Disease description.
Osteoporosis is a systemic bone disease that may be due to multiple causes of decreased bone density and bone mass and destruction of bone microarchitecture, resulting in increased bone fragility and thus susceptibility to fracture.
Disease classification.
Osteoporosis is divided into two major categories: primary and secondary. Primary osteoporosis is divided into postmenopausal osteoporosis (type I), senile osteoporosis (type II), and idiopathic osteoporosis (including adolescent type).
Postmenopausal osteoporosis generally occurs within 5-10 years after menopause in women; senile osteoporosis generally refers to osteoporosis occurring in the elderly after the age of 70; and idiopathic osteoporosis mainly occurs in adolescents, the cause of which is still unknown.
Pathogenesis.
In addition to primary osteoporosis, which is mainly associated with menopause and old age, osteoporosis may also be caused by a variety of diseases, called secondary osteoporosis. The significance of understanding the causes of osteoporosis is that only by grasping the “hand behind” the cause of osteoporosis can we target and curb “osteoporosis” and truly treat the cause.
The common diseases that may cause osteoporosis are.
Endocrine diseases: diabetes (type 1, type 2), hyperparathyroidism, Cushing syndrome, hypogonadism, hyperthyroidism, pituitary lactinoma, hypopituitarism, etc.
(ii) connective tissue diseases: systemic lupus erythematosus, rheumatoid arthritis, dry syndrome, dermatomyositis, mixed connective tissue disease, etc.
③A variety of chronic kidney diseases leading to renal osteodystrophy.
④Gastrointestinal diseases and nutritional diseases: malabsorption syndrome, post-major gastrointestinal resection, chronic pancreatic diseases, chronic liver disorders, malnutrition, long-term intravenous nutritional support therapy, etc.
⑤ Hematologic system diseases: leukemia, lymphoma, multiple myeloma, Gaucher disease and myelodysplastic syndrome, etc.
(6) Neuromuscular system diseases: hemiplegia, paraplegia, motor dysfunction, myotonic dystrophy, rigid man syndrome and myotonic syndrome due to various causes.
(vii) Long-term braking (such as long-term bed rest) or space travel.
(viii) After organ transplantation.
(⑨) Regular use of the following drugs: glucocorticoids, immunosuppressants, heparin, anticonvulsants, anticancer drugs, aluminum-containing antacids, thyroid hormones, chronic fluorosis, gonadotropin-releasing hormone analogues (GnRH a), or dialysis solution for renal failure.
Pathogenesis.
Enhanced bone resorption and/or insufficient bone formation resulting in decreased bone mineral content and decreased bone strength.
Pathophysiology.
Enhanced bone resorption can lead to thinning, thinning, and fracture of bone trabeculae, making the bone less resistant to stress and prone to fracture.
Clinical manifestations.
(i) High-risk groups.
People with risk factors for osteoporosis are the risk group prone to osteoporosis. Risk factors for osteoporosis include
Inherent factors: ethnicity (Caucasians and yellow people have a higher risk of osteoporosis than blacks), old age, female menopause, and maternal family history.
2. Non-inherent factors: low body weight, hypogonadism, smoking, excessive alcohol, coffee and carbonated beverages, lack of physical activity, braking, nutritional imbalance in the diet, excessive or insufficient protein intake, high sodium diet, calcium and/or vitamin D deficiency (low light exposure or intake), diseases affecting bone metabolism or the use of drugs affecting bone metabolism (glucocorticoids, immunosuppressants, heparin, anticonvulsants , anticancer drugs, aluminum-containing antacids, thyroid hormones, GnRH-a or dialysis solutions, etc.)
(ii) Disease symptoms
Osteoporosis itself includes three main types of symptoms
1. Pain: Patients may have low back pain or peripheral aches and pains, and the pain is aggravated when the load increases or the activity is limited, and in severe cases there are difficulties in turning over, sitting up and walking.
2. Spinal deformation: Severe osteoporosis may lead to height shortening and hunchback. Vertebral compression fracture can lead to thoracic deformation, abdominal compression, and affect cardiopulmonary function, etc.
3. Fracture: Fractures occurring from non-trauma or minor trauma are fragility fractures. It is a low-energy or non-violent fracture, such as a fall from a standing height or less than a standing height or a fracture that occurs as a result of other daily activities. The common sites where fragility fractures occur are the thoracic and lumbar spine, hip, radius, distal ulna and proximal humerus.
