A song in praise of mothers, “Mother by Candlelight” sings, “Mother by Candlelight, your waist has become less upright …..” , which reflects a sign of aging in older women from the side – hunchback. Since hunchback is common among older women, many people do not consider it as a disease and think it is a normal sign of old age. In fact, most hunchbacks are caused by fractures of the vertebrae that make up the spine, and these fractures are closely related to osteoporosis. Osteoporosis is a common disease among the elderly, especially elderly women, and needs to be brought to our attention. First, let’s get to know what is osteoporosis? Bone plays a role in protection, support and movement for the body. The main components of bone are bone matrix and hydroxyapatite, which is mainly composed of calcium and phosphorus, the latter also known as bone mineral. Bone is divided into cortical bone and cancellous bone. Simply put, the bones of the limbs belong to cortical bone, which consists of thick and dense bone cortex forming a tubular bone with a bone marrow cavity in the middle, while the bones of the spine belong to cancellous bone, the outer layer of which is a thin bone cortex and the inner part is composed of many trabeculae interwoven into a mesh or sheet. Osteoporosis is a decrease in bone mineral content per unit volume, which is manifested by thinning of the bone cortex in the extremities and sparse trabeculae and increased porosity in the spine. As a result of this pathological change in bone, the strength of the bones decreases and the ability to resist external forces decreases, and a slight external force can lead to a fracture. In fact, osteoporosis itself is painless, but chronic, repeatedly aggravated low back and extremity pain and even deformation of the spine occurs when repeated multiple microfractures or compression fractures occur. Human bones stop growing after the age of 16 to 18, but bone density continues to increase until almost 30 years of age, when a stable equilibrium of bone formation occurs. At about age 35, bone loss begins to increase gradually at a very slow rate as part of the natural aging process. This process is experienced by both men and women, but women themselves have smaller skeletal volumes than men, and around age 50 there is another physiological process unique to women – menopause. Menopause means that a woman’s ovaries are failing and the amount of estrogen produced decreases significantly, and there are receptors for estrogen on the bones, which have a protective effect on the bones. Due to the significant decrease of estrogen after menopause, the original protective effect of estrogen on bone disappears, bone resorption increases, bone calcium loss in the form of urinary calcium via the kidneys increases, and women enter a period of rapid loss of bone mass. The average annual bone loss rate is reported to be 2.5-5.0% during the 3-5 years after menopause, which leads to an increased risk of osteoporosis and fracture, and is the reason why women are more prone to osteoporosis than men. Currently about 200 million people worldwide suffer from osteoporosis. Its incidence has jumped to the seventh place of common diseases and diseases. The situation of osteoporosis disease prevention and treatment in China is also very serious, women due to physiological peculiarities, the incidence of osteoporosis especially after menopause is significantly higher than that of men with osteoporosis, the incidence of women over 60 years of age is as high as 60%-70%. Having osteoporosis means having a higher risk of fracture. Slender, brittle bones do not cause pain per se, but fractures can cause pain and other problems. These fractures include fractures of extremity bones that will interfere with limb movement; repeated microfractures of vertebrae in the spine that will lead to chronic low back pain, and compression fractures of vertebrae in the spine that will lead to deformation of the vertebrae, shortening of height and hunchback. Healthy bone can resist external forces without fracture when the body falls from a standing height, whereas in osteoporosis fractures can occur during such minor trauma, which is medically known as a fragility fracture. Once a fragility fracture occurs it means that severe osteoporosis has occurred. Common fracture sites include: forearm fractures, spinal compression fractures and hip fractures. Forearm fractures are often seen in the forearm above the wrist during a fall. Spontaneous compression fractures can occur in severe osteoporosis, such as coughing or sneezing, which can cause vertebral fractures. Hip (crotch) fractures are the most common site of fragility fractures at the age of 70-80 years, usually occurring after a fall and eventually leading to inability to care for oneself in daily life