Osteoporosis is not an unfamiliar word, but few people see it as a disease, considering it as a normal degenerative change in the human body. Back pain, bowing and hunching look like an aging phenomenon, but in essence it is a disease state of osteoporosis, which we cannot take lightly, but must be actively prevented and treated. Bone remodeling Bone, like other tissues, is constantly undergoing metabolism, and this is called bone remodeling. It is the process of reaching a balance between bone resorption and bone production, just as our hair keeps falling out and growing back. The rate of bone remodeling in adults is about 5%-15% per year, and the process of bone remodeling includes three stages: bone resorption, bone formation and bone matrix mineralization. In bone resorption, osteoclasts remove minerals from old bone; in bone formation, osteoblasts first form osteoid and calcify into new bone. The process of bone remodeling and calcium metabolism is mainly regulated by three important hormones (parathyroid hormone, calcitonin, and 1,25(OH)2D3). These three hormones coordinate with each other to maintain the balance of calcium levels in the blood and to keep bone metabolism going normally. When this balance is disrupted or when endocrine disruption occurs, it causes impaired bone metabolism and imbalance in the bone remodeling process. Then it is easy to see that osteoporosis is caused by abnormal bone metabolism. Chen Xiaoming, Department of Orthopedics, Siping Central Hospital ● Why osteoporosis? Osteoporosis caused by abnormal bone metabolism is manifested by the decrease of calcium content in bone, both the increase of bone resorption, the decrease of bone formation and the impairment of mineralization process. In middle-aged and elderly people, especially women, due to the metamorphosis of body organ functions, the aforementioned disorder and reduction of the three major hormones affecting bone calcium metabolism, the absorption of bone is increasing, and the calcium in bone is dissolved and free into the blood, forming free calcium, which cannot be used by the body and then returned to the bone, reaching the kidneys with blood circulation and then eliminated from the body with urine, resulting in a large loss of calcium in the long run. At the same time, bone formation also decreases, and new bone cannot be mineralized, so that the double reversal of bone remodeling, the calcium content in bone decreases, the number of bone trabeculae decreases, the gap increases, and the bone becomes soft, resulting in serious osteoporosis over time. Does osteoporosis require calcium supplementation? The answer is no. Why is it wrong to take calcium supplements if osteoporosis is not a calcium deficiency? In fact, patients in osteoporosis, due to the dissolution of bone calcium, the lack of calcium in the bone, at this time, the increase of free calcium in the blood, blood calcium is not only not lacking, but also high. At this time to supplement calcium, after absorption into the blood, not used by the body, the same will also be excreted. Therefore, it is useless to simply supplement calcium. It should be addressed first to inhibit osteocalcinolysis and promote osteocalcin production, so that the free calcium in the blood returns to the bone to mineralize into bone, which requires a certain process and time, and then when the blood calcium is reduced, then start supplementing calcium to be utilized. Therefore, patients with osteoporosis are not suffering from insufficient calcium intake, but from insufficient calcium utilization, and should not start with calcium supplementation, but rather with treatment. Osteoporosis is prone to fracture Bone consists of cortical bone and cancellous bone. Cortical bone is hard and can withstand large loads and is usually located in the center of the bone. The cancellous bone is composed of trabeculae, which are rich in blood circulation and bear less load, and is mostly located at one end of the bone. The vertebrae, femur and radius are made up of cancellous bone, and these three parts of the bone are subjected to heavy weight or high activity frequency. If combined with osteoporosis, the number of trabeculae decreases and the bone cortex becomes thinner, a fracture can easily occur. Some people who have osteoporotic fractures do not even know that they are old and think that they are “shrinking” and that the occasional back pain is the result of old age. Can osteoporosis cause pain? Osteoporosis can cause pain, mostly when you are at rest or after an activity with unexplained bone pain throughout the body. The location of pain is usually not fixed, the duration of pain is uncertain, and it does not last, and