(iii) Hazards of osteoporosis.
Pain itself can reduce the quality of life of patients, spinal deformation and fracture can cause disability, make the patient’s activities limited, unable to take care of themselves, increase the incidence of pulmonary infections, bedsores, not only the quality of life and mortality of patients increased also brings a heavy economic burden to individuals, families and society.
Diagnosis and differential diagnosis
At present, the diagnosis of osteoporosis mainly relies on bone density examination, and the currently accepted method is X-ray dual-energy bone resorption (DXA) for diagnosis. Quantitative ultrasound bone mineral density (QUS) results cannot be used for diagnosis. The T-value in the BMD report = (measured BMD – peak BMD of the same sex in normal subjects) ÷ (standard deviation of BMD in normal subjects of the same sex) is mainly used to indicate the BMD level in postmenopausal women and men over 50 years of age. z-value = (measured BMD – peak BMD of the same sex in normal subjects) ÷ (standard deviation of BMD in normal subjects of the same sex).
(measured BMD – mean BMD of normal people of the same sex and age) ÷ (standard deviation of BMD of normal people of the same sex and age population), used to indicate BMD levels in premenopausal women, children and men before the age of 50. t-value ≥ -1 is normal bone mass, t-value ≤ -2.5 is osteoporosis, -2.5 the second diagnostic step after confirming osteoporosis or low bone mass is to determine the presence of secondary cause of osteoporosis, and primary osteoporosis can be diagnosed only after secondary osteoporosis is excluded. Therefore, routine blood tests, liver and kidney function, blood calcium and phosphorus, alkaline phosphatase, blood parathyroid hormone, 24-hour urine calcium and phosphorus, and tests related to suspected diseases are required, and routine tests include lateral X-ray of the thoracic and lumbar spine, ultrasound of the kidney and tests related to suspected diseases. These tests and examinations are necessary and important for the proper treatment of osteoporosis and the future monitoring of the disease.
The third step is to evaluate the patient’s risk of future fractures
Treatment of the disease
(i) Basic measures
1. Lifestyle modification
(1) A balanced diet rich in calcium, low in salt and moderate in protein.
(2) Physical exercise and rehabilitation for bone health with attention to appropriate outdoor activities.
(3) Avoid smoking, alcohol abuse and the use of drugs that affect bone metabolism, etc.
(4) Take various measures to prevent falls: for example, pay attention to the presence of diseases and medications that increase the risk of falls, and strengthen protective measures for yourself and the environment (including various joint protectors), etc.
2. Basic supplements for bone health
(1) Calcium: The recommended daily calcium intake for adults is 800mg (elemental calcium amount) by the Chinese Nutrition Society, and the recommended daily calcium intake for postmenopausal women and the elderly is 1000mg. the average daily calcium intake for the elderly in China is about 400mg from the diet, so the average daily elemental calcium supplement should be 500mg-600mg.
(2) Vitamin D: The recommended dose for adults is 200 units of 5μg/d, and the recommended dose for the elderly is 400-800IU (10-20μg/d). The dose can be 800-1200IU for the treatment of osteoporosis (the vitamin D content in calcium and vitamin D complex preparations currently sold in China is generally low). It is recommended that serum 25OHD levels should be 30ng/ml (75nmol/L) or higher in the elderly to reduce the risk of falls and fractures. Blood and urine calcium should be monitored regularly and the dose adjusted as appropriate.
Calcium and vitamin D preparations should be used with caution if the patient has kidney stones and high urinary calcium.
(ii) Pharmacologic interventions.
Calcium supplementation alone is not sufficient for the treatment of osteoporosis, and the following drugs should be added according to the patient’s condition.
Indications for drug treatment: osteoporosis (T≤-2.5) or fragility fracture; or bone loss (-2.5)
1. Anti-bone resorption drugs.
(1) bisphosphonates: the drugs available are alendronate, zoledronate sodium, risedronate sodium, etc.
(2) Calcitonin: more suitable for patients with painful symptoms of osteoporosis. Not suitable for long-term use. Salmon calcitonin 50IU/time, subcutaneous or intramuscular injection, 2~5 times per week according to the condition; salmon calcitonin nasal spray 200IU/day; eel calcitonin 20U/week, intramuscular injection.
