Osteoporosis is a systemic, metabolic disease of the skeletal system characterized by reduced bone mass, destruction of bone microstructure, increased bone fragility, decreased bone strength, and susceptibility to fracture.
Characteristics of osteoporotic fractures
More elderly patients with more comorbidities; more fractures are comminuted; delayed healing; high disability rate; high re-fracture rate.
Basic principles of treatment
Displacement, fixation, functional exercise and anti-osteoporosis treatment
Diagnostic features
1. History of osteoporotic fracture or minor trauma;
2. Pain, swelling, functional impairment and other symptoms may occur;
3, deformity, bone rubbing sensation (sound), abnormal activity and other signs;
4.Vertebral compression fracture may lead to short height or hunchback deformity.
Imaging examination
(1) General X-ray examination.
①The radiograph should include the upper and lower adjacent joints of the injury site, and the hip fracture should include bilateral hip joints;
(2) In addition to fracture signs, there are also signs of osteoporosis;
(3) In case of vertebral compression fracture, there is a wedge-shaped change or “double concave sign”.
(2) CT examination: CT examination can be considered for intra-articular or peri-articular fractures and intra-vertebral canal compression; while CT and/or three-dimensional imaging is required for hip, ankle and proximal humerus fractures with complex displacement.
(3) MRI examination.
①It can diagnose occult fracture;
(2) To determine whether the fracture is healed or not, the TIWI of unhealed fracture is low signal, T2WI is high or equal signal, and the lipid suppression sequence is high signal.
(4) Bone scan (SPECT/ECT): suitable for patients who cannot undergo MRI, and helps to determine the vertebrae responsible for pain.
Bone density examination
Dual-energy X-ray absorptiometry (DXA): T value ≥ -1.0 SD is normal; -2.5 SD < T value < -1.0 SD is low bone mass or reduced bone mass; T value ≤ -2.5 SD is osteoporosis; the degree of reduction is in accordance with the diagnostic criteria for osteoporosis, and accompanied by one or more fractures is severe osteoporosis.
Laboratory tests
The routine preoperative tests include blood calcium and phosphorus, 24-hour urine calcium, 25(OH)VitD, calcitonin, and parathyroid hormone, if necessary.
Common osteoporotic fracture sites: spine fracture, hip fracture, distal radius fracture, proximal humerus fracture
Other treatments
Anti-osteoporosis treatment – pay attention to perioperative anti-osteoporosis treatment
(1) Basic treatment drugs: active vitamin D, calcium preparations. Additional supplementation of elemental calcium 500-600 mg daily or substitution with calcium-containing herbs (e.g. natural bone powder) is recommended. In elderly people with renal insufficiency and 1a hydroxylase deficiency, active vitamin D should be supplemented and blood and urine calcium should be monitored.
(2) Anti-bone resorption drugs: bisphosphonates, calcitriol, etc. Bisphosphonates: standardized conventional doses have no adverse effect on fracture healing and can be considered sequential therapy for 3-5 years. Calcitonin: can relieve osteoporotic bone pain, intermittent repetitive dosing can be used if necessary
(3) Pro-bone formation drugs: PTH fragments, androgens, active vitamin D, etc.
(4) Chinese patent medicines or herbal medicines: for example, bone-strengthening drugs, herbal medicines containing flavonoid bioactive ingredients, etc.
Medication principles.
Those who have used anti-osteoporosis drugs before the fracture can continue to apply; whether to strengthen the anti-bone resorption drugs for those who need to be bedridden for a long time after the fracture is decided according to the bone conversion index after the fracture.
Those who did not use anti-osteoporosis drugs before fracture.
① For those who underwent emergency or early internal fixation surgery after fracture, anti-osteoporosis treatment is recommended in due course when the patient’s general condition is stable after surgery.
②Patients with temporary non-operative or conservative treatment after fracture are recommended to have anti-osteoporosis treatment at the appropriate time when the systemic trauma response is stable.
Physiotherapy
Physiotherapy is simple, non-invasive, effective and safe, and can promote fracture healing.
Rehabilitation training
The combination of active and passive exercises, with active exercises as the main mode of exercise. Step by step, avoid rough handling.
Exercise therapy
Weight-bearing exercise and resistance exercise are the main exercises, such as brisk walking, dumbbell exercises, weight lifting and pedaling exercises. Pay attention to the development of individualized discretionary exercise prescription, and choose the exercise mode, frequency, time and intensity according to the individual.