Osteoporosis in middle-aged and elderly people is not a disease, it is a physiological phenomenon and does not require treatment at all. I have expressed this view long ago. The reason for picking up this topic again is to illustrate the reversible and irreversible physiological phenomenon of osteoporosis from the perspective of bone nutrition. Zhou Menghan, Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University The survival of any tissues and cells in the organism cannot be separated from nutritional metabolism. Nutrients and metabolites cannot be transported without blood. The same is true for bone tissue. The number of bone cells in each person’s life is constant. The metabolism of bone cells is a repair metabolism, not a replacement metabolism. The death of bone cells is replaced by bone fibrous connective tissue (which is no longer the original bone tissue cells). If the metabolism of bone is greater than the repair of bone, starvation occurs – this is – osteoporosis, which is essentially bone atrophy. Osteoporosis occurs not only in middle-aged and elderly people, but even in young people. There are two causes of its genesis. One is a congenital decision. This is determined by the combination of genes at the time of embryo formation (the most serious is osteogenesis imperfecta). Such people are not very fit from childhood, and a slight excess of natural activity (this amount is for their physique) results in pain in the corresponding muscles and joints. They recover naturally by sleeping and unconsciously reducing the amount of activity (pain is unconsciously reduced in children). In adulthood, osteoporosis comes earlier in this type of person than in a person with a strong constitution, and can appear around the age of 25 to 30. The other one is osteoporosis with bone wasting. This kind of osteoporosis is gradually formed later in life. It also includes the aforementioned congenitally weak people. Disuse osteoporosis can be divided into acute disuse osteoporosis and chronic or progressive osteoporosis according to the speed of its occurrence. Acute osteoporosis occurs in a short period of time, one to two weeks. It is mostly due to immobilization or relative immobilization of a limb or the entire body, such as immobilization in a cast or continuous bed rest for a week to several months, or prolonged confinement in a confined space, etc. This condition can reduce the blood supply to the body’s blood vessels and the metabolic supply of fibrin in the bone tissue, leaving the bone in a starved state and leading to osteodystrophy. Bone thinning with enhanced translucency (x-ray) occurs (without x-ray there would be no diagnosis of osteoporosis). This osteoporosis, is reversible. Because the degree of vascular damage and sclerosis does not change much during the same age period, it can be gradually restored as before by removing the restrictive activity conditions and activities. Chronic or progressive osteoporosis is what people often talk about as osteoporosis. It is mostly seen in adulthood, and appears early in those who are in poor health and later in those who are in strong health. This is due to the gradual hardening of blood vessels and the gradual decrease of blood supply, resulting in osteodystrophy. Because it is progressive, it is not obvious in a short period of time, but usually has a decreasing value only after several years or ten years. This osteoporosis is irreversible. Because this does not occur at the same age time, the degree of hardening of vascular damage varies from age to age, and the older the age, the greater the degree of hardening and the worse the improvement of blood supply. From the above description, we can know that osteoporosis occurs as a result of the blood supply to the blood vessels. Only by ensuring adequate blood supply can the onset of osteoporosis be delayed (which is an ideal state). Osteoporosis is bound to appear sooner or later due to different ages and different degrees of hardening of blood vessels after fatigue damage. Osteoporosis is not a pathology, it is a physiological phenomenon. It is atrophy of bone (not degeneration, if degeneration should be regressed to a child). Acute atrophy can be improved by activity. Chronic atrophy, through activity, can remain intact is good. Since osteoporosis is not a disease, we cannot talk about treatment. Treatment must be administered, and it is inevitable to enter the misunderstanding. Here are some treatment misconceptions. Osteoporosis requires calcium supplementation A number of methods have arisen around the argument of calcium supplementation. The hard supplementation method, oral or intravenous injection of calcium. This method is an attempt to use concentration to press calcium into the bone tissue. Calcium is a trace element in the body, and a trace amount means that it is not needed in large amounts and is absorbed in limited amounts at one time. A little is enough. The amount of calcium in the human body is the result of accumulation over time. The biggest recipient of hard supplementation is not the person, it is the toilet. The bypass method, oral or intramuscular injection of vitamin D, calcitonin, etc. This method promotes the synthetic use of calcium to achieve the goal of getting calcium into the bone tissue. The error in these two methods is that the principle is wrong. Osteoporosis is not a lack of calcium, it is a lack of fibers that fill the bone tissue. Calcium plays a scaffolding role in bone tissue. Calcium deficiency is characterized by “soft” bone tissue, such as rickets, also known as chondromalacia. Osteoporosis is characterized by “brittle” bone tissue. In other words, osteoporosis is due to the fact that there is only calcium left in the bone tissue. It is like a room that has been emptied and only the walls are left. Only people with low blood calcium need calcium supplements. Bone is the body’s calcium reservoir, and the calcium in the reservoir is not usually used. With short-term low blood calcium, there is no reduction in bone calcium; it is only with long-term low blood calcium that there is a small loss of calcium from the calcium reservoir. Bone gets to the point of decalcification and chondromalacia can occur. The binding method, oral fluoride or a bisphosphonate (such as alendronate). This is an attempt to change the structure of the bone scaffold to achieve treatment for osteoporosis. This drug does not work on normal bone structure and has a great affinity only for areas of bone damage (bone tumors, fractures). The bone salts it forms are not the normal bone matrix. It is therefore dense and has poor transmission to X-rays. Doctors will judge the improvement or cure of osteoporosis based on this. Unbeknownst to them, the bone matrix formed is harder than normal bone matrix, which increases brittleness and makes it more prone to fracture. The inclusion of hard bone tissue in the middle of the bone tissue increases damage to the bone around the hard tissue. It is like putting a pebble in a basket of eggs, the eggs around the stone tend to break upside down. Many people think that osteoporosis is the cause of injury because there is pain. Little do they know that pain in middle-aged and elderly people has other causes, but it is never osteoporosis. There is a very simple fact: once the state of osteoporosis exists, it does not change often. However, pain in middle-aged and elderly people changes frequently. It goes away from time to time. Pain in middle-aged and elderly people has nothing to do with osteoporosis. In everything you do, you have to be clear about the direction. If the direction is wrong, no amount of methods will be effective.