(3) Selective estrogen receptor modulators (SERMs): Used in female patients to reduce the incidence of estrogen receptor-positive invasive breast cancer without increasing the risk of endometrial hyperplasia and endometrial cancer. Raloxifene, 60 mg daily, is contraindicated in patients with a history of venous embolism and a tendency to thrombosis, such as during prolonged bed rest and sedentary periods.
4) Estrogens: should only be used in female patients. The advantages and disadvantages should be fully evaluated and the following principles should be followed.
Indications: Women with menopausal symptoms (hot flashes, sweating, etc.) and/or osteoporosis and/or risk factors for osteoporosis, especially advocated to be started early in menopause for greater benefit and less risk.
Contraindications: Estrogen-dependent tumors (breast cancer, endometrial cancer), thrombophilia, unexplained vaginal bleeding and active liver disease and connective tissue disease are absolute contraindications. Use with caution in cases of uterine fibroids, endometriosis, family history of breast cancer, gallbladder disease and pituitary lactinoma.
Estrogen should be used in conjunction with appropriate doses of progestin preparations to counteract the stimulation of the endometrium by estrogen in women with a hysterectomy, and only estrogen without progestin should be used in women who have had a hysterectomy.
The regimen, dose, preparation selection and duration of treatment of hormone therapy should be individualized according to the patient’s condition. Apply the lowest effective dose.
Adhere to regular follow-up and safety monitoring (especially breast and uterus).
Whether to continue the medication should be evaluated annually according to the characteristics of each woman for pros and cons.
2. Drugs to promote bone formation.
Parathyroid hormone (PTH), which should not be treated for more than 2 years. The usual dose is 20 μg/d by intramuscular injection. Blood calcium levels should be monitored during administration to prevent the development of hypercalcemia.
3. Strontium salt: strontium ranelate, 2g/d at bedtime. It is not recommended for those with CCr<30ml/min.
4. Other drugs.
(1) Active vitamin D: more suitable for the elderly, renal insufficiency, 1α hydroxylase deficiency. This includes 1α hydroxyvitamin D (alpha osteotrope) and 1,25
dihydroxyvitamin D (osteotriol). Blood and urine calcium levels are monitored regularly. The dose of osteopontinol is 0.25-0.5μg/d; α-osteopontinol is 0.5-1.0μg/d. In the treatment of osteoporosis
When treating osteoporosis, it can be used in combination with other anti-osteoporosis drugs.
(2) Vitamin K2 (tetraenolone): 15mg tid with meals. Contraindicated in patients taking Warfarin.
Surgical treatment.
It mainly refers to the treatment of osteoporotic fractures. Percutaneous vertebroplasty (vertibroplasty) and kyphoplasty (kyphoplasty) are
one of the new advances in minimally invasive spine treatment, which is suitable for fresh without spinal cord or nerve root symptoms and severe pain Del vertebral compression fractures, with excellent pain relief. Osteoporotic distal radius-ulnar fractures in the elderly are mostly comminuted
The fracture involves the articular surface and is easily deformed after fracture healing, often resulting in wrist and finger dysfunction. The treatment method is usually by manual repositioning, splinting or plaster fixation, or external fixator fixation. For a few unstable fractures, surgery may be considered.
For a few unstable fractures, surgery can be considered.
Hip fractures have the following characteristics.
1. high mortality rate, prone to complications such as pneumonia, urinary tract infection, decubitus ulcers and venous thrombosis of the lower limbs.
2. High rate of osteonecrosis and non-healing.
3. High rate of deformity and disability.
4.Slow recovery. Surgical treatment includes internal fixation, artificial joint replacement and external fixator. Non-surgical treatment is also available.
Disease prognosis.
Determinants are.
1, whether the primary disease causing osteoporosis is cured or controlled.
2. whether the patient’s risk factors for having osteoporosis can be minimized
3. whether initial and recurrent fractures can be prevented.
Disease prevention.
Strengthening exercise and ensuring adequate calcium intake from adolescence, as well as preventing and actively treating various diseases, especially chronic wasting diseases with malnutrition and malabsorption, preventing various gonadal dysfunctional diseases and growth disorders; avoiding long-term use of drugs that affect bone metabolism, etc., can try to obtain the ideal peak bone mass and reduce the risk of osteoporosis in the future.
