1.What is osteoporosis?
Osteoporosis is a group of bone diseases caused by a variety of causes, characterized by a decrease in the amount of bone tissue per unit volume. In most osteoporosis, the decrease in bone tissue is mainly due to increased bone resorption, and osteoporosis is characterized by skeletal pain and susceptibility to fracture.WHO definition: “Osteoporosis is a systemic bone disease characterized by low bone mass and damage to bone microarchitecture, leading to increased bone fragility and susceptibility to fracture”.NIH definition. “Osteoporosis is a disease of the skeletal system characterized by decreased bone strength and increased risk of fracture”, which includes primary and secondary osteoporosis.
Primary osteoporosis refers to bone degeneration with increasing age (or after menopause in women) and includes senile osteoporosis and postmenopausal osteoporosis in women. Secondary osteoporosis refers to osteoporosis caused by certain diseases, drugs or other causes. For example, diabetes mellitus, hyper- or hypothyroidism, hyperparathyroidism, and prolonged bed rest.
In the 1990s, about 200 million people worldwide were threatened by osteoporosis. The prevalence of osteoporosis in men and women over 50 years of age in the United States is 3-6% and 13%-18%; the prevalence of low bone mass in men and women is 28-47% and 37-50%. In a Canadian study on osteoporosis, the prevalence of osteoporosis of the lumbar spine and osteoporosis of the femoral neck in women was 12.1% and 7.9%, respectively, with an overall prevalence of 15.8%; in men, the prevalence of osteoporosis of the lumbar spine and osteoporosis of the femoral neck was 2.9% and 4.8%, respectively, with an overall prevalence of 6.6%. A serious consequence of osteoporosis is fractures, mostly of the lumbar spine, hip and wrist. In the United States, osteoporotic fractures occur in 25% of postmenopausal women, with femoral neck fractures, vertebral compression fractures and fractures of the lower radius being the most common, and vertebral fractures in women in the European region: 3.5% in <50 years of age and 27.9% in 50-85 years of age.
The total prevalence of fracture in people over 50 years old is 26.6%, hip fracture is 1.9%, forearm fracture is 4% and vertebral fracture is 13.1%. In some areas of China, the total fracture rate of people over 50 years old is 26.6%, and vertebral fracture is 13.3%.
2.What are the symptoms of osteoporosis
1) Pain
Low back pain is the most common symptom of primary osteoporosis, the proportion of patients with pain is as high as 70% to 80%, and bone pain can generally occur when there is more than 12% bone loss. The pain spreads along the spine to both sides, decreases when supine or sitting, increases when posteriorly extended when upright or when standing or sitting for a long time, and worsens when bending, coughing, or straining to stool. In patients with osteoporosis, the vertebrae are compressed and deformed, the spine is flexed forward, and the muscles are fatigued or even spasmed, thus producing pain. New thoracolumbar compression fractures can also produce acute pain, with intense pain with slight activity, strong pressure and percussion pain in the spinal spinous process of the corresponding area, and intercostal neuralgia, radiating pain in the extremities, sensory-motor disorders in both lower limbs, and pain behind the sternum if the corresponding spinal nerve is compressed. If the spinal cord and cauda equina nerve are compressed, bladder and rectal functions are also affected.
2) Shortening of height and hunchback
The symptoms of shortening of height and hunchback mostly appear after pain because the anterior part of the vertebrae of the spine is heavily loaded, especially the 11th and 12th thoracic vertebrae and the 3rd lumbar vertebrae, which are heavily loaded and therefore easily compressed and deformed, resulting in the forward tilt of the spine and the formation of hunchback. As we age, osteoporosis increases, the curvature of the hunchback increases, and the height becomes shorter. In elderly people with osteoporosis, the vertebrae are compressed and shortened by about 2 mm per vertebra, resulting in an average shortening of 3 to 6 cm in body length.
3) Fracture
It is the most serious complication of degenerative osteoporosis, osteoporosis fracture occurs mostly in twisting the body, holding objects, opening windows and other indoor daily activities, even if there is no apparently large external force, then fracture can occur, it is clinically manifested as a sudden and severe low back pain fracture, a slight activity, significantly aggravated. The sites of occurrence are the thoracic and lumbar vertebrae, the distal radius and the upper end of the femur. Compression fracture of thoracic and lumbar vertebrae, backward curvature of the spine, thoracic deformity, can significantly reduce lung capacity and maximum air exchange, patients can often appear chest tightness, shortness of breath, dyspnea, abdominal distension and other symptoms, and in serious cases affect the function of the spinal cord and cauda equina, paralysis and urinary and fecal dysfunction, the patient’s quality of life is reduced, and in serious cases also life-threatening.