in 25-35% of cases, mortality within one year in 20% of cases, reoccurrence within one year in 20% of cases, continued long-term care for more than one year after discharge from the hospital in 10% to 15% of cases, resulting in motor impairment of the lower limbs and permanent disability in 50% of cases. Patients shorten their healthy life expectancy by 5 to 10 percent. One study found that the 1-year mortality rate of patients with femoral neck fractures was even higher than the 1-year mortality rate of some malignancies. Epidemiological studies in the United Kingdom have found that 1 in 2 women and 1 in 5 men over the age of 50 will have a fragility fracture in their lifetime. Osteoporosis has become a big problem that endangers the health of the elderly and is a common disease among the elderly in China, especially elderly women. With the improvement of people’s living standards, the average life expectancy of elderly women has increased, and women are in menopause for 1/3 of their lives. The prevention and treatment of postmenopausal osteoporosis is an important health issue for elderly women to extend their life expectancy and improve their quality of life. Postmenopausal osteoporosis is mainly associated with postmenopausal estrogen deficiency. The age of onset is mostly between 50 and 70 years old, and it is characterized by rapid bone loss and more pronounced loss of osteoporosis. Fractures mostly occur in the osteoporotic-dominated vertebrae, upper femur and distal radius. Geriatric osteoporosis, mainly related to ageing, generally occurs in elderly people over 65 years of age. It manifests as a slow loss of bone mass with approximately the same rate of osteoporosis as bone density loss. osteoporosis in women over 70 years of age includes the effects of both menopause and increased age. However, the same postmenopausal women have relatively healthy bones, while others develop fractures very early after menopause, suggesting individual differences in the risk of osteoporosis and fracture occurrence. Common risk factors for osteoporosis include: genetics, age, premature menopause, thin body size, smoking, alcohol consumption and vegetarianism. There are also a number of chronic diseases that can affect the development of osteoporosis, commonly including chronic gastrointestinal diseases, rheumatic diseases, and endocrine system diseases. A family history of fragility fractures, age over 60, menopause before 45, or a decline in estrogen due to surgery or medications, a thin body type, a long-term vegetarian diet or chronic diarrhea resulting in low intestinal calcium and phosphorus absorption have a higher incidence of osteoporosis. Osteoporosis is a disease that occurs insidiously and is mostly asymptomatic in the early stage, and symptoms usually appear 5 to 10 years after menopause. Once pain, hunchback or short stature appear, it means that a fracture has occurred. Therefore, patients who are at high risk of developing osteoporosis as mentioned above should be screened for early diagnosis. The current gold standard for osteoporosis diagnosis is the dual-energy X-ray absorptiometry bone density, which is available in most hospitals above the municipal level in China and is safe because the amount of X-ray radiation is equivalent to 1/10th of a chest X-ray. There are also some basic medical institutions using wrist X-ray bone densitometry or ultrasonic bone densitometry of the heel, but these tests can only be used as a means of screening for osteoporosis, not as a diagnostic method, and confirming the diagnosis still requires dual-light energy X-ray bone density. Osteoporosis is diagnosed when a fragility fracture has developed or when dual-light-energy X-ray BMD shows osteopenia (T-value below -2.5), which occurs within 5-10 years after menopause and becomes postmenopausal osteoporosis. Drug treatment can only slow down or stop bone loss, but cannot normalize the structure of bone trabeculae that have undergone pathological changes. Therefore, scholars at home and abroad agree that prevention of osteoporosis is more important and effective than treatment. As mentioned earlier, the peak of bone density is at the age of 35, and after 35 years of age, bone density has already started to go “downhill”, so prevention of osteoporosis should start from youth and middle age, rather than when osteoporosis has already appeared. The main preventive measures include diet, sunlight and exercise. Diet: to maintain adequate calcium intake, the main source of calcium in the diet from dairy products and soy products, lactose intolerant people often appear flatulence and other discomfort after drinking milk, such people can drink yogurt or low lactose milk. High-salt diet, strong tea, coffee and alcohol can inhibit calcium absorption or increase calcium excretion, so