/3的台灣婦女在一生中會發生一次脊椎體/ 髖部/或腕部肢骨折,其風險高於乳癌、卵巢癌和子宮癌;男性也有1/5的風險,且風險高於前列腺癌。發生過一次骨質疏鬆骨折後,約50%患者將會再發生第二次骨折,而每次骨折之後,再出現新骨折的風險呈指數形式增高。根據台灣健保資料庫分析發現,同時具有慢性疾病包括:糖尿病、風濕性關節炎、腦中風、巴金森氏症、器官移植、癌症、腎臟透析患者,髖部骨折風險相對增加。林醫師表示,依中央健康保險署統計,發生髖部骨折的老人,一年內之死亡率女性約為11.2%,男性則高達18%,死因以長期臥床引發之感染為主。

「預防重於治療」!林醫師建議,民眾可以改善日常生活行為,戒菸、戒酒和減少含咖啡因飲品,去除危險因子、增加鈣和維生素 D3 攝取量、從事荷重運動、肌力增強運動和平衡訓練,強化骨量和體能並改善居家及公共環境,使用防護設施,以防範骨折。
請注意以下4個危險信號:第一個:身高跟年輕時相比少4公分;第二個:體重過輕、BMI<18.5或是年紀減體重小於10;第三個:站著的時候,頭枕部與牆壁的距離大於3cm;第四個:肋骨下緣與骨盆小於2cm或是1指幅。如有以上症狀,建議及早至骨科門診進行檢查。

Case 1:70-year-old grandpa Zhang was busy at work when he was young, often drinking, eating abnormally, and lacking exercise. Faced with his shorter and shorter height, he did not treat it seriously. Recently, he accidentally fell while taking a bath and caused a hip fracture. After admitted to the hospital for surgery, he finally realized that he had already suffered from osteoporosis.

Case 2:82-year-old grandmother Wang was under diagnosed of osteoporosis but refused to seek medical treatment. She thought that drinking more milk, eating more dried fish, and taking calcium supplement could cure the disease. She fell down at home when getting up in the morning. She felt severe pain in her waist and could not stand up on her own since then. She quickly ask her son for help who was at work . After a series of examinations , the spine X-ray revealed a compression fracture of the lumbar spine. Since then, Grandma Wang's quality of life has deteriorated.

Dr. Lin Hsiao Ju, Department of Orthopedics, Xinying Hospital of the Ministry of Health and Welfare, explained that bone loss is a problem that will inevitably happen with aging. According to the World Health Organization, osteoporosis is already an important disease second only to coronary heart disease. Based on the average life expectancy in Taiwan, about one-third of Taiwanese women will have a vertebral body/hip/or wrist fracture in their lifetime, and the risk is higher than breast cancer, ovarian cancer and uterine cancer; men also have a 20% risk of osteoporotic fracture , and the it is higher than prostate cancer. After an osteoporotic fracture, about 50% of patients will have a second osteoporotic fracture. After each fracture, the risk of a new fracture increases exponentially. According to the analysis of the Taiwan National Health Insurance Database, patients with chronic diseases including diabetes, rheumatoid arthritis, stroke, Parkinson's disease, organ transplantation, cancer, and kidney dialysis have a relatively increased risk of hip fracture. Dr. Lin indicated that according to the statistics of the Central Health Insurance Agency, the mortality rate of the elderly with hip fractures within one year is 11.2% for women and 18% for men. The main cause of death is secondary infection caused by long-term bed rest.

"Prevention is better than cure"! Dr. Lin suggested that people can improve their daily life behaviors, quit smoking, quit drinking and reduce caffeine-containing drinks, remove risk factors, increase calcium and vitamin D3 intake, engage in load-bearing exercises or muscle strengthening exercises or balance training, strengthen bone mass and physical fitness ,improve the home and public environment by using protective facilities to prevent fractures.

Please pay attention to the following 4 red flags:
The first one: the height is 4 cm less than when you were young;
the second one: underweight; BMI<18.5 or the number age minus weight is less than 10;
the third one: when standing, the distance between the headrest and the wall is greater than 3cm;
the fourth one: The lower edge of the ribs and the pelvis are less than 2cm or 1 finger width.
If you have any one of above symptoms, it is recommended to go to the orthopedics clinic for examination as soon as possible.

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