3.How to diagnose osteoporosis?
Bone density test: In 1994, the World Health Organization (WHO) established the diagnostic criteria for osteoporosis, and the bone density measured by dual-energy X-ray as the “gold standard” for the diagnosis of osteoporosis, which is now recognized and widely used by the medical community worldwide. BMD can be used to diagnose patients with osteoporosis in a graded manner, to predict the risk of fracture, to predict the risk of local fracture by measuring BMD at specific sites, and to determine the effectiveness of treatment by the change in BMD before and after treatment.
WHO recommends grading osteoporosis according to BMD value, stipulating that BMD value plus or minus 1 standard deviation (SD) in normal healthy adults is normal, and a decrease (1 to 2.5) SD from normal is bone loss; a decrease of 2.5 SD or more is osteoporosis; a decrease of 2.5 SD or more with fragility fracture is severe osteoporosis.
4.How to prevent osteoporosis
Osteoporosis especially emphasizes the implementation of three levels of prevention.
1) Primary prevention
It should start with children and adolescents, such as paying attention to reasonable dietary nutrition and consuming more foods with high calcium and phosphorus content, such as fish, shrimp, milk, dairy products, bone broth, eggs, beans, mixed grains, green leafy vegetables, etc. Adhere to a scientific lifestyle, such as adhere to physical exercise, more sunbathing, do not smoke, do not drink alcohol, less coffee, strong tea and carbonated beverages, less sugar and salt, animal protein should not be too much, late marriage, less childbirth, breastfeeding period should not be too long, as much as possible to preserve calcium in the body, enrich the calcium pool, increase the peak bone to the maximum is the best measure to prevent osteoporosis later in life. For the high-risk group with genetic genes, focus on follow-up and early prevention.
2) Secondary prevention
Bone loss accelerates in middle age, especially in women after menopause. Bone density check should be conducted annually during this period, and early preventive and curative measures should be taken for people with rapid bone loss. In recent years, most scholars in Europe and the United States advocate starting long-term estrogen replacement therapy within 3 years after menopause, while insisting on long-term preventive calcium supplementation to safely and effectively prevent osteoporosis.
3) Tertiary prevention
Patients with degenerative osteoporosis should be actively treated with drugs to inhibit bone resorption (estrogen, CT, Ca) and promote bone formation (active VitD), and measures to prevent falls and upsets should also be strengthened. For middle-aged and elderly fracture patients should actively operate, implement strong internal fixation, early activity, give physical therapy, physiotherapy psychological, nutrition, calcium supplementation, curb bone loss, improve immune function and overall quality and other comprehensive treatment.
5.How to detect vertebral fracture?
1) X-ray of the lesion site: X-ray can detect fractures and other lesions, vertebral fractures often occur in the concentration of force, namely, the lower thoracic and upper lumbar vertebrae, the 11th and 12th thoracic vertebrae and the 1st and 2nd lumbar vertebrae, X-ray can be seen in the collapse of the anterior edge of the vertebral body in the form of wedge-shaped changes, also known as compression fractures
2) MRI: MRI can clarify the fracture site and identify whether it is a fresh or old fracture, and also facilitate the differential diagnosis of tuberculosis and metastatic vertebral tumor.
6.What should I do if I have a vertebral fracture?
The treatment goals for osteoporotic vertebral fractures are
1) To relieve pain and improve mobility disorders
2)To correct abnormal bone metabolism
3) To improve the quality of bone and prevent fractures from occurring.
Treatment of osteoporotic vertebral fractures.
1)Minimally invasive treatment: vertebroplasty: it is a minimally invasive surgery in which a puncture needle is put into the diseased vertebral body under the guidance of C-arm X-ray machine or CT, and a balloon can be put into the diseased vertebral body to expand it first, and then specific material is injected or specific material is injected directly into the fractured vertebral body to achieve the purpose of relieving pain, stabilizing the fracture and allowing the patient to return to normal life as soon as possible, and the surgery can relieve pain immediately and allow the patient to get out of bed the next day.
2) Use of anti-osteoporosis drugs and calcium, for three consecutive years, once a year with intravenous anti-osteoporosis drugs, once a year for bone density measurement, usual calcium supplements, increased exercise and sun exposure to prevent the occurrence of vertebral re-fractures.
7.Do men also have osteoporosis?
Yes, but the onset of osteoporosis is postponed compared to women of the same age, and the incidence is lower than that of women. In addition, among male patients with vertebral fractures, the proportion of vertebral metastases is significantly higher than that of women. Therefore, for male vertebral fracture patients, tumor indexes and other related examinations should be done to exclude the possibility of tumor metastasis, and ECT and even PET-CT examination and biopsy if necessary should be performed to further clarify the diagnosis.