Osteoporosis is a “silent epidemic”, with no symptoms in the early stages, but often when it becomes serious to a certain extent, pain and fractures suddenly appear, therefore, osteoporosis is also known as the “silent killer”, and is receiving more and more attention. World Osteoporosis Day is celebrated on October 20 every year.
Typology and prevention of osteoporosis
I. Overview
Osteoporosis (OP) is a systemic bone disease characterized by low bone mass and destruction of the fine structure of bone, resulting in increased bone fragility and susceptibility to fracture. The disease can occur in different genders and at any age, but it is mostly seen in postmenopausal women and older men. Osteoporosis is divided into two main categories: primary and secondary. Primary osteoporosis is subdivided into postmenopausal osteoporosis
(type I), senile osteoporosis (type II) and idiopathic osteoporosis (including adolescent type). Postmenopausal osteoporosis generally occurs within 5 to 10 years after menopause; senile osteoporosis generally refers to osteoporosis occurring after the age of 70; and idiopathic osteoporosis mainly occurs in adolescents, the cause of which is still unknown.
II. Risk factors
(A) Uncontrollable factors
Ethnicity, old age, female menopause, maternal family history.
(B) controllable factors
Low body weight, low sex hormones, smoking, excessive alcohol consumption, coffee and carbonated beverages, lack of physical activity, dietary calcium and/ or vitamin D deficiency (low light exposure or insufficient intake), certain diseases and application of certain drugs (secondary osteoporosis).
III. Clinical manifestations
Pain, spinal deformation and the occurrence of fragility fractures are the most typical clinical manifestations of osteoporosis. However, many patients with osteoporosis often have no obvious conscious symptoms in the early stage, and are often found to have osteoporotic changes only after the fracture occurs by X-ray or bone density examination.
(a) Pain: Patients may have low back pain or peripheral pain, and the pain may worsen when activity increases or activity is limited, and in severe cases, there are difficulties in turning over, sitting up and walking.
(ii) Spinal deformation: patients with severe osteoporosis may have height shortening and hunchback. Vertebral compression fractures can lead to thoracic deformity, abdominal compression, and affect cardiopulmonary function, etc.
(iii) Fracture: A fracture that occurs after mild trauma or daily activities is a fragility fracture. Most common sites for fragility fractures are the thoracic and lumbar spine, hip, distal radius and ulna (wrist area), proximal humerus (near the shoulder) and heel of the foot. Fractures can also occur at other sites. After a fragility fracture has occurred, the risk of a second fracture increases significantly.
IV. Diagnosis
(I) Bone mineral density measurement
Bone mineral density (BMD), referred to as bone mineral density, is currently used to diagnose osteoporosis, predict the risk of osteoporotic fracture, monitor the natural course of disease, and evaluate pharmacological interventions.
It is the best quantitative indicator for diagnosing osteoporosis, predicting the risk of fracture, monitoring the natural course of the disease, and evaluating the efficacy of pharmacological interventions. The risk of fracture is associated with low BMD, and the risk of fracture is increased by the presence of other risk factors.
Bone densitometry: Dual-energy X-ray absorptiometry (DXA) is the currently accepted method of bone density screening, and its measurement is the gold standard for the diagnosis of osteoporosis. Our bone densitometer is the dual-energy X-ray absorptiometry method. During the examination, only the non-dominant hand needs to be placed on the examination table, and the result will be obtained after one or two minutes, which is accurate, convenient and fast.
(B) Diagnostic criteria
Refer to the diagnostic criteria recommended by the World Health Organization (WHO). Based on bone densitometry: T-value is commonly used, namely
①T-value R-1.0 is normal bone mass
② -2.5T value -1.0 for reduced bone mass (or low bone mass)
③T value Q-2.5 is osteoporosis
④Severe osteoporosis if T value Q-2.5 is accompanied by one or more fractures.
For non-menopausal women, the diagnostic criteria are
① Z-value > -2, with BMD values within the normal range for the same age group.
② Z value ≤ -2, BMD is lower than normal peers. If the T value > -2.5 or Z value -2, and clinical occurrence of fragility fracture can also be diagnosed as osteoporosis. Examination site: lumbar spine 1-4 or hip.
V. Prevention and treatment
Primary prevention: It is the prevention of disease without disease. Through various appropriate ways and methods, such as increasing outdoor activities, reasonable exposure to sunlight, scientific fitness, etc. to obtain the ideal peak bone mass. Reduce the loss of bone minerals in perimenopausal and postmenopausal women and the elderly, and reduce the incidence of osteoporosis. To actively prevent secondary osteoporosis, in addition to proper prevention and treatment of primary diseases, drugs that can cause side effects such as osteoporosis (glucocorticoids, heparin, anti-epileptic drugs, etc.) should be used with caution and in appropriate amounts in the treatment of certain diseases, and corresponding measures should be taken to prevent the occurrence of complications such as osteoporosis.
