Osteoporosis is a decrease in the amount of bone tissue within each unit. Bone growth and development begins in the embryonic period and continues for more than 20 years after birth. The amount of bone no longer changes in adults, but bone metabolism continues unabated, i.e., the two processes of bone production and bone resorption are in balance. Bone production remains constant after age over 40 years. However, bone resorption increases, and after several decades the amount of bone tissue is only half the amount it was at age 30. Once the density of bone decreases to the point where it becomes difficult to tolerate the stresses of daily life, pathological fractures can occur.
I. Disease factors.
1, age factor: age, metabolism slows down, bone formation is less than bone resorption, bone volume begins to decrease.
2, menopause: women after menopause estrogen levels decline, and estrogen plays a vital role in promoting bone formation and inhibiting bone resorption, so osteoporosis in women excess of men.
3, nutritional deficiencies: calcium and vitamin D intake is low. Calcium is a material needed for bone formation, and vitamin D can promote calcium absorption. Young adults need 400 IU of vitamin D daily, and 800 IU for the elderly.
4.Low sunlight: sunlight can promote the activation of vitamin D in the human body. Activated vitamin D can promote the absorption of calcium. Half of human vitamin D3 sources come from food, and the other half from sunlight exposure. The elderly do not have enough light, can cause vitamin D3 deficiency.
5, lack of exercise: bone mass and exercise are closely related, athletes after long-term exercise bones thickened density increased after fracture local fixation muscle paralysis space flight weightlessness can make the bones thinner density reduced.
Second, the main symptoms of osteoporosis.
1, pain: the most common symptom of osteoporosis in the elderly is low back pain, accounting for 70%-80% of patients with osteoporosis pain. In the course of senile osteoporosis, the morphology and structure of the bone are damaged as a result of the increasing bone resorption and serious loss of bone mass. In the trabeculae, the trabeculae become thinner, thinner, perforated or even broken, and in the bone cortex, the cortex becomes thinner.
2.Stature shortening and spinal deformation: mostly appear after pain, compression of thoracic and lumbar vertebrae, and average shortening of 3-6cm in length in elderly people with osteoporosis.
3, fracture: This is the most common and serious complication of osteoporosis in the elderly. Fractures mostly occur in the upper femur (hip), distal radius (wrist) and vertebrae. The onset of osteoporosis is slow, and the clinical manifestations are usually mild or only low back pain. If the low back pain suddenly increases, it indicates a fracture.
III. Diagnosis of osteoporosis.
The common clinical indicators used for osteoporosis are
1. Fragility fracture: refers to fractures that occur during non-trauma or minor trauma, which is a clear manifestation of the decrease in bone strength. It is also the end result and complication of osteoporosis. They are commonly found in the wrist (distal radius), vertebrae, and hip (upper femur). The diagnosis of osteoporosis is made when a fragility fracture occurs.
2.Diagnostic criteria based on bone mineral density measurement: the World Health Organization recommended diagnostic criteria: bone mineral density less than one standard deviation below the peak bone value of normal people of the same sex and race is normal (T value -1), bone mineral density value between -1 and -2.5 is bone loss (-2.5 < T value < -1), bone mineral density less than or equal to -2.5 is osteoporosis (T value ≤ 2.5). Severe osteoporosis is considered when the degree of bone density reduction meets the diagnostic criteria for osteoporosis and is accompanied by one or more fractures. Regular bone density examinations are recommended for the elderly population. In addition, X-ray examination can show a reduction in bone mass of more than 1%. Conventional radiographs can show thinning of the tubular bone cortex, widening of the medullary cavity, reduction in the number of trabeculae, and widening of the gap.
Prevention and treatment of osteoporosis in the elderly.
Prevention of osteoporosis includes those who do not yet have fracture sparing but are at risk of osteoporosis, should prevent or delay the development of osteoporosis and avoid the first fracture (primary prevention); and those who already have osteoporosis with T value ≤ -2.5 or have already had fragility fracture should avoid fracture or re-fracture.
The complete spectrum of osteoporosis prevention and treatment measures includes basic measures, pharmacological interventions and rehabilitation.
The content of basic measures includes.
1.Lifestyle adjustment
(1) A balanced diet rich in calcium, low in salt and moderate in protein.
(2) Appropriate outdoor activities and sunshine, physical exercise and rehabilitation that contribute to bone health.
(3) Avoid smoking, alcohol abuse, and the use of drugs that affect bone metabolism.
(4) Use various measures to prevent falls, such as crutches. Pay attention to the presence of diseases and medications that increase the risk of falls.
(5) Strengthen protective measures for yourself and the environment, (including various joint protectors), etc.
2.Bone health basic supplements
(1) Calcium: China’s Nutrition Society has set a daily calcium intake of 800mg for adults is the appropriate dose to obtain the ideal bone peak and maintain bone health, if the supply of calcium in the diet is insufficient, calcium supplements can be used, the recommended daily calcium intake for postmenopausal women and the elderly is 1000mg. Calcium intake can alleviate the loss of calcium and improve bone mineralization. It should be used in combination with other drugs for the treatment of osteoporosis. There is no sufficient evidence that calcium supplementation alone can replace other anti-osteoporosis medications.
