I. Current status of research on osteoporotic spine fractures 1. Epidemiological survey of osteoporotic spine fractures Osteoporosis (OP) has increased in prevalence with the demographic changes in society and the increase in the percentage of elderly population. These fractures occur in bone tissue rich in cancellous bone such as vertebral bodies, distal radius, and proximal femur. Osteoporotic vertebral fracture (OPVF) causes low back pain that often goes unnoticed by the physician, and in cases where the cause is unknown, the patient is put back in bed for treatment. The fracture of the injured limb may lead to increased osteoporosis and complications. The possibility of re-fracture increases for those who have fractures, forming a vicious circle. The incidence of osteoporotic spine fractures increases rapidly with age, with a prevalence of less than 0.02% for men and women under 45 years of age, compared with 0.12% for men and 0.13% for women over 85 years of age, but the actual incidence is higher. According to X-ray statistics, the incidence of spinal fractures in women over 85 years of age in the United States is over 50%, and 25% of women over 50 years of age have one or two spinal fractures in their lifetime. The prevalence of spinal fractures in the Australian population is 20%, 21% in Denmark, which is basically the same in both countries, and 9% in the United Kingdom. The incidence is also higher in men, with a female to male ratio of 2:1. The above are the results of a survey based on the Rochester method of measurement, and the results still vary widely by race, age, and method of measurement. At present, there is no accurate survey in China. Despite our greater awareness of vertebral fractures, there are still more missed diagnoses occurring due to the lack of training and experience of physicians in this area. Data from a survey showed that moderate and severe osteoporotic fracture changes in the spine were found in 14% of 23% of hospitalized women who underwent routine X-ray chest examinations, and radiologists reported only 50% of them. In China, Chen Jing et al [8] reported 125 patients with low back pain and fractures in the elderly, all of whom were examined by spinal X-ray ortho-lateral radiographs, which revealed more than one vertebral fracture in 56.25%. The above situation indicates that our clinical work on vertebral osteoporotic changes has not been well performed and further improvement is needed. 2. Diagnostic criteria of osteoporotic spine fracture First, according to the diagnostic criteria of osteoporosis proposed by WHO in 1993, osteoporosis can be diagnosed if the following conditions are met: 1. Normal: bone mineral content (BMD or BMC) is not less than 1 SD of the average value of normal adults. 2. Decreased bone mass: BMD or BMC is less than 1 SD of the average value of normal adults, but not more than 2.5 SD. 3. Osteoporosis: BMD or BMC below 2.5 SD of normal adult average. 4. Severe osteoporosis: BMD or BMC below 2.5 SD of normal adult average, with one or more fractures. The BMD or BMC measurements referred to in this criterion are the results of dual-energy X-ray bone densitometry (DEXA) measurements of the lumbar spine in the orthogonal position, hip or forearm, and are used as the gold standard. Secondly, according to the Genant semi-quantitative method for fracture degree assessment, the vertebral body from T4 to L4 with normal morphology and size is considered as grade 0 (normal); a vertebral body height reduction of 20% to 25% and vertebral body projection area reduction of 10% to 20% is considered as grade 1 (mild fracture or Ⅰ degree fracture); a vertebral body height reduction of 26% to 40% and vertebral body projection area reduction of 21% to 40% is considered as grade 2 ( The vertebral body height and vertebral body projection area were reduced by 26% to 40% and the vertebral body projection area was reduced by 21% to 40%, which was grade 2 (moderate fracture or grade II fracture); the vertebral body height and vertebral body projection area were reduced by more than 40%, which was grade 3 (severe fracture or grade III fracture). All cases were defined by a vertebral body height reduction (compression) of 15% or more, and spine fractures were defined by measuring vertebral body height measuring the anterior edge height (AH), middle height (MH) and posterior edge height (PH), and if AH/PH or MH/PH were lower than 3 standard deviations from the normal mean, the diagnosis was osteoporotic spine fracture. Most domestic scholars consider vertebral body height measurement on lateral spine radiographs for diagnosis, and a decrease of 3-4 mm in the anterior, posterior or central height of the vertebral body, or a decrease equal to or greater than 15-20%, as diagnostic criteria. Several objective examination methods, including the same vertebral body anterior, posterior or central height ratio (wedge or concave, respectively); adjacent vertebral body posterior margin height ratio or a single vertebral body (T4) were used as reference values. The purpose of the reference normal range criteria is to take into account intervertebral and interindividual differences. 