Secondary prevention: It is the early treatment of disease, early detection, early diagnosis and early treatment through investigation and bone density screening, strengthening the supervision and health guidance for people prone to osteoporosis, relieving bone pain, improving health and improving quality of life through pharmacological and non-pharmacological means.
To improve the quality of life through drug and non-drug means to relieve bone pain, improve health, and delay aging.
Tertiary prevention: It is a comprehensive prevention and treatment, focusing on preventing fractures.
Commonly used drugs for the treatment of osteoporosis
Indications for drug treatment: people with existing osteoporosis (TQ2.5) or who have had a fragility fracture; or people with existing bone loss (-2.5T1.0) with risk factors for osteoporosis.
Calcium: The recommended daily calcium intake of 800mg (elemental calcium amount) for adults is the appropriate dose to obtain the ideal bone peak and maintain bone health, and the recommended daily calcium intake of 1000mg for postmenopausal women and the elderly.
Vitamin D: 400 units per day for women aged 51-70 years and 600mg per day for older women aged 70 years and above. the upper limit of safe daily intake of vitamin D is 2000 units.
Complex preparation: Calcium D, a combination of calcium carbonate and active vitamin D3, each tablet contains 600 mg of elemental calcium and 125 units of active vitamin D. 1 to 2 tablets/day. Take 1 tablet 1 hour before bedtime to keep blood calcium levels stable at night and to reduce or not cause nocturnal hypocalcemia (cramps). Watch for constipation while taking the medication.
Active vitamin D: Appropriate doses of active vitamin D (e.g., a-bonitol, osteotriol) promote bone formation and mineralization and inhibit bone resorption.
It also inhibits bone resorption. Blood and urine calcium levels should be tested regularly. Studies have shown that active vitamin D is beneficial in increasing bone density, increasing muscle strength and balance in older adults, and reducing the risk of falls, which in turn reduces the risk of fractures. Active vitamin D, which includes 1a-hydroxyvitamin D (a-skeletalol) and 1,25-bishydroxyvitamin D (osteotriol), is more suitable for the elderly. The former is effective when liver function is normal, while the latter is not affected by liver or kidney function. They should be used under the guidance of a physician and blood and urine calcium levels should be monitored regularly. The dose of osteopontinol is 0.25-0.5ug/d; a-osteopontinol is 0.25-0.75ug/d. It can be combined with other anti-osteoporosis drugs in the treatment of osteoporosis.
Bisphosphonates: effectively inhibit osteoclast activity and reduce bone conversion (calcium and phosphorus loss). Evidence from clinical trials shows that alendronate (e.g. alendronate sodium) can significantly increase bone density in the lumbar spine and hip and significantly reduce the risk of fractures in the vertebrae and hip. If the correct dosing method is strictly followed (e.g., alendronate should be taken in the morning on an empty stomach with 200 ml of water, and no lying down or eating within 30 minutes after taking the drug), drug reflux or esophageal ulceration may occur in very few patients. Therefore, it should be used with caution in patients with esophagitis, active gastric and duodenal ulcers, and reflux esophagitis. The latter is more convenient to take, less irritating to the digestive tract, effective and safe, and thus has better compliance.
Calcitonin: inhibits the biological activity of osteoclasts and reduces the number of osteoclasts. It can prevent bone loss and increase bone mass. There are two types of calcitonin analogs currently in clinical use: salmon calcitonin and eel calcitonin analogs. Evidence from randomized double-blind controlled clinical trial studies has shown that 200 IU of synthetic salmon calcitonin nasal spray daily reduces the incidence of vertebral fractures in patients with osteoporosis. Another outstanding feature of calcitonin analogs is their ability to significantly relieve bone pain, which is effective in chronic pain due to osteoporotic fractures or skeletal deformities as well as bone pain caused by diseases such as bone tumors, making them more suitable for patients with osteoporosis who have painful symptoms. The course of application of calcitonin-based preparations depends on the condition and other conditions of the patient. In general, the application dose is 50 IU/dose of salmon calcitonin, subcutaneously or intramuscularly, 2 to 5 times a week depending on the condition; 200 IU/day of salmon calcitonin nasal spray; 20 IU/week of eel calcitonin, intramuscularly. Application of calcitonin, a small number of patients can have facial flushing, nausea and other adverse reactions, and occasionally allergic phenomenon.
In addition to the above drugs, there are estrogens, selective estrogen receptor modulators, thyroid hormones and some traditional Chinese medicines (such as Jin Tian Ge capsules and Strong Bone capsules), which can be used separately according to the condition and individual situation.
Osteoporosis is a disease that can be prevented and treated early, so let’s all take action and make everyone have strong bones!