Calcium in adulthood is a basic measure to prevent osteoporosis, and cannot be used as osteoporosis treatment drugs alone only as a basic adjunctive drug. Prevention in adulthood consists of two main aspects. The first is to try to delay the rate and extent of bone loss, and for postmenopausal women, the accepted measure is early supplementation with estrogen or a combination of estrogen and progestin. The second is to prevent fractures in patients with osteoporosis, and avoiding risk factors for fractures can significantly reduce the incidence of fractures.
Use of specific drugs.
1. Bisphosphonates.
Effectively inhibit osteoclast activity and reduce bone conversion. The potency of different bisphosphonates to inhibit bone resorption varies greatly, so the dose and usage of different bisphosphonate drugs in clinical practice also varies.
(1) Alendronate sodium (alias: Anlan, Gubang, Fosamax Alendros, Fosamax).
Indications: Approved by SFDA in China for the treatment of postmenopausal osteoporosis, male osteoporosis and glucocorticoid-induced osteoporosis.
Efficacy: Clinical studies have demonstrated increased bone mineral density in the lumbar spine and hip and reduced risk of vertebral and non-vertebral fractures in patients with osteoporosis. Longest clinical data up to 10 years.
Dosage: Oral tablet, 70 mg once weekly or 10 mg once daily; also available as a combination tablet of alendronate 70 mg + Vit.D3 2,800 IU once weekly. To avoid irritation of the upper gastrointestinal tract when this drug is taken orally, it is recommended that alendronate be taken on an empty stomach with 200-300 ml of plain water and that it be taken in an upright position (standing or sitting) without lying down for 30 minutes after taking it. Also, avoid milk, juice and other beverages as well as any food and medicine during this period. Caution: Use with caution in cases of gastric and duodenal ulcers and reflux esophagitis.
(2) Etidronate sodium.
Indications: The indications approved by SFDA in China are primary osteoporosis, postmenopausal osteoporosis and drug-induced osteoporosis.
Efficacy: Clinical studies have demonstrated an increase in bone mineral density in the lumbar spine and hip and a decrease in the risk of vertebral fracture in patients with osteoporosis.
Dosage: Take 0.2g orally twice a day between meals. Avoid foods high in calcium (e.g., milk or dairy products) and mineral-containing vitamins or antacids within 2 hours of taking this product.
Caution: Use with caution in patients with renal impairment and in pregnant and lactating women.
(3) Ibandronate sodium.
Indications: SFDA-approved indications in China for the treatment of postmenopausal osteoporosis.
Efficacy: Clinical studies have demonstrated an increase in bone mineral density in the lumbar spine and hip and a decrease in the risk of vertebral and non-vertebral fractures in patients with osteoporosis.
Dosage: Intravenous infusion of 2 mg of ibandronate in 250 ml of physiologic saline every 3 months, IV over 2 hours.
Note: Not used in patients with renal creatinine clearance <35 ml/min.
(4) Ritidronate.
Indications: The indications approved by SFDA in China are the treatment of postmenopausal osteoporosis and glucocorticoid-induced osteoporosis. Some countries also approve the treatment of osteoporosis in men. Efficacy: Clinical studies have demonstrated an increase in bone mineral density in the lumbar spine and hip and a decrease in the risk of vertebral and non-vertebral fractures in patients with osteoporosis.
Dosage: Oral tablets 5 mg once daily or tablets 35 mg once weekly, as for alendronate.
Caution: Use with caution in patients with gastric and duodenal ulcers and reflux esophagitis.
(5) Zoledronic acid injection.
Indications: It has been approved by SFDA for the treatment of postmenopausal osteoporosis in China.
Efficacy: Clinical studies have demonstrated an increase in bone mineral density in the lumbar spine and hip and a decrease in the risk of vertebral and non-vertebral fractures in patients with osteoporosis.
Dosage: Intravenous dose of zoledronic acid 5 mg over at least 15 minutes. Use only once a year. Hydrate on the day of injection. Note: Not used in patients with renal creatinine clearance <35 ml/min.
2. Calcitonin.
Calcitonin is a calcium-regulating hormone that inhibits the biological activity of osteoclasts and reduces the number of osteoclasts, thereby preventing bone loss and increasing bone mass. Another outstanding feature of calcitonin is that it can significantly relieve bone pain, which is effective for chronic pain caused by osteoporotic fractures or bone deformation as well as bone pain caused by bone tumors and other diseases, and is therefore more suitable for osteoporosis patients with painful symptoms. There are two types of calcitonin-based preparations currently in clinical use.
