A survey in 1999 found that the prevalence of osteoporosis in people over 60 years of age was 11% and 21% for men and women in the orthogonal lumbar spine, and 11% and 27% for the femoral neck, respectively. The prevalence of osteoporosis has jumped to the 7th place of various common diseases in the world.
Osteoporosis (OP) is a group of systemic skeletal disorders characterized by a decrease in bone mass or (and) destruction of bone tissue microstructure, thus leading to decreased bone strength, increased bone fragility, and a high risk of fracture. Bone strength is mainly determined by two factors: bone mineral density and bone mass. Bone mineral density (BMD) can be expressed as the amount of minerals per unit area (volume), and the BMD of any individual is a combination of both peak bone mass and bone loss. Bone mass includes a general term for skeletal architecture, bone metabolic conversion, cumulative bone destruction (microfractures), and degree of bone mineralization. Osteoporosis includes three stages of bone loss, osteopenia and osteoporotic fracture. Primary osteoporosis and secondary osteoporosis sexual.
Consequences of osteoporosis: osteoporotic fracture, a direct consequence of osteoporosis, reduced quality of life
The main factors affecting the quality of life are pain, mobility, mental health level and even the high cost of medical care.
High mortality rate
Patients with osteoporotic fractures require prolonged bed rest, loss of independent living ability, pessimism and anxiety, or secondary diseases such as pneumonia, urinary tract infections, bed sores, and venous thrombosis, which are more specific causes of increased mortality. Hospitalization and health care costs are high. The clinical manifestations of osteoporosis are mainly pain, hunchback and height shortening, and the occurrence of fragility fractures.
Pain
Pain is the main complaint, often in the back, but it can also be generalized skeletal pain or pain in the hip, knee, or wrist joints. Hunchback and shortening of height are important signs of osteoporosis and are the result of chronic cumulative and compression fractures of the vertebral body.
Fractures
Osteoporosis is highly susceptible to fractures and is often the first symptom and reason for patients to seek medical attention. The most common sites of fracture are the spine, distal flexure and proximal femur.
Other manifestations
Posterior convexity of the spine may cause compression of the abdominal cavity, which may lead to visceral prolapse, constipation, abdominal distension, and loss of appetite; compression of the thoracic cavity may form a hiatal hernia, obstruction of food passage or reflux esophagitis, and pain and discomfort in the upper abdomen and lower chest. Severe hunchback can affect ventilation. In addition, patients may see brittle and unattractive hair, fracture and fall off, loose teeth, brittle and easily fractured teeth.
Imaging methods of osteoporosis ：
Conventional X-ray examination method; photon absorptiometry; mono/dual energy X-ray absorptiometry; CT examination; magnetic resonance imaging (MRI); quantitative ultrasound bone densitometry.
Treatment principles of osteoporosis
1.Increase or maintain bone mass
2.Improve bone strength
3.Eliminate the causative factors (etiology)
4.Prevent fractures from occurring
5.Symptomatic treatment.
Nutritional treatment of osteoporosis
1. Normal adults need to consume 1000 mg of calcium daily to maintain calcium balance, and even up to 1500 mg for postmenopausal women.
2, calcium-rich food preferred cow’s milk and dairy products, (225ml milk contains 300mg of calcium) its easy to be absorbed and used; soy, black beans and soy products also contain more calcium; shrimp skin, kelp, seaweed, sesame paste, etc. are rich in calcium.
3, unfavorable to the intestinal calcium absorption factors.
(1) cereals, bran and beans outer skin contains more phytic acid, can be combined with calcium into insoluble phytate.
(2) spinach, amaranth, asparagus, wild rice and other vegetables contain more oxalic acid, can form inadmissible calcium oxalate with calcium, are not conducive to absorption.
(3) too much dietary fiber and fat, but also affect the absorption of calcium, because the fatty acids in fat and calcium to form calcium soap.
4, the factors that favor intestinal calcium absorption.
(1) Vitamin D can promote the absorption of calcium and maintain normal blood calcium levels through PTH and CT regulation.
(2) Lactose can chelate with calcium into low molecular soluble complexes to promote calcium absorption.
(3) Some amino acids in dietary protein can form soluble calcium salts with calcium and facilitate calcium absorption.
(4) The increased calcium requirement of the body can increase the absorption rate of calcium.
Common drug treatment for osteoporosis
1, calcium: calcium is divided into two categories: inorganic calcium and organic calcium.
Inorganic calcium mainly includes calcium carbonate, calcium chloride, calcium phosphate, calcium hydrogen phosphate, and calcium hydroxide, etc. Organic calcium mainly includes calcium gluconate, calcium lactate, calcium acetate, calcium citrate, and calcium amino acid, etc. Calcium gluconate, calcium citrate and calcium amino acids are the most commonly used calcium supplements in clinical practice.
(1) Calcium gluconate is a traditional calcium supplement, but it contains only 9% calcium and is usually not used for oral calcium supplementation. It is mostly used clinically as an injection to treat acute hypocalcemia and certain allergic diseases. 0.5/tablet, 2 tablets tid, 1~1.5 hours after meal.
(2) Diclofenac and Calcium D are commonly used as calcium carbonate. However, their poor water solubility and small bioavailability can neutralize stomach acid and cause belching, bloating, constipation and other discomforts. It is not suitable for people with stomach acid deficiency. Calcium D, 600mg/tablet, 1 tablet qd; DiQiao 300mg/tablet 1 tablet bid, taken at bedtime.
(3) Calcium Leroy is an amino acid calcium with high solubility, high absorption rate and less gastric irritation. 275 mg/tablet, 1 tablet bid, taken on an empty stomach and at bedtime. The disadvantage is that it is more expensive.
(4) Maxine calcium is calcium citrate. With little gastrointestinal irritation, absorption does not depend on gastric acid, so there is no belching and gastric discomfort common to calcium carbonate, especially suitable for elderly people with insufficient gastric acid secretion. 2 tablets tid.
2, vitamin D preparations, mainly involved in the regulation of calcium and phosphorus metabolism, to promote the mineralization of bone.
Commonly used vitamin D preparations are: Alfadi three, Menggwang, Gaisan Chun and rocalciferol 0.25 mcg/tablet 0.25 mcg bid 0.5 mcg qd 3. Diphosphonates are bone resorption inhibitors. Commonly used diphosphonates are: Fosamax 70mg/tablet, 1 tablet qw, TENCO 10mg/tablet, 10mg qd. 4. Calcitonin preparations are potent bone resorption inhibitors. Commonly used calcitonin preparations are: mircalcitol injection 50IU qd, mircalcitol nasal spray 100IU nasal spray qd. Exercise is also a necessary method for the treatment of osteoporosis.