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Abstract: Osteoporosis occurs mostly in middle-aged and elderly people, especially in postmenopausal women and those older than 70 years of age, and is mainly triggered by a decline in bone density and bone quality due to multiple causes. The patient in this case was 75 years old and usually in good health, but in the last 2-3 months, she often felt pain and soreness in her lower back and sometimes her whole spine. She was diagnosed with osteoporosis after consultation, and her symptoms were significantly relieved by symptomatic treatment such as medication.
Basic information】Female, 75 years old
Disease Type】Osteoporosis
Hospital】The First Hospital of Harbin Medical University
Date of consultation】March 2021
Treatment plan】Lifestyle improvement + medication (calcium carbonate D3 granules + vitamin D drops + disodium clodronate capsules)
Treatment Period】Long-term treatment, outpatient follow-up after 1 year
Treatment effect】Significant relief of low back pain and increase in bone density
I. Initial consultation
The patient is 75 years old and is still physically strong, so she can go out for a walk, buy groceries or do some housework, but in the past 2-3 months, she often feels pain and swelling in her lower back, and sometimes her whole spine is uncomfortable. Originally, the patient did not want to come to the clinic, but his family was afraid that it might be a bad disease such as tumor, so he was persuaded to come to the clinic with great difficulty. The patient was 175 cm tall, weighing about 70 kg, with a moderate body shape and some hunchback. The spine of the cervical, thoracic and lumbar regions all had percussion pain on examination, but the pain of the spine of the thoracolumbar region was obvious, while the sensation of urination and defecation and the strength of both lower limbs were normal.
II. Treatment history
The patient’s low back pain first required the exclusion of spinal pathology, so the patient was advised to take an X-ray first. The films showed that although there were no vertebral lesions such as tumors or fractures, all the vertebrae had some deformation, medically known as wedge-shaped changes, and the bone cortex at the edges of the vertebrae was significantly thinner, so the initial consideration was osteoporosis causing the low back pain. The subsequent bone density examination confirmed my diagnosis, and the patient’s bone density was -4.35, which was considered severe osteoporosis. So the treatment mainly focused on osteoporosis, including strengthening outdoor activities and light exposure in summer, adjusting lifestyle, paying attention to rest, diet to ensure calcium intake, regular supplementation of calcium carbonate D3 granules and vitamin D drops, oral bisphosphonate drugs, such as disodium clodronate capsules, and instructing the patient to pay attention to avoid falls in daily life and to review bone density once a year.
III. Treatment effect
After going home, the patient ensured sufficient rest and took oral medication at the same time. 2 weeks later, the patient complained of relief of low back pain at the time of re-checking, after which he started the standardized treatment. 1 year later, the patient was hospitalized again with zoledronic acid injection, and the bone density at this re-checking improved compared with last year, and he felt no obvious discomfort, and osteoporosis was effectively treated.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment. Since low back pain is one of the common symptoms in the elderly, and osteoporosis causes 70%-80% of the pain to spread along the spine to both sides, and the pain is related to the posture, which shows that the pain decreases when lying on the back or sitting down, and increases when standing upright or standing for a long time, and increases when bending and coughing or straining to stool, if this situation occurs in daily life, go to If this condition occurs in daily life, go to the hospital for consultation. It is important to avoid long-term strenuous exercise or heavy lifting to avoid aggravating the symptoms of osteoporosis. In addition, you must follow the doctor’s instructions and take the medication according to the course of treatment, do not stop taking the medication on your own or do not take the medication as prescribed.
V. Personal insight
Human calcium is often lost inadvertently, so osteoporosis can also appear quietly. In the early stage of osteoporosis, there is often no discomfort, but as the disease worsens, many symptoms will appear. First of all, it can be manifested as wandering pain in various parts of the body, with spinal pain being the most common. Secondly, osteoporosis causes fluctuations in calcium levels in the blood, which can easily cause muscle cramps, most commonly in the calf muscles, most often at night or early in the morning. In addition, osteoporosis causes the vertebrae of the spine to become progressively narrower, eventually leading to hunchback. Finally, osteoporosis reduces the strength of bones, which can easily cause fragility fractures. The most common fracture sites include the lumbar spine, thoracolumbar segment, distal radius and hip joint. Therefore, postmenopausal women and older adults over 70 years of age should have their bone density checked regularly, and if they are diagnosed with osteoporosis as this patient was, they should begin standardized treatment as soon as possible.