I. Overview of osteoporosis.
Osteoporosis (osteoporosis) is a systemic metabolic bone disease characterized by a decrease in bone mass and destruction of the microstructure of bone, manifested by an increased brittleness of the bone and thus a greatly increased risk of fracture, which can easily occur even with minor trauma or without trauma. Osteoporotic fractures are also known as fragility fractures, and surgical treatment of fractures is an important treatment method. Fractures in the elderly are a difficult problem for orthopaedic surgeons.
The fracture is a difficult problem for the orthopedic surgeon. The elderly have poor surgical tolerance and often have more or less underlying disease, which makes it difficult to obtain reliable stability of the implant after surgery and can easily loosen or fall off, thus leading to fixation failure and affecting the healing of the fracture.
Osteoporosis is a chronic disease caused by multiple factors. There is usually no specific clinical manifestation before the fracture occurs. The disease is more common in women than in men (about 4/5 of women), and it is common in postmenopausal women and the elderly. With the increase of the elderly population in China, the incidence of osteoporosis is on the rise, therefore, preventive health care is very important, not to neglect the work of anti-osteoporosis, and not to think that old age is too late, osteoporosis prevention and treatment is never too late.
Second, the causes of osteoporosis.
There are many causes of osteoporosis, the most common causes are summarized in the following areas.
1, endocrine factors: currently considered to be the most important influencing factor. Including postmenopausal women and older men, the decline in the level of sex hormones, thyroid cells secrete calcitonin reduction.
2, genetic factors: about 46%-62% of people have immediate family correlation.
3.Nutritional factors: insufficient intake of protein, calcium, phosphorus, vitamins and trace elements, loose and lost teeth in the elderly, and reduced intake of food that is not easily chewed are correlated.
4, disuse osteoporosis: reduced exercise, reduced weight-bearing of the affected limb after trauma, especially to avoid long-term bed rest, bed rest for more than a week can appear bone mineral loss.
5. Secondary diseases: rheumatic diseases, diabetes, liver disease, kidney disease, thyroid disease, digestive diseases, bone tumors and metastatic bone tumors, etc.
Three, the performance of osteoporosis.
1, pain: pain in many bones throughout the body, back pain is most common, the pain increases after prolonged standing and standing, and is relieved after sufficient activity.
2, height loss, hunchback
3, fracture: minor trauma can cause fracture. The best fracture sites in order of occurrence are spine (spinal vertebral compression fractures are common, often unknowingly, lumbar fractures more than thoracic fractures) –> proximal femur (femur near the hip joint, intertrochanteric fractures, femoral neck fractures are common, often due to falls) –> distal radius (fractures near the wrist joint, often due to protective bracing from falls) –> proximal humerus (falls or impacts) –> Ankle (sprain or violent trauma).
IV. Examination.
1.Bone mineral density measurement (BMD), bone mass assessment: including single-energy photon absorptiometry SPA, dual-energy photon absorptiometry DPA, dual-energy X-ray absorptiometry DEXA, there are also methods to determine bone mineral density with the help of CT and ultrasound.BMD to assess the severity of osteoporosis is intuitive and clear, and changes in its indicators often take six months or more to observe significant changes.
2.Biochemical examination: Measurement of minerals and certain metabolic biochemical indicators in blood and urine is fast and agile, and changes can be monitored within a short period of time.
3.X-ray examination: discovering sparing by observing bone cortical thickness and bone trabeculae morphology, which cannot determine the degree of sparing, and has preliminary diagnostic value and census value.
V. Key population.
According to the latest treatment guidelines established by the National Osteoporosis Foundation (National Osteoporosis Foundation) in the United States, the following groups of people need to be tested for bone density.
1, postmenopausal women over 65 years of age, despite various preventive measures, this group of people are still at risk of osteoporosis and need to focus on it, and if osteoporosis exists it should be treated accordingly.
2. Postmenopausal women with one or more risk factors and younger than 65 years of age.
a. History of postmenopausal fractures (except skull, facial bones, ankles, fingers and toes);
b. Wasting (less than 57.7 kg
c, no obvious traumatic cause, vertebral body height compression of more than 20% or 4 mm at the time of lumbar spine film (vertebral compression fracture can be confirmed);
d. One parent has a history of hip fracture;
e. Current smoking.
3. Postmenopausal women with fragility fractures;
4, Diagnosed with osteoporosis based on BMD measurements and decided to systematically treat;
5. Women on long-term hormone replacement therapy;
6, Men with fractures after minor trauma;
7, people with X-rays showing bone loss and patients with other diseases that can cause osteoporosis.
VI. Prevention and treatment.
1, balanced nutrition, proper calcium supplementation: pay attention to the intake of calcium, phosphorus, vitamin D, protein and trace elements.
2, regular physical exercise, weight-bearing exercises: after the age of 35 need to customize a regular exercise program to increase bone reserves, avoid long-term bed rest, avoid long-term absence of sunlight.
3.Treat related diseases that cause osteoporosis.
4.Prevent fractures: prevent falls and slips, bright and dry places for activities, support canes or crutches. Osteoporosis fractures need to be treated in time to avoid a vicious cycle of osteoporosis exacerbated by loss of function.
5, drug treatment is divided into three categories: in addition to oral calcium tablets, drug treatment needs to be used under the guidance of a doctor (red markings are clinically used anti-osteoporosis drugs)
a. Bone resorption inhibitors to reduce further loss of bone: estrogen, calcitonin, diphosphonates, isoproterenol are in this category;
b. Bone formation promoters to increase bone mass: including fluoride, vitamin K, parathyroid hormone, androgens, growth hormone, etc;
c. Bone mineralization promoters to promote bone calcium deposition and increase bone mass, such as vitamin D and calcium.