I. What is osteoporosis?
Characteristics: Decrease in bone mass and destruction of bone microstructure
Consequences: reduced bone strength, increased brittleness, increased risk of fracture, disability and even death, which seriously affects the quality of people’s life in their old age. Osteoporosis means that fractures can occur at any time. If fractures do not occur in osteoporosis, there is no need to study osteoporosis.
II. Epidemiology
Osteoporosis is an important public health and socioeconomic issue of growing concern worldwide. With the aging of the population, osteoporosis has become the most common human disease. The incidence of osteoporotic fractures is higher than the combined incidence of heart attack, stroke and breast cancer, and it is a major threat to the health and independent living of all postmenopausal women and older adults.
Osteoporosis is more common in women than in men, and the age of onset is earlier than in men. The incidence of osteoporosis and fractures increases with age.
Osteoporosis occurs silently and is often recognized only when a fracture occurs, and is known as a silent killer.
III. How does osteoporosis occur?
1. Nature: Increased bone conversion rate, bone resorption > bone formation, imbalance leading to loss of bone mass.
2. Estrogen action: estrogen level decreases, bone conversion accelerates, bone resorption exceeds bone formation, resulting in progressive bone loss.
3. Other disorders related to hormone metabolism: some hormones in the body are related to the process of bone formation and resorption, that is, related to osteoporosis.
4. Osteoporosis fracture mechanism.
▲ Skeletal factors: low bone mass, bone resorption, poor bone quality
The first step in the process is the development of a new bone.
4. Consequences of osteoporosis and its fracture.
◆General manifestations: pain, hunchback, shortening of height
◆Fracture: three major areas of fracture: vertebrae, hip and radius fracture
◆Threat of hip fracture: slow recovery of function, affecting the quality of life.
◆Increased burden on patients, families and society
◆Increased morbidity (complications), even life-threatening.
V. Diagnosis of osteoporosis.
1. Medical history and clinical manifestations (symptoms and physical examination): Has there been a fracture? It often manifests as fractures of the wrist, hip and vertebrae after a minor fall.
Osteoporotic fractures should be differentially diagnosed and bone mineral density measured.
2. Bone density.
(1) Detection criteria and evaluation: lumbar spine, hip and radius. Osteoporosis is diagnosed when BMD is lower than the adult mean of 2.5 SD, and bone loss can be diagnosed when BMD is lower than 1-2.5 SD.
In postmenopausal women, a decrease in bone mass of 1 standard deviation increases the risk of fracture exponentially, and if the decrease is greater than 2 standard deviations, the risk of fracture will increase 4-fold.
(2) Detection instruments and techniques: single-photon absorptiometry SPA, single-energy X-ray absorptiometry SXA, two-photon absorptiometry DPA, dual-energy X-ray absorptiometry DXA, bone ultrasonography, etc.
3. Differential diagnosis.
(1) Tumor: myeloma? Metastatic tumor?
(2) lumbar degeneration (osteoarthritis), lumbar spinal stenosis, lumbar instability, lumbar muscle strain, etc.
4. Risk factors for osteoporotic fracture and evaluation.
(1) age: >65 years; (2) history of hip and wrist fracture (non-violent fracture after 45 years of age); history of hip fracture in mother; (3) thin stature; (4) low bone density or X-ray showing osteoporosis; (5) certain bad habits: low activity in general, smoking, anorexia, low calcium diet; (6) use of corticosteroid drugs; (7) hunchback, shortening of height significantly; (8) frequent back pain; (9) estrogen deficiency, early menopause (<45
Evaluation: With more than 2 risk factors, the risk of fracture will increase by 30%.
VI. Prevention and treatment mechanism and program
(I) Treatment goals: relieve pain, promote osteogenesis, improve bone quality, reduce fracture rate, and reduce disability.
(II) Subjective motivation for prevention and treatment: Everyone has the ability and power to stop or delay osteoporosis, but first must have determination, confidence and perseverance.
(C) Reasons and mechanisms of prevention
Bone density begins to decline gradually after the age of 50. Postmenopausal women and the elderly often develop osteoporosis in later years as a result if they are not treated or not treated accordingly.
Prevention of osteoporosis: Obtaining ideal peak bone mass and reducing bone loss.
