Prevention and Treatment
Once an osteoporotic fracture occurs, the quality of life decreases and various complications occur, which can be disabling or fatal, so prevention of osteoporosis is more realistic and important than treatment. Moreover, osteoporosis can be prevented.
Primary prevention of osteoporosis is aimed at those who have not had a fracture but have risk factors for osteoporosis, or those who already have a reduction in bone mass (-2.5 < T ≤ -1) and should be prevented from developing osteoporosis. The ultimate goal of prevention is to avoid.
occurrence of the first fracture. Secondary prevention and treatment of osteoporosis refers to those who already have osteoporosis (T≤-2.5) or have already had a fracture, and the ultimate goal of prevention and treatment is to avoid the first fracture and re-fracture. Osteoporosis
Prevention and treatment strategies for osteoporosis include.
1. Basic measures.
(1) Lifestyle modification: a balanced diet rich in calcium, low in salt and moderate in protein. Physical exercise and rehabilitation that contribute to bone health, with attention to appropriate outdoor activities. Avoid smoking, alcohol abuse and careful use of drugs that affect bone metabolism, etc. 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.
①Calcium: The recommended daily calcium intake of 800mg (elemental calcium amount) for adults is the appropriate dose to obtain the ideal bone peak and maintain bone health, if the calcium supply in the diet is insufficient, calcium supplements can be used, the recommended daily calcium intake for postmenopausal women and the elderly is 1,000mg. the average daily calcium intake of the elderly in China is about 400mg from the diet, so the average daily supplement should be Calcium intake can slow down the loss of bone and improve bone mineralization. When used for the treatment of osteoporosis, it should be used in combination with other drugs. There is insufficient evidence to suggest that calcium supplementation alone can replace other anti-osteoporosis drug therapy. The choice of calcium should take into account its safety and effectiveness.
②Vitamin D: facilitates the absorption of calcium in the gastrointestinal tract. Vitamin D deficiency can lead to secondary hyperparathyroidism, which increases bone resorption and thus causes or exacerbates osteoporosis. The recommended dose for adults is 200 units (5ug)/d. Elderly people often have vitamin D deficiency due to lack of sunlight and impaired intake and absorption, so the recommended dose is 400 to 800 IU (10 to 20ug)/d. Some studies have shown that vitamin D supplementation increases muscle strength and balance in the elderly, thus reducing the risk of falls and thus the risk of fractures. Vitamin D should be used in combination with other drugs when used for the treatment of osteoporosis. Clinical application should pay attention to individual differences and safety, regularly monitor blood and urine calcium, and adjust the dose as appropriate.
2.Medication: Indications: people with osteoporosis (T≤-2.5) or fragility fracture; or people with bone loss (-2.5
(1) Bisphosphonates: effectively inhibit osteoclast activity and reduce bone conversion. Evidence from a large sample of randomized double-blind controlled clinical trials shows that alendronate (Fosamax or Gubang) can significantly increase bone density in the lumbar spine and hip and significantly reduce the risk of fracture in the vertebral body and hip. Alendronate formulations are available in China. Other bisphosphonates such as hydroxyethyl bisphosphonate (Etidronate) can also be applied exploratively (cyclic dosing). The application should be based on the characteristics of each preparation, and the correct method of administration should be strictly followed (e.g. alendronate should be taken in the morning on an empty stomach with 200ml of water, and not lying down or eating within 30 minutes after taking the drug), and drug reflux or esophageal ulcers occur in very few patients. Therefore, it should be used with caution in patients with esophagitis, active gastric and duodenal ulcers, and reflux esophagitis. The latter is more convenient to take, less irritating to the digestive tract, effective and safe, and thus has better compliance.
Calcitonin: It can inhibit the biological activity of osteoclasts and reduce the number of osteoclasts. It can prevent bone loss and increase bone mass. There are two types of calcitonin analogs currently in clinical use: salmon calcitonin and eel calcitonin analogs. Evidence from randomized double-blind controlled clinical trial studies has shown that 200 IU of synthetic salmon calcitonin nasal spray (migestrol) daily reduces the incidence of vertebral fractures in patients with osteoporosis. Another outstanding feature of calcitonin analogs is their ability to significantly relieve bone pain, which is effective in chronic pain due to osteoporotic fractures or skeletal deformities as well as bone pain caused by diseases such as bone tumors, making them more suitable for osteoporotic patients with painful symptoms. The course of application of calcitonin-based preparations depends on the condition and other conditions of the patient. In general, the application dose is 50 IU/time of salmon calcitonin, subcutaneously or intramuscularly, 2 to 5 times a week depending on the condition, 200 IU/day of salmon calcitonin nasal spray; 20 IU/week of eel calcitonin, intramuscularly. Application of calcitonin, a small number of patients may have adverse reactions such as facial flushing, nausea, and occasional allergic phenomena.
(iii) Selective estrogen receptor modulators (SERMs): effectively inhibit osteoclast activity and reduce bone conversion to premenopausal levels in women. Evidence from a large sample of randomized double-blind controlled clinical trial studies suggests that one tablet of raloxifene (60 mg) daily can stop bone loss, increase bone mineral density, and significantly reduce the incidence of vertebral fractures is an effective drug for the prevention and treatment of postmenopausal osteoporosis. It is used only for female patients and is characterized by selective action on estrogen target organs, no adverse effects on breast and endometrium, and can reduce the incidence of estrogen receptor-positive invasive breast cancer without increasing the risk of endometrial hyperplasia and 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 this 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 prolonged bed rest and sedentary periods.
Estrogens: These drugs should only be used for female patients. Estrogenic drugs can inhibit bone turnover and prevent bone loss. Clinical studies have well demonstrated 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 comprehensive assessment of the pros and cons of hormone supplementation therapy, it is recommended that hormone supplementation therapy follow the following principles: Indications: Women with menopausal symptoms (hot flashes, sweating, etc.) and/or osteoporosis and/or osteoporosis risk factors, especially advocating greater benefits and less risk when started early in menopause. 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 undergone 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 of the breast and uterus). Whether to continue the drug should be evaluated annually for pros and cons according to the characteristics of each woman.
(2) Drugs to promote bone formation: parathyroid hormone (PTH): Randomized double-blind controlled trials have confirmed that small doses of rhPTH (1-34) 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 must be applied under the guidance of a medical professional. The duration of treatment should not exceed 2 years. The general dose is 20ug/d, injected intramuscularly. Blood calcium levels should be monitored during administration to prevent the occurrence of hypercalcemia.
(3) Other drugs.
① Active vitamin D: appropriate doses of active vitamin D can promote bone formation and mineralization and inhibit bone resorption. Some 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. Active vitamin D is more suitable for the elderly, which includes 1α-hydroxyvitamin D (α-osteol) and 1,25-bishydroxyvitamin D (osteotriol), the former being effective when liver function is normal, while the latter is not affected by liver or kidney function. They should be used under the guidance of a physician and blood and urine calcium levels should be monitored regularly. The dose of osteotriol is 0.25-0.5ug/d; α-osteotriol is 0.25-0.75ug/d. In the treatment of osteoporosis, it can be used in combination with other anti-osteoporosis drugs.
②Chinese medicine: clinically proven effective Chinese medicine such as strong bone capsule can also be used according to the condition.
③Phytoestrogens: There is no strong clinical evidence that the current phytoestrogen preparations are effective in the treatment of osteoporosis.