3. Risk factors for osteoporotic spine fracture The occurrence of osteoporotic spine fracture is caused by many factors. Decreased spine BMD, falls, and previous fracture history become the main risk factors for spine fracture, but gender, increasing age, genes, geographic season, menopausal age body mass index, occupation, TCM dialectical typing, and many daily biochemical modalities are associated with OPVF. However, there is a lack of accurate and consistent understanding of the distribution, characteristics, and risk factors of osteoporotic spine fractures, and a lack of systematic clinical information on the correlation between osteoporotic spine fractures and their differential staging. 3.1 BMD or BMC and OPVF Many prospective studies have shown that the risk of fracture increases 1.5 to 3.0 times for every 1 SD decrease in BMD. In our country when vertebral BMD decreases by 1 SD, the fracture risk increases 2.6-fold. Previous epidemiological studies have firmly established that low BMD is the single most important risk factor for osteoporotic fracture. bMD measurement has a high specificity for assessing fracture risk. An epidemiological study by Dargent et al. showed that very low BMD (<-3.5 SD) was a good predictor of fracture. Their epidemiological survey of 6933 older women over 75 years of age found that a 2.5 to 3.5 SD decrease in BMD in women with fracture risk factors including age, fall history, dynamic balance, gait speed, and visual acuity significantly improved fracture predictive values with a sensitivity of 37% and specificity of 85%. After comparing the bone mineral content of fracture patients and normal subjects, Xu Shunqing et al. showed that bone mineral content was negatively correlated with fracture risk, and the lower the bone mineral content, the greater the fracture risk, and for every 0.1 g/cm-2 decrease in bone mineral content, the fracture risk increased about 1-fold. The bone mineral density of osteoporosis patients decreases to the bone mineral density that is susceptible to fracture, which is called the fracture threshold, and the fracture threshold is extremely important for identifying people at high risk of fracture and preventing fracture. Xiao Yueyong et al. concluded that the fracture threshold of vertebral bone mineral content is 100 mg/ml for cancellous bone and 220 mg/ml for cortical bone, and Sun Jian et al. found that the BMD of healthy people gradually decreases with age, decreasing by 0.38% per year for women and 0.22% per year for men after the age of 40, and women 1-5 years after menopause can lose 3%-5% of cancellous bone per year; women lose About 1/3 of dense bone and 1/2 of cancellous bone are lost during the lifetime of women; the increase in the incidence of vertebral fracture with age is consistent with the decrease in bone mineral density. Thus, the relationship between vertebral fracture and bone density is close. 3.2 Falls and OPVF In addition, falls are another important factor for the occurrence of OPVF. Shen Lin et al. investigated the incidence of osteoporotic fractures in the elderly population in Wuhan and found that 59.7% of the patients had fractures due to falls, and most of the spinal fractures tended to occur non-traumatically and naturally. For example, vertebral fractures occur during daily activities such as lifting and carrying heavy objects, exercising with slightly large movements, or even when someone simply turns over while lying in bed or sleeps with their feet on the quilt. Falls in the elderly are the result of the interaction of many complex factors, including age, intellectual status, living conditions and the impact of balance function. The decline of balance in the elderly is one of the important risk factors for falls and an important predictor of falls in the elderly. In particular, elderly patients with osteoporosis are more prone to fall events due to disturbances in gait and balance and muscle movement disorders, which increase the chance of fracture. It has been reported abroad that 30% of older adults over 65 years of age fall at least once a year, and the probability of falling increases gradually with age, with an annual incidence of falls of up to 50% in those over 80 years of age. A retrospective study by Guesens et al. showed that among 2649 admitted postmenopausal women, the relative risk of fracture was 1.9 for women with a 1 SD decrease in BMD compared with women without osteoporosis and no falls, and further adjusted for age and body mass index, the relative risk of fracture was 2.8, and when added to If a history of falls is added, the relative risk of fracture increases to 6.0; women with a BMD decline of more than 2.5 SD and a history of falls have a relative risk of fracture as high as 24.8. 