Osteoporosis is mostly asymptomatic before the appearance of a fracture, so it is important to identify the patient’s risk factors in advance and take appropriate preventive measures, such as changes in diet and lifestyle habits. At the same time, drugs can only thicken the thinning trabeculae and repair the perforations, but they cannot yet reconnect the broken trabeculae, i.e., the microstructure of the damaged bone tissue cannot be completely repaired, so prevention of the disease is more realistic and important than treatment.
Prevention of osteoporosis contains two meanings: firstly, prevention in high-risk groups, mainly postmenopausal women; secondly, in the general population. Risk factors for osteoporosis include: white and oriental races, wasting, chronic inadequate intake of calcium and other nutrients, low physical activity, addiction to alcohol, tobacco and coffee, and post-ovariectomy. For postmenopausal women with these risk factors, early estrogen use for prevention should be advocated if there are no other contraindications. Since insufficient peak bone mass is an important factor in the development of reduced bone density and osteoporosis in adulthood, attention should be paid to a balanced diet, especially calcium intake, from adolescence and even infancy, and oral calcium supplements should be taken if necessary (see below for the choice of calcium supplements). In adolescence, more exercise is encouraged, and in the elderly, especially in patients with bone loss or osteoporosis. Attention should be paid to the choice of exercise program and the amount of exercise. Due to the reduced emergency and response capacity of the elderly. Therefore, we should try to pay attention to the daily protection of the elderly, such as rising after meals and getting up at night, in order to reduce the risk of falls and the incidence of osteoporosis-related fractures.
Prevention includes obtaining optimal peak bone mass, intervening in risk factors for the development of osteoporosis, and reducing bone loss. Peak bone mass is determined by both genetic and environmental factors. Genetic factors are the main ones, accounting for about 75%, but so far there are no effective interventions, and environmental factors can be adjusted and controlled. Therefore, preventive measures for environmental factors should start in childhood as well as in adolescence, including adequate calcium intake and appropriate exercise, especially weight-bearing exercise can increase peak bone mass. Elimination of risk factors is also an effective means of preventing osteoporosis, such as smoking cessation and avoidance of alcohol abuse, excessive caffeine, low body weight, prolonged braking, and excessive exercise should be avoided whenever possible. For patients who must ingest glucocorticoids and other factors that increase the risk of osteoporosis, certain precautions should be taken, such as using the lowest effective dose possible, using hormones by inhalation if possible, or alternate day therapy with hormones, and performing muscle strengthening exercises. Effective preventive measures include the following.
Exercise
Regular exercise during childhood and adolescence results in higher bone mass than those who do not exercise regularly. Weight-bearing exercise is preferred among the various types of exercise and increases BMD, although the exact mechanism is not known. In adulthood, multiple types of exercise contribute to the maintenance of bone mass. For menopausal women who adhere to 3 h of exercise per week overall calcium increases and exercise is appropriate in moderation. However, bone loss is accelerated in those who exercise excessively to cause amenorrhea. Exercise also improves sensitivity as well as balance, reducing the chances of falls in older people. Patients with osteoporosis are encouraged to be as active as possible.
Nutrition
Good nutrition is important for the prevention of osteoporosis, including adequate amounts of calcium, vitamin D, vitamin C and protein. From childhood onwards, the daily diet should have an adequate intake of calcium, which influences the acquisition of peak bone mass. In Europe and the United States, the recommended daily intake of calcium (elemental calcium) is 1,000 to 1,200 mg for adolescents, 800 to 1,000 mg for adults, 1,000 to 1,500 mg per day for postmenopausal women, and 1,500 mg/d for men after age 65 and other patients with risk factors for osteoporosis. Calcium intake can be slightly lower than the above amount. Calcium carbonate, calcium chloride, calcium lactate, and calcium gluconate contain 40%, 27%, 13%, and 9% elemental calcium, respectively. If calcium is taken after a meal, along with 200ml of liquid, it can promote the absorption of calcium, and it is better to take it in divided doses than in one dose. Those who lack stomach acid can take calcium citrate to facilitate absorption. The intake of vitamin D is 400-800U/d.
Prevention of falls
The chances of falls in patients with osteoporosis should be minimized to reduce hip fractures as well as Coles fractures. The incidence of falls in the elderly increases exponentially with age. Moderate exercise can help prevent falls in the elderly by improving sensitivity and balance. Diseases and injuries that are likely to cause falls should be treated promptly and effectively. Avoid the use of medications that affect body balance.