Salmon calcitonin and eel calcitonin analogs.
(1) Salmon calcitonin.
Indications: The indications approved by SFDA in China are for the treatment of postmenopausal osteoporosis.
Efficacy: Clinical studies have demonstrated increased bone density in the lumbar spine and hip in patients with osteoporosis, and evidence from randomized double-blind controlled clinical trials has shown that 200 IU of synthetic salmon calcitonin nasal spray daily reduces the risk of vertebral and non-vertebral fractures and significantly relieves bone pain.
Dosage: Salmon calcitonin formulations are available as nasal sprays and injections. Salmon calcitonin nasal spray is applied at a dose of 200 IU/day; salmon calcitonin injection is generally applied at a dose of 50 IU/time, subcutaneously or intramuscularly, 2~7 times a week depending on the condition.
Note: A few patients may have facial flushing, nausea and other adverse reactions, occasionally allergic phenomenon, according to the requirements of the drug instructions to determine whether to do allergy testing.
(2) Eel Calcitonin.
Indications: The indications that have been approved by SFDA in China are for the treatment of postmenopausal osteoporosis.
Efficacy: Clinical studies have shown that it increases bone density in the lumbar spine and hip of patients with osteoporosis and significantly relieves bone pain.
Dosage: 20 IU/week by intramuscular injection.
Note: A few patients may have facial flushing, nausea and other adverse reactions, occasional allergic phenomena, according to the drug instructions to determine whether to do allergy testing. 3.
3. Active vitamin D.
Including 1α hydroxyvitamin D (α- osteopontinol) and 1,25 dihydroxyvitamin D (osteopontinol) two. Active vitamin D is more suitable for the elderly, patients with renal insufficiency, and patients with 1α hydroxylase deficiency.
(1) 1α hydroxylated vitamin D (α- osteopontin).
Indications: Approved by SFDA in China as a drug for the treatment of osteoporosis.
Efficacy: Appropriate doses of active vitamin D can promote bone formation and mineralization, and inhibit bone resorption. Studies have shown that active vitamin D is beneficial in increasing bone density, increasing muscle strength and balance in the elderly, reducing the risk of falls, and thus reducing the risk of fractures.
Dosage: 0.5-1.0 μg/day orally.
Caution: Apply under medical supervision.
(2) 1,25 Dihydroxyvitamin D (osteotriol).
Indications: Approved by SFDA for the treatment of osteoporosis in China.
Efficacy: Appropriate doses of active vitamin D can promote bone formation and mineralization, and inhibit bone resorption. Studies have shown that active vitamin D is beneficial in increasing bone density, increasing muscle strength and balance in the elderly, reducing the risk of falls, and thus reducing the risk of fractures.
Dosage: 0.25-0.5 μg/day orally.
Caution: Apply under medical supervision. 4.
4. parathyroid hormone (PTH).
Trials have confirmed that small doses of rhPTH (1 to 34) have a role in promoting bone formation and are effective in treating severe postmenopausal osteoporosis, increasing bone density and reducing the risk of vertebral and non-vertebral fractures, and are therefore indicated for patients with severe osteoporosis. It should always be applied under the guidance of a medical professional. The duration of treatment should not exceed 2 years. Intramuscular injection. Monitor blood calcium levels during administration to prevent the development of hypercalcemia.
5. Selective estrogen receptor modulator (SERMS).
Effectively inhibits osteoclast activity and reduces bone conversion to premenopausal levels in women. Evidence from clinical experimental studies suggests that one tablet of raloxifene (60 mg) daily can stop bone loss, increase bone density, and significantly reduce the incidence of vertebral fractures, making it an effective drug for the prevention and treatment of postmenopausal osteoporosis. It is only used for female patients and is characterized by selective action on estrogen target organs, with no adverse effects on the breast and endometrium. It reduces the incidence of estrogen receptor-positive invasive breast cancer and does not increase the risk of endometrial hyperplasia or endometrial cancer. It has a modulating effect on blood lipids. A small number of patients may experience hot flashes and lower limb cramps while taking the drug. It is temporarily contraindicated in perimenopausal women with severe hot flashes. Foreign studies have shown that the drug mildly increases the risk of venous embolism, so it is prohibited for people with a history of venous embolism and a tendency to thrombosis, such as during long-term bed rest and sedentary periods.
