Osteoporosis Q&A
Introduction: With the extension of human life span and the advent of social aging, osteoporosis has become an important health problem for human beings, jumping to the sixth place of common diseases and multiple morbidities. The serious consequence of osteoporosis is the occurrence of osteoporotic fractures (fragility fractures), and osteoporotic fractures will significantly increase the rate of disability and mortality, for example, within one year after the occurrence of hip fractures, up to 20% of those who die from various complications, while about 50% of those who survive are disabled, and the quality of life is significantly reduced. However, osteoporosis is a preventable and treatable disease, and early prevention can prevent the development of osteoporosis and fracture; even if a fracture has occurred, as long as appropriate and reasonable treatment is used, the risk of another fracture can still be effectively reduced. Therefore, it is important to popularize the knowledge of osteoporosis, achieve early diagnosis, predict the risk of fracture in time and take standardized prevention and treatment measures.
Q: Osteoporosis and osteoporotic fracture are diseases that seriously affect the health of middle-aged and elderly people, becoming a public health problem that needs to be faced by an aging society. From your experience, what is the current level of awareness of osteoporosis among the public in China?
A: Due to a lot of media explanations and propaganda, people are more familiar with diseases such as hypertension and diabetes, but they do not know much about osteoporosis. This is because the early symptoms of osteoporosis are not obvious and can only be clearly diagnosed through relevant tests, so the public has less understanding and knowledge of osteoporosis; even some doctors are not very familiar with the diagnosis and prevention of osteoporosis.
Q: Could you please introduce the classification of osteoporosis?
A: Osteoporosis is divided into three main categories: primary osteoporosis, secondary osteoporosis and idiopathic osteoporosis. Among them, primary osteoporosis is the most common and can be divided into two categories: postmenopausal osteoporosis in women and senile osteoporosis after the age of 70. Osteoporosis in women after the age of 70 is also classified as senile osteoporosis. Postmenopausal osteoporosis is associated with a decrease in estrogen levels; the occurrence of senile osteoporosis is related to degenerative changes in the bones, vitamin D deficiency and metabolic disorders. There are many causes of secondary osteoporosis, including diseases such as hyperparathyroidism, hyperthyroidism and adrenocorticism, the use of drugs such as antineoplastic drugs and glucocorticoids, and factors such as braking and weight loss. Idiopathic osteoporosis is less common and is mainly seen in children and young adults and is genetically and genetically related.
Q: How do you think the public is aware of the prevention of osteoporosis?
A: Patients do not know they have osteoporosis when they have mild or no symptoms in the early stages. It is only in the middle or late stages, when there is unexplained back pain, a decrease in height of more than three centimeters or multiple fractures, that patients will find out that they have osteoporosis after consulting a doctor. Not only patients, but even some doctors mislead patients, for example, that calcium supplementation may cause stones. So in general, the public’s awareness of osteoporosis prevention is still very weak.
Q: How is osteoporosis diagnosed and differentially diagnosed in clinical practice? What is the specific process?
A: First of all, easy patients with risk factors should be screened. Risk factors that cannot be changed include ethnicity, old age, female menopause, maternal family history, etc.; risk factors that can be changed include low body weight, hypogonadism, smoking, excessive alcohol consumption, excessive coffee consumption, lack of physical activity, calcium and vitamin D deficiency, drugs affecting bone metabolism, etc. Then by examining routine blood, urine and blood biochemical indicators such as calcium, phosphorus and alkaline phosphatase in easy patients, and in some cases, thoracic and lumbar spine X-ray, if abnormalities are found, those with the possibility of secondary osteoporosis can be referred for specialist consultation. Patients with the possibility of primary osteoporosis have their bone density measured and their T-value observed. a T-value above -1.0 is considered normal, between -1.0 and -2.5 is called low bone mass, and less than -2.5 is diagnosed as osteoporosis and needs to be treated accordingly.
Self-Screening Tool (OSTA)
Q: Clinically, once an osteoporotic fracture occurs, the patient’s quality of life will be significantly reduced, so prevention is especially important. What are the current preventive measures for osteoporotic fractures?
A: The prevention of osteoporotic fractures starts with the prevention of osteoporosis. The prevention of osteoporosis is a lifelong process, and calcium intake, sunlight and exercise are the easiest and simplest ways to prevent osteoporosis. Firstly, during childhood, women during pregnancy and perimenopause should pay attention to increase calcium intake, such as consuming more calcium-rich foods like milk, soy products, dark vegetables, sesame seeds and small shrimp skin. Second, pay attention to more exercise, which promotes bone growth. Proper sunlight promotes the synthesis of vitamin D in the body, which is conducive to the absorption and utilization of calcium; in addition, it is important to change poor lifestyles such as smoking, alcoholism, excessive consumption of coffee or carbonated beverages.
For patients who have been clearly diagnosed with osteoporosis, it is necessary to carry out active anti-osteoporosis treatment. It is important not only to prevent osteoporotic fractures but also to prevent falls. For patients with low bone mass, the World Health Organization (WHO) recommends the use of a simple tool for fracture risk prediction, FRAX, which calculates the probability of hip fracture and any significant site fracture within 10 years as a guide to whether or not to administer anti-osteoporosis medication.