★ Ideal peak bone mass: begins in childhood and continues through adolescence and young adulthood. Adequate calcium, proper nutrition, and moderate weight-bearing exercise can enrich the bone pool and achieve the optimal peak bone mass.
★Reducing bone loss: avoid high-risk factors and try to correct them, enhance exercise, adequate calcium, and prevent falls.
(IV) Therapeutic drugs
1. Commonly used drugs and mechanism of action.
Inhibit bone resorption drugs: calcitonin, diphosphonate, vitamin D
Promote bone formation drugs: parathyroid hormone
Bone mineralization drugs: vitamin D, calcium
Improve bone quality: calcitonin, vitamin D, diphosphonates
2. Calcium and osteoporosis: Calcium is a major mineral component of bones and is a prerequisite for healthy bones and normal growth; therefore, adequate amounts of calcium (>1000 mg/day) and vitamin D should be consumed from food.
3. Phosphate: anti-osteoporosis effect is obvious, its effect: reduce bone loss, increase bone density, reduced the risk of fracture of the hip, vertebrae and other parts of the body, reversing the process of osteoporosis. Fosamax, taken orally once a week, helps to reduce both hip and vertebral fractures. Miganta, administered intravenously once a year, is easy to use and has shown good efficacy in the clinical research literature.
4. Estrogen replacement therapy (HRT): It can prevent bone loss, increase bone density and reduce fracture rate. It can also improve the symptoms of menopause caused by estrogen deficiency. It should be performed under the guidance of a doctor.
5. Selective estrogen receptor modulators: have beneficial effects on the prevention and treatment of osteoporosis, without the side effects of estrogen.
6. Calcitonin (calcitriol): good pain relief, improves calcium balance, prevents bone loss, and increases bone density and bone mass.
7. Parathyroid hormone has good osteogenic effect and is used for patients with severe osteoporosis.
8. Combined use of drugs
(E) Prevention and control population: patients with osteoporosis, patients with osteoporotic fractures, and people at high risk of osteoporosis. For early detection of bone loss, effective measures should also be taken to prevent and treat.
(F) How you can prevent osteoporosis and fracture
(1) Talk to a relevant medical professional; (2) Avoid or reduce risk factors such as smoking and excessive alcohol consumption; (3) Increase the intake of vitamin D and calcium in your diet or take D+calcium in moderation; (4) Exercise regularly and in moderation.
What forms of exercise and how much?
Forms of exercise: walking, hill walking, swimming, dancing, etc., should be tailored to individual circumstances.
Gradual, frequent, moderate and regular exercise is better than one strenuous exercise. Combine specific situations to make exercise fun.
(5) Avoid falls (non-slip floors, avoid hypnotics, fewer obstacles, better lighting, handles on certain occasions, etc.)
(6) Treatment of diseases that cause osteoporosis
(7) Proper nutrition
(7) Treatment of osteoporotic fractures.
1. drug treatment
2. treatment of complications
3. Non-surgical treatment of fracture
4. surgical treatment: mainly for hip fractures, i.e. femoral neck fractures and intertrochanteric fractures.
Surgical methods
lManipulation/surgical repositioning + internal fixation: Applicable to: ① femoral neck fractures with insignificant displacement (mainly trans-neck and basal type); ② intertrochanteric fractures with displacement.
Total hip replacement/artificial femoral head replacement: for subtrochanteric femoral neck fractures or trans-neck femoral neck fractures with significant displacement.
5. Rehabilitation treatment
Conclusion.
◆The incidence of osteoporotic fractures is increasing due to the aging of the population.
◆Osteoporosis causes a huge medical burden, physical and mental suffering of patients, burden and family burden.
◆Timely and active prevention and treatment is beneficial to improve bone quality and bone mass, reduce the occurrence of fractures and improve the quality of life.
◆Improve bone mass by taking comprehensive measures, including combined drug therapy, adequate food calcium, moderate exercise and reasonable nutrition.
◆For those who need surgery for hip fracture, they should make adequate preoperative preparations, choose suitable surgical methods and prevent and control various complications. Patients who undergo surgery must also undergo comprehensive anti-osteoporosis treatment at the same time, mainly pharmacological treatment.