Calcium treatment
(1) Types of calcium preparations and their evaluation indexes: Calcium carbonate, calcium citrate and calcium in milk are collectively called the three major sources of calcium. Although the following indicators of different calcium preparations are evaluated with different results. So far it is difficult to prove the difference in clinical efficacy between various different pharmaceutical calcium supplements.
①Type of calcium and calcium content: Calcium carbonate contains the highest elemental calcium, up to 40%. It is the component of most calcium preparations. Calcium phosphate containing 3 calcium atoms contains 38% calcium. Calcium phosphate containing 2 calcium atoms contains 23% calcium, and calcium chloride contains 27% calcium. Calcium citrate contains 2l% calcium, but with super-concentration technology, one tablet contains up to 315 mg of elemental calcium, and two tablets a day can supply 630 mg of elemental calcium. Calcium lactate contains 13% calcium. Calcium gluconate contains 9% calcium, and it takes 12 tablets (50mg per tablet) to supply 600mg calcium a day, which is not acceptable to patients.
Does calcium require stomach acid to dissolve? Calcium in milk and organic acid calcium such as calcium citrate can dissolve naturally in the gastrointestinal tract (no gastric acid required) and produce ionic calcium that can be absorbed. If dissolution requires gastric acid, it is restricted to patients with low gastric acid, such as the elderly, for example, calcium carbonate. Calcium citrate can be taken at the time of gastric emptying. However, calcium carbonate preparations are best taken with meals, as stomach acid and acid in food can help them dissolve.
③ Can calcium preparations be taken in the morning on an empty stomach or when the stomach has been emptied of the meal: If it can, for example, calcium citrate, there is no disadvantage of inhibiting the absorption of calcium ions by substances such as oxalate and phosphate in food, and there is no disadvantage of calcium ions preventing the absorption of iron in food. Calcium carbonate preparations that require dissolution by stomach acid are best not taken on an empty stomach.
④The advantages and disadvantages of the acid roots of the acid combined with the element calcium: a certain acid roots of the calcium preparation after dissolution are: A. Among the inorganic acid roots, carbonic acid roots can produce CO2, i.e., gas production; phosphate roots provide phosphorus; chloride ions produce acid. B. Among the organic acid roots. Gluconic acid, lactic acid, acetic acid, etc. have little benefit; citric acid (i.e. citrate) acid root in the urine can inhibit the formation of kidney stones or kidney calcification in the renal parenchyma by increasing the concentration of calcium ions in the urine.
⑤ Bioavailability: Different preparations containing the same amount of elemental calcium, the one with a greater value of elevated blood calcium after oral administration is said to have a high bioavailability of calcium. Calcium in calcium citrate and milk is superior to calcium carbonate. The same calcium preparation (e.g. 600 mg of elemental calcium) taken in 2 divided doses a day is better absorbed intestinally than a single dose.
⑥Calcium tablets with or without vitamin D: Calcium supplements with unactivated vitamin D suppressed in the same tablet have two superiorities over calcium preparations without vitamin D: A. Activation promotes intestinal calcium absorption. B. Unactivated vitamin D improves muscle strength and prevents falls in the elderly better than activated vitamin D.
(7) Chewable or not: Older people complain about choking when swallowing a calcium tablet the size of a “bullet head”. People prefer calcium tablets that can be crushed in the mouth.
It is rich in calcium, 225ml of qualified milk contains about 300mg of elemental calcium and has excellent bioavailability. Those who have diarrhea and abdominal pain after drinking milk, the reason is insufficient lactase gene expression. The way to stimulate the liver to establish lactase is to drink one sip of milk per day in the 1st week, two sips of milk per day in the 2nd week, and so gradually increase the amount, eventually you can drink 1 to 2 pounds of milk per day.
(2) Dose: Reference value of daily elemental calcium intake (RDD) for national population: set at 800mg/d for many years in various countries and increased to l000mg/d in many countries in 1997. Chinese have low dietary calcium (350-500mg/d) and rely on secondary hyperparathyroidism and bone calcium absorption into the blood to maintain normal blood calcium, thus inducing bone loss. The 1-day calcium intake of non-elderly Chinese should reach 800-1000mg of elemental calcium for adults, 1000-1200mg/d for adolescents, and 1000-1500mg/d for women over 65 years of age suffering from osteoporosis.