6. Estrogens.
These drugs can only be used in female patients. Estrogenic drugs can inhibit bone turnover and prevent bone loss. Clinical studies have well documented that estrogen or estrogen-progestin supplementation therapy (ERT or HRT) can reduce the risk of osteoporotic fractures and is an effective measure to prevent and treat postmenopausal osteoporosis. Based on a thorough evaluation of the pros and cons of hormone supplementation therapy, it is recommended that hormone supplementation therapy follow the following principles.
(1) Indications: Women with menopausal symptoms (hot flashes, sweating, etc.) and/or osteoporosis and/or risk factors for osteoporosis, especially advocated to be started early in menopause for greater benefit and less risk.
(2) Contraindications: Estrogen-dependent tumors (breast cancer, endometrial cancer), thrombophilia, unexplained vaginal bleeding and active liver disease and connective tissue disease are absolute contraindications. Use with caution in cases of uterine fibroids, endometriosis, family history of breast cancer, gallbladder disease and pituitary prolactinoma.
(3) The application of estrogen in those with a uterus should be combined with appropriate doses of progestin preparations to counteract the stimulation of the endometrium by estrogen. Women who have undergone hysterectomy should be treated with estrogen only, without progestin.
(4) The protocol, dose, preparation selection and duration of treatment of hormone therapy should be individualized according to the patient’s condition.
(5) Apply the lowest effective dose.
(6) Adhere to regular follow-up and safety monitoring (especially breast and uterus).
(7) Whether to continue the drug should be evaluated annually according to the characteristics of each woman for pros and cons.
7. Strontium salts.
Strontium (Strontium) is one of the essential trace elements involved in many physiological functions and biochemical effects in the human body. Strontium has a chemical structure similar to that of calcium and magnesium, and is present in small amounts in normal human soft tissues, blood, bones and teeth. StrontiumRanelate, a synthetic strontium salt, is a new generation of anti-osteoporosis drug.
Indications: It has been approved by SFDA in China for the treatment of postmenopausal osteoporosis.
Efficacy: In vitro experiments and clinical studies have confirmed that strontium ranelate can act on both osteoblasts and osteoclasts, and has the dual effect of inhibiting bone resorption and promoting bone formation. Clinical studies have confirmed that strontium ranelate treatment can increase bone density, improve bone microstructure, and reduce the risk of vertebral and non-vertebral fractures.
Dosage: 2g/day orally at bedtime, preferably 2 hours after eating.
Caution: Do not take with calcium and food as this may interfere with drug absorption. Not recommended for use in patients with severe renal impairment with creatinine clearance <30 ml/min.
8. Vitamin K (tetraene-methylnaphthoquinone).
Tetraene-methylnaphthoquinone is an isoform of vitamin K2, a coenzyme of γ-carboxylase, and plays an important role in the formation of γ-carboxyglutamate, which is necessary for osteocalcin to perform its normal physiological function. Animal tests and clinical trials have shown that tetraenolone can promote bone formation and have some inhibitory effect on bone resorption, and can increase bone mass in osteoporotic patients. The therapeutic dose of tetraenolone is 15 mg orally three times a day for adults, after meals (poor absorption when taken on an empty stomach, patients must be allowed to take it after meals). Major adverse reactions: Stomach upset, abdominal pain, skin pruritus, edema and mild elevation of transaminases in a few patients. Contraindicated in patients taking Warfarin.
9. Phytoestrogens.
There is no strong clinical evidence that current phytoestrogen preparations have definite efficacy in improving bone density and reducing fracture risk.
10. Chinese medicines.
There are several SFDA-approved Chinese medicines for the treatment of osteoporosis in China. Most of them have the efficacy of relieving symptoms and reducing bone pain. Large clinical studies of Chinese medicines to improve bone density and reduce fracture risk are lacking, and more standardized and rigorous evidence of long-term safety is needed.
As mentioned earlier, there are various anti-osteoporosis drugs, and their main mechanisms of action vary. The main mechanism of action varies from inhibiting bone resorption to promoting bone formation, and there are also drugs with multiple mechanisms of action. For patients who have been diagnosed with osteoporosis, they should go to a regular hospital as early as possible to receive comprehensive treatment, individualized guidance and rational use of medication from a specialist.