There are now over 90 million people with osteoporosis nationwide, and worldwide, on average, one person is diagnosed with osteoporosis every 3 seconds! In recent years, the incidence of osteoporosis has been increasing and is trending significantly younger!
What is osteoporosis?
Osteoporosis (OP) is a metabolic bone disease characterized by decreased bone mass and destruction of bone tissue microarchitecture, leading to increased bone fragility and ease of fracture.
Patients often present with bone pain and muscle weakness as the first symptoms, but most patients are unaware of the bone loss and are not diagnosed with osteoporosis until a bone density check or even a fracture occurs, hence the name “silent killer”.
Osteoporosis can be divided into postmenopausal osteoporosis (type I), senile osteoporosis (type II) and secondary osteoporosis, of which postmenopausal osteoporosis is the most common, but in recent years, with the change of people’s living standards and ways, secondary osteoporosis is also gradually increasing.
Complications after fracture are the most frightening
While symptoms such as bone pain can be relieved by medication, once a patient has a fracture, it will lead to many problems.
First of all, bone is formed in continuous bone reconstruction. Once a fracture occurs and enters a bed rest period, the normal load on bone is weakened or disappears, and bone reconstruction corresponding to external load is subsequently weakened, causing bone atrophy and a decrease in mechanical strength, and bone will be lost in a cascade, aggravating osteoporosis and forming a vicious circle. One study showed that after 4 weeks of bedrest, the bone mass of iliac cancellous bone began to decline, and after 25 weeks of bedrest, the bone mass decreased by about 33%.
Second, in addition to causing short height and local pain, spinal compression fractures also cause deformation of the spine, which affects the normal physiological structure of the thorax, thus affecting cardiopulmonary function and causing patients to experience chest tightness, shortness of breath, and difficulty in breathing.
Finally, patients who are bedridden for a long time may also develop a series of clinical problems such as lung infection, decubitus ulcers and lower limb embolism, which reduce the quality of patients’ survival and increase medical and nursing costs.
How to improve the diagnosis rate of osteoporosis
There are 2 primary screening tools commonly used for the diagnosis and screening of osteoporosis. Their convenience not only allows for widespread clinical application, but also allows patients to perform self-testing, moving the gateway to osteoporosis prevention and diagnosis significantly forward.
The International Osteoporosis Foundation (IOF) has developed the Osteoporosis Risk One-Minute Test, which consists of 10 simple questions that can be answered with a yes or no answer, and as long as one question has a “yes” result, the patient is considered to be at risk for osteoporosis and needs further BMD testing A definitive diagnosis is needed.
The Osteoporosis Self-Screening Tool for Asians (OSTA) is a simple diagnostic standard based on the population of postmenopausal women in eight Asian countries and regions, and the OSTA index is calculated as (weight – age) × 0.2. Bone density testing is recommended to clarify the diagnosis for patients at intermediate and high risk levels.
In addition, there is a simple tool for predicting the risk of osteoporotic fracture (FRAX, click on the bottom “Read the original article” to access the online version of the calculator), which can be used to calculate the probability of osteoporotic fracture within 10 years, for those who do not have information on BMD, or for those who need anti-osteoporosis medication if they have reduced bone mass. To provide a reference for the need for pharmacological treatment, in China, the recommended intervention threshold is a probability of hip fracture ≥ 3% or any significant osteoporotic fracture occurring with a probability > 20%.
In clinical practice, the main criterion for diagnosing osteoporosis is the bone mineral density value, which has different diagnostic criteria according to race, gender, and age, and generally diagnoses osteoporosis by a decrease in bone mineral density ≥ 2.5 standard deviations from the peak bone mass of normal adults of the same gender and race.
However, the amount of bone mass does not represent all the information of bone. The ultimate goal of prevention and treatment of osteoporosis is to prevent the occurrence of osteoporotic fractures, and if a patient has a fragility fracture (non-traumatic or minor trauma-induced fracture), osteoporosis can also be diagnosed.
How to prevent and treat osteoporosis?
The most critical treatment for osteoporosis is vitamin D supplementation, which promotes calcium absorption, is beneficial for bone health, maintains muscle strength, improves physical stability, and reduces the risk of fracture. A Meta-analysis showed that vitamin D3 supplementation reduced the incidence of falls by 31%. Moreover, vitamin D supplementation has a high safety profile and can be used in patients with liver function and mild renal insufficiency.
Another key measure to prevent osteoporosis is naturally calcium supplementation, but how? How much calcium to take? What calcium supplementation are some of the problems that plague people. The recommended daily intake for normal adults is 800-1200mg of calcium, which can be taken through diet (such as milk, sesame paste, shrimp, etc.) or through oral calcium supplements. Clinical studies have confirmed that dietary calcium supplementation is more effective and safer (bone broth does not supplement calcium!) There is no significant difference in the absorption rate between calcium tablets and calcium solutions.
Bisphosphonates are by far the longest clinically used anti-bone resorption drugs, and evidence-based medical studies have shown that a sustained increase in hip BMD can be observed after 3-5 years of continuous application of three different dosage forms of bisphosphonates. However, bisphosphonates can cause some adverse effects (e.g., dyspepsia, osteonecrosis of the jaw, hyperthermia), so timely drug changes are needed depending on the patient’s bone conversion markers and the patient’s adverse effects.
In addition, calcitonin, estrogen, and androgen parathyroid hormone can all partially improve patients’ osteoporosis symptoms, which can be used clinically and flexibly according to patients’ clinical reality.
No amount of medication can replace a good lifestyle. Only by increasing outdoor exercise from a young age, eating more dairy products, quitting smoking and drinking less coffee can we minimize bone loss and fundamentally reduce the chance of osteoporosis.