care should be taken to reduce exposure to these foods. Excessive vegetarianism or dieting will lead to insufficient fat-soluble vitamin D, which will also lead to osteoporosis, and can be supplemented with calcium tablets and vitamin D as nutritional supplements when necessary. In addition, excessive thinness, due to the reduction of gravity felt by the bone and other reasons are also more prone to osteoporosis than normal weight people, of course, over-obese people are also prone to osteoporosis due to a combination of complex reasons. Sunlight: Vitamin D plays a very important role in bone mineral deposition, and dietary intake of vitamin D is very limited. People rely mainly on light, and the skin synthesizes vitamin D for use by the body under ultraviolet light. Women generally spend less time outdoors and excessive sun protection in pursuit of whitening may lead to increased risk of osteoporosis and should pay attention to increased sunlight exposure. Exercise: Skeletal muscles produce pulling effects on bone during exercise, and these forces contribute to bone renewal and health, while more developed skeletal muscles also form mechanical protection for bones, so proper exercise to improve the body’s skeletal muscle content will help prevent osteoporosis. However, it should be noted that for people who already have osteoporosis or are at a higher risk of developing osteoporosis should first have their bone density measured and have an exercise program developed by a medical professional to avoid overly strenuous exercise that can cause fragility fractures. Once the diagnosis of postmenopausal osteoporosis is established, aggressive treatment should be started in order to prevent fractures. The current clinical treatment for osteoporosis includes: lifestyle interventions, nutritional supplements and anti-osteoporosis medications. Lifestyle interventions are similar to the above-mentioned measures to prevent osteoporosis, but it is important to note that exercise should not be strenuous in order to avoid fractures, but it is also important not to exercise because of osteoporosis, as braking is an important trigger of osteoporosis. Nutritional supplements include calcium and vitamin D. The body’s blood calcium has to maintain a certain balance, when the blood calcium drops, that is, from the body’s calcium reservoir – the bones to extract calcium, insufficient bone calcium is insufficient bone mineralization, bone density decreases. In 1994, the National Institutes of Health recommended that women should consume 1500mg of calcium per day after menopause and l500-2000mg per day after age greater than 65. calcium sources should be food-based, with dairy products containing the highest amount of calcium, such as 100ml of milk containing 100mg of calcium. There are many calcium preparations available, but when choosing calcium preparations with high calcium content should be used to reduce the amount of medication taken, for example, calcium carbonate has a much higher calcium content than calcium gluconate. Calcium supplementation with the right amount of vitamin D can promote intestinal calcium absorption. It should be noted that calcium supplementation should be prohibited when suffering from hypercalcemia or high urinary calcium kidney stones. Experienced endocrinologists will regularly evaluate blood calcium and urinary calcium indicators after calcium supplementation to avoid high blood calcium or high urinary calcium, etc. Anti-osteoporosis drugs are now commonly used mainly include bisphosphonates, estrogen receptor modulators and calcitonin, while other drugs include estrogen and progesterone replacement and parathyroid hormone. Bisphosphonates can inhibit osteoclasts in bones and reduce bone destruction, so they have a strong anti-osteoporosis effect. Studies have shown that these drugs can prevent the risk of fracture in patients with osteoporosis in the long term and significantly, so they are the most commonly used anti-osteoporosis drugs at present. Various other anti-osteoporosis drugs have their own characteristics and adverse effects, and patients should seek the help of an endocrinologist for a comprehensive assessment of skeletal and systemic conditions to develop an individualized treatment and follow-up plan. In conclusion, osteoporosis is a common disease in postmenopausal women, which often brings serious adverse effects on women’s health and needs to be actively prevented and treated. The high incidence of osteoporosis, especially in women, should be prevented from middle age and young adulthood. Osteoporosis often has no obvious symptoms in its early stages and requires screening and diagnosis for early diagnosis and treatment in high-risk groups. May all women pay attention to bone health and support a happy life in the future.