3.3 Prior Fracture History and OPVF Another risk factor is a history of prior fractures. Low BMD and history of fracture are complementary risk factors for the occurrence of fracture, with those with both risk factors having a greater risk of fracture than those with only one risk factor; and those with either risk factor having a greater risk of fracture than those with no risk factor for fracture. The presence of a spinal fracture is an important predictor of the occurrence of another spinal fracture or non-spinal fracture. The importance of timely detection of spinal fractures has been accepted by many scholars as a high risk factor for re-fracture. the MORE study by Professor Delmas showed that the severity of spinal fracture predicted the 3-year risk of spinal fracture and non-spinal fracture. Patients with severe spinal fractures (degree III) had a 38% risk of spinal re-fracture and a 14% risk of non-spinal fracture; those with degree II had a 24% and 8% risk of fracture, respectively; and those with degree I had a 4% and 6% risk. Nationally, it was reported that a history of vertebral fracture increased the risk of other vertebral fractures and hip fractures by 5 and 3 times, respectively, and for women without a history of vertebral fracture, other types of fractures also increased the risk of vertebral fractures and hip fractures by 1 time, respectively. It can be seen that the diagnosis of non-violent spinal fractures through the first time is of great practical importance to propose the prevention of either re-spinal fractures or non-spinal fractures. 3.4 Gender and OPVF From the analysis of the gender composition ratio of fracture occurrence, Yu Liang et al. reported that the incidence of various fractures due to osteoporosis increased above the age of 50 years, with a more pronounced increase in women, and reached a peak in the age group of 61-70 years. The reason for this is that women experience rapid bone loss involving mainly cancellous bone around the age of 49 years with the onset of menopause and a decrease in estrogen levels, whereas men experience a slow bone loss process. This different change in bone metabolism due to different alterations in male and female sex hormones creates the sex characteristics of osteoporotic fractures. However, other studies have shown that the difference in spinal fracture rates between men and women is small (15-25%) and age-related. On the surface, spinal fractures are lower in men than in women, but in fact, the severity, incidence, and morbidity and mortality of spinal fractures are higher in men than in women. This is due to the fact that men are less likely to see a doctor or seek medical help than women. In this regard, if mild fractures are included, spinal fractures in men may not be lower than in women. 3.5 Ageing and OPVF The spine is the most common site for osteoporotic fractures. the incidence of vertebral fractures is almost zero before the age of 50 years, while the incidence increases almost exponentially after the age of 85 years, by more than 3% for each year of age. It appears that more than half of women will experience at least one vertebral fracture in their lifetime, and about half will experience multiple fractures. However, only 1/3 of vertebral fractures are clinically diagnosed. Another study found that the risk of fracture increases with age even if the bone density levels are the same, and the incidence of spinal fractures increases with age in people after age 50, especially in women. Our survey found that women's bone mass peaks at 30 to 35 years of age, and bone loss begins at 35 years of age, with the fastest loss in the first few years after menopause. In foreign countries, it is reported that bone resorption exceeds bone formation at the age of 30, and thereafter, bone loss is about 10% every 10 years, with increasing age, BMD decreases, brittleness increases, and strength becomes weaker. The influence of age on the disease is multifaceted, in addition to the dominant role of the decline in BMD, on the other hand, with ageing, gonadal function decreases, gastrointestinal function is weakened, the absorption of calcium and protein is insufficient, sunlight and exercise are reduced, the strength of human skeletal muscle decreases, the coordination of movement is poor, especially in the elderly, the reaction to the outside world is slower, making the chance of fracture greatly increased. 