there are no local abnormalities. Patients do not get better after seeking medical help, and they suffer from mental and physical pain. The mechanism of pain from osteoporosis is very complex and is not fully understood. It is generally believed that it may be related to the destruction of bone structure or stimulation of bone tissue under pressure, or it may come from the indirect stimulation of bone trabeculae fracture or release of chemical substances when bone tissue is damaged. How to know if you are suffering from osteoporosis Osteoporosis does not have special symptoms like other diseases, but comes to you quietly, but it can still suggest that people may have osteoporosis from many symptoms. This is a precursor of osteoporosis. In addition, the most simple examination of osteoporosis is to take a local X-ray to observe whether the bone cortex is thinning and whether the bone trabeculae of cancellous bone are sparse. However, X-rays are generally seen only when there is more than 30% bone loss, and this test is not accurate enough. At present, the measurement of osteoporosis mainly relies on bone mineral density measurement, and it is an important objective basis for diagnosis to determine whether osteoporosis is suffered from according to the value of bone mass by doing bone mass measurement instrument in hospital. Why women have a high incidence of osteoporosis At present, the pathogenesis of osteoporosis is not fully understood, but for postmenopausal women who are prone to osteoporosis, it is known to be closely related to the decrease of estrogen. As women age, ovarian function decreases and estrogen secretion decreases, which directly affects the body’s absorption of calcium and bone metabolism. As a result, the incidence of osteoporosis is significantly higher in women than in men. It seems that the focus of osteoporosis prevention and treatment should be on middle-aged and elderly women. Since osteoporosis is caused by the imbalance between bone formation and bone resorption, it can be treated by inhibiting bone resorption and stimulating bone formation to increase bone mass and delay and stop the occurrence of osteoporosis. Drugs for the treatment of osteoporosis are generally divided into three categories: 1. drugs to inhibit bone resorption, such as estrogen, bisphosphonates, calcitonin, etc. 2. drugs to promote bone formation, such as fluoride, parathyroid hormone. 3. drugs for bone mineralization: active vitamin D and calcium agents. The above-mentioned are only the types of drugs, each of which also includes many kinds, here is a brief list of a few: Estrogen: replacement therapy (replacing the gradual reduction of one’s own hormones) is very common, but given the high number of complications, it is not used alone, but mostly in combination with other drugs. The preparations currently used are mainly imported products, such as: Levi’s, Bemisil, Anxon (for men). Bisphosphonates: Fosamax, Tianke, Gubang, Banderin, Edron, Bonin, Acoda. Calcitonin: Micaresin, Icariin. Fluoride: Toledin. Bone mineralizers (both: calcium supplements): Farnesol, Alfa D3, Mungerwang, Frostbite, Lixin, Active VD3, Calcium Nocturne, Rogaine, Irrigated Pure, Calcium D. The use of the above drugs, it is worth noting that the inhibition of bone resorption drugs can not increase bone density, generally after six months to a year of treatment, bone density no longer increases, the rate of bone loss after discontinuation of the drug is the same as before treatment or even accelerated, therefore, to be used in combination with other Therefore, it is better to use them in combination with other drugs. Bone mineralizers should not be taken at the beginning, but should be started after half a month of using other drugs (or when the blood calcium value has dropped to normal or below). Fluoride should be used at low doses and intermittently. High dose treatment increases the fracture rate of peripheral cortical bone instead. ● Can osteoporosis be prevented? The bone density of Chinese people is about 8% lower than that of Westerners, which may be related to the ethnicity and the Chinese diet. Therefore, Chinese people are more prone to osteoporosis. If bone loss or osteoporosis is detected early and treated scientifically, about half of the femoral neck and vertebral fractures can be avoided. To prevent osteoporosis, we should do the following: first, maintain a healthy lifestyle; second, maintain a balanced diet and take enough calcium and vitamin D; third, do not smoke and do not drink a lot of alcohol; fourth, regularly perform weight-bearing exercises, such as running, rope skipping, aerobics, tennis and brisk walking, which are good for the bones.