Q: Which patients need pharmacological intervention in the 2011 edition of the Chinese Medical Association’s Osteoporosis and Bone Mineral Diseases Branch Guidelines for the Diagnosis and Treatment of Primary Osteoporosis?
A: Those who have one of the following conditions need to be considered for pharmacological treatment.
1, patients with osteoporosis (BMD: T ≤ -2.5) regardless of whether there has been a fracture or not.
2, patients with low bone mass (BMD: -2.5 < T ≤ -1.0) and the presence of more than one osteoporosis risk factor, regardless of whether there has been a fracture.
3.In the absence of bone densitometry, drug therapy should also be considered for those with one of the following conditions.
(1) Have had a fragility fracture.
(2) OSTA screening is “high risk”.
(3) A probability of hip fracture ≥ 3% or a probability of any significant osteoporotic fracture ≥ 20% as calculated by the FRAX tool.
Q: How is anti-osteoporosis medication administered?
A: Calcium and vitamin D are the basic therapeutic agents for osteoporosis. Nowadays, anti-osteoporosis drugs mainly include two categories of bone resorption inhibitors and bone formation promoters.
At present, bone resorption inhibitors are widely used, such as bisphosphonates, estrogen receptor modulators, calcitonin, estrogen and so on. For recently menopausal women suffering from osteoporosis with obvious postmenopausal symptoms, estrogen can be used, but care should be taken that the dosage should not be too large and the duration should not be too long. The Chinese Society of Obstetrics and Gynecology recommends that estrogen should preferably be used for no more than 4 years, and the patient’s breast, endometrial and cardiovascular conditions should be monitored. Bisphosphonates have a better effect of inhibiting bone resorption, and alendronate is the most commonly used third-generation bisphosphonate. Bone formation promoters include agents such as parathyroid hormone (PTH), which can treat osteoporosis by promoting the growth of osteoblasts. In addition, strontium salts, which can both inhibit bone resorption and promote bone formation, have also been used as a new drug in clinical treatment.
Q: What is the current preferred route of medication for the treatment of osteoporosis?
A: At present, most of the drugs for osteoporosis are taken orally, and some are injected. For example, bisphosphonates are both oral and intravenous formulations; calcitonin is available as a nasal spray and intramuscular injection; and parathyroid hormone is a subcutaneous injection. Osteoporosis is a chronic disease, and oral administration is more convenient. However, the specific choice of oral preparation or injection depends on the specific condition of the patient.
Q: Alendronate is a bisphosphonate, one of the classes of oral drugs recommended in the osteoporosis treatment guidelines, what are the specific indications and contraindications of this drug? What are the specific indications and contraindications of this drug? What is the specific method of administration and efficacy?
A: Alendronate is the third generation of bisphosphonates, and the research results show that alendronate not only can significantly improve the vertebral and hip bone density of postmenopausal women, but also can reduce the incidence of vertebral and non-vertebral fractures by about 50%. Similarly, similar effects were still seen in men with osteoporosis and secondary osteoporosis.
Alendronate is indicated for patients with significant bone resorption and high bone turnover index. Its usage is one tablet of 70mg once a week, on an empty stomach, taken orally with a glass of warm boiled water (200-250 ml), followed by a meal 30 minutes later. Avoid lying down after taking the drug to prevent drug reflux from irritating the esophagus. It is effective in preventing vertebral, non-vertebral and hip fractures. However, it should be used with caution in patients with gastric and duodenal ulcers, reflux esophagitis, hypocalcemia and those with poor liver and kidney function.
Q: The 2011 edition of the “Guidelines for the diagnosis and treatment of primary osteoporosis” introduces the concept of “combination drugs”, which means that patients with osteoporosis should be treated with other drugs in addition to bisphosphonates. What are the current recommended combination regimens?
A: Calcium and vitamin D are the basic drugs for the prevention and treatment of osteoporosis. On this basis, depending on the patient’s age, gender, condition, presence of comorbidities, and affordability, suitable drugs such as bisphosphonates, estrogen receptor modulators, estrogen, calcitonin, parathyroid hormone, strontium salts, etc. can be selected for treatment. Concomitant use of drugs with the same mechanism of action as anti-osteoporosis is not recommended in combination, as excessive inhibition of bone growth can affect bone strength.
Q: A new bisphosphonate and vitamin D combination (Formica) is now in clinical use. In which groups is this drug suitable for application? What advantages does Formica have over other single drugs of its kind? How is it currently used in clinical practice?
A: In anti-osteoporosis treatment, whether or not to take adequate vitamin D and calcium supplements can significantly affect the therapeutic effect. According to the relevant epidemiological survey in China, many people with osteoporosis are in a state of low vitamin D level and low calcium intake. Fomega is very suitable for people with low vitamin D because it can be supplemented with an additional 2800 units of vitamin D per week while applying alendronate, and the price is the same as that of single alendronate, which is both convenient and affordable to use. Therefore, the clinical use of this compound is promising, and it may gradually replace the single alendronate formulation in the future.