(2) Vitamin D: It is beneficial for promoting calcium absorption, for bone health, for maintaining muscle strength, for improving physical stability, and for reducing the risk of fracture. The recommended dose for adults is 200 units (5µg)/day, and the elderly often have vitamin D deficiency due to lack of sunlight and impaired intake and absorption, so the recommended dose is 400-800 units (10-20µg)/day, and the dose is 800-1200 units/day when used for the treatment of osteoporosis.
3.Drug intervention.
Many people think that osteoporosis is simply a lack of calcium, but it is not. Medical research has confirmed that taking calcium tablets and vitamin D alone cannot effectively treat osteoporosis and prevent osteoporotic fractures. Vitamin D promotes the absorption of calcium, a material needed for bone formation.
There are 2 types of cells in human bone, one is osteoblast and the other is osteoclast. Under normal circumstances, bone metabolism is through osteoblasts to form new bone and osteoclasts to break down old bone and absorb it.
In childhood and adolescence, bone formation is greater than bone resorption, bone mass increases, and bones are constantly strong, and at the age of 30-40, bone formation and bone resorption are in balance, and bone mass is maintained at a high level. After the age of 40 for women and 50 for men, bone formation is less than bone resorption and bone mass begins to decrease. At this time, if there are some risk factors or other diseases that lead to increased osteoclast activity and accelerated bone resorption, or decreased osteoblast activity and slowed bone formation and decreased bone mass, these can lead to osteoporosis, and it is useless to simply supplement with more calcium.
The main anti-osteoporosis drugs are.
(1) bisphosphonates
Arlen phosphate sodium, trade names such as Fosamax and Gubang. Its mechanism of action is to inhibit the function of osteoclasts, thereby inhibiting bone resorption. To avoid stimulation of the esophagus and stomach, it is recommended to take the drug on an empty stomach with 200-300ml of boiled water, and not to lie down for 30 minutes after taking the drug, but to stand or sit up. Milk, juice, and other beverages should not be consumed during this period.
Zolay phosphate injection Zolay phosphate 5mg intravenous drip for at least 15 minutes once a year.
(2) Calcitonin: It is a calcium-regulating hormone that inhibits the biological activity of osteoclasts and reduces the number of osteoclasts, thus preventing the release of bone calcium into the blood, preventing bone loss, and lowering blood calcium, hence the name calcitonin. Another characteristic of calcitonin is that it can significantly relieve pain, which is effective for pain caused by osteoporotic fracture or bone deformation as well as bone pain caused by bone tumor disease, and is therefore more suitable for osteoporotic patients with painful symptoms.
(3) Estrogens: Estrogens can also inhibit bone loss. The proper use of estrogen therapy for menopausal women is generally safe and is suitable for women before and after menopause before the age of 60, especially for patients with menopausal symptoms and atrophy of the reproductive tract. However, it is contraindicated in patients with existing breast cancer and endometrial cancer.
(4) Parathyroid hormone: Parathyroid hormone is a representative drug for promoting bone formation at present. Small doses of parathyroid hormone have been shown to promote bone formation. 20ug/day by subcutaneous injection. The trade name is Foteo (Teriparatide).
(5) Selective estrogen receptor modulator: chemical name: raloxifene, trade names include: evit. The drug exhibits estrogen-like activity on the bones and inhibits bone resorption, while it exhibits anti-estrogenic activity on the breast and uterus, thus not stimulating the breast and uterus. 60mg/tablet, one tablet daily.
(6) Strontium salt: Strontium is one of the essential trace elements and is involved in many physiological functions and biochemical effects of the human body. Synthetic strontium salt strontium ranelate can act on both osteoblasts and osteoclasts, with the dual effect of inhibiting bone resorption and promoting bone resorption, which is a new generation of anti-osteoporosis drugs.
(7) Active vitamin D: including 1,25 bis-hydroxyvitamin D3 (osteotriol) and 1αhydroxyosteol (α-osteol). Appropriate doses of vitamin D promote bone formation and mineralization and inhibit bone resorption. Active vitamin D also increases muscle strength and balance in the elderly, reducing the risk of falls and thus the risk of fractures. When treating osteoporosis, it can be combined with other anti-osteoporosis drugs.
4. Rehabilitation.
Exercise is one of the successful measures to ensure bone health. Exercise has different effects on bones at different times, increasing bone mass in childhood, gaining bone mass and maintaining it in adults, and maintaining bone mass and reducing bone loss in the elderly. Exercise can prevent fragility fractures in two ways: increasing bone density and preventing falls.
Recommendations for rehabilitation treatment.
(1) Exercise principles
Individual principle: due to the differences in individual physiological status and motor function, choose the exercise modality that is suitable for you. Assessment principle: Each individual should be evaluated in terms of nutrition and organ function when choosing exercise modality.
Produce bone effect principle: weight-bearing, resistance, overload and accumulation of exercise can produce bone effect, resistance exercise has site specificity, that is, the increase in bone volume of bones under stress.
(2) exercise mode: weight-bearing exercise, resistance exercise is appropriate. For example: brisk walking, dumbbell exercises, weightlifting, rowing, pedaling exercises, etc.
(3) exercise frequency and intensity: there is no uniform standard, it is recommended: weight-bearing exercise 4 to 5 times a week, resistance exercise 2 to 3 times a week. Intensity to each exercise muscle soreness and swelling, the next day after rest this feeling disappeared as appropriate.