3.6 Genes and OPVF Genes determine the size and structure of the skeleton from the beginning of life. The acquisition of peak bone mass during the growth period and the decline in BMD after menopause have a strong genetic background, and genetic genes explain more than 80% of the variation in BMD, with different incidence in different races. Preliminary results have shown a link between the vitamin D receptor gene, estrogen receptor gene, type I collagen gene, interleukin 6 gene and transforming growth factor β gene and bone formation and fracture occurrence. Jouanny et al. showed that children of single parents with low BMD had a 4-fold higher risk of developing low BMD than the normal group, while children of two parents with low BMD had a 9-fold higher risk of developing low BMD than the normal group. A study by Henderson et al. of 1,169 cases in 69 families showed a genetic predisposition to osteoporosis in 45% of families, with a 33% correlation between mothers and daughters and a 19% correlation between sisters, but no correlation with individual age of onset or severity of osteoporosis. a study by Francois et al. also showed that premenopausal women with a family history of osteoporosis had a higher BMD than those without a family history of osteoporosis. is lower in premenopausal women with a family history of osteoporosis than in premenopausal women without a family history of osteoporosis, and in particular, the lumbar spine is affected early. Other studies have shown that other factors associated with osteoporosis and fracture risk are also genetically related, such as body mass index, age at menopause, etc. 3.7 Geographic season and OPVF According to the literature, the incidence of various fractures caused by osteoporosis has a tendency to be significantly higher in Caucasians than in Yellows and Blacks, in colder regions than in warmer regions, in winter than in summer and autumn, and in urban populations than in rural and fishing village populations. According to domestic statistics, the total prevalence of spinal fractures in women over 50 years of age in Beijing is 15%, and the age-standardized total prevalence of spinal fractures is 5.5% lower than that of white women in the United States. In Guangzhou, the prevalence of osteoporotic fractures was 12.2% and the prevalence of spinal fractures was 7.8%. The total prevalence of each osteoporotic fracture in the Wuhan area was 7.31% in the elderly population aged 60 years or older, with a total prevalence of 4.08% for spine fractures. Season of occurrence, the incidence of fractures was significantly higher in winter and summer than in spring and autumn. The reasons for the high incidence of fractures in winter may be related to the increased chance of falls due to the cold and slippery roads, long days and dark nights, and less UV light exposure, vitamin D deficiency, and weakened bone strength and muscle power. The occurrence of fracture in summer is mostly related to more outdoor activities in this season, coupled with hot weather, bathing, washing things, moving things to keep cool, and other daily activities that increase the chance of slipping, holding things under weight, changing postures, and twisting the body. The prevalence of fracture varies according to the population in the region, due to the difference in diet with high and low calcium, geochemical composition of the soil, water, food and other bone minerals, as well as the altitude and latitude of the sunlight received. 3.8 Age at menopause and OPVF The risk of OPVF tends to increase significantly with the number of years of menopause, with the risk of fracture increasing nearly twofold at 15 years of menopause and nearly threefold in older women who have been menopausal for more than 20 years. Postmenopausal women with at least one or more fractures had earlier age at menopause, longer years of menopause, more births, longer months of breastfeeding, and older age than women without fractures, and age and BMD values were the most important influencing factors for osteoporosis accompanied by fractures in postmenopausal women. The fracture rate increases with earlier age at menopause. If the age of menopause was <40, 40-44, 45-49, 50-54, and ≥55 years, the fracture rate was 8.7%, 11.0%, 7.8%, 5.6%, and 4.3%, in that order. Therefore, postmenopausal women who are older and have lower bone density should be especially focused on prevention as a high-risk group for fracture. 3.9 Chinese medicine classification and OPVF, however, there is a lack of clinical data in this area. Lu Xiongcai et al. treated 173 cases of thoracolumbar fractures in hospitalized elderly people and concluded that the disease is a deficiency of the liver, spleen, and kidney as the root cause, fall and flash as the causative factors, and qi stagnation and blood stasis as the symptoms; and old age and weakness, deficiency of kidney essence, loss of bone marrow and bone nourishment as the main pathogenesis. The treatment should take into account both the symptoms and the root cause, and be divided into spleen and kidney yang deficiency type (72 cases, mostly males, accounting for 47 cases) and liver and kidney yin deficiency type (101 cases, mostly females, accounting for 85 cases). 