腎と骨代謝 Vol.17 No.2(3)


特集名 閉経と骨代謝
題名 閉経後骨粗鬆症の病態
発刊年月 2004年 04月
著者 太田 博明 東京女子医科大学産婦人科学教室
【 要旨 】 閉経後骨粗鬆症の発症はエストロゲンの低下を要因とするため,明らかな性差があり,その罹患者のほとんどは女性である.エストロゲンの低下により,骨吸収抑制不全を生じ,骨代謝異常を呈することから,骨量の低下のみならず骨微細構造の劣化をきたすため,骨強度は低下する.そのため軽微な外力によって非外傷性骨折である脆弱性骨折を生じることになる.脆弱性骨折の初発部位としては脊椎椎体が多く,わが国では50歳代後半から認められる.この脆弱性骨折は多発化する傾向にあり,70歳代から2個以上の多発化が顕著となる.このように骨粗鬆症は進行すると,脆弱性骨折を起こし,しかも多発化するので,背部痛・腰部痛と脊柱変形に伴う生活の質や機能の低下および健康感の低下をきたす.日常生活動作や生活の質が阻害され,健康感を損なう本症は,とくに中高年女性にとって健康を脅かす疾患として,今後ますます重要な意味合いをもつ疾患となることは必至である.
Theme Menopausal derangement in bone metabolism
Title Postmenopausal osteoporosis: Its clinical features
Author Hiroaki Ohta Department of Obstetrics and Gynecology, Tokyo Women's Medical University
[ Summary ] Postmenopausal osteoporosis results primarily from a reduction in endogenous estrogen levels, and thus accounts for gender differences, with female patients suffering from this condition predominantly.
Reductions in estrogen levels lead to failure to inhibit bone resorption resulting in abnormalities in bone metabolism. Reduction of the bone density and deterioration of the bone microenvironment combine to compromise bone strength in affected patients, thereby making their bone susceptible to non-traumatic fracture with only minor external pressure. The most common site for initial bone fracture occurrence is reported to be the spine, as commonly seen in Japanese patients in their late fifties and older. These "brittle bone" fractures tend to be multiple in nature, and more than two fractures are frequently noted in patients in their seventies or older. The development of osteoporosis is thus associated with multiple brittle bone fractures, poor quality of life and bodily function due to back and lower back pain, and spinal deformity that result from the condition. Therefore, osteoporosis will certainly become the focus of increasing concern for middle-aged and elderly women, particularly as a potentially debilitating condition affecting activities of daily living and the quality of life of these patients.
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