Osteoporosis is a common, systemic disease of bone metabolism with a generalized decrease in bone mass and microarchitectural changes in bone tissue, leading to increased bone fragility and susceptibility to fracture. Osteoporosis is also a worldwide epidemic disease with high morbidity and mortality.
Bone changes with age
Throughout life, bones are constantly renewing themselves, breaking down and rebuilding, known as skeletal remodeling, which is done by osteoblasts and controlled by osteoclasts. The continuous resorption and reconstruction of bone is a lifelong process. Normal bone metabolism is a dynamic balance between resorption and formation, but the balance is disrupted by excessive resorption and insufficient formation due to various reasons, resulting in a decrease in bone mass and osteoporosis. This process manifests itself in different ways at different ages. The accumulation of bone mass reaches its peak at about 30-35 years of age. Generally from the age of 40 for women and from the age of 50 onwards for men, the rate of bone loss gradually accelerates, the rate of bone formation gradually slows down, and there is a decrease in both mineral salts and matrix of bone, leading to a decrease in bone density. Menopausal women, in particular, are accompanied by varying degrees of osteoporosis.
The incidence of osteoporosis continues to increase with age, with significant gender differences. It is higher in women than in men. The rate of bone loss is also faster. Both cortical bone and cancellous bone mass are reduced, with the latter decreasing more rapidly. According to domestic and international reports, the onset of osteoporosis in women is about 10 years earlier than in men, and the incidence is also higher than in men by about 10.9%-21.7%.
Prevalence of osteoporosis
At present, about 200 million people worldwide suffer from osteoporosis, and about 25 million people in the United States (about 1/10 of its total population) suffer from osteoporosis in varying degrees, 80% of whom are women. And in 1/3-1/2 of menopausal women suffer from this disease. China is a large country with a large population, accounting for 22% of the world’s population, and is also the country with the largest elderly population, accounting for 27% of the total population aged 60 years or older in the middle of the next century, amounting to 400 million people. Although there is no comprehensive survey report in China, but according to many provinces, cities and regions of the general and research results, showing that the incidence rate of 20.1% of the population over 50 years old, of which 10.3% for men 32.0% for women. Shanghai and Beijing surveys reported that the prevalence of osteoporosis over 60 years of age was 40%-50% in women and about 20% in men. The prevalence is similar to that in Hong Kong, but lower than that in Europe and the United States.
Causes of osteoporosis
The occurrence of osteoporosis is related to many factors, such as gender, age, race, region, heredity, diet, exercise, lifestyle, disease status, etc. The onset of osteoporosis is also related to the physiological and pathological activities of bones.
The dietary structure in China is not reasonable, and the daily intake of calcium per capita is only half of the supply. A proper diet, increased calcium intake and appropriate exercise and light exposure are important measures to prevent and treat osteoporosis.
Patients with osteoporosis have three major symptoms
More than half of the patients may have pain, the most common one being low back pain, followed by shoulder and back, neck or wrist and ankle. Initially, the pain is only present when changing position and is often limited to the low back, occasionally radiating to the front or both lower extremities, and the pain is sometimes mild or severe. In severe cases, there may be varying degrees of low back pain. Back pain is caused by spasm of the paravertebral muscles due to partial or total atrophy of the spine. The presence or absence of back pain and its severity do not have a parallel relationship with the degree of osteoporosis.
2. skeletal deformities anterior spinal tilt, stooping, hunchback and short stature. It may be accompanied by persistent pain, which is often aggravated by bending, lifting or jumping activities.
Fracture As osteoporosis worsens, localized pressure pain may appear on the bones, and even fractures of different degrees may occur under the action of minor external forces. The fracture sites are mainly in the spine (11th and 12th thoracic vertebrae and 3rd lumbar vertebrae), the neck of the femur and the distal radius, and the spine, which is deformed and shortened by wedge-shaped compression fractures, which is the main reason for the shortening of the elderly. Shortening of the thoracic spine may be accompanied by chest discomfort and pulmonary dysfunction, and symptoms such as abdominal distention and constipation. Fractures of the spine (thoracic and lumbar), hip (femoral neck) and wrist (radius) are commonly referred to as the “three major fractures of osteoporosis”.
Signs of osteoporosis
Back pain; back and leg pain; short stature; hunchback; fractures; loose teeth.
People at risk for osteoporosis
Advanced age; menopause; short stature; low physical activity; inadequate calcium intake; smoking; alcoholism and long-term use of corticosteroids; heparin; antiepileptic drugs and immunosuppressants.
Risk factors for hip fracture
(1) Age: In women over 65 years of age, the risk of hip fracture increases twofold for every 10-year increase in age.
(2) Bone mineral density: a 1s decrease in heel BMD and hip BMD is associated with a 2-fold and 2.6-fold increase in the risk of hip fracture, respectively.
(3) Mother’s history of fracture is a predictor of hip fracture risk. In particular, if the mother’s fracture occurred before age 80, the woman had a 2-fold increased risk of hip fracture.
(4) Postural instability from falls is a hip fracture risk factor. Factors for non-syncopal falls in elderly men and women are a history of more than 3 falls in the first year.