3.10 Other factors The relationship between bone mass or BMD and body weight or body mass index (BMI) has been confirmed by numerous studies, i.e., bone mass is significantly and positively correlated with body weight or BMI. [BMI (kg/cm2) = weight (kg )/height (cm)2] Some domestic authors suggest that patients with a body mass index ≤20 kg/m2 should exercise their muscle coordination and take the necessary medication for osteoporosis. In addition, occupation, exercise, sun exposure, vision loss, medication, diet, smoking, alcohol and caffeine can increase the risk of OPVF. II. Awareness of osteoporotic spine fractures in ancestral medicine 1. Awareness of the etiology of osteoporotic spine fractures Osteoporotic spine fractures can be pathological spontaneous fractures or fractures caused by external forces. When analyzing the pathogenesis of these fractures, it can be said that internal factors are the main factors, external factors are important factors, and external factors act through internal factors. Therefore, the "origin" is osteoporosis and the "symptoms" are spinal fractures. In early Chinese medicine, osteoporosis and osteoporotic fractures were not mentioned, but the back pain often caused by this disease was recorded in some detail. For example, "Su Wen - pulse to the essence of the chapter" pointed out that "the waist is the house of the kidney, turn shaking can not, the kidney will be exhausted." The Treatise on the Origin of the Diseases considers that lumbago is related to five conditions: deficiency of Yang in Shaoyin, wind and cold in the lumbar region, strain and injury to the kidneys, fall and injury to the lumbar region and sleeping on wet ground. In Danxi Xinfa (The Method of the Heart), "Low back pain is caused by dampness and heat, kidney deficiency, blood stasis, contusion and flash, and phlegm accumulation". According to Zhang Jiebin, "Where the lumbago is long and chipper and repeatedly occurs, the kidney is deficient; in case of cloudy rain or prolonged sitting and heavy pain, it is also wet; in case of all cold and pain, or like warmth but hate cold, it is also cold; in case of all heat and pain and like cold but hate heat, it is also hot; in case of depression and anger and pain, the stagnation of qi; in case of sorrow and thought and pain, the deficiency of qi; in case of labor that is pain, the failure of liver and kidney; it should be treated by identifying what it is. ". "Waist for the kidney of the House, the kidney and bladder for the table, so in the meridian is the sun, in the organs is the kidney qi, and for the punch, Ren, Governor with the important meeting. Therefore, all those who suffer from lumbago are mostly due to the deficiency of true yin, so it is most appropriate to cultivate kidney qi as the mainstay; those who have actual evil and suffer from lumbago are only two or three out of ten". "The deficiency of lumbago, eight or nine out of ten, but the examination of its neither surface evil, and no damp heat, but either by the age of decline, or by labor, or by the loss of alcohol, or the seven emotions caused by depression, then all belong to the true yin deficiency signs. Where the deficiency of the evidence of the marquis, the form must be clear and white, or see the black, the pulse must be slow, or see the subtle, or to travel is not supported, then rest less can, or to fatigue and weakness and labor is more. Where the accumulation and gradual arrival, are not enough; violent and painful, more surplus; internal injury endowment, are not enough, external infection of evil real, more surplus. Therefore, the treatment should identify the cause. Where the kidney water true yin deficiency, essence and blood weakening and pain is appropriate for danggui dihuang drink, and zuo gui pills, right gui pills as the most, if the disease is a little light, qing'e pill, simmering kidney powder, tonic marrow dan, two sage pills, tong qi san and so on, all have the option to use." Chinese medicine believes that the relationship between the kidney and the bone is close, "Nei Jing", "the kidney is also the bone". In the book of "Ying Xiang Da Lun", it is stated that "the kidney produces bone marrow", in the book of "Inversion", it is stated that "if the kidney does not produce, the marrow will not be satisfied", and in the book of "Ling Shu", it is stated that "the brain is the sea of marrow", and in the book of "Nei Jing", it is also clearly stated that "For those who have bone impotence, tonify the kidney to cure it." The theory of Chinese medicine believes that the kidney is closely related to aging, and when the kidney essence is insufficient in old age, the role of the kidney in producing marrow in the bones also decreases. Marrow is produced by kidney essence and is hidden in the bone cavity to nourish the bones. If kidney essence is sufficient, the bones will be nourished and the marrow will be full and healthy. If the kidney essence is insufficient, the bone marrow is empty, the bone loses its nourishment, the bones are soft. According to the theory of Chinese medicine, osteoporosis is considered as kidney deficiency bone impotence and kidney deficiency bone pain. Osteoporosis is a systemic multi-causal skeletal disease characterized by a decrease in bone mass per unit volume and abnormalities in the microstructure of bone tissue. It mainly manifests as pain, deformities and fractures in the thoracic back and lower back. Medical science considers the relationship between this disease and kidney deficiency to be extremely important. Suwen Shanggu Tianzhen said: "five or eight kidney deficiency, hair fall teeth haggard; six or eight Yang Qi failure on the upper, face scorched hair and temples issued white; seven or eight liver failure, tendons can not move; eight or eight days of exhaustion, less essence, kidney failure, the shape of the body are extreme, just teeth hair go." Chinese medicine believes that "the kidney is the main bone" kidney collects essence, essence is the main marrow, marrow is hidden in the bone, nourishing the bone. Kidney essence is sufficient, the bone marrow biochemical source, the bones are nourished by the bone marrow and strong. In old age, the kidney energy declines, the kidney essence is deficient, the bone marrow is not enough, and the bones become osteoporotic, weak and fragile. Low back pain is the most common and earliest symptom, mainly soreness, and there is obvious pressure and percussion pain in the spinous process, accompanied by general skeletal pain, soreness and weakness, if not prevented in time, there will be fractures, hunchback, waist, hip and knee joint movement is limited, showing the position of "spine instead of head, coccyx instead of heel". This shows that the strength and weakness of kidney essence is closely related to bone and metabolism. This fully demonstrates that the theory of Chinese medicine that "the kidney collects essence and produces marrow" was correct and scientific more than two thousand years ago. It was found that as we age, the incidence of kidney deficiency gradually increases, while the bone mineral content in human bones gradually decreases. The spleen is the mother of all bones. The spleen is responsible for transporting and transforming, ascending and clearing, and distributing essence. Spleen deficiency is an important factor in the development of osteoporosis. In the book of Suwen, "The Five Flavors of the Spleen": "If we are careful with the five flavors, then the bones will be correct, the tendons will be soft, the blood will flow, and the couples will be dense, as such, the bones will be refined, and if we are careful with the path, we will have a long life. This means that diet and taste affect the growth of bones and are closely related to the function of the spleen and stomach. The spleen is the origin of the posterior, the source of biochemistry, the master of all the bones, the transformation of blood, blood, essence, liquid to glory and nourishment to moisten the bones. The innate essence also depends on the continuous nourishment of the water and grain essence of the spleen and stomach. If the spleen and stomach are deficient, the source of transformation is not invigorated, the essence cannot be distributed in all directions, so that the road is empty and the form is greatly injured. The spleen and stomach are the pivot of the qi flow, and they are the hub of the qi flow, transporting up and down and moistening the four sides, thus maintaining the mutual transformation of qi, blood, essence, and fluid. If the spleen and stomach function is exhausted, the qi transformation is lost, the pivot is blocked, and the blood does not turn into essence, the bones cannot be irrigated by essence deficiency, cannot be nourished by blood deficiency, and cannot be transported by qi deficiency, so there is no way to produce marrow to nourish the bones, resulting in the occurrence of osteoporosis. Dietary flavor on bone development, such as "Su Wen - angry Tong Tian Lun" said: "is therefore careful and five flavors, then the bone is tender, blood to flow, couples to dense, as is the bone to fine, careful way as the law, long have the life of heaven." And diet and the spleen and stomach are closely related, the spleen is the essence of the latter, the main transport and transformation of water and grain essence, the source of Qi and blood biochemical, and the main muscle limbs. The "Medical Zong must read impotence" said: "Yangming deficiency is less blood, can not moisten the tendons, so Chi longitudinal, the tendons longitudinal band veins can not be collected and led, so the foot impotence not used." Weakness of the spleen and stomach leads to deficiency in the production of water and grain essence, resulting in loss of nourishment of the muscles, bones and marrow, and lack of use of the limbs. Spleen deficiency cannot nourish the innate, which in turn leads to kidney essence deficiency, loss of nourishment of tendons and bones, and bone impotence. The liver collects blood and the kidney collects essence. In Chinese medicine, it is said that "essence and blood have the same origin" and "liver and kidney have the same origin". If the liver is out of balance, liver qi stagnation, depletion of yin and blood, liver blood deficiency, can lead to kidney essence loss, so that the bone marrow does not nourish, limbs do not use. Or depression, external evil stagnation leads to liver qi stagnation, qi and blood stagnation, bone marrow veins and ligaments lose nourishment. According to Chinese medicine, "women are liver-oriented", liver qi stagnation leads to qi and blood stagnation, and the overflowing of the blood and flushing may cause menstrual disorders and even amenorrhea. Most women show signs of liver depression after menopause, and their bone mass decreases rapidly, which proves that liver depression is closely related to osteoporosis. Modern research shows that liver depression is mainly related to higher nerve activity and autonomic dysfunction, but also to endocrine disorders, especially hyperprolactin disorders. This is an important pathogenesis of postmenopausal osteoporosis in women. Through decades of research, theoretical exploration and clinical practice, domestic scholars have gradually systematized the theoretical research on the treatment of osteoporosis in TCM, and accumulated rich clinical experience and put forward many incisive and unique insights: (a) Kidney deficiency, spleen deficiency and blood stasis are the main etiological mechanisms of osteoporosis. According to the theory of traditional Chinese medicine and combined with clinical experience, Professor Liu Qingsi believes that the occurrence of osteoporosis is mainly related to three factors: kidney deficiency, spleen deficiency and blood stasis, among which kidney deficiency is the main cause of the disease. The pathological characteristics of osteoporosis are "multiple deficiencies and stasis". (2) Emphasis on "three theories", "three perspectives", "three sites" and "three multiple pathological mechanisms". (1) "Three theories" The theory that the kidney governs the bones: the kidney is the "essence of the innate nature", it collects essence, governs the bones and produces marrow, and is closely related to the reproductive, endocrine and gonadal systems, and the physiological process of the kidney is greatly related to the flourishing, flourishing, leveling and decay of the bones. "The physiological process of the kidney is greatly related to the prosperity, strength, flatness and failure of the bone. The spleen and kidney are related: the spleen is the "essence of the latter day", the main transporting and corrupting water and grain essence, the spleen disperses essence, which is transferred to the lungs and returned to the kidneys, the spleen and kidneys promote each other and are interdependent, and it is often said that "the spleen and kidneys are sick together". Weakness of the spleen and kidney is the main pathological change of osteoporosis. Blood stasis theory: the dysfunction of the internal organs of patients with osteoporosis and the unfavorable meridian qi affect the flow of qi and blood, resulting in pain and dysfunction. Blood stasis can lead to obstruction of qi and blood flow, and nutrients cannot moisten the internal organs, causing deficiency of both spleen and kidney and aggravating symptoms. (2) "Three points of view": Discriminatory view: the eight syllabuses, viscera, qi and blood, three jiao, and meridians are the fundamental rules of Chinese medicine in the diagnosis and treatment of diseases. Holistic view: internal and external, up and down, yin and yang, surface and interior, meridians and qi and blood are all interrelated, making the human body an organic whole, and they are interrelated, mutually promoting and restraining each other, making the human body a whole with complex functions. The treatment of osteoporosis should not only target the local treatment of bones, but also consider the changes of the patient's whole body. The concept of balance: there are two contradictory aspects in the normal organism, namely, yin and yang, hot and cold, internal and external, and surface and internal. Under the influence of certain factors, there is a bias or deficiency, resulting in an imbalance in the body and producing disease. The purpose of treatment is to adjust the internal environment of the body to bring it into a new balance in order to restore the normal function of the body. (3) "Three sites" It is believed that the main sites of osteoporosis are the kidney, spleen and meridians, followed by the liver and qi and blood. (4) "Three multiple pathogenic mechanisms" The pathogenic characteristics of osteoporosis can be summarized as a systemic skeletal disease with multiple deficiencies, multiple stasis, and multiple systems and organs. The classification of TCM evidence is based on TCM theory to distinguish and generalize the etiology, pathology, disease location and its development, regression and prognosis of the disease. The traditional identification system of Chinese medicine, such as the eight syllabuses and the identification of internal organs, is a summary of the experience of long-term clinical practice in Chinese medicine. In recent years, some scholars have carried out investigations and analyses of the Chinese medical evidence of osteoporosis based on the recognized diagnostic criteria for osteoporosis. However, the correlation between osteoporotic spinal fractures and their identification and typing has not been mentioned. Based on the etiology, clinical symptoms and signs of primary osteoporosis, Prof. Liu Qingshi et al. summarized the classification of osteoporosis into four types, namely, kidney-yang deficiency type, liver-kidney-yin deficiency type, spleen-kidney-yang deficiency type, and qi-stagnation-blood stasis type, which can be seen either singly or simultaneously. This typology is simple and clear, and is also easier to apply clinically. 3 , dialectical treatment study For fractures, the treatment principles for fractures should be followed first, and then the etiology should be treated according to the underlying cause of osteoporotic spine fractures - osteoporosis. According to the understanding of the characteristics of the etiology and pathogenesis of osteoporosis in Chinese medicine, the treatment of osteoporosis in Chinese medicine should be based on the principle of "tonifying deficiency and resolving stasis", that is, in addition to tonifying the spleen and kidney, activating blood circulation and resolving stasis is also an important treatment method. At present, the main treatment methods for osteoporosis are: tonifying the kidney, tonifying the kidney to invigorate blood and tonifying the kidney to strengthen the spleen. Through clinical and experimental research, it was confirmed that the treatment principle of "tonifying the kidney and strengthening the bone, strengthening the spleen and benefiting the qi, invigorating the blood and promoting the circulation of blood" is scientific and reasonable, and has obvious advantages and innovation compared with other treatment methods, and this principle has important guiding significance for the treatment of osteoporosis in Chinese medicine. Chinese medicine treatment of osteoporosis should be based on evidence-based treatment, and implement the treatment principles of combination of movement and static, tendon and bone, internal and external treatment, and cooperation between doctors and patients. Osteoporosis has a long course and requires long-term treatment. Chinese medicine has obvious advantages due to its precise curative effect and no obvious side effects. 4, Summary The osteoporotic spine fracture with osteoporosis as the root cause is a multifactorial and multi-linked metabolic bone disease, and current research still fails to clearly reveal what factors play a dominant role and the interactions between various factors, so it is important to clearly explain the direct etiology and pathological mechanisms of osteoporotic spine, how to reasonably predict the risk of osteoporotic spine fracture and thus timely intervention, and reduce the risk of fracture. Therefore, we need to explore further how to predict the risk of osteoporotic spine fractures and how to intervene to reduce the risk of fracture. In the field of Chinese medicine research on osteoporosis and osteoporotic fractures, we should try to expand the research on the treatment from kidney, liver and spleen, the combination of diseases, the identification of the causes and the low toxicity of Chinese medicine, to improve the clinical prevention and treatment rate of osteoporotic spine fractures and to reduce the risk of various susceptible groups, which is the ultimate